Domestic HPV vaccines are now on the market, so why is it still so hard to get a shot?

Since the launch of imported HPV vaccines, demand has continued to surge, with appointments scheduled for two years in the future. The launch of domestic vaccines has not alleviated the "difficulty in getting a shot". What is the reason behind this? Is it necessary to pursue the nine-valent vaccine?

Written by Liu Daheng, Song Meng, Lai Tianying (Medical and Health Group)

Editor/Feng Xiaohong New Media Editor/Chen Xuanzhi

Since the HPV vaccine was approved for marketing, vaccination with HPV vaccine seems to have become a "health trend" for modern sophisticated women. Recently, this vaccine has become popular again!

On May 18, the first domestically produced bivalent HPV vaccine was administered at Hubei Provincial Maternal and Child Health Hospital to a 10-year-old girl named Keke. This means that China has become the third country in the world to successfully develop and produce HPV vaccines. The localization of HPV vaccines may break the monopoly of imported HPV vaccines on the market and reduce vaccination costs for consumers.

(Photo from Weibo @People's Daily)

On the morning of May 22, Yu Luming, member of the National Committee of the Chinese People's Political Consultative Conference, vice chairman of the Beijing CPPCC, and director of the Beijing Medical Security Bureau, submitted a proposal to the two sessions of the National People's Congress, suggesting that HPV vaccine be included in the national immunization program (free vaccination for girls 9-14 years old).

(Photo from Weibo @新京报)

As soon as the proposal was released, it quickly triggered a wave of public opinion.

Many netizens shared their bitter experiences in the appointment process: it is difficult to make an appointment, it is not cheap, it is out of stock quickly, and you even need to find someone you know to get vaccinated. From these keywords, it is not difficult to see that the HPV vaccine is so popular that it is even difficult to get a shot!

In fact, ever since the imported HPV vaccine was introduced into mainland China, it has been in short supply. Some people even have to make appointments for two years later, and some people go to Hong Kong specifically to get the HPV vaccine.

▲ Netizens share their bitter tears during the booking process (Photo source: Hezhong e-loan information)

What exactly is the HPV vaccine? Why is it so difficult to make an appointment? How can I make an appointment if I want to get this vaccine?

What is the grudge between HPV and humans?

Relevant experts said that the Chinese name of HPV (Human Papilloma Virus) is human papillomavirus. It looks round and like a ball. It is actually a protein shell wrapped around the viral DNA. It is the smallest DNA virus known so far.

▲HPV virus (picture from the Internet)

This virus family is huge and only invades humans, not animals. Currently, more than 200 HPV subtypes have been discovered, which are divided into two categories: low-risk (non-carcinogenic) and high-risk (carcinogenic) according to their pathogenicity and carcinogenicity risks.

HPV is a virus that is highly specific to mucous membranes and skin. It has a certain infection rate in the vulva, genital tract, anus and even oropharynx of the normal population, and both men and women are at risk of infection. For example, low-risk HPV infection can cause benign lesions such as genital warts and recurrent respiratory papilloma; high-risk HPV virus can cause some cancers, such as cervical cancer, anal cancer, oropharyngeal cancer, vaginal cancer, vulvar cancer, penile cancer, etc.

According to statistics, about 5% of cancers worldwide are caused by high-risk HPV, among which cervical cancer is one of the most common cancers. Studies have shown that about 99.7% of cervical cancers are related to HPV infection, which means that HPV infection means a greatly increased risk of cervical cancer.

Relevant experts said that human infection with HPV is very common. According to statistics, up to 80% of people will be infected with HPV, but most of them have no obvious symptoms when infected. For example, HPV-induced cervical cancer generally does not have any symptoms in the early stage of the patient. Many people may find superficial inflammation of the cervix or a small amount of leucorrhea during gynecological examinations. In the middle and late stages, there will often be an increase in leucorrhea, fishy odor, irregular vaginal bleeding, persistent pain in the sacrum, buttocks and thighs, and more serious cases may feel difficulty in urination and defecation.

How did you get infected with HPV? Some experts point out that the main route of HPV infection is sexual contact. In addition, indirect contact in life, such as contact with the daily necessities of the infected person, and close contact, such as mouth-to-mouth kissing, can also cause infection. There are also medical-related infections and mother-to-child transmission, for example, which may be related to medical staff's own infection, improper disinfection of instruments, or close contact when the baby is delivered through the birth canal.

Don't panic if you are unfortunately infected! According to experts, after the virus invades the human body, the human immune cells will definitely not be happy and will fight it. In fact, this is just like fighting against the cold virus. Immunity is the biggest nemesis of the virus. Therefore, most HPV infections are temporary. It is reported that the HPV infection rate in the uterus and vagina of female college students in the United States is 43%, the clearance rate after 6 months is 31%, and the clearance rate after 8 months is 89%, indicating that the human body can spontaneously clear the HPV virus. According to statistics, 95% of HPV infections can be cleared by the immune system within two years.

Of course, there is another situation where although the immune system is "strong", the virus replicates "crazily" in the body and may eventually be outnumbered and the two sides enter a stalemate. At this time, the human body may not have any symptoms, but the HPV test is positive.

Pathogens seem to pick on the weak ones. For people with persistent infection, if their immunity is defective or reduced, HPV virus will be "unbridled". Especially for those with high-risk HPV infection, persistent or repeated infection will increase the risk of cancer.

Experts say that currently there is no effective method to fight HPV virus, so prevention is the key to fighting HPV. The advent of HPV vaccine plays an important role in HPV prevention, as it can stimulate the human immune system to produce targeted protective antibodies, thereby reducing the incidence of malignant tumors or precancerous lesions caused by HPV.

The upgrading of health concepts and insufficient production capacity have made it difficult to get a shot of HPV vaccine

Since the world's first HPV vaccine was launched in 2006, my country has begun to focus on localizing the HPV vaccine. The research and development process has been going on for a full decade since the domestically produced bivalent HPV vaccine received clinical approval in 2010.

After the imported HPV vaccine was launched in the domestic market, there has been a surge in demand, with appointments in various parts of the country sometimes having to wait until two years later.

Recently, there have been reports that starting from May, most community hospitals in provinces and autonomous regions such as Hubei, Xinjiang, Jilin, Yunnan, Jiangsu, and Shandong will be able to make appointments for vaccination with the domestically produced bivalent HPV vaccine, and it is expected to cover the entire country by the end of the year.

▲Domestic HPV vaccine (Image source: Screenshot of the news broadcast)

However, the launch of the domestically produced bivalent vaccine has not reduced the hot demand for imported vaccines.

The reporter called a community health service center in Chaoyang District, Beijing, and the staff said: "At present, the domestically produced bivalent vaccine has not been distributed in Beijing, but this community health service center currently has imported bivalent, quadrivalent and nonavalent vaccines, and the prices of one shot are 585 yuan, 800 yuan and 1,325 yuan respectively. However, due to control reasons during the epidemic, a district-based appointment system is adopted, and appointments need to be made at a community health service center near where you live."

The reporter then called a health service center in Daxing District near where he lived, but the staff said: "Currently, all HPV vaccines of all prices are out of stock, and the specific supply time is not clear. If you need it, you can only consult in a month."

The HPV vaccine market is booming, and the price of the nine-valent HPV vaccine is rising. Although it costs more than 1,300 yuan per shot, consumers still hope to get the nine-valent HPV vaccine directly, rather than the cheaper two-valent or four-valent vaccines.

Xiao Ge, who had received the nine-valent HPV vaccine before, said that she was very concerned about her health. She chose the nine-valent vaccine because she thought it was more cost-effective. In addition to preventing cervical cancer, it can also cover other diseases caused by HPV virus infection. Although the two-valent and four-valent vaccines are cheaper, you get what you pay for, and she always feels that getting the nine-valent vaccine directly can make her feel more at ease.

However, when appointments for the nine-valent vaccine were unavailable, consumers, out of health concerns, booked out the two-valent and four-valent vaccines early, leading to a tight supply of vaccines through various channels.

The source of the mismatch between supply and demand can be traced back to Merck, the world's only manufacturer of the nine-valent HPV vaccine. Public data shows that Merck supplies the nine-valent HPV vaccine to more than 70 countries and regions around the world. As the United States and Australia listed the nine-valent HPV vaccine as a public welfare program for free vaccination, its demand has soared, and the number of vaccinations in China has increased year by year. In addition, the production cycle of each nine-valent HPV vaccine is more than 3 months, and insufficient production capacity has led to a shortage of vaccines.

Is the nine-valent HPV vaccine really better?

There are currently three types of HPV vaccines available on the market globally and in my country: bivalent HPV vaccine (launched globally in 2007 and in China in 2016); quadrivalent HPV vaccine (launched globally in 2006 and in China in 2017); and nine-valent HPV vaccine (launched globally in 2006 and in China in 2018).

Relevant experts said that the so-called "price" refers to the number of HPV types that can be prevented. The higher the price, the wider the scope of prevention. Vaccines of different prices target different groups of people and have different purposes. Due to the low incidence of male-related malignant diseases, it is currently recommended for women to be vaccinated for cost-benefit considerations.

The bivalent HPV vaccine is suitable for women aged 9 to 45 years old, targeting two high-risk subtypes, HPV-16 and HPV-18. The quadrivalent HPV vaccine is suitable for women aged 20 to 45 years old. It adds two low-risk subtypes, HPV-6 and HPV-11, to the bivalent HPV vaccine. Although it cannot improve the prevention of cancer compared to the bivalent vaccine, data show that adding these two subtypes can reduce the incidence of genital warts. The nine-valent HPV vaccine is suitable for women aged 16 to 26 years old. It adds five more subtypes on the basis of the quadrivalent vaccine, but compared with the bivalent HPV vaccine, the protection rate can only be increased by 5.5%.

According to statistics, most cervical cancers in the Chinese population are caused by HPV-16 and HPV-18. From a macro-epidemiological perspective, controlling these two types of viral infections can effectively control the incidence of cervical cancer.

▲The types of viruses currently targeted by the bivalent, quadrivalent and nine-valent vaccines

That is to say, if the purpose is only to prevent cervical cancer, the bivalent HPV vaccine can meet this requirement.

But why did quadrivalent and nine-valent vaccines appear? A medical biology expert told reporters that there are two angles to explain this phenomenon. First, from the perspective of disease prevention, quadrivalent and nine-valent vaccines can prevent more virus subtypes than two-valent vaccines; second, the commercial perspective may also have a certain impact on vaccines, such as increasing the selling point of products by increasing the types of vaccines.

Compared with imported vaccines, domestically produced bivalent HPV vaccines are more affordable. The price of domestically produced bivalent HPV vaccines is 329 yuan per shot. The cost of two shots for 9-14 year olds is 658 yuan, and the cost of three shots for 15-45 year olds is 987 yuan. The total cost of imported bivalent, quadrivalent, and nine-valent HPV vaccines is about 1,800 yuan, 2,400 yuan, and 4,000 yuan respectively.

▲Imported nine-valent HPV vaccine (picture from the Internet)

The domestically produced bivalent HPV vaccine may break China's reliance on imported HPV vaccines due to lower costs and expanded production capacity, allowing us to promote the vaccine on a large scale in a short period of time, giving more Chinese women the opportunity to get the HPV vaccine, and solving the problem of "hard to get a shot" of HPV vaccine. Consumers should clearly understand their needs, rather than blindly taking more expensive vaccines.

I want to get vaccinated, how do I make an appointment?

Since May 2020, most community hospitals in Hubei, Xinjiang, Jilin, Yunnan, Jiangsu, Shandong and other provinces can gradually make appointments for domestic HPV vaccines online or by phone, and there are appointment windows for various HPV vaccines on apps such as Alipay, WeChat and Taobao.

▲You can make an appointment for the domestic HPV vaccine through the "Vaccine Service" applet (Image source: Alipay applet screenshot)

Although there are many ways to make an appointment, the domestically produced bivalent HPV vaccine has not yet been widely distributed, and the current problem of "difficulty in getting a shot" has not been solved.

Now, the domestic nine-valent HPV vaccine is in the clinical trial stage, and the vaccine is being developed by Xiamen Wantai Canghai and Xiamen University, Beijing Wantai Biological Pharmaceutical Co., Ltd., Shanghai Bowei Biotechnology Co., Ltd., and Beijing Kangleweishi Biotechnology Co., Ltd. Among them, the vaccine development progress has entered the phase III clinical trial stage in April this year. The domestic nine-valent HPV vaccine will be available in a while to fill the market gap.

In addition, experts jointly remind: If women who are preparing for pregnancy want to get vaccinated, it is recommended to wait until the end of the pregnancy to get vaccinated; if they become pregnant unexpectedly during the vaccination period, there is no need to terminate the pregnancy, and they can continue to get the vaccine that has not been received after delivery; For breastfeeding women, vaccination is not recommended in mainland my country at present.

For older women who cannot be vaccinated, there are other ways to prevent cervical cancer. As long as strict and regular screening is carried out, abnormalities can be detected at a stage that is easier to treat.

However, some people are not suitable for vaccination. For example, people with coagulation disorders, low immunity, or those who are receiving medication that may damage the immune system; people who are allergic to protein or yeast (may be allergic to the ingredients in the vaccine). In addition, people over 45 years old who have had sex are not recommended for vaccination because they may have been repeatedly infected with HPV and have sufficient immunity, so the possibility of being infected with HPV again is not high.

References:

[1] Yao Jun, Li Man, Zhong Ping, et al. The Geographical Distribution of Subtypes of HPV Infection and the Relationship with Cervical Lesions. Journal of Practical Obstetrics and Gynecology, 2011, 027(001): 34-38.

[2] Dr. Ding Xiang: "Before doing anything naughty, every girl needs a cancer prevention vaccine"
https://mp.weixin.qq.com/s/X0MPOqOc_J1_Pq0uyEfnZA

[3] Sohu News: "Nine-valent HPV vaccine can be administered at Boao Super Hospital! Click here for questions you want to know."
https://www.sohu.com/a/233615822_482345

[4] Beijing Local Treasure: “Can the 9-valent vaccine be used to pay for medical insurance in Beijing? How can people over 26 get vaccinated?”

https://mp.weixin.qq.com/s/Oz3LNt8I-Lo0zB3AOOejTg

[5] Science and Technology Daily: “Cervical cancer vaccine is recommended to be included in the national immunization plan! Get a sneak peek at the vaccination guide”

https://baijiahao.baidu.com/s?id=1667759854204084473&wfr=spider&for=pc

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