Decision making for government-funded HPV vaccination programs in China: a multiple streams framework-based analysis
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摘要: 人乳头瘤病毒（human papillomavirus，HPV）的持续感染可引起包括宫颈癌在内的多种威胁人类健康的疾病，造成沉重的疾病经济负担。研究表明，HPV疫苗可有效预防HPV感染和降低宫颈癌的发病率，但在国家层面我国目前尚未将HPV疫苗纳入免疫规划。多源流理论是由美国学者金登提出用以分析公共政策议程的重要理论工具，该理论框架也适用于免疫项目决策过程的分析。本文基于多源流理论，从问题源流、政策源流、政治源流、试点地区项目的政策外溢效应及政策倡导者的推动等方面分析我国HPV疫苗纳入免疫规划决策的主要影响因素，并提出可行性对策和建议，为国家和地区将HPV疫苗纳入免疫规划相关政策的制定、最终达到消除宫颈癌的目的提供决策依据。Abstract: Persistent infection of human papillomavirus (HPV) can cause a variety of diseases including cervical cancer, which affects human health and leads to a huge socio-economic burden. Although it has shown that HPV vaccines could effectively prevent HPV infection and reduce cervical cancer incidence, China hasn′t introduced HPV vaccination into the national immunization program. The multiple streams framework proposed by Kindon is an essential theoretical tool for analyzing public policy agendas and is suitable for analyzing decision-making processes of immunization programs. In this study, we adopted multiple streams framework to assess main influencing factors of introducing HPV vaccination into the immunization programs by examining the problem stream, policy stream, politics stream, the policy spillover effect of pilot cities, and the role of policy entrepreneurs. And we also give some suggestions to promote the inclusion of HPV vaccines in the immunization programs at regional and national levels, and finally achieve the purpose of ‘eliminating cervical cancer′.
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Key words:
- human papillomavirus /
- multiple streams framework /
- vaccine /
- immunization program
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表 1 我国HPV疫苗免费或补贴接种试点情况（截至2022年3月25日）
地区 开始时间 接种对象及年龄 疫苗类型 内蒙古自治区鄂尔多斯[3] 2020年8月（准格尔旗） 当地户籍13～18周岁女性（第2年开始为当年新满13周岁的女性） 进口二价 2021年（全市） 福建省厦门市[4] 2020 — 2022年 13～14.5周岁在校女生 国产二价 山东省济南市[43] 2021年11月 15周岁以下七年级女生 国产二价 四川省成都市[44] 2021年11月 13～14岁在校女生 国产/进口二价和进口四价 江苏省无锡市[45] 2021年12月 初二学段女生 国产二价 江苏省连云港市[45] 2021年12月中旬 初二学段女生 国产二价 海南省[46] 2022年2月 13～14.5周岁 国产二价 浙江省宁波市鄞州区[47] 2022年2月 未公布 未公布 河南省郑州新密市[48] 2022年2月 12～14岁女生 未公布 河北省石家庄市[49] 2022年3月 14周岁女生 国产二价 重庆市[50] 2022年 未公布 未公布 广东省[51] 2022年9月 14周岁以下初一女生 国产二价 
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