Advancing the National Immunization Program in an era of achieving universal vaccine coverage in China and beyond

Background Immunization is a cornerstone of public health.Despite great success,China’s National Immunization Program(NIP)faces challenges,such as the integration of several World Health Organization-recommended vaccines and other systemic issues.The Innovation Laboratory for Vaccine Delivery Research(VaxLab),supported by the Bill&Melinda Gates Foundation and established in 2021 at Duke Kunshan University,focuses on enhancing China’s NIP through research and policy advocacy.This editorial aims to summarize the key findings of the manuscripts published in the collection contributed by VaxLab team and set the future research agenda.Key findings The collection contains eleven manuscripts discussing China’s immunization landscape and strategies to improve coverage,particularly for non-NIP vaccines like human papillomavirus vaccine(HPV),pneumococcal conjugate vaccine(PCV),Haemophilus influenzae type b vaccine(Hib),and rotavirus vaccines.Key findings include:(i)The COVID-19 vaccination campaign demonstrated China’s capacity for rapid,large-scale immunization efforts,suggesting potential for broader vaccine coverage improvements;(ii)Efforts in combating cervical cancer through the HPV vaccine indicate progress but also highlight challenges like vaccine supply and equitable access;(iii)The lag in adopting higher-valent paediatric combination vaccines in China needs attention to address regulatory and health system hurdles;(iv)Disparities in access to non-NIP vaccines underscore the need for government initiatives to improve vaccine coverage,especially for remote areas and marginalized populations;(v)Original studies emphasize the influence of caregivers’knowledge,health workers’financial incentives,and concerns about vaccine efficacy on immunization rates;(vi)Case studies from the Weifang City of China and Indonesia to introduce PCV offer insights on successful vaccine introduction strategies and the impact of innovative financing and government support.Conclusion The articles emphasize the need for government leadership,strategic policymaking,and public awareness to enhance vaccine coverage and equity.The VaxLab will continue strengthening China’s NIP by focusing on vaccine financing,emphasizing diversity,equity,and inclusion,and improving maternal vaccination coverage.Research will extend to Southeast Asian and Western Pacific regions,especially in middle-income countries facing challenges in vaccine financing and delivery.The collective efforts outlined in this collection show a commitment to evolving and adapting immunization strategies to meet global health goals and to provide equitable access to vaccines for all.

中国的扩大免疫规划项目：成就、挑战及更健康的儿童

中国的免疫规划是实现拯救生命，预防病痛，实现全球健康目标，并减低健康看护成本的一项国家层面开展的宝贵措施。中国的免疫规划在过去的数年中已取得了众多瞩目的成就，但依然面临着持续的挑战。疫苗生物技术的发展，对全球目标（疾病消灭、消除或控制）的承诺增加了对现代免疫规划的期望。本篇述评旨在陈述中国免疫规划工作近年来的进展，探讨中国如何利用这些成果和挑战来强化免疫规划体系。

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

China’s immunization programs conducted a unified,tightly coordinated COVID-19 vaccination campaign during the dynamic COVID Zero period that reached well over 90%of the population with vaccines having>90%effectiveness against serious-to-fatal COVID-19.The campaign was eight times the size of the annual routine national immunization program,administering 3.4 billion doses of vaccines while monitoring vaccine coverage,acceptability,safety,and effectiveness.Every asset of the routine immunization program had to be strengthened and expanded to attain high coverage and reach hundreds of millions of adults who had not been vaccinated since childhood.Program strengthening and expansion were in directions aligned with the World Health Organization’s Immunization Agenda 2030,which has a vision that"everyone,everywhere,at every age fully benefits from vaccines for good health and well-being"and requires reaching all children,adolescents,and adults with lifesaving vaccines.Momentum from this campaign should not be lost but should be invested into achieving what is possible with a properly resourced national immunization program that is now proven to be capable of reaching everyone in the world’s largest country throughout the life course,and to do so with all vaccines recommended by the World Health Organization.

Global Pediatric Pulmonology Alliance(GPPA)proposal for COVID-19 vaccination in children

Coronavirus disease 2019(COVID-19)remains a global epidemic.As of August 18,2021,the number of reported cases has exceeded 207 million globally,with more than 4.3 million deaths.COVID-19 has brought devastating losses to human society.The overall crude mortality rate is 1-3%.Although pediatric deaths from COVID-19 are rare,they do occur,as over 9,000 children have died from COVID-19 globally to date[1].With the gradual and broad application of COVID-19 vaccines around the world,the rising proportion of cases among children and unvaccinated young adults demands attention.According to World Health Organization surveillance data.

Global Pediatric Pulmonology Alliance recommendation to strengthen prevention of pediatric seasonal influenza under COVID-19 pandemic

The World Health Organization(WHO)announced COVID-19 as a global pandemic in March of 2020[1].The COVID-19 pandemic may persist for a long period of time.Global prevention and control becomes a complex and challenging task,and such efforts should be sustained.Although general measures,such as social distancing,face masks,respiratory hygiene and hand sanitization,will bear fruits for decreasing spread of other respiratory illnesses including influenza,the specific prevention through vaccination is a key focus especially in the upcoming winter and spring seasons[2].

Forty and Twenty Years Ago and Now--Virus Elimination Successes and New Challenges

Forty years ago,smallpox was declared eradicated by the World Health Organization(WHO).As D.A.Henderson,Director of the Smallpox Eradication Programme at the WHO quoted from the 33^(rd) World Health Assembly(1980)(1),“...the world and all its peoples have won freedom from smallpox...a most devastating disease...since earliest time,leaving death,blindness,and disfigurement in its wake and which only a decade ago was rampant in Africa,Asia and South America.”

Exporting China’s Successes in Vaccine Preventable Hepatitis

Almost four decades of science,innovation,and programmatic effort to control and prevent vaccinepreventable viral hepatitis have paid off spectacularly well in China.In the pre-vaccine era,nearly 10% of children were infected by hepatitis B virus(HBV)—especially during childbirth—causing them to be lifelong carriers of HBV,able to infect others,and in great danger of liver cancer and cirrhosis as adults(1).