Strong policies, digitalization boost immunization program

China's national immunization system has grown more robust and intelligent in recent years, positioning the country to further expand vaccination coverage and strengthen international collaboration, according to a senior expert at the Chinese Center for Disease Control and Prevention.

Lance Rodewald, a senior adviser with China CDC's national immunization program, began observing the country's immunization efforts in 2012 while working at the World Health Organization China office and continued his efforts after joining the immunization program in 2018.

The program includes 14 types of vaccines that can prevent 15 infectious diseases, along with the newly added human papillomavirus vaccine introduced in November. Official data show the vaccination rate for program vaccines among eligible children has remained above 90 percent in recent years.

"The most important factor contributing to high coverage levels is strong immunization systems at the provincial, prefecture and county levels," he said.

"These systems implement a consistent, vertically integrated immunization program, with more than 100,000 high-quality vaccination clinics dedicated to making program vaccines conveniently available to every family," he said.

To catch up on missed doses, school-entry vaccination checks are carried out in partnership with schools. "This makes schools safer from infectious diseases and achieves the highest individual protection for all schoolchildren," he said.

The rapid development of digital tools has further enabled precise, real-time management of each child's vaccination status, accurate monitoring of coverage, and detection of gaps at individual and community levels.

"Digitalization also supports active vaccine safety and effectiveness monitoring by linking vaccination records with medical and disease surveillance records, while maintaining the privacy of health information," he added.

The robust immunization program has produced clear results, with the incidence of many vaccine-preventable diseases declining to historic lows.

Rodewald cited concerted efforts at all levels to ensure full coverage of routine measles vaccination amid a flare-up of the disease from 2013 to 2016.

"The result was the elimination — and likely eradication — of the endemic H1 measles genotype by 2019," he said, adding that measles incidence in China remains at extremely low levels despite resurgences in other countries and isolated imported cases, attesting to strong population immunity built through routine immunization.

Another notable achievement was the introduction of the inactivated polio vaccine into the program in 2016 as the first of a four-dose schedule.

"This adjustment had the tremendous benefit of preventing vaccine-associated paralytic polio, adding to the safety of polio vaccination while helping to maintain polio-free status for more than 25 years," he said.

Rodewald also underscored the solid implementation of China's Vaccine Administration Law, enacted in 2019.

"Now, every dose of vaccine — program or non-program — can be traced every step of the way from manufacturer to the person vaccinated, ensuring reliable pedigree and proper management of every dose administered," he said.

According to disease control authorities, China has, over the past five years, optimized the immunization schedule for the diphtheria-tetanus-pertussis, or DTaP, combination vaccine, implemented supplementary polio vaccine doses, and included the HPV vaccine in the national program.

Rodewald said the establishment of the National Immunization Advisory Committee in 2017 — a panel of experts providing science-based recommendations — has played an important role in guiding these policy advances.

"Following successful city and provincial introductions of the HPV vaccine, the national program now includes the HPV vaccine for middle-school girls starting this year, which is expected to greatly lower the lifetime risk of cervical cancer," he said.

Looking ahead to the next five years, Rodewald said he sees "an exciting time of immunization program expansion in fulfillment of the Vaccine Administration Law".

He noted that the WHO's Immunization Agenda 2030 promotes vaccination throughout life, for children, adolescents and adults.

For children, five WHO-recommended vaccines could be considered for inclusion in China's program: pneumococcal conjugate, Haemophilus influenzae type b, varicella, influenza and rotavirus.

"In addition to these childhood vaccines, there is tremendous health and economic benefit to be gained from adult vaccines available in China, such as vaccines for shingles, influenza and pneumonia," he said.

Rodewald said the expansion of program vaccines should be based on factors that include potential health impact, disease epidemiology and supply capacity. He said he is hopeful some vaccines will be included or that new guidance on their optimal use will be issued in the coming years.

During the 14th Five-Year Plan period (2021-25), China swiftly detected and managed outbreaks of mpox, cholera, chikungunya and dengue fever, preventing them from becoming large epidemics, authorities said.

Rodewald said a key strength in outbreak response is the powerful and innovative capacity of the country's laboratory network.

"These laboratories have been able to develop and make widely available highly sensitive diagnostic tests for both old and new pathogens," he said.

He also highlighted the responsive disease surveillance network and the capacity of local CDCs to act effectively, reflecting the overall resilience of China's infectious disease control system.

According to the Recommendations of the Communist Party of China Central Committee for Formulating the 15th Five-Year Plan for National Economic and Social Development that was released in October, the country has proposed increasing public health capacity, strengthening the disease control system, and effectively preventing and controlling major infectious diseases in the next five years.

Rodewald suggested aligning with WHO goals such as developing pandemic preparedness plans, advancing cervical cancer and tuberculosis elimination, and building more resilient health systems.

"Striving to accomplish these WHO goals can strengthen China's public health capacity and foster solidarity regionally and globally," he said.

He also stressed the importance of global cooperation in public health, proposing deeper engagement with the WHO through expert committees and collaborating centers, identifying opportunities within the Belt and Road Initiative, expanding China's role in global vaccine supply, and providing more training for international students and public health workers.

"Through deepening participation in the WHO prequalification program, more Chinese-produced vaccines can be made available through international organizations to increase the global supply of lifesaving vaccines," he said.

"Regardless of the complexities of the international landscape, public health scientists thoroughly enjoy working together — and for good reason," he said. "The goals of public health transcend international borders, and by working together, public health problems of global proportion can be more effectively solved."