Scientific Papers

Accelerating into Immunization Agenda 2030 with momentum from China’s successful COVID-19 vaccination campaign during dynamic COVID Zero | Infectious Diseases of Poverty

IA2030 has seven strategic priorities: integration of immunization with primary care, country commitment to immunization fulfilling people-centered demand for vaccines, ensuring high and equitable coverage, vaccinating throughout the life course and integrated with essential services, management of outbreaks and emergencies, sustainable supplies of vaccines, and research and innovation. The COVID-19 vaccination campaign was well aligned with all seven of IA2030’s strategic priorities. The priorities that can impart the most momentum to the program and support the global IA2030 vision are ones that increase the number of vaccines in the routine program (Strategic Priority 2, Commitment and Demand) and broaden the age groups recommended for routine vaccination (Strategic Priority 4, Life Course & Integration). Another strategic priority with long-term benefit for China and the world is Strategic Priority 7, Research & Innovation. The COVID-19 campaign relied heavily on research and innovation, as exemplified by rapid and successful development of new and innovative COVID-19 vaccines, new vaccine delivery techniques, and new vaccination strategies in a fully digitalized immunization program that harnessed big data and artificial intelligence for monitoring and analyzing vaccine safety, effectiveness, and coverage.

IA2030 talks about “breadth of protection,” meaning implementing and sustaining high coverage with all WHO-recommended vaccines. The COVID-19 vaccination campaign conclusively proved that China’s immunization program can rapidly develop and introduce a new vaccine and achieve high vaccine coverage. The COVID-19 vaccination campaign was an astonishing eight times the size of the annual routine immunization program. This momentum and experience can be used to facilitate introduction of the vaccines that are recommended by WHO for all national programs but are not currently in China’s program. Recent [8, 9] and earlier [10] analyses of China’s national immunization program have recognized the disparity between the vaccines recommended by WHO and the vaccines included in China’s program and have recommended strategies to introduce new vaccines. A legislatively supported mechanism, the National Immunization Advisory Committee (NIAC), now exists that can recommend to government non-program vaccines that should be moved into the program based on evidence of preventable burden of disease and vaccine effectiveness, safety, cost effectiveness, and supply security [11]. Just as NIAC supported COVID-19 vaccination strategy, it can support evidence-based introduction of other vaccines. Moving human papillomavirus (HPV), pneumococcal conjugate (PCV), influenza, Haemophilus influenzae type b (Hib), varicella, and rotavirus vaccines into the national program would bring equitable and high coverage of these vaccines to well over 100 million young children and adolescents, preventing suffering from these infectious diseases while saving society money. Using domestically developed and produced vaccines will strengthen China’s vaccine industry and foster innovative development of new vaccines for use in China and for WHO prequalification and global use. For example, combining China’s Sabin-strain inactivated poliovirus vaccines into diphtheria, tetanus, acellular pertussis-, Hib-, and hepatitis B-containing combination vaccines could make “space” in the domestic routine immunization schedule for other vaccines while maintaining high polio vaccine coverage well into the future, for as long as is needed in China and elsewhere [12].

A thrust of IA2030 is life course vaccination. With its target population of everyone over the age of 3 years, China’s COVID-19 vaccination campaign exemplified life-course vaccination. COVID-19 vaccination was vigorously promoted to the elderly [13], people with comorbidities, health care workers and other working age adults, and school-age children. These are the same target populations for seasonal influenza vaccine. China CDC has recommended influenza vaccination of these populations for years [14], however uptake has been low except in several leading cities that have embraced influenza vaccination of these key target populations. The COVID-19 vaccination campaign proved that these populations can be reached to achieve high and equitable coverage. The COVID-19 vaccination experience can be used to make progress on influenza vaccination of these important target populations.

The maximum age for eligibility of National Immunization Program vaccines was recently raised from 14 to 18 years of age. This age range expansion can provide adolescents the opportunity to catch up on any program vaccinations they missed and to receive HPV vaccine once it is included in the program. But why stop at 18 years of age? The IA2030 vision is for the entire life course, as was the COVID-19 campaign. Program eligibility across all ages would enable immunization clinics, community health centers, and primary care providers to bring “everyone, everywhere, at all ages” the full benefits of vaccines. For adults, this could include not only influenza vaccine, but also pneumococcal and zoster vaccines in a comprehensive program integrated with primary care. Innovative financing of adult vaccines, as was done for COVID-19 vaccines with the Medical Insurance Fund, could support universal immunization program eligibility that would lead to equitable and high coverage for all—in good alignment with IA2030.

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