National Immunization Program in Action： ＂Vaccine Fairness＂-It is not easy to say that I love you.

　　The COVID-19 epidemic that swept the world this year has made us realize the role and value of vaccines more deeply. Vaccine, as the most effective, economical and convenient way to prevent diseases, has protected billions of lives around the world since its birth.

　　National immunization program, as an important public health service covering the whole people, is a vital link in disease prevention. China began to implement planned immunization in 1978, and has made remarkable achievements in the past 40 years. In the initial stage of immunization planning, only 4 vaccines were used to prevent 6 diseases, which was expanded to 14 vaccines to prevent 15 diseases, and the immunization planning system was continuously improved.

　　However, immunization programs cannot cover all areas. How can we maximize "vaccine equity" and promote health equity? How much can the national immunization program play?

　　All the people — — The proper meaning in the question

　　The existence of the National Immunization Program is devoted to providing everyone with equal protection of health and life. According to statistics, the vaccination rate of major immunization programs in China has remained above 96% for a long time. At the national and provincial levels, it has achieved a very high coverage level in every township and county, including remote areas. At present, the incidence of vaccine-preventable diseases has dropped to the lowest level in history. From 2000 to now, China has been kept polio-free. Although some "wild poison" has been imported and spread, there is basically no polio. Through the vaccination of hepatitis B vaccine, in 2014, the hepatitis B carrying rate of children under 5 years old in China has dropped to 0.32%, avoiding tens of millions of hepatitis B virus carriers and millions of patients with cirrhosis and liver cancer.

　　Seminar Series on Global Health and Innovation Communication in Peking University — — At the symposium on "Vaccine Equity and Health Poverty Alleviation", Director Yin Zundong of the Center for Immunization Planning of China Center for Disease Control and Prevention said that vaccines are by far the most economical and effective tool to save lives, and the national immunization plan is to send this tool to everyone, no matter where they live or how high their income is, they can use this tool to protect themselves and their families.

　　However, according to him, there are relatively more preventable diseases in underdeveloped areas in western China. For example, in 2011, imported Pakistani wild poliovirus (WPV) was found in southern Xinjiang, and in 2019, a case of type II CVDPV occurred in Leibo County, Liangshan Prefecture, Sichuan Province, which is related to the relative difficulty in carrying out routine immunization.

　　Poverty — — The biggest threat factor

　　2020 is the decisive year for getting rid of poverty, and it is also the year for building a well-off society in an all-round way and ending the 13 th Five-Year Plan. A major epidemic occurred in the final year, which made the task of poverty alleviation even more arduous. It is even more difficult to implement the immunization program, especially in economically underdeveloped areas.

　　Zhou Jiushun, deputy director of the Sichuan Provincial Center for Disease Control and Prevention, said that compared with relatively developed areas such as Chengdu, the vaccination rates in remote and poverty-stricken areas such as Ganzi, Aba and Liangshan are lower, resulting in higher risk of illness. In the case that the incidence of measles in Sichuan Province is low, "there were measles outbreaks in Ganzi Prefecture and Aba Prefecture in 2015 and 2016, because the local basic immunization was not solid enough, and the vaccination needles were not inserted, which caused problems." Finally, the incidence of measles was controlled by the other 18 cities and States to carry out leak detection and replanting in the form of counterpart support.

　　Less financial investment, insufficient personnel engaged in vaccination, insufficient professional and technical ability of personnel, weak infrastructure, inconvenient transportation, etc. are all practical difficulties in carrying out vaccination work in poverty-stricken areas like Liangshan Prefecture. For example, Zhou Jiushun said that some villages are far away from the inoculation point, so rural doctors have to contact residents in advance and go to the residential area for vaccination regularly, but some remote pastures have no signal at all. When local herders go out for several months, doctors can’t contact their parents at all, and vaccination is not guaranteed. "It’s not that the staff don’t work hard, nor that parents don’t want to come. It’s just that the cost of a shot of vaccine is too uneconomical. The light fare will cost hundreds of dollars, and there are many cases of using zip lines and wading into the river."

　　How to find and "fill" areas with weak routine immunity and prevent poor people in underdeveloped areas from further poverty and returning to poverty due to illness requires more attention and support from the whole society, and also requires the state to increase all-round investment, which has become an inevitable choice.

　　Expansion — — The trend of the future

　　A key point of vaccination work is to bring the new vaccine into the national immunization plan as soon as possible, so as to reduce the disease burden of vaccine-preventable diseases in poor areas to a greater extent, thus achieving health and poverty alleviation. However, the expansion not only involves the choice of financing strategy of national immunization program, but also faces the vaccination problem of non-immunization program vaccine.

　　Incorporating the new vaccine into the national immunization plan for mass vaccination will be a great economic expenditure at the national and social levels, and the economic pressure cannot be ignored. Fang Hai, deputy director of the Joint Research Center for Vaccine Economics of peking university health science center-China Center for Disease Control and Prevention, pointed out that the main reason why China has not included some vaccines in the national immunization program at present is economic problems. This will lead to regional differences to a certain extent, especially in the vaccination of non-immunization programs. In 2014, there was a 19-fold difference between the provinces with the highest and lowest number of non-immunization programs per capita. People in economically underdeveloped areas are generally faced with a certain lag and unfairness in the vaccination of non-immunization programs. Because it is difficult for low-income people in underdeveloped areas to obtain high-quality medical services and receive less non-immunization vaccines, they are more vulnerable to infectious diseases. "If people lose their health or their children are disabled because of diseases, then it is difficult for this family to get rid of poverty."

　　Fang Hai believes that it is necessary to provide children with vaccines such as pneumonia, influenza and Haemophilus that many families choose to vaccinate in urban areas or economically developed areas at the same time, which is also the direction advocated by the current national policy. He suggested that we can try various financing methods, establish a benign interaction and reasonable complementarity of government taxes, medical insurance and individual self-payment, encourage qualified places to give priority to inclusion, improve the vaccination rate, and reduce the incidence of preventable diseases caused by non-immunization programs. At present, there are many such attempts. For example, in 2014 and 2016, Ningbo and Fujian respectively included the non-immunization program vaccine in their personal accounts for reimbursement. In 2019, Shenzhen and some areas carried out free influenza vaccination for key populations, and Ordos recently launched a household registration of 13— 18-year-old female HPV vaccine is free of charge.

　　Planning — — The road to health and poverty alleviation

　　Vaccine is by far the cheapest life-saving tool, and immunization program is also a great weapon to eliminate human health inequality. In order to promote the construction of healthy China and build a well-off society in an all-round way, the "Healthy China 2030" Planning Outline also puts forward the requirement of "strengthening public health services covering the whole people". In the vaccination work, it is emphasized that "the national immunization program will continue to be implemented and the vaccination rate of school-age children will be maintained at a high level". The coverage level of immunization program in our country is extremely high, which fully embodies the principle of fairness of immunization as a basic health service and lays a good foundation for preventing poverty caused by illness and returning to poverty due to illness. Next, if some new vaccines, including cervical cancer vaccine, streptococcus pneumoniae vaccine, Hib vaccine and rotavirus vaccine, can be included in the immunization plan, it will benefit underdeveloped areas and rural families who can’t afford these vaccines now, and it will also be a new opportunity to improve the fairness of vaccines.

　　Moving the prevention gate forward through immunization program is also in line with the requirements of "reforming and perfecting the disease prevention and control system, resolutely implementing the health and health work policy of putting prevention first, persisting in standing by, and moving the prevention gate forward" put forward by the General Secretary of the Supreme Leader at the 12th meeting of the Central Committee for Comprehensively Deepening Reform this year. Only by moving the gate forward in disease prevention and control can the poor people get less sick and reduce the disease burden to the maximum extent. Only by putting prevention and control ahead can the disease be left behind.