Title : From local pilots to national policy: Key issues and challenges in implementing nationwide HPV vaccination in China
Abstract:
In October 2025, China announced the inclusion of human papillomavirus (HPV) vaccination into the National Immunization Program (NIP), marking the first addition of a new vaccine to the national schedule since 2008 and the first to explicitly target adolescents rather than young children. This landmark policy reflects a strategic shift in China’s public health priorities, recognizing cervical cancer prevention as a public good and aligning national action with the World Health Organization’s global strategy for cervical cancer elimination. The decision was enabled by more than a decade of subnational experimentation, during which locally financed HPV vaccination programs were implemented in approximately one-third of provinces, achieving relatively high coverage and generating critical operational experience. This Viewpoint examines the evolution of China’s HPV vaccination policy and analyses key challenges facing nationwide implementation. These include the sustainability of service delivery financing under current central–local fiscal arrangements, vaccine hesitancy and misinformation, public preferences for higher-valency vaccines, and the difficulty of achieving equitable coverage beyond school-coordinated delivery platforms. Drawing on lessons from local pilots and international experience, we propose policy recommendations to strengthen fiscal coordination, institutionalize school-based delivery, invest in strategic risk communication, and embed monitoring and implementation research within program rollout. China’s experience offers timely lessons for other middle-income countries seeking to scale up HPV vaccination while balancing equity, sustainability, and public trust.
