Big news for China's health care program, as the country plans to add its domestic HPV vaccine to its national immunization program this year, making it free for school-aged girls.
This is the first revision of China's national immunization program in 17 years.
So why now and how will the policy help protect public health?
We are live from Beijing.
This is Roundtable.
I'm Steve.
Thank you very much for being with us today.
And for the program, I'm joined by Niu Honglin and Niu Shan.
First on the show, China has announced its first update to the national immunization program in 17 years.
This is a very big deal.
The inclusion, the change, is a domestically produced HPV vaccine.
It's a landmark policy that will provide free vaccination to school-aged girls.
It's a strategic move aimed at drastically reducing the future burden of cervical cancer by overcoming critical barriers of cost and limited access.
By integrating the vaccine into routine public health services, China aims to achieve the high vaccination coverage necessary for herd immunity, protecting individual health and also advancing national goals for health equity and long-term wellness.
It is indeed a very big deal.
Good afternoon, Yonglin and Yushan.
Welcome back, I have to say.
It's been a long time.
Thank you.
It's nice being back, but it's nicer being on these kind of reporting trips.
Yeah, we're going to talk about that later in Happy Place.
But let's get to this first on the show.
It's a very big deal.
It's an important issue.
Yuxiang, kick us off.
Yeah, I was very excited to hear that China now plans to include the human papillomavirus vaccine, or the HPV vaccine, in our national immunization immunization program, as announced by officials from the National Administration of Disease Control and Prevention.
So the country would roll out HPV vaccination services this year for all eligible girls, like you mentioned earlier Steve, and the aim is to just protect women's health in general.
Yeah, so this is going to cover a large percentage of young women all around the country, yes?
Yeah, and it's not really entirely a new move, to be honest, because many Chinese cities and regions in China they had already rolled out similar programs locally.
For example, data from the National Health Commission showed that 18 provinces, including South Asia's Guangdong and Hainan province, as well as cities such as Zhengzhou in central China's Henan province and Ordos in north China's Inner Mongolia autonomous region, they have all incorporated HPV vaccination into their local government-backed public service projects, which means that this in previous years already kind of had already been initiated in several places here in China.
And also statistics indicate that the free vaccination policy now covers about 60 percent of eligible girls nationwide.
That is great news, as you mentioned.
So how are they planning on doing this then?
There are majorly three steps we see or three forms.
We see free provision, fixed subsidies and medical insurance coverage.
Specifically, most regions offer the domestically developed vaccines that protect against the two most common HPV strains.
Now, this is interesting because There are over hundreds of different types of strains.
Some are relatively so-called harmless, in the sense that your body would not react to it drastically.
You would not feel any symptoms and it would not lead to any other severe diseases, including cancer.
But some are high risk ones, meaning the high risk ones might lead to different type of those things that we've already mentioned.
So, for different strains, there are two most common HPV strains that are free of charge, while providing subsidies for other types of vaccines.
So if we got to the two most dangerous and also common strains get into the program, we are already solving the major part of the problem.
Yeah.
We'll check out in more detail a little bit later about the different types of of vaccines that are available.
The target population here, we mentioned it briefly already, school-aged girls.
Right.
They're mainly the girls aged between 13 to 14 with local household registration or school enrollment.
And in some areas the age range has been extended or limited to certain grades in junior high schools, and usually it's the schools that are the primary organizers of the vaccination.
And a few regions also include women from low-income backgrounds as service recipients.
That's one major advancement, I'll say, of this initiative of adding women.
HPV vaccine into this national program, that is, it covers a wider range of girls and women, so that the prevention of the lead on diseases and cancers can already start when they're as young as teenagers.
These are school programs, are they?
Or I'm wondering because in Canada these types of vaccinations, the HPV vaccination shots, are part of publicly funded school-based vaccination programs in all of the provinces in canada and all of the territories in canada.
It's not a mandatory shot, it's just available through school programs.
Um, and i think they begin at the age around 12 or 13 it's the sixth grade, i think, of elementary school in canada.
Well, to start with, there is a scientific background or reason for it.
That is, not only are we trying to protect girls from this, as young as possible from the disease.
Also, when you get the vaccination early, in these early days, your body responds to it better.
It builds up this protecting system in your health, in your body, stronger and earlier, which means even if, for people a little bit older getting the same kind of vaccine, they would not generate the similar type of protection system in the body, which explains the age to start with.
And also here in China, when it comes to the vaccination system, we have different types.
For example, when a kid is in kindergarten, it is mandatory to have the shots of certain vaccines.
You have to have those to get into the classroom, to Get into the herd, because the herd is already herd immune.
Yes.
You need to be one of the herd.
Understood.
I think in Canada, I don't think it's it goes province by province.
I don't think it's a nationally mandated thing to receive certain vaccinations for the whole country to enter school.
But there are certain provinces.
I want to say Quebec and New Brunswick are the provinces, but there could be more or I might be wrong about those.
But it depends on the province if you want to enter school in the first place.
So those are the mandatory ones, but after that there are other kinds of vaccinations that you get to choose.
You can say, because for some kids They are allergic to certain type of medicine, meaning that they cannot cannot take certain vaccination.
And also some vaccination are not completely free of charge, which means some families can choose to take it or not.
But many of these programs are school based.
School will tell you when the doctors will come to the classrooms.
Make each and every kid cry, but give them really proper health protection and you can choose to sign up for it or not.
It's not the kid's favorite day at school, that's for sure.
This is a good learning experience, this topic for me today because yes, we're talking about the immunization.
The target audience here is school-aged girls, but this is something that can affect men as well.
And one of the things that I learned from the Canadian government website is that if not immunized for HPV, if you're not immunized for it 75 of Canadians will get it at some point in their lifetime.
And if that applies to Canada, well then that's probably going to apply to the majority of countries around the world.
Now we haven't discussed, I think for a lot of people Maybe we've heard of this before, maybe not as a matter of fact.
So I think we should spend at least a few minutes learning about what this is.
So what is the disease itself and why is this immunization or vaccination considered such a crucial step, especially when we're talking about preventing things like cervical cancer or other related cancers?
So the HPV virus in general.
It is a ubiquitous virus that can infect literally anyone, male or female.
Once you are infected, the virus will live in different parts of your body and some sources would identify HPV as the most contagious.
Common sexually transmitted infection.
There are more than you're right only, and there are more than 200 types of human risk.
Sorry, human high risk and low risk, HPV Viruses, strains and, in fact, most sexually active people would get the HPV at some point in their lives.
The version I heard was that for for women in general, 80 of us will get at least once every HPV infection in our lives.
So that's just how common it is.
It is common.
And the reason why this is dangerous is because most people with it will experience no symptoms whatsoever.
They will feel totally fine and they won't even know that they're infected, at least during the first year of infection.
Yeah, and it can, and it can live in your body for uh, one to two years and then go away on its own.
That's for certain types.
Those would be for the low risk types right, but for certain strains, for a small number of people, the infection can persist and it can lead to complications, like certain types of cancers, And that's why the coverage is incredibly important.
And more specifically, it's most important to prevent cervical cancer.
Right.
And after giving birth, women here in China would get some checkups, and that would include HPV tests.
Yes, I think it's because it's relatively even more common for women after giving birth.
So having the test would help protect women with the situation and also provide them with specific kind of treatment as well.
And now we know that a study released by the National Cancer Center in 2004 reviewed that cervical cancer cases among Chinese women account for 22 23 of the global total, while deaths account for 16 worldwide.
And almost all cervical cancer cases by saying almost all I'm talking about, over 997 are related to HPV infection, and persistent HPV infection can potentially develop into cervical cancer.
Yeah, so there you, I mean, that's pretty much the proof, isn't it?
That specific type of cancer, that is the cause of it.
So this is very scientific and the proof is in the pudding, as they say.
And just a tiny little note here, that is, cervical cancer is definitely one thing, but there are other cancers that can affect both men and women are also related to HPV, which is why men are recommended even to have the vaccination as well.
Boys too.
And those vaccinations can start at a very early age, as young as nine years old, as a matter of fact.
So then why the vaccination?
There was a report from China Daily that talks about the vaccination provides a really important line of defense.
So what is that line of defense?
Right.
Here in China the current available two-valent or four-valent and nine-valent HPV vaccines.
They can all effectively prevent more than 70 of cervical cancer cases.
That's the efficiency of using vaccination as a protection or as a protection layer before screening, I'll say, before getting any type of HPV infections.
And this is according to chief physician Wei Lihui at Peking University People's Hospital.
And globally speaking, health agencies recommended HPV vaccination for children of all genders before the onset of sexual activity, which again is for protection mostly.
Yeah.
So obviously, again, these statistics are proof that these vaccinations are not just helpful.
They're almost necessary, right?
Why then?
Let's get to the why.
Why is China's inclusion of the HPV vaccine in the national immunization program?
Why is this considered to be such a landmark decision?
Yeah, well, China has fully, say, implemented its national immunization program ever since 1978.
And it initially included only four vaccines, such as the BCG vaccine, which is used to prevent tuberculosis, and the measles vaccine.
But by 2007 the program had expanded to 14 vaccines covering the prevention of 15 infectious diseases vaccines they covered within the program.
They are free and compulsory for children aged zero and six And I did a little bit of checking.
So for young kids, before entering preschool they kind of need to take around eight different types of vaccine.
Yes, many times to the community hospital with my kid.
Oh, already?
Yeah.
And each vaccine, sometimes you need to take, I think, three shots, three doses.
For HPV, I took three doses back in when I was studying in the UK.
So I would assume for kids, it's Yeah, similar.
But some of these vaccines, they are only vaccinated in epidemic areas, as in.
They're not mandatory for people that's from outside of these risky areas.
And for those people, if you want to take such vaccines but you're not really in the say, the zone where this epidemic may happen.
The higher risk zones.
Yeah, you kind of need to pay for it.
It's not completely free in your case.
But yeah, most of these vaccines, they are free.
I think these kind of vaccination plans come definitely with two major reasons.
One is that the epidemic is a pandemic, meaning that we do need vaccination to drive away the disease.
That's one reason.
And the other reason would be having this kind of vaccination would significantly reduce, improve the situation in the sense that, for example, for HPV1, if 90 of girls aged 9 to 14 receive two doses of the domestically produced 2-valent which is a concept we'll explain a bit later vaccine combined with a certain level of screening, the incidence of cervical cancer can be significantly reduced.
So that would be the reason we now have this kind of vaccination that can improve the health situation significantly, then definitely we would like to have more people being able.
Having access to the vaccination, and putting it into a national health plan is definitely the way to do it.
And I mentioned about the two valent.
Valent is a concept that is common with vaccination.
It's not specific for HPV.
The idea is how many strains or how many types of strains it include in this situation, specific vaccination.
For example, the two-valent one means there are two major types.
There's also the four-valent one having four, nine-valent one having nine different strains, and China is actively researching on producing the 15-valent ones.
And Yushan also mentioned how many shots you get, how many rounds or doses you would need to have.
There are definitely different reasons for it.
Some are to uh, stimulus your body again so it can generate the protective line in your body, immune line, your body as such, and generally for those who are under the age of 24.
Now, here in china, for the domestic vaccination it takes two doses, and for those uh before the age well, between the age of 24 to 45 it takes three doses.
Okay, so it depends then.
Um, the topic, i mean this type of discussion on the vaccines, has been around for quite some time, right?
This isn't just popping up this year.
No, not entirely.
Back in 2020.
I think that's when it started to get popular, where a lot of female friends around me of all different ages they were trying to get such vaccine in China.
So people searched for their own way.
Some need to fly to Hong Kong to get it.
And sometimes the queue can be as long as you have to wait for like a year or so to get your chance.
Yes.
In Chinese mainland we didn't used to have a lot of different clinic, let's say community medical services, for that.
And then, when it comes to April 2021, the National Health Commission began to propose taking the cervical cancer elimination campaign as an entry point for building healthy cities.
That's including the promoting of the use of HPV vaccines and strengthening tertiary prevention of cervical cancer.
That's a process where the primary prevention referring to health education and also HPV vaccination, and then followed by the secondary prevention of cervical cancer screening.
Also, this tertiary prevention still refer to preventing disease progression, which means that later on in your life, once you get it which is a common thing for women nowadays if you get it, you stop its progression and you deal with it as early as possible.
Sure, so back in 2020, you said people were flying to different locations to get their vaccinations.
2021, that's when the national health commission proposed um creating a bigger campaign about this.
And then in that year, they rolled out some pilot city programs.
Yeah, the first batch of the 15 pilot city or districts that's officially launching their program for cervical cancer prevention and control.
Then some provinces and cities all started to roll out policies, like I mentioned earlier, to provide free HPV vaccinations for girls of just appropriate age.
Okay, then jump forward a couple of years later.
What happened after that?
That's around in January 2023, right?
The National Health Commission and nine other departments.
They jointly issued an action plan for speeding up the review and approval of domestic HPV vaccines at the well, the national level this time, while encouraging qualified regions at the local level to carry out vaccination pilots and just explore multiple channels to support the vaccination for girls in just under-resourced areas.
And coming to this September, here we come the city of Beijing, who fully launched the free HPV vaccination program for 7th grade girls enrolling in 2025.
And that's using domestically produced two valid HPV vaccines.
That protects these girls from the two most dangerous variants.
I think it's HPV
16 and 18 that can most easily cause cervical cancer if left untreated.
Yeah.
I mean, this is just such a wonderful development for the health program in the country, isn't it?
Yes.
I think the first time I heard about the idea the concept having vaccination for HPV diseases related diseases was in around 2016.
Vaccines, of course, but it was already accessible in certain parts and it's already in the topic.
But back then, I was freshly and just graduated from college and...
The way to understand it, to understand the concept, understand the vaccination, were various among my classmates and also in the society.
Some people would say, well, young girls do not need this.
This is for sexually active women.
It's for relatively older women.
You do not find this disease in young girls.
And that was surprising.
Not the major concept or idea about it, but definitely it was a relatively stronger voice.
So the vaccinations were available at that time, about 10 years ago, but the education on the topic wasn't that strong 10 years ago.
Exactly my point.
And later on you see more and more people not only working in the field of doing research and developing better vaccination shots, but also doing very proactively education work in different places, in different schools.
You see primary, middle school having different education sessions, teaching people about how to protect their health.
And nowadays, when we see this free vaccination plan being included in the country's health plan, the overall health plan, we do not hear the voices about.
Oh, that's so.
The girls we're talking about are so young, they do not need this vaccination.
The stigma is already, I think, almost completely get out of the disease, as well as the action of getting the vaccinations.
The vaccinations the foreign vaccinations that were available 10 years ago.
One was from a UK pharmaceutical company that was approved for use in China in July of 2016.
That was a two-valent vaccine.
Then, a year later, in 2017, there was a four-valent vaccine that was from a US company that was approved for marketing here in the country.
And then in 2018, there was the nine-vallon HPV vaccine that was also from a U.S. company.
It got some conditional approvals for marketing in China as well.
I can only imagine that those would have been expensive at the time to receive those.
I think so, especially if you're trying to get it from within China, then Back then it's not really all covered by your medical insurance if you decide to get those vaccinations.
I remember yeah, still back in 2018, I was studying in the UK and back then I had no idea of this vaccine at all.
My friends here in China, they were ringing me saying that oh, you are in London right now.
Why don't you get the vaccine?
I'm like, why?
See, they got the education.
They've already had this education and this notion and awareness of Yeah, this is something that you should get.
Early as possible.
As early as possible, even though back then we were already like 24, 25-ish.
But still, as early as possible, the earlier the better.
So under their influence, I kind of took up the courage.
You know how it feels when you're all alone in a different land and then all of a sudden you're suggested to get a vaccine locally.
I spent around 400 pounds.
I think that roughly equals 3600 yuan here and got it quite easily in the pharmacy there in London.
And it's quite common for the medical staff there to receive Chinese students coming into their pharmacy and say oh, I kind of want to get the three boosts.
And we just scheduled my three different shots, scheduled a date for me.
At the pharmacy itself?
At the pharmacy.
There were no hospital visits at all required in the UK.
But here in China, back in 2018...
You kind of have to book it and pay for it yourself.
And that's just how big of a leap of faith we've got within the past few years.
But then following those foreign vaccines came the domestic ones.
And there were two domestically produced, two valid vaccines that were approved for market launch.
One in 2019, one in 2022 that were widely used and they have proven to be successful with girls as young as 9 to 14.
And then China rolled out its domestically developed 9-valent HPV vaccine and it further expanded the cervical cancer protection for that age group, starting at 9 but all the way up to women aged 45.
Yes.
As well.
So, with all of this kind of really wonderful information that we're sharing today and all of the wonderful things that we're learning here, there are still some difficulties, some challenges.
And one of those challenges and I can I can kind of understand it.
I think you said the stigma is disappearing.
Right.
This is only for sexually active people.
Um, and i can understand why that would make some parents, especially parents of of a young daughter, a little hesitant.
They might, if they, if they're not fully aware of the topic, if they're not educated on the topic, it might make them feel uncomfortable.
Yes, i think it's not fully disappeared.
Like you said, it's disappearing and people are getting more information and getting educated about it, especially the parents of young girls having a vaccination.
I talked about more than 10 years ago when I first heard about it.
I also heard parents of my classmates saying, you don't need it.
You are not sexually active and it's for elder ladies.
You do not need to take a shot that is totally unnecessary.
And I'm not really sure, but I think in certain corners of the country there might still having or the conversation might still happening.
Well, what was the reaction from parents on social media?
Take Beijing, for example.
This year, Beijing began to offer free HPV vaccination to all seventh grade or first year middle school girls, as we mentioned earlier.
And on social media, there are quite a mix of reactions shared by parents and students.
So some are strongly supporting the rollout and others are just preferring to wait a little and see if there are any side effects and if it does something to the girl and if an HPV vaccine really does what it claims, especially the nine strains.
That means that in three different times you are putting in nine different kind of anti-virus kind of chemicals into into into your body.
What it does to your body is sometimes remain unknown and known to people.
And Yeah, again back in 2018 2019, I've got a roommate to both of us, or girls, and I'm very grateful for my parents, who were a hundred percent supportive of even though they did not fully know what the vaccine is.
They only know that it's protective and that it's going to help me in the next say, decade or two decades in my life to prevent me from getting any diseases.
Well, in the meantime this is a real sharing from my roommate's parents saying that you don't know what it does, so why take it in a foreign land and just blindly believe that if they say it's effective, it's going to be effective to you?
So I think nowadays, as more and more people start to get the awareness of HPV vaccine and more and more people are getting it, the knowledge or the gap of knowledge will gradually be filled.
This is...
From the start, this is really a beginning of things.
We're offering free two-string vaccination, which is kind of just the basic, comparing with nine strings.
But again, this is just the start of moving on to something better.
Besides, for those who are considering oh, I can wait a little bit for the, for example, the four-stringed one, to be rolled out and to be included in the free plan.
Do not.
Because getting yourself protected early as possible is more important than getting a, for example, four-valent one, comparing to the two-valent one.
So the earlier, well, the timing is even more important.
And also, boys or men can have it.
And for the herd immunity to work even better to protect your significant other.
It is also recommended.
Yeah.
This is a worldwide thing.
From February 2025, the WHO 148 of the WHO member states.
They've incorporated the vaccine into their national immunization programs.
132 different countries have reported vaccination coverage estimates for the first dose among those 132 countries.
15 of them achieved 90% coverage for the first dose.
Upper middle income countries presented the highest coverage, about almost 72 for the first dose there.
It's good because education is important here.
And I think, if the country is rolling out this upgrade to its national health coverage, we can't forget how important the education is right.
And this needs to start, in my opinion, around middle school.
I think in Canada.
If I remember correctly, that's when our education on these types of diseases started.
And of course in middle school students are going to be a little bit immature about this and they're going to be cracking jokes and laughing and it's going to make some parents uncomfortable, of course.
But at the same time, That old expression, the more we know, right?
The more you know on a topic, that allows you to make an informed decision.
I can't sit here and say, go and inject something into your body.
That's something that people make.
They make that decision on their own, right?
But you have to be educated on this and you have to treat it like it's a real thing and don't ignore it and don't have that attitude of oh, it's not going to happen to me, right.
That's the best we can do.
