Coverage and Equity of Childhood Vaccines in China

Abstract

ImportanceMeasuring vaccination coverage rates and equity is crucial for informing immunization policies in China.ObjectivesTo estimate coverage rates and multidimensional equity for childhood vaccination in China.Design, Setting, and ParticipantsThis cross-sectional study was conducted via a survey in 10 Chinese provinces between August 5 and October 16, 2019, among children ages 6 months to 5 years and their primary caregivers. Children’s vaccination records and their primary caregivers’ demographics and socioeconomic status were collected. Data were analyzed from November 2019 to March 2022.Main Outcomes and MeasuresVaccine coverage rates were measured as a percentage of National Immunization Program (NIP) and non-NIP vaccines administered before the day on which the child was surveyed. A multidimensional equity model applied a standardized approach to ranking individuals from least to most unfairly disadvantaged by estimating differences between observed vaccination status and estimated vaccination status as function of fair and unfair variation. Fair sources of variation in coverage included whether the child was of age to receive the vaccine, and unfair sources of variation included sex of the child and sociodemographic characteristics of caregivers. Absolute equity gaps (AEGs), concentration index values, and decompositions of factors associated with vaccine equity were estimated in the model.ResultsVaccine records and sociodemographic information of 5294 children (2976 [52.8%] boys and 2498 [47.2%] girls; age range, 6-59 months; 1547 children aged 12-23 months) and their primary caregivers were collected from 10 provinces. Fully immunized coverage under the NIP was 83.1% (95% CI, 82.0%-84.1%) at the national level and more than 80% in 7 provinces (province coverage ranged from 77.8% [95% CI, 74.3% to 81.3%] in Jiangxi to 88.4% [95% CI, 85.7%-91.1%] in Beijing). For most non-NIP vaccines, however, coverage rates were less than 50%, ranging from 1.8% (95% CI, 1.3%-2.2%) for the third dose of rotavirus vaccine to 67.1% (65.4% to 68.8%) for the first dose of the varicella vaccine. The first dose of Haemophilus influenzae type b vaccine had the largest AEG, at 0.603 (95% CI, 0.570-0.636), and rotavirus vaccine dose 3 had the largest concentration index value, at 0.769 (95% CI, 0.709-0.829). The largest share of non-NIP vaccine inequity was contributed by monthly family income per capita, followed by education level, place of residence, and province for caregivers. For example, the proportion of explained inequity for pneumococcal conjugate vaccine dose 3 was 40.94% (95% CI, 39.49%-42.39%), 22.67% (95% CI, 21.43%-23.9%), 27.15% (95% CI, 25.84%-28.46%), and 0.68% (95% CI, 0.44%-0.92%) for these factors, respectively.Conclusions and RelevanceThis cross-sectional study found that NIP vaccination coverage in China was high but there was inequity for non-NIP vaccines. These findings suggest that improvements in equitable coverage of non-NIP vaccination may be urgently needed to meet national immunization goals.

Impact of Varicella Immunization and Public Health and Social Measures on Varicella Incidence: Insights from Surveillance Data in Shanghai, 2013–2022

“…The results showed that the average coverage rate of the one-dose or first-dose VarV was 96.23% in 2013-2018 birth cohorts and that of a second-dose VarV was 86.06% in 2013-2015 birth cohorts after the introduction of the two-dose VarV program, which is higher than that in other areas of China [28][29][30][31]. The varicella incidence decreased by 45.25% after one year of the two-dose VarV immunization program.…”

Comparative analysis on the multi-agent co-payment financing mechanism of four doses of children's PCV13 in Weifang city, China

“…Pneumococcal diseases impose substantial burden on both families and society [16] . PCV vaccination which is the most cost-effective method to prevent PDs has not been included in Chinese NIP, and the vaccination coverage among children is low [10,[17][18][19] . Weifang, the rst city in China has implemented a policy of providing free PCV13 vaccination to children under 2 years old.…”

“…As per the latest data in 2022, the purchase price of PCV13 in China is much higher than that of the United Nations International Children's Emergency Fund (UNICEF) [9] . Due to the high purchasing price and other factors, the vaccination rate of PCV13 in China is only 1.3%, which is signi cantly lower than the rates in Australia, the United Kingdom, the United States, and South Africa [10] . Therefore, it is essential to explore scienti c and reasonable PCV13 nancing methods and clarify the sharing mechanism among the government, society, and individuals to improve the vaccination rate and promote health equity [11][12][13] .…”

Vaccine pricing strategies in China

“…In 2019, the coverage rate of non-NIP vaccines ranged from 1.8% for the third dose of rotavirus vaccine, 5.1% for the third dose of 13-valent Pneumococcal conjugate vaccine (PCV13), 25.0% for the third dose of Haemophilus influenzae type b (Hib) vaccine and 67.1% for the first dose of varicella vaccine. There were significant inequalities in non-NIP vaccination, which were strongly associated with family incomes 6…”

“…The survey also found that half of the participants who would not have opted for non-NIP vaccines would change their decision if non-NIP vaccines were covered by health insurance 17. The largest factor contributing to inequality in non-NIP vaccines is monthly household income per capita 6. Moreover, the procurement situation varies across provinces, and different types of vaccines are offered.…”