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Background:
HPV vaccination for the prioritized adolescent girls is well accepted and implemented in developed countries as an effective measure for cervical cancer prevention and control with increasing population-level effectiveness evidence accumulated. This study is to assess the feasibility of universal HPV vaccination among adolescent girls...
Citations
... In 2018, the 9vHPV was approved in China, 23 preliminary demonstrating their effectiveness and safety. [24][25][26] However, issues related to loss of public confidence in vaccination and misperceptions surrounding vaccine safety have emerged in some regions, [27][28][29] despite the data from large epidemiological studies and active surveillance programs by national and international organizations, which overwhelmingly support the safety of HPV vaccination. [30][31][32] As misunderstandings regarding vaccine safety and clusters of anxiety-related immunization reactions can have damaging consequences for vaccination programs. ...
The safety of human papillomavirus (HPV) vaccines, one of the major challenges to public vaccination, has been controversial. This study assessed the adverse reactions of 9-valent HPV (9vHPV) vaccines. This open-label, observational, multi-center, post-marketing study assessed the safety of 9vHPV administered according to local clinical practice. All post-marketing adverse events (AEs) reports received between December 2019 and November 2021 in Chongqing were analyzed. A total of 1000 individuals aged 16–26 years provided safety data post-vaccination; The most common AEs (60.1%) experienced by 9vHPV vaccine recipients were vaccination-site AEs (pain, swelling, induration) and non-vaccination-site AEs (dizzy, weak, fever). Vaccination-site AEs most were mild-to-moderate in intensity. Discontinuations and HPV 9-related serious AEs were rare (0.3% and 0.0%, respectively). Eight SAEs were reported during the study but none were considered as related to the study vaccine. The 9vHPV vaccine was generally well tolerated in subjects aged 16–26 years; Vaccination-site AEs were more common with 9vHPV.
... To begin with, given the rapid increase in the HPV vaccination rate among Grade 7 girls in Shenzhen after the municipal government began actively addressing it, it is imperative for local health agencies, professional societies, and non-governmental organisations to engage in more active, advocacy-oriented outreach to stimulate policy and funding attention. This aligns with findings from a policy analysis conducted in 2019, which suggested that the lack of powerful advocates and health professionals' mobilisation skills hindered the feasibility of universal HPV vaccination in Shenzhen [33]. Advocacy efforts are more likely to succeed when advocates are tightly coalesced and able to transform international norms and up-to-date evidence into political influence, and link the issue to national political priorities, such as the Healthy China Initiative, thereby pressuring the local government to take action [34,35]. ...
... Advocacy efforts are more likely to succeed when advocates are tightly coalesced and able to transform international norms and up-to-date evidence into political influence, and link the issue to national political priorities, such as the Healthy China Initiative, thereby pressuring the local government to take action [34,35]. The involvement of influential individuals, such as Prof. Youlin Qiao, and partnerships with networks focused on vaccine equity, [33,36]. Additionally, strong governmental leadership and effective coordinating mechanisms are essential for achieving policy goals [35]. ...
... Thirdly, the applicability of Shenzhen's experience to other areas of China is uncertain due to differences in economic development levels and healthcare systems. In an earlier health policy analysis, Chen et al. suggested that introduction of the HPV vaccination for eligible girls in Shenzhen was shaped by local legislative environment, economic development level, and social norms on immunisation and sexuality [33]. Therefore, it is important to conduct further research to understand the contextual factors that may impact implementation of the vaccination in different settings. ...
Cervical cancer is a major public health concern in China, accounting for almost one-fifth of the global incidence and mortality. The recently prequalified domestic bivalent human papillomavirus (HPV) vaccine offers a practical and feasible preventive measure. In response to the global call for action, the National Health Commission issued an Action Plan to eliminate cervical cancer by 2030, with promotion of the HPV vaccination for school-aged girls as a critical step. Despite this, implementation of the vaccination has been patchy, with very low coverage among eligible girls. To address this, from December 2021 to December 2022, a demonstration project was launched in Shenzhen, Guangdong Province, to promote the inclusion of HPV vaccine in local immunisation programme and to address existing barriers to implementation. Using multiple sources of data, this article presents a case study of the demonstration project, analysing its impact on rolling out HPV vaccination among eligible girls and identifying any challenges encountered during implementation. The demonstration project has shown promising results in increasing the HPV vaccination rate, promoting public awareness and acceptance of the domestic HPV vaccine, and establishing a model for quickly scaling up the vaccination at the municipal level. The success of the project can be attributed to several factors, including strong governmental commitment, sufficient funding, multi-sectoral collaboration , ensured vaccine accessibility and affordability, improved vaccination services, and effective health education and communication strategies. Lessons learned from Shenzhen can provide valuable insights for future advo-cacy and implementation of the vaccination in other areas of China, but challenges must be addressed to achieve universal coverage. These include addressing vaccine hesitancy, expanding the programme to cover a broader age range, and ensuring consistent quality of vaccination services in primary care facilities. Overcoming these challenges will require innovative strategies, public-private partnerships, and sustained funding and resources. Future research should focus on evaluating the long-term effectiveness of the vaccination programme and identifying contextual factors that may impact its implementation in different settings. Overall, the effective control of cervical cancer in China will rely on the "political will" to ensure the incorporation of preventive interventions into policies and universal programme coverage.
... These include shortages of HPV vaccines, cultural and literacy barriers, sensitivity to requesting a vaccine for a sexually transmitted infection, and negative events linked to vaccination that undermine public's trust 11 . Local legislative environment, economic development level, and social norms on immunization and sexuality can also shape adoption of the national and provincial policies 12 . In addition, HPV vaccination programmes for eligible girls are mostly school-based, therefore can face challenges such as the belief that the vaccination is inappropriate for school-aged girls, offence of traditional norms, disagreement from schools, low priority compared to other health education issues, lack of governmental support, and hesitancy of parents and students 13 . ...
Cervical cancer is a major public health concern in China, accounting for almost one-fifth of the global incidence and mortality. The recently prequalified domestic bivalent HPV vaccine offers a practical and feasible preventive measure. In response to the WHO's call for action, the National Health Commission established an Action Plan to eliminate cervical cancer by 2030, with the promotion of HPV vaccination for eligible girls as a critical step. Despite this, implementation of the vaccination programme has been patchy, with very low coverage among eligible girls. To address this, a demonstration project was launched in Shenzhen in December 2021 to promote the inclusion of HPV vaccine in the immunisation programme and to address existing barriers to implementation.
Using multiple sources of data, this article presents a case study of the demonstration project, analysing its impact on increasing the HPV vaccination rate among eligible girls and identifying any challenges encountered during implementation. The demonstration project has shown promising results in increasing the HPV vaccination rate, promoting public awareness and acceptance of the domestic HPV vaccine, and establishing a model for scaling up the vaccination programme at the municipal level. The success of the project can be attributed to several factors, including the strong governmental commitment, sufficient funding, multi-sectoral collaboration, improved vaccine accessibility and affordability, enhanced capacity of primary care practitioners, and effective health education and communication strategies.
Lessons learned from Shenzhen can provide valuable insights for future advocacy and implementation in other areas of China, but challenges must be addressed to achieve universal coverage. These challenges include vaccine hesitancy, expanding the programme to cover a broader age range, and ensuring consistent quality of vaccination services in primary care facilities. Overcoming these challenges will require innovative strategies, public-private partnerships, and sustained funding and resources. Future research should focus on evaluating the long-term effectiveness of the HPV vaccination programme and identifying contextual factors that may impact implementation in different settings. Overall, the effective control of cervical cancer in China will rely on the “political will” to ensure that preventive interventions are incorporated into policies and that programme coverage is equitable and universal.
... 11 It was not until July 2016, a decade after the first HPV vaccine's licensing in the USA, when the first commercial HPV vaccine, Cervarix, was approved to use in mainland China. 12 The first Chinese domestic HPV vaccine (Cecolin), a bivalent vaccine against HPV 16 and 18, was licensed by the Chinese Food and Drug Administration in Dec 2019 and priced only half of Cervarix. 13 However, HPV vaccine coverage rate remains low. ...
Objectives
China suffers from high burdens of human papillomavirus (HPV) and cervical cancer, whereas the uptake of HPV vaccine remains low. The first Chinese domestic HPV vaccine was released in 2019. However, collective evidence on cost-effectiveness of HPV vaccination in China has yet to be established. We summarised evidence on the cost-effectiveness of HPV vaccine in China.
Design
Systematic review and narrative synthesis
Data sources
PubMed, EMBASE, China National Knowledge Infrastructure and Wanfang Data were searched through 2 January 2021
Eligibility criteria for selecting studies
Cost-effectiveness studies using a modelling approach focusing on HPV vaccination interventions in the setting of China were included for review.
Data extraction and synthesis
We extracted information from the selected studies focusing on cost-effectiveness results of various vaccination programmes, key contextual and methodological factors influencing cost-effectiveness estimates and an assessment of study quality.
Results
A total of 14 studies were included for review. Considerable heterogeneity was found in terms of the methodologies used, HPV vaccination strategies evaluated and study quality. The reviewed studies generally supported the cost-effectiveness of HPV vaccine in China, although some reached alternative conclusions, particularly when assessed incremental to cervical cancer screening. Cost of vaccination was consistently identified as a key determinant for the cost-effectiveness of HPV vaccination programmes.
Conclusions
Implementing HPV vaccination programmes should be complemented with expanded cervical cancer screening, while the release of lower-priced domestic vaccine offers more promising potential for initiating public HPV vaccination programmes. Findings of this study contributes important evidence for policies for cervical cancer prevention in China and methodological implications for future modelling efforts.
... In fact, concerning the probable side effects in the Chinese population, as no clinical trial had reported the same vaccine safety profile as observed elsewhere, the Chinese government delayed their approval. In 2016, these vaccines were approved (157), demonstrating their effectiveness and safety (135,158,159). However, vaccination coverage remained low, and the HPV-associated burden was still high in this area. ...
Diagnosed in more than 90% of cervical cancers, the fourth deadliest cancer in women, human papillomavirus (HPV) is currently the most common pathogen responsible for female cancers. Moreover, HPV infection is associated with many other diseases, including cutaneous and anogenital warts, and genital and upper aerodigestive tract cancers. The incidence and prevalence of these pathologies vary considerably depending on factors including HPV genotype, regional conditions, the study population, and the anatomical site sampled. Recently, features of the cervicovaginal microbiota are found to be associated with the incidence of HPV-related diseases, presenting a novel approach to identify high-risk women through both blood and cervical samples. Overall, the HPV repartition data show that HPV infection and related diseases are more prevalent in developing countries. Moreover, the available (2-, 4-, and 9-valent) vaccines based on virus-like particles, despite their proven effectiveness and safety, present some limitations in terms of system development cost, transport cold chain, and oncogenic HPV variants. In addition, vaccination programs face some challenges, leading to a considerable burden of HPV infection and related diseases. Therefore, even though the new (9-valent) vaccine seems promising, next-generation vaccines as well as awareness programs associated with HPV vaccination and budget reinforcements for immunization are needed.
... Communicable disease policy analysis studies concentrated on two main viruses; human immunodeficiency virus (HIV) and human papillomavirus (HPV). Analyses in relation to HPV looked at the feasibility of implementation and non-implementation of a HPV vaccination programme in upper-middle to high income countries [41,72]. HIV-related studies varied from policies like task shifting of HIV/AIDS case management to community health service centres [55], and male circumcision for HIV prevention [71], to HIV testing policies among female sex workers [79]. ...
Background: Developed in the late 20th century, the health policy triangle (HPT) is a policy analysis framework used and applied ubiquitously in the literature to analyse a large number of health-related issues.
Objective: To explore and summarise the application of the HPT framework to health-related (public) policy decisions in the recent literature.
Methods: This narrative review consisted of a systematic search and summary of included articles from January 2015 January 2020. Six electronic databases were searched. Included studies were required to use the HPT framework as part of their policy analysis. Data were analysed using principles of thematic analysis.
Results: Of the 2217 studies which were screened for inclusion, the final review comprised of 54 studies, mostly qualitative in nature. Five descriptive categorised themes emerged (i) health human resources, services and systems, (ii) communicable and non-communicable diseases, (iii) physical and mental health, (iv) antenatal and postnatal care and (v) miscellaneous. Most studies were conducted in lower to upper-middle income countries.
Conclusion: This review identified that the types of health policies analysed were almost all positioned at national or international level and primarily concerned public health issues. Given its generalisable nature, future research that applies the HPT framework to smaller scale health policy decisions investigated at local and regional levels, could be beneficial.
... HPV-preventive vaccines yield more clinical benefits when vaccinated in early life (8). Thus, it is speculated that adolescent girls aged 13-15 years could benefit more than older women of HPV-infection status would from an HPV vaccination program in China (28). ...
Human papillomavirus (HPV) infection has a key role in the development of cervical cancer. The present study aimed to determine the HPV type distribution among females of Uyghur ethnicity in Xinjiang province, northwest China. A total of 12,165 individuals aged 30-79 years from 12 villages in Zepu County, Kashgar Prefecture, Xinjiang province were recruited for screening. Cervical and vaginal swabs from each subject were collected by gynecologists and tested for HPV DNA using Luminex xMAP technology. The results indicated that the overall HPV prevalence was 9.34% (1,136/12,165) in the present cohort; 7.41% (901/12,165) of the individuals were positive for high-risk type HPV (HR-HPV) and 1.64% (200/12,165) were positive for multiple types. Among the individuals who tested positive for HR-HPV types, the three most prevalent types were HPV16 (2.83%), HPV31 (0.99%) and HPV68 (0.88%). Subgroup analysis by age indicated that the highest frequency of HPV infections occurred in subjects aged >60 years. The most common genotype combinations in subjects with multiple types were HPV16 + HPV54, HPV16 + HPV31 and HPV16 + HPV68. The present study provided data on the prevalence and type distribution of HPV infections among Uyghur females in Xinjiang province, northwestern China, which will assist in the assessment of the potential cost-effectiveness of HPV screening and vaccination in this population. The data will also facilitate the determination of HPV68 and 54 strains that should be included in the multi-type vaccine and the establishment of a vaccination program that caters for the different age groups of the Uyghur population.
... ' We used purposive sampling to explore opinions and perceptions of these stakeholders. We have published details and methodological limitations of our sampling approach elsewhere [19]. We obtained ethical approval from the Survey and Behavioral Research Ethics Committee of the Chinese University of Hong Kong. ...
... Fourth, our study suggests that unlike the situation in low-and middle-income settings, there was acknowledgement of the important role of research evidence in HPV vaccination policy-making here [19]. Hong Kong's researchers had the capacity to do studies on disease burden and economic evaluations, and local decision makers recognized the importance of evidence. ...
Studies have assessed early population-level impact of human papillomavirus (HPV) vaccination programs for preventing cervical cancer. Through a case study in Hong Kong we examined stakeholder engagement and interactions to promote a universal HPV vaccination program using the Health Policy Triangle framework for structured health policy analysis. Using data from a document review and semi-structured in-depth interviews, we used thematic and stakeholder analyses to describe the process of policy formation. Given Hong Kong’s political and health system, and a mix of Chinese and Western values, stakeholders judged legitimacy of the process differently. We discuss their varied ethical stances and the role of research evidence for informing policy-making. For effective HPV vaccination policy and promotion of universal free HPV vaccination among adolescent girls, new strategies are needed to broaden acceptance of the process, to frame policies in terms of facts and values, and to connect research to policy-making and improve coalition-building.
The high prevalence of human papillomavirus (HPV) infection in China suggests there would be a substantial positive health impact of widespread vaccination against HPV. We adapted a previously described dynamic transmission model of the natural history of HPV infection and related diseases to the Chinese setting to estimate the public health impact in China of 2-valent (with and without cross-protection), 4-valent, and 9-valent HPV vaccination strategies. The model predicted the incidence and mortality associated with HPV-related diseases, including cervical and noncervical cancers, genital warts, and recurrent respiratory papillomatosis (RRP), based on the various vaccination coverage rate (VCR) scenarios, over a 100-year time horizon. The public health impact of the 4 vaccination strategies was estimated in terms of cases and deaths averted compared to a scenario with no vaccination. Under the assumption of various primary and catch-up VCR scenarios, all 4 vaccination strategies reduced the incidence of cervical cancer in females and noncervical cancers in both sexes, and the 4-valent and 9-valent vaccines reduced the incidence of genital warts and RRP in both sexes. The 9-valent vaccination strategy was superior on all outcomes. The number of cervical cancer cases averted over 100 years ranged from ~ 1 million to ~ 5 million while the number of cervical cancer deaths averted was ~ 345,000 to ~ 1.9 million cases, depending on the VCR scenario. The VCR for primary vaccination was the major driver of cases averted.
Citation: AlShurman, B.A.; Tetui, M.; Nanyonjo, A.; Butt, Z.A.; Waite, N.M.; Vernon-Wilson, E.; Wong, G.; Grindrod, K. Understanding the COVID-19 Vaccine Policy Terrain in Ontario Canada: A Policy Analysis of the Actors, Content, Processes, and Context. Vaccines 2023, 11, 782. Abstract: (1) Background: Canada had a unique approach to COVID-19 vaccine policy making. The objective of this study was to understand the evolution of COVID-19 vaccination policies in Ontario, Canada, using the policy triangle framework. (2) Methods: We searched government websites and social media to identify COVID-19 vaccination policies in Ontario, Canada, which were posted between 1 October 2020, and 1 December 2021. We used the policy triangle framework to explore the policy actors, content, processes, and context. (3) Results: We reviewed 117 Canadian COVID-19 vaccine policy documents. Our review found that federal actors provided guidance, provincial actors made actionable policy, and community actors adapted policy to local contexts. The policy processes aimed to approve and distribute vaccines while continuously updating policies. The policy content focused on group prioritization and vaccine scarcity issues such as the delayed second dose and the mixed vaccine schedules. Finally, the policies were made in the context of changing vaccine science, global and national vaccine scarcity, and a growing awareness of the inequitable impacts of pandemics on specific communities. (4) Conclusions: We found that the triad of vaccine scarcity, evolving efficacy and safety data, and social inequities all contributed to the creation of vaccine policies that were difficult to efficiently communicate to the public. A lesson learned is that the need for dynamic policies must be balanced with the complexity of effective communication and on-the-ground delivery of care.
