Students offered free shots to prevent cervical cancer
A student is vaccinated against HPV at a clinic in Juungar Banner, Ordos, Inner Mongolia autonomous region, on Aug 1. (YANG YAN / FOR CHINA DAILY)
Guo Cunlan, 51, a farmer in Inner Mongolia autonomous region, knew nothing about cervical cancer until a few years ago, when the local government offered residents free examinations for the disease.
"In our village we were not in the habit of undergoing such examinations. I only go to the hospital if I feel really sick. Otherwise, I just endure the pain," she said.
Guo and her husband, 54, work more than 10 hours a day during summer in Nianfang Qushe village, Juungar Banner, Ordos, planting corn, potatoes and millet, as well as raising a pig and some 10 chickens.
Some classmates said they have relatives who have developed cervical cancer, but I’m not afraid of the disease after being vaccinated
Hao Ye, 15-year-old middle school student in Juungar Banner, Ordos, Inner Mongolia autonomous region
In winter, her husband does odd jobs such as other agricultural work and bricklaying, while their son is employed at a coal mine and daughter, Hao Ye, 15, attends middle school. The family's annual income is less than 30,000 yuan (US$4,320).
Hao's school recently told parents that female students ages 13 to 18 could have free vaccinations against human papillomavirus, or HPV, which causes cervical cancer.
"We were thrilled to hear the news. Women of my age are too old for the vaccine, but my daughter can have it to eliminate a hidden danger in her life," Guo said, adding that she and her husband had no plans to have Hao vaccinated at their expense.
The girl, who was vaccinated on Aug 1, said all female students in her class had applied for the shots. "Some classmates said they have relatives who have developed cervical cancer, but I'm not afraid of the disease after being vaccinated," she added.
Early this month, Juungar Banner became the first area in China to offer female students free vaccinations against HPV. About 11,000 young women are expected to benefit from the policy.
Wang Genhou, director of Juungar Banner Health Commission, said free cervical and breast cancer examinations conducted among local women ages 35 to 64 over the past 10 years had found high HPV infection rates.
Cervical cancer is mainly caused by HPV, and vaccination is the most effective way to prevent the disease, Wang said.
In late April, at the fourth session of its 17th People's Congress, Juungar Banner approved a 10-point plan to improve people's livelihoods. "Promoting the health of girls on campus" was second on a list of priorities after offering the elderly free vaccinations against flu and pneumonia.
Wang said, "The aim is to look after women's physical and psychological health and improve their quality of life," adding that the local government is increasing investment in people's livelihoods in tandem with "substantial economic development".
Wang said the new policy received a "great response", and about 5,000 people had been vaccinated. "It has helped raise awareness of self-protection among women," he added.
A nurse in Wuhan, Hubei province, displays the first batch of domestically produced HPV vaccine in May. (XIONG QI / XINHUA)
'A good thing'
Wang Er'rui, 39, who also lives in Juungar Banner, said she used to know little about cervical cancer and was unaware there was a vaccine for it. She had a physical examination for the disease in 2018, and her 15-year-old daughter has been vaccinated along with other female students at her school.
"She doesn't know what it means, but I believe it's a good thing," Wang said. "We parents have discussed the vaccinations, and some are concerned about possible side effects. But at the end of the day, it's good to know that the government cares about us. If it hadn't introduced the free vaccinations, I would never have paid for them, as they're too expensive."
Lyu Ping, director of the Juungar Banner Maternity and Childcare Hospital, said three injections are needed against two types of HPV, costing a total of 1,770 yuan. There is a service fee of 20 yuan for each inoculation. "This is no small amount for the residents," Lyu added.
The hospital is among those designated to conduct the free vaccinations program in Juungar Banner, along with health centers in towns and communities. From Aug 3 to Aug 9, 749 girls were inoculated at Lyu's hospital.
He said a survey conducted at schools found that more than 10,000 girls qualify for the vaccinations, and some 80 percent of them said they were willing to take part in the program. The hospital plans to complete the first round of injections before the end of October.
"The program is in such demand that people often have to wait in line," Lyu said, adding that each vaccine is given a specific code to provide a record of the company producing it and the person it is administered to.
From 2011 to last year, the hospital gave free breast and cervical cancer examinations to more than 80,000 women, of whom over 550 had contracted HPV and 55 were confirmed to have cervical cancer.
"We carried out a huge number of preliminary examinations during this time and enhanced awareness of the disease and prevention measures among the public. I think most women already had some knowledge of it," Lyu said.
Zhang Zhanjie, director of Longkou Town Health Center in Juungar Banner, said the facility will administer free HPV vaccinations to about 600 primary and middle school students. The first batch of 200 vaccines was used within four days from Aug 1, and the center is waiting for a second batch of 400. All the vaccines are imported.
Some local students studying elsewhere are returning home to be vaccinated, and the total number of those receiving the shots may reach 800, Zhang said.
The service is available seven days a week and is conducted by four medical staff members. Parents must register, sign a consent form and learn about possible side effects. "Just one student felt slightly dizzy, the temperature of another rose to 37.5 C, but all the others were fine," Zhang said.
"Parents are rushing to get their children vaccinated in case supplies run out. Every year, women are confirmed to have contracted cervical cancer in the town. Awareness of the disease is improving, although many patients still only see a doctor when their condition deteriorates and they are already in the terminal stage, which also places a considerable financial burden on a family."
Zhang said the local government attaches great importance to issues related to people's livelihoods, such as culture, education and health. For example, the center, which covers 4,000 square meters and boasts advanced medical equipment, recently recruited more doctors.
Liu Zheng, deputy director of the Ordos Health Commission, said that following the vaccination trial in Juungar Banner, free HPV shots will be offered to females ages 13 to 18 throughout the city.
"The program aims to promote women's health, improve people's quality of life, sense of happiness, and contribute to the strategy of 'Healthy Ordos, Healthy China'," Liu said, adding that there is a high incidence of cervical cancer in the city.
One of the most common and fatal tumor diseases affecting women in China, cervical cancer caused 47,739 deaths in 2018. In the same year more than 100,000 women nationwide contracted cervical caner, according to the International Agency for Research on Cancer. The number is about 20 percent of the total worldwide.
Qiao Youlin, professor of epidemiology at the Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College's School of Population Medicine and Public Health in Beijing, said the incidence of and deaths related to the disease have risen over the past two decades in China. This is because sexual intercourse is taking place at a younger age than in previous generations, increasing exposure to potential HPV infection, Qiao said.
The World Health Organization regards vaccination as the primary method to prevent cervical cancer. In 2018, Tedros Adhanom Ghebreyesus, its director-general, called for action to eliminate the disease and recommended that girls ages 9 to 14 get HPV vaccinations.
Qiao said most Asian countries and regions, including China, mainly target middle school students ages 13 to 15 for vaccination.
The WHO has a target for all member states to provide HPV vaccinations to 90 percent of girls under 15 by 2030, he added.
At the launch of the vaccination program in Ordos on Aug 1, Li Yinuo, chief representative of the Bill & Melinda Gates Foundation's Beijing office, said that fewer than 1 percent of Chinese girls ages 9 to 15 may have received the vaccinations.
Li said cervical cancer kills more than 270,000 women worldwide every year and is the third most-common cancer among Chinese women ages 15 to 44.However, it is also the only malignant tumor that can be effectively prevented by vaccination, she added.
"The program in Juungar Banner will provide direct and effective protection for girls and prevent them contracting the disease," she said, adding that it also shows that society cares about women, especially those from low-income families.
Challenges ahead
The first HPV vaccine was put on the market in 2006. Since then, 104 countries have provided free inoculations for groups of young women, according to media reports.
However, the vaccine still faces challenges such as limited supplies, pricing and public awareness, Li said.
"Juungar Banner will set an example for other regions, and the program will also help promote health throughout the world," she said, adding that the foundation is working with the WHO and the Global Alliance for Vaccines and Immunization to promote HPV vaccines in middle-and low-income countries.
"Only through government investment and the immunization program making progress can vaccines become accessible for everyone, especially the poor," Li said. She called for efforts to be made by the authorities, private institutions and charities to achieve this goal.
Tao Lina, a former vaccine expert at the Shanghai Center for Disease Control and Prevention, said other regions, especially those with strong economies, can learn from the experience in Juungar Banner to conduct similar programs.
"The area has set an example, but whether the practice can become popular depends on financing and ideas from decision-makers," he said, adding that it may be possible to conduct programs in cities such as Beijing and Shanghai.
Late last year, China approved its first domestically produced HPV vaccine for females ages 9 to 45, providing an alternative to products from overseas drug makers, according to the National Medical Products Administration.
The vaccine went on the market in May, with each dose costing 329 yuan, compared with about 600 yuan for imported vaccines. Girls ages 9 to 14 only need two doses of the domestic vaccine, but three doses of imported products are required.
Yu Luming, a national political adviser who submitted the proposal in May to offer girls ages 9 to 14 free HPV inoculations, said supply shortages and the high price of imported products are affecting the popularization of HPV vaccines, but using domestic alternatives means that more women can afford them.
He added that being vaccinated costs much less than the medical treatment for cervical cancer.
Yu also suggested increasing supplies of domestic HPV vaccines by optimizing the approval process, reducing dependence on imported products and giving financial support to developing regions.
Contact the writers at yuanhui@chinadaily.com.cn
