China Expands National Immunization Program to Include HPV Vaccines for Eligible Females
On September 11, Shen Hongbing, Vice Minister of the National Health Commission and Director of the National Disease Control and Prevention Administration, stated at a press conference that China will launch HPV (human papillomavirus) vaccine (cervical cancer vaccine) vaccination services for eligible females this year, and will include HPV vaccines in the National Immunization Program (NIP) to protect women’s health.
In the field of public health, the NIP provides vaccines free of charge under government auspices, aiming to improve the overall health of the population and ensure accessibility regardless of economic status. Prior to this, China’s NIP primarily covered children under 6 years old—for example, the BCG vaccine and hepatitis B vaccine that all infants receive after birth—with very few vaccines targeting adolescents or adults.
In recent years, various vaccines (including influenza vaccines and pneumonia vaccines) have been widely recommended for inclusion in the NIP, and HPV vaccines have ultimately emerged as the "lucky ones."
This is largely due to their clinical benefits. In 2022, there were 150,700 new cases of cervical cancer in China, with an overall upward trend in incidence and a growing number of younger patients. HPV, short for human papillomavirus, is mainly transmitted through mother-to-child contact, sexual contact, and skin-mucosa contact. Cervical cancer is the only preventable cancer worldwide—99.7% of cervical cancer cases are caused by persistent infection with high-risk HPV subtypes. The globally recognized most effective way to prevent cervical cancer is HPV vaccination.
I. Once-Surging Demand and Extremely Low Penetration
At the Baihedong Community Health Service Center in Guangzhou’s Liwan District, glass display cabinets on the second floor showcase boxes of HPV vaccines from different brands, along with introductions to their production technologies.
To date, a total of 6 HPV vaccine brands have been approved for use in China: imported vaccines include GlaxoSmithKline’s bivalent vaccine, and Merck’s quadrivalent and 9-valent vaccines; domestic vaccines include bivalent and 9-valent vaccines from Wantai Bio, and bivalent vaccines from Walvax Bio.
Infographic by He Miao; Data compiled by Li Kewen
There are over 200 known subtypes of HPV, among which the high-risk subtypes 16 and 18 are the primary causes of cervical cancer. In addition, 7 other subtypes are relatively common and can cause cervical cancer or condyloma acuminata.
A "bivalent vaccine" refers to one that prevents infection with 2 subtypes (16 and 18), while a "9-valent vaccine" expands protection to 9 subtypes.
Infographic by He Miao; Data compiled by Li Kewen
In 2016, mainland China approved the first HPV vaccine for marketing—GlaxoSmithKline’s bivalent vaccine—10 years later than Hong Kong and Taiwan regions of China. Despite the high price of imported HPV vaccines (ranging from 580 yuan to 800 yuan per dose), pent-up demand was quickly released. According to data from national routine immunization reports, the number of HPV vaccine doses administered in China soared from 3.417 million in 2018 to 12.279 million in 2020. Due to insufficient supply, some imported HPV vaccines were in short supply for a long time, and many eligible females traveled to Hong Kong or even overseas to receive vaccinations.
However, whether this once-surging demand was just the tip of the iceberg or the entire iceberg soon became clear.
In 2022, the cumulative first-dose coverage rate and full-dose coverage rate of HPV vaccines among females aged 9–45 in mainland China were 10.15% and 6.21%, respectively. For girls aged 9–14, the first-dose vaccination rate was only 4.00%.
Behind this huge contrast lie issues of accessibility (due to previous price and supply constraints), as well as regional differences in public awareness and willingness to be vaccinated against HPV.
Infographic by He Miao; Data compiled by Li Kewen
In recent years, as the supply of HPV vaccines has increased, doses have become more accessible. However, whether choosing domestic or imported vaccines, price remains a major barrier for many families.
Before Walvax Bio’s bivalent HPV vaccine was launched in March 2022, Wantai Bio’s bivalent HPV vaccine was the only domestic option available in China. Due to limited procurement quantities in individual cities, enterprises had little incentive to lower prices. In 2021, the procurement price of Wantai Bio’s vaccine for Jinan’s public-funded program was approximately 330 yuan per dose—equivalent to the price in the self-funded market.
For imported HPV vaccines, the full three-dose course of the most expensive 9-valent imported vaccine has long cost around 4,000 yuan, a significant expense that many families need to weigh carefully.
In fact, signs of this situation emerged earlier. Before HPV vaccines were introduced in China, a cross-sectional study covering 21 urban and rural areas found that 68% of female respondents were willing to pay approximately 500 yuan for an HPV vaccine, while only 6% were willing to pay over 2,000 yuan for an imported vaccine.
Inadequate science popularization is another factor affecting vaccination willingness.
While some willing recipients scramble to book vaccines (similar to how people rush to buy Moutai liquor), other eligible females refuse vaccination due to rumors that HPV vaccines can cause death, disability, or affect fertility.
Nevertheless, the Chinese government has long been determined to promote HPV vaccination.
The World Health Organization (WHO) previously set the "90-70-90" targets for 2030: 90% of girls complete full HPV vaccination by age 15; 70% of women aged 35 and 45 receive high-precision cervical cancer screening; and 90% of women diagnosed with cervical disease receive treatment. These targets form the core of the WHO’s Global Strategy to Accelerate the Elimination of Cervical Cancer launched in 2020. China subsequently stated its full support for this strategy.
According to research by a team led by Zhao Fanghui, Director and Researcher of the Epidemiology Research Office at the Cancer Hospital of the Chinese Academy of Medical Sciences, if bivalent HPV vaccines are included in the NIP, cervical cancer could be eliminated in China by around 2060—provided that screening coverage is expanded and disease treatment is strengthened.
Furthermore, compared to promoting free vaccination city by city, directly including HPV vaccines in the NIP not only covers a broader population but also enables far larger procurement volumes. This not only simplifies the promotion and popularization of HPV vaccines but also helps the government negotiate more favorable prices as a bulk purchaser.
However, in China, the journey of HPV vaccines—from being unavailable, to being in short supply after launch, to finally becoming free—has spanned many years. Countless scientists, clinicians, and experts have worked to popularize HPV vaccination and promote its inclusion in the NIP. This journey encapsulates the development of HPV vaccines in China over the past two decades.
II. Expanding from Local Pilots to National Implementation
Duan Xianzhi, currently Chief Physician of the Obstetrics and Gynecology Department at Beijing Tongren Hospital Affiliated to Capital Medical University, was a key figure in promoting cervical cancer screening and HPV vaccination across Ordos, Inner Mongolia. She was also the advocate behind China’s first regional program offering free HPV vaccination.
Qiao Youlin is an expert in cancer prevention and control with over 30 years of experience in cervical cancer prevention. He has played a pivotal role in promoting cervical cancer screening and HPV vaccination popularization in China.
Around 2005, Duan Xianzhi—then Director of the Obstetrics and Gynecology Department at the Inner Mongolia Autonomous Region People’s Hospital—began collaborating with Qiao Youlin to promote cervical cancer screening programs in Inner Mongolia. The following year, GlaxoSmithKline’s bivalent HPV vaccine (Cervarix) was approved for marketing overseas for the first time. A year later, European and American countries began incorporating HPV vaccines into their national immunization programs. Zhao Fanghui, a core member of Qiao Youlin’s team and a researcher on China’s cervical cancer elimination strategies, witnessed these international developments and hoped that China would at least keep pace with global progress.
"We argued at the time that China should also do this, but we really felt that vaccines were still far beyond our reach," Zhao Fanghui told Jiemian News.
Qiao Youlin, meanwhile, hoped that pharmaceutical companies would recover their vaccine development costs within five years, after which prices could drop—making it easier to include HPV vaccines in the NIP. Starting in 2008, he collaborated with domestic peers to conduct clinical trials in China for imported HPV vaccines (from GlaxoSmithKline and Merck) and Wantai Bio’s domestic bivalent HPV vaccine. Between 2016 and 2018, several imported HPV vaccines were approved for marketing in China.
However, due to various factors, large-scale vaccination (driven by volume-based price reductions) and the subsequent rapid improvement in women’s health did not materialize as expected.
Qiao Youlin then shifted his approach, deciding to start with local pilots.
Ordos, which had launched comprehensive screening for two cancers (cervical and breast cancer) in 2016, became an ideal choice. In late 2019, with the facilitation of Qiao Youlin, Duan Xianzhi, and others, GlaxoSmithKline negotiated a supply price of 580 yuan per dose with Ordos. Under this plan, recipients only paid for one dose for the full three-dose course—equivalent to a two-thirds price reduction. Ordos then launched a local pilot program providing free HPV vaccination for schoolgirls aged 13–18.
Despite some twists and turns, free HPV vaccinations began in Jungar Banner, Ordos, in August 2020. Unlike the international practice of vaccinating girls aged 13–15, Jungar Banner expanded the target group to 18-year-olds (covering students from the first year of junior high school to the third year of senior high school). Three years later, Jungar Banner had administered the first HPV dose to 13,373 eligible girls, achieving a vaccination rate of 91.42%. In 2021, Ordos issued a document to provide free HPV vaccination for all eligible females in the city, later becoming the first prefecture-level city in China to meet the WHO’s "90-70-90" targets.
Subsequently, public-funded HPV vaccination pilots received support from the national government, and this pilot model began to be promoted across the country.
Infographic by He Miao; Data compiled by Li Kewen
At the end of 2020, the National Health Commission launched the "Healthy City Construction to Promote Innovative Models for Healthy China Initiatives" pilot program, focusing on cervical cancer prevention and control. Many selected cities also began providing free HPV vaccination for local eligible girls.
Zhao Fanghui, as head of the pilot management office, participated in promoting this national-level pilot model. She observed that vaccination efforts required collaboration across multiple departments—not just health authorities, but also women’s federations, finance departments, and education authorities. "If the government takes the lead, things progress very quickly," she noted.
Initially, some experts debated whether a 90% vaccination rate was achievable. However, within less than two years, cities like Jinan and Chengdu had already reached this target.
Du Heng, Chief Program Officer of the Bill & Melinda Gates Foundation’s Beijing Office, whose work includes advocating for the inclusion of four WHO-recommended vaccines in China’s NIP, told Jiemian News that the aforementioned institutional innovations were crucial in advancing the inclusion of HPV vaccines in the NIP. "On one hand, they allowed localities to take the lead in trials; on the other hand, they fostered healthy competition between regions," she explained.
"Local leaders all prioritize the ‘Healthy China’ initiative as a key government benchmark," she added.
However, the process of moving a vaccine from local pilots to national inclusion in the NIP involves more complex considerations—particularly health economics cost-benefit analysis. This requires using model data to prove that government spending on vaccinating the target population is "cost-effective" for public health investments.
This is no easy task.
Du Heng told Jiemian News that it takes approximately 2–3 years to develop a mature health economics model for a vaccine. First, data must be collected; then, model fitting is conducted—equivalent to "building the wheel first" to verify its suitability and functionality—before finally estimating the cost-benefit of vaccination based on different assumptions and strategies.
Work on this front began in 2018, the same year the WHO issued its global call to eliminate cervical cancer. Zhao Fanghui, a member of the WHO’s Expert Group on Cervical Cancer Elimination, returned from a meeting in Geneva and immediately led her team in developing China’s own dynamic model. "Since the WHO called for global elimination, we needed to answer: Can China eliminate cervical cancer? If so, when, how, and what specific measures are needed?" she said.
Given China’s rapid changes in urbanization, population aging, and sexual behavior patterns, Zhao Fanghui’s team developed a highly detailed model.
Initially, using bivalent vaccines as the basis, the team predicted that cervical cancer could be eliminated in China by around 2060—provided that vaccines were included in the NIP, screening coverage was expanded, and disease treatment was strengthened. They then explored ways to accelerate this process, such as when to switch to 9-valent vaccines. Finally, they conducted economic calculations: for example, at what price and supply volume would government investments in vaccines save costs in later screening and treatment.
Gradually, this body of evidence outlined the value of including HPV vaccines in the NIP.
During this period, changes also quietly occurred at the national and market levels.
With increased supply and more vaccines entering the market, price competition for HPV vaccines in China’s public-funded market began. In March 2024, Wantai Bio won a bid in Jiangsu at a price of 86 yuan per dose—marking the first time a public-funded HPV vaccine fell below 100 yuan. Less than six months later, Walvax Bio won a bid in Shandong’s public-funded program at 27.5 yuan per dose—roughly the price of a cup of Heytea milk tea.
Another opportunity arose from the sharp decline in the number of newborns, which freed up funds in the NIP budget.
According to a report by Caixin Weekly, Tang Shenglan—Co-Director of the Global Health Institute at Duke Kunshan University and Director of the Vaccine Delivery Research and Innovation Laboratory—estimated in 2024 that nationwide bulk procurement of bivalent HPV vaccines through the NIP would cost less than 1 billion yuan.
For comparison, the subsidy fund for the "Expanded National Immunization Program" had dropped from a peak of 4.8 billion yuan in 2021 to 3.03 billion yuan in 2023. As a result, industry insiders sensed that the time was ripe for expanding the NIP.
III. How to Implement the Policy
Looking back at this approximately 20-year journey—from cervical cancer screening, to the approval of HPV vaccines in China, to the promotion of public-funded vaccination through Healthy City pilots, and finally to inclusion in the NIP—this story involves not only science, business, official courage, and government wisdom, but also close collaboration and serendipity. Many participants have also mentioned one word in unison: equity.
Du Heng told Jiemian News that in the self-funded market, two issues stand out: First, women in economically underdeveloped regions with insufficient medical resources face higher cervical cancer incidence and disease burden, yet have poorer access to vaccines. In some regions with no commercial returns, enterprises simply refuse to supply vaccines. Second, HPV vaccines are most effective at protecting girls aged 9–15, yet enterprises often prioritize the more profitable adult female market.
For such vaccines, reshaping health equity and providing a safety net for groups with the least resources is the significance of the NIP. According to vaccination guidelines, females below a certain age require fewer doses. For example, Merck’s guidelines state that for full efficacy, girls under 14 only need two doses of the quadrivalent HPV vaccine, while those over 14 need three doses. In other words, vaccinating younger eligible girls also reduces overall costs.
However, at the September 11 press conference, Shen Hongbing only announced the plan to include HPV vaccines in the NIP, with specific details (such as the type of vaccine to be used and the specific vaccination schedule) yet to be released. One obvious difference from previous NIP policies (which targeted infants and children aged 0–6) is that the target group for HPV vaccines will be eligible schoolgirls.
At the September 11 press conference, Shen Hongbing mentioned that China will promote the development and application of electronic immunization certificates nationwide, optimize the layout of vaccination facilities to make it easier for people to receive vaccinations nearby, and encourage local governments to introduce policies such as scheduled appointments, weekend vaccinations, and home-based vaccinations for special groups to meet diverse public needs.
Qiao Youlin also told Jiemian News that after HPV vaccines are included in the NIP, efforts should be made to strengthen public education, conduct local disease surveys, and counter the negative influence of "anti-vaccine" advocates. For example, the public should be informed why domestic vaccines are chosen—domestic and imported vaccines are actually very similar in efficacy, and domestic vaccines can also ensure supply security to avoid shortages. Additionally, if a rare disease occurs suddenly after years of absence, some people may attribute it to vaccines; in such cases, data from local disease surveys should be used to respond.
Since many localities have already implemented public-funded bivalent HPV vaccination programs, a wealth of experience and methods can be drawn upon. Jiemian News conducted a simple survey on social media to identify reasons for "unwillingness to receive HPV vaccines" and found that most concerns come from girls’ parents. In local implementation, schools typically notify parents to take their daughters for vaccination, meaning parents are the actual decision-makers. Therefore, after national inclusion, parents should be a key target for science popularization.
Based on past experience, it is predictable that the vaccination rate of HPV vaccines will increase significantly after their inclusion in the NIP.
For example, before hepatitis A vaccines were included in the NIP, the vaccination rate in Huzhou, Zhejiang, was 9.09%; a decade later, it had risen to 99.25%.
Currently, there are no authoritative forecasts on how many additional HPV vaccine doses will be administered annually in China after NIP inclusion. However, taking Guangdong Province as an example: after launching free HPV vaccination for eligible girls in 2022, the number of doses administered increased from 1.44 million in 2020 to 7.66 million in 2023. Therefore, supply stability has also become a key concern.
Currently, there are two domestic HPV vaccine manufacturers in China: Wantai Bio and Walvax Bio. If bivalent vaccines are chosen for the NIP, both manufacturers had a production capacity of 30 million doses per year in 2022, meaning domestic vaccines alone could meet a supply demand of 60 million doses per year.
Including HPV vaccines in the NIP is not the end of China’s cervical cancer prevention journey. Just as in the field of innovative drugs, domestic HPV vaccines are gradually catching up to imported ones.
On September 9, Wantai Bio’s 9-valent HPV vaccine was administered for the first time in Xiamen. As China’s first domestic 9-valent HPV vaccine, its protective efficacy is comparable to that of imported vaccines, while the full-course vaccination price is only 40% of that of imported versions. Beyond this, clinical research on 15-valent HPV vaccines and vaccines for male vaccination is also underway in China.
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