S:Hello everyone. Welcome to CBN Friday Special, I’m Stephanie Li.
R:And I’m ZHANG Ran.
S: Ran, I’m going to get vaccinated against HPV this weekend.
R:That’s so lucky of you! Getting HPV shots can be a challenge for many due to the rising demand and limited supply of vaccines. Until a few years ago, a lack of access to HPV vaccines on the Chinese mainland drove many “medical tourists” to places like Hong Kong to get vaccinated. And scalpers emerge to offer services to help some individuals to obtain successful appointments by illegal ways.
S:After years of anticipation and advocacy, regulators on the Chinese mainland finally approved the use of HPV vaccine in 2016. This was a major step forward for women. Actually, China had to rely on foreign-produced HPV shotsuntil2020. HPV vaccines were first available on the Chinese mainland in August 2017, a year after British pharmaceutical company GlaxoSmithKline gained approval for its Cervarix vaccine from Chinese authorities in 2016. Two years later, China’s State Drug Administration approved Merck’s Gardasil 9 vaccine protecting against nine strains of HPV. However, a single injection of Cervarix costs nearly 600 yuan, while a single shot of the 9-valent kind costs more than 1200 yuan.
R:That means a complete course of three shots could cost more than 3000 yuan. But thegood news is, China has approved the production of the first domestically made vaccine against HPV at the end of 2019, before which the high prices and limited supply of imported vaccines remained a burden for many in the country.China has become the third country globally to achieve an independent cervical cancer vaccine supply. In terms of safety and efficiency, the effects of domestic vaccines are comparable to imported ones, but they cost much less.
S:Well, currently, three types of HPV vaccines are available in China,but the 9-valent shotis the most sought-after but harder to get due to supply constraints. I’ve noticed a common misunderstanding about the vaccine that the higher the valent, the better.Although higher-valent vaccines can protect against a wider range of viruses, the two most common virus strains cause 84.5 percent of cervical cancer, which means one can be mainly protected by taking the 2-valent HPV vaccines.
Moreover, the 2- and 4-valent vaccines are suitable for wider age groups. When facing a shortage of 9-valent doses, it is important to receive the other two alternatives at an early age to expand immunisation coverage. The 2-valent HPV vaccine developed by Walvax Biotechnology has got green-light to go to market in China last month, making it the second domestically made HPV vaccine in China.
R:Yes. HPV is a leading cause of cervical cancer, the fourth-most common form of malignant tumours in women worldwide with an estimated 604 000 new cases in 2020. The human papillomavirus (HPV) is a common sexually transmitted type of virus that can cause cancers of the cervix, genitals, anus and throat.
In 2020, cervical cancer killed over 60,000 women in China, the second most common in cancer among Chinese women, according to a government report.Despite that cervical cancer is avoidable via yearly routine physical examinations, it"s better to be vaccinated to stay healthy.
S:However, the benefits of HPVvaccinationcontinue to be overshadowed by poor awareness, widespread misconceptions about the nature of HPV, and harmful stigmas, especially among men. I found that women diagnosed with HPV are often not just worried about their risk of developing cervical cancer, but also about what will happen if their partners or others take the diagnosis as a sign of unfaithfulness.
R:Such worries may have been caused by incomplete scientific research. In the early 1900s, medical specialists collectively referred to cancers of the uterus and cervix as “cancer of the womb,” with some doctors believing that these cancers were caused by women engaging in “excessive” or “immoral” sexual behaviour. In the mid-20th century, experts instead began attributing the cause of cervical cancer to cervical fissures that occur during labor, temporarily dispelling some of the stigma surrounding the disease.
But by the end of the century, a succession of scientific studies proved that the primary cause of cervical cancer was HPV, transmitted through sexual activity, and beliefs about promiscuity and sexual immorality once again reared their ugly heads.
S:Most HPV awareness campaigns focus solely on women, and the vaccine itself is often referred to as the “cervical cancer vaccine.” By emphasising that the risk of infection in women is closely correlated to the frequency of their sexual activity and number of sexual partners, while ignoring the risks the virus poses to men.
R:You’re right. The truth is, both sexes are equally likely to contract the virus. Although scientists began studying HPV’s effects in men much later than in women, the virus has already been linked to serious diseases such as anal cancer, penile cancer, and cancer of the throat. It’s a matter of health in both men and women!
S:So it’s a pressing issue to promote access to HPV vaccines. In March 2021, 15 cities across China were chosen as the first batch of pilot cities for exploring local free HPV vaccination strategies. Junghar Banner in Inner Mongolia launched the first free HPV vaccination program in 2020, then more Chinese cities have followed suit, including Xiamen in East China’s Fujian province in September 2020 and Jinan, the capital city of Shandong province, a year later.
South China’s Guangdong province also announced its plans to offer free HPV vaccines to eligible female residents under 14 years of age starting this September.A budget of 600 million yuan ($94.3 million) has been allocated for free vaccinations from 2022 to 2024. Last month, South China’s Hainan province launched its free HPV vaccination project, with plans for administering two doses of the vaccine to 71,000 girls aged between 13 and 14 and a half this year.
R:In fact, in December 2020, China’s National Health Commission announced to back the global strategy of accelerating the elimination of cervical cancer, which was initiated by the WHO in November 2020. The strategy stipulated getting 90 percent of girls vaccinated with HPV vaccine before they turn 15 by 2030, and set the target of eliminating cervical cancer through vaccination, screening and treatment.
The NHC also vowed it will work with related departments to accelerate research and approval of HPV vaccines, ramp up production, encourage local authorities to launch pilot projects and roll out more awareness campaigns.
S:Currently, the vaccination rate for women aged 9 to 14 is less than 1 percentin the country, according to state media. So I look forward to the day that we can all get access to affordable HPV shots, and more people will be able to get rid of their prejudiceand misunderstandings against the vaccine.
“九价已打，花呗已还，车房已买……”
近几年，各大社交平台频繁出现类似的有趣文案，背后显示出目前人们接种HPV九价疫苗的迫切需求，以及“一苗难求”的困境。为了打上一针九价HPV疫苗，有人甚至组团到香港等地接种。
为何会出现“一针难求”的情况？
九价HPV疫苗是用于预防人乳头瘤病毒（HPV）感染引起的宫颈癌，可以预防90%以上的宫颈癌，疫苗于2014年在美国获批上市。国家药品监督管理局在2018年4月有条件批准用于预防宫颈癌的九价HPV疫苗在国内上市。中国批准上市的九价HPV疫苗产自美国制药商默沙东，国内由智飞生物独家代理，每年批签发量仅有数百万只，远远不能满足国内的需求量。九价HPV疫苗的接种适龄人群为16岁~26岁，按照国家统计局的数据，我国适龄接种九价HPV疫苗的人数约为1.2亿人。若按智飞生物2020年的批签发量计算，能够接种到该疫苗的人数还不足总数的1.5%。
因此自上市以来，九价HPV疫苗就一直处于供不应求的状态，接种需通过网上预约，往往要排队一年，预约系统也是“秒光”。比如在深圳，市民要接种九价HPV疫苗要靠摇号，每一期的中签率都不足3%，中签率如同摇车牌一样。
但随着国产HPV疫苗上市，“一苗难求”的局面有望被打破。
2017年8月，HPV疫苗中国大陆首次上市。在此一年前，英国制药公司葛兰素史克生产的希瑞适疫苗获得中国当局批准。两年后，中国国家药品监督管理局批准了默沙东九价疫苗。注射一针希瑞适的费用约600元，而一针九价更是超过1200元，高昂的价格仍然让不少人“望而却步”。
2020年1月，中国国家药监局批准首个国产双价人乳头瘤病毒疫苗(馨可宁)的上市注册申请，这也意味着中国成为全球继美国和英国后第三个成功研发生产HPV疫苗的国家。国产疫苗入局将有效缓解疫苗短缺局面，大大提升产能。国产疫苗就安全性和有效性而言，与进口疫苗相当，但价格要低得多，每针仅需329元。
截至目前，中国已批准使用五种HPV疫苗，包括三种二价HPV疫苗、一种四价HPV疫苗和一种九价HPV疫苗，但最受欢迎的仍是九价疫苗。在大众的观念中，人们认为价格越高越好。
事实上，专家表示，尽管九价疫苗可以预防9种亚型HPV病毒，但二价HPV疫苗可预防高危型16型、18型病毒，二价HPV疫苗也是不错的选择。此外，二价和四价疫苗的适龄范围更广。面临九价疫苗短缺的局面，重要的是尽早接种二价、四价疫苗，以扩大免疫覆盖范围。
此外，像对HPV本质的认识不足、HPV污名化等问题都会让女性迟迟不敢接种HPV疫苗。诊断出患有HPV的女性，不仅担心自己患宫颈癌的风险，还会担心他人将诊断结果视为乱交或不忠。
同时，中国目前HPV宣传活动往往只关注女性群体，疫苗也通常被称为“宫颈癌疫苗”。事实上，男女感染HPV的可能性是一样的。了解过HPV宣传活动的男性，也只抱有“旁观”的态度，不愿主动接种。
其实，宫颈癌作为唯一一个病因明确的肿瘤，是可以预防的。定期的宫颈筛查能有效发现宫颈癌前病变，有效管理与及时治愈宫颈癌前病变，预防宫颈癌。
宫颈癌防治早已引起了政府高度重视。2019年，农村女性“两癌”检查项目被纳入基本公共卫生服务，宫颈癌筛查工作的连续性得到提升。在城市地区，各地组织开展了大量宫颈癌筛查与体检服务。然而，目前我国仍面临着宫颈癌总体筛查覆盖率低，基层服务能力有限，偏远地区女性筛查可及性差等问题。
2020年12月10日，国家卫生健康委表示，我国将全力支持世界卫生组织提出的《加速消除宫颈癌全球战略》，《战略》明确到2030年，将实现全球90%的女孩在15岁之前完成HPV疫苗接种，通过疫苗接种、筛查和治疗等三级防治路径，推动全球实现消除宫颈癌的目标。
世界卫生组织（WHO）近年来正式提出了全球消除宫颈癌的战略目标。2018年5月，WHO总干事谭德塞宣布了全球消除宫颈癌的行动号召。
疫苗是宫颈癌防控的第一道关口。感染HPV病毒的主要途径是性行为，所以还没有进入性活跃年龄段的9～15岁女孩是当前HPV疫苗预防接种工作的关键人群。通过为9～15岁女性接种HPV疫苗，同时配合筛查、及时治疗，宫颈癌可能成为人类历史上全面预防和消除的第一个癌症。
目前，全球已有110个国家和地区，包括卢旺达等部分低收入国家，将HPV疫苗纳入国家免疫规划（免费接种），超过75个国家（英美意加德澳等）和地区对9～14岁女孩采用两剂次免疫程序。在疫苗接种覆盖率高的国家和地区，HPV感染率和宫颈癌前病变的发病率下降达到90%。
但在中国，目前HPV疫苗在9～15岁人群中的接种率还非常低——即使在上海，HPV疫苗在9～14岁女性中的接种率还不到1%。目前，我国鄂尔多斯、厦门、济南等地相继试点了HPV疫苗免费接种，为HPV疫苗进入其他地区免疫规划积累了经验。
（欢迎大家提供意见和反馈，请联系主播李莹亮：liyl@21jingji.com）
Executive Editor: Sonia YU
Editor: LI Yanxia
Host: Stephanie LI
Writer: Stephanie LI, ZHANG Ran, CHEN Zihui
Sound Editor: ZHANG Ran, CHEN Zihui
Graphic Designer: ZHENG Wenjing, LIAO Yuanni
Co-produced by 21st Century Business Herald Dept. of Overseas News & SFC Audio/Video Dept.
Presented by SFC
编委: 于晓娜
策划、编辑：李艳霞
播音：李莹亮
撰稿：李莹亮、张然、陈梓慧
音频制作：张然 、陈梓慧
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