In Depth: China Wants to Give Adult Vaccinations a Shot in the Arm

China faces significant challenges in increasing adult vaccination rates, with very low coverage compared to countries like the U.S. For example, in 2023, only 4.16% of Chinese adults over 60 received a flu shot, while pneumococcal and shingles vaccine coverage was even lower at 3.23% and less than 0.1%, respectively. This starkly contrasts with the U.S., where 42% of adults received flu shots, and pneumococcal and shingles vaccine coverage reached higher percentages, particularly among seniors [para. 1][para. 3][para. 4].

The low adult vaccination rates stem from a systemic focus on treatment over prevention in China's healthcare system. With an aging population set to impose greater pressure on healthcare resources, authorities are turning to preventative measures like vaccination to reduce disease burdens and save costs. To address this, pilot programs allowing doctors to prescribe vaccines during consultations have been launched in provinces like Shandong, Zhejiang, Guangdong, and Chongqing since 2021. These programs aim to integrate vaccination into routine medical care, leveraging the trust patients have in their doctors [para. 2][para. 5][para. 6][para. 7].

Shandong province’s efforts have gained particular attention. In 2023, its CDC initiated a pilot program across several hospitals and clinics, focusing on flu, pneumococcal, and shingles vaccines. By July 2024, provincial health authorities expanded the program's objectives, aiming to cover at least two districts or counties in each of Shandong's 16 cities by the end of 2025. Elsewhere, similar programs in provinces like Zhejiang and Guangdong have reported increased vaccine uptake, with Qingdao's pilot areas observing a 40% rise in adult vaccinations from 2022 to 2023 [para. 6][para. 9][para. 11].

However, scaling these efforts is challenging. One major hurdle is the disconnect between China’s CDCs, which oversee immunization programs, and hospitals, which fall under health commissions. This fragmentation complicates data sharing and system integration. For instance, despite Shandong setting up a system to connect doctors with vaccination records, hospitals must secure funding for integration, deterring participation. Community health doctors also face overwhelming workloads, leaving them little time to promote vaccinations [para. 12][para. 13][para. 14].

Public willingness to pay for vaccines presents another barrier. Since adult vaccines like shingles are not covered by insurance and can cost thousands of yuan, many households find them unaffordable. This issue is compounded by the absence of national policies offering financial incentives or funding for adult vaccination services. Local attempts to expand insurance coverage have stalled, with national authorities providing no clear plans to include additional vaccines in reimbursement schemes [para. 15][para. 16][para. 17].

Historical vaccine safety scandals have further dented public trust. This complicates efforts to improve awareness and acceptance of adult vaccinations. Additionally, logistical challenges, such as cold chain management, exacerbate the difficulty of ensuring vaccine availability across regions [para. 16][para. 18].

Experts argue that promoting preventative care like vaccinations could create a positive cycle, reducing infectious diseases and alleviating pressure on primary healthcare resources. For this strategy to succeed, improved policy support, cross-departmental cooperation, and financial incentives will be essential. Without these measures, China’s adult vaccination programs may struggle to achieve their full potential [para. 10][para. 18][para. 20].