Decision making for government-funded HPV vaccination programs in China: a multiple streams framework-based analysis
-
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′.
-
Key words:
- human papillomavirus /
- multiple streams framework /
- vaccine /
- immunization program
-
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 -
[1] World Health Organization. Global strategy to accelerate the elimination of cervical cancer as a public health problem[EB/OL]. (2020 – 11 – 17)[2021 – 08 – 15].https://www.who.int/publications/i/item/9789240014107. [2] PATH. Global HPV vaccine introduction overview[EB/OL]. (2022 – 03 – 17)[2022 – 05 – 09].https://www.path.org/resources/global-hpv-vaccine-introduction-overview/. [3] 鄂尔多斯市人民政府. 中国首针免费HPV疫苗在鄂尔多斯市准格尔旗开打[EB/OL]. (2020 – 08 – 18)[2021 – 08 – 16]. http://www.ordos.gov.cn/gk_128120/wsjkly/zccs_2/202008/t20200818_2735841.html. [4] 南方都市报. 厦门将为适龄女生免费打HPV疫苗, 系国内首个大城市[EB/OL]. (2020 – 09 – 09)[2021 – 08 – 15]. https://www.sohu.com/a/417246317_161795. [5] Burchett HED, Mounier-Jack S, Griffiths UK, et al. National decision-making on adopting new vaccines: a systematic review[J]. Health Policy and Planning, 2012, 27(S2): ii62 – ii76. [6] 文宏, 崔铁. 中国决策情境下的多源流模型及其优化研究[J]. 电子科技大学学报(社科版), 2014, 16(5): 12 – 19. doi: 10.14071/j.1008-8105(2014)05-0012-08 [7] 约翰·W·金登. 议程、备选方案与公共政策[M]. 丁煌, 方兴, 译. 2版. 北京: 中国人民大学出版社, 2004: 119. [8] 江永清. 基于多源流模型的我国双创政策之窗开启分析[J]. 中国行政管理, 2019(12): 96 – 102. [9] 王玲玲. 多源流理论视域下的政策议程设置研究 —— 以全面两孩政策为例[D]. 长春: 吉林大学, 2017. [10] 俞瑞雪. 中国情景下的政策企业家: 形成、类型与功能[J]. 统计与管理, 2021, 36(6): 61 – 66. [11] 李燕, 朱春奎. “政策之窗”的关闭与重启 —— 基于劳教制度终结的经验研究[J]. 武汉大学学报(哲学社会科学版), 2017, 70(5): 117 – 130. [12] De Wals P, Espinoza-Moya ME, Béland D. Kingdon's multiple streams framework and the analysis of decision-making processes regarding publicly-funded immunization programs[J]. Expert Review of Vaccines, 2019, 18(6): 575 – 585. doi: 10.1080/14760584.2019.1627208 [13] Nyitray AG, Iannacone MR. The epidemiology of human papilloma-viruses[J]. Current Problems in Dermatology, 2014, 45: 75 – 91. [14] 岳晓丽, 龚向东, 李婧, 等. 2008 – 2016年中国性病监测点尖锐湿疣流行特征分析[J]. 中华皮肤科杂志, 2017, 50(5): 321 – 325. doi: 10.3760/cma.j.issn.0412-4030.2017.05.003 [15] Lu Y, Li PY, Luo GF, et al. Cancer attributable to human papillomavirus infection in China: burden and trends[J]. Cancer, 2020, 126(16): 3719 – 3732. doi: 10.1002/cncr.32986 [16] 孟令昊, 胥秋艳, 李科, 等. 1990 — 2019年中国女性宫颈癌疾病负担变化的分析[J]. 中国循证医学杂志, 2021, 21(6): 648 – 653. [17] 陶思源, 彭介入, 王英, 等. 子宫颈癌及癌前病变患者直接经济负担及其影响因素研究[J]. 中华预防医学杂志, 2018, 52(12): 1281 – 1286. doi: 10.3760/cma.j.issn.0253-9624.2018.12.017 [18] Bruni L, Saura-Lázaro A, Montoliu A, et al. HPV vaccination introduction worldwide and WHO and UNICEF estimates of national HPV immunization coverage 2010 – 2019[J]. Preventive Medicine, 2021, 144: 106399. doi: 10.1016/j.ypmed.2020.106399 [19] 宋祎凡, 刘晓雪, 尹遵栋, 等. 2018 — 2020年中国9~45岁女性人乳头瘤病毒疫苗估算接种率[J]. 中国疫苗和免疫, 2021, 27(5): 570 – 575. [20] You DY, Han LY, Li L, et al. Human papillomavirus (HPV) vaccine uptake and the willingness to receive the HPV vaccination among female college students in China: a multicenter study[J]. Vaccines, 2020, 8(1): 31. doi: 10.3390/vaccines8010031 [21] 徐颖, 王铁英, 魏晓雨, 等. 2014 — 2019年我国成人四类疫苗接种现状及其影响因素[J]. 中国初级卫生保健, 2020, 34(10): 83 – 86. doi: 10.3969/j.issn.1001-568X.2020.10.0025 [22] Hu SY, Xu XQ, Zhang YY, et al. A nationwide post-marketing survey of knowledge, attitude and practice toward human papillomavirus vaccine in general population: Implications for vaccine roll-out in mainland China[J]. Vaccine, 2021, 39(1): 35 – 44. doi: 10.1016/j.vaccine.2020.11.029 [23] Qiao YL, Wu T, Li RC, et al. Efficacy, safety, and immunogenicity of an Escherichia coli-produced bivalent human papillomavirus vaccine: an interim analysis of a randomized clinical trial[J]. JNCI: Journal of the National Cancer Institute, 2020, 112(2): 145 – 153. doi: 10.1093/jnci/djz074 [24] Zhu FC, Chen W, Hu YM, et al. Efficacy, immunogenicity and safety of the HPV-16/18 AS04-adjuvanted vaccine in healthy Chinese women aged 18 – 25 years: results from a randomized controlled trial[J]. International Journal of Cancer, 2014, 135(11): 2612 – 2622. doi: 10.1002/ijc.28897 [25] Chen W, Zhao Y, Xie X, et al. Safety of a quadrivalent human papillomavirus vaccine in a phase 3, randomized, double-blind, placebo-controlled clinical trial among Chinese women during 90 months of follow-up[J]. Vaccine, 2019, 37(6): 889 – 897. doi: 10.1016/j.vaccine.2018.12.030 [26] Li RC, Li YP, Radley D, et al. Safety and immunogenicity of a vaccine targeting human papillomavirus types 6, 11, 16 and 18: a randomized, double-blind, placebo-controlled trial in Chinese males and females[J]. Vaccine, 2012, 30(28): 4284 – 4291. doi: 10.1016/j.vaccine.2012.02.079 [27] Garland SM, Pitisuttithum P, Ngan HYS, et al. Efficacy, immunogenicity, and safety of a 9-valent human papillomavirus vaccine: subgroup analysis of participants from Asian countries[J]. The Journal of Infectious Diseases, 2018, 218(1): 95 – 108. doi: 10.1093/infdis/jiy133 [28] 张丽娜, 李克莉, 杜雯, 等. 2019年中国疑似预防接种异常反应监测[J]. 中国疫苗和免疫, 2021, 27(4): 438 – 445. [29] Drolet M, Bénard É, Pérez N, et al. Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: updated systematic review and meta-analysis[J]. The Lancet, 2019, 394(10197): 497 – 509. doi: 10.1016/S0140-6736(19)30298-3 [30] Zhang YR, Wang Y, Liu L, et al. Awareness and knowledge about human papillomavirus vaccination and its acceptance in China: a meta-analysis of 58 observational studies[J]. BMC Public Health, 2016, 16: 216. doi: 10.1186/s12889-016-2873-8 [31] 中华预防医学会妇女保健分会. 子宫颈癌综合防控指南[M]. 北京: 人民卫生出版社, 2017: 37 – 40. [32] Zhang SK, Pan XF, Wang SM, et al. Perceptions and acceptability of HPV vaccination among parents of young adolescents: a multicenter national survey in China[J]. Vaccine, 2013, 31(32): 3244 – 3249. doi: 10.1016/j.vaccine.2013.05.046 [33] 闫慧姣, 苏征, 刘书君, 等. 新冠疫情后中国HPV疫苗认知及推广态度调查[J]. 中国公共卫生, 2021, 37(12): 1731 – 1736. doi: 10.11847/zgggws1136540 [34] 郭建铭, 郑斌, 李娜, 等. 人乳头瘤病毒疫苗预防中国女性宫颈癌药物经济学研究的系统评价[J]. 中国现代应用药学, 2021, 383(4): 445 – 452. doi: 10.13748/j.cnki.issn1007-7693.2021.04.011 [35] Xia CF, Xu XQ, Zhao XL, et al. Effectiveness and cost-effectiveness of eliminating cervical cancer through a tailored optimal pathway: a modeling study[J]. BMC Medicine, 2021, 19(1): 62. doi: 10.1186/s12916-021-01930-9 [36] 许晓君, 唐娴, 李小毛, 等. 广东省适龄人群HPV疫苗不同免疫策略的卫生经济学评价[J]. 中国肿瘤, 2022, 31(2): 139 – 145. doi: 10.11735/j.issn.1004-0242.2022.02.A009 [37] Luo Y, He HQ, Tang XW, et al. Cost-effectiveness of 2-dose human papillomavirus vaccination for 12-year-old girls in Zhejiang province: implications for China′s expanded program on immuni-zation[J]. Human Vaccines and Immunotherapeutics, 2020, 16(7): 1623 – 1629. doi: 10.1080/21645515.2019.1711299 [38] 国家卫生健康委, 国家发展改革委, 教育部, 等. 健康中国行动 —— 癌症防治实施方案(2019 — 2022年)[J]. 中国肿瘤, 2019, 28(11): 803 – 806. doi: 10.11735/j.issn.1004-0242.2019.11.A001 [39] 潇湘晨报. 国家卫健委: 将逐步推广HPV疫苗适龄人群免费接种[EB/OL]. (2021 – 02 – 24)[2021 – 09 – 10].https://www.163.com/dy/article/G3K8JT690534P59R.html. [40] 新华社. 国家卫生健康委将启动试点推进宫颈癌疫苗应用[EB/OL]. (2021 – 04 – 30)[2021 – 11 – 20]. http://www.gov.cn/xinwen/2021-04/30/content_5604244.htm. [41] 中国家庭报. 健康中国行动| 健康城市建设推动健康中国行动创新模式试点工作在山东济南启动[EB/OL]. (2021 – 09 – 22)[2021 – 12 – 29].https://www.cfnews.org.cn/newsinfo/1933768.html. [42] 鄂尔多斯市准格尔旗卫生健康委. “关爱女生健康进校园” —— 政府免费接种宫颈癌疫苗助推健康准格尔建设[EB/OL]. (2021 – 09 – 22)[2021 – 12 – 20]. http://wjw.ordos.gov.cn/zdzt/jkeedsxd/202109/t20210922_2999401.html. [43] 济南日报. 15周岁以下在校七年级女孩免费接种HPV疫苗方案确定[EB/OL]. (2021 – 10 – 14)[2021 – 12 – 20]. http://www.jinan.gov.cn/art/2021/10/14/art_1861_4893262.html. [44] 四川在线. 西部首个!成都将为13~14岁在校女孩普遍接种HPV疫苗[EB/OL]. (2021 – 11 – 19)[2021 – 12 – 20]. http://edu.sc.gov.cn/scedu/c100494/2021/11/19/19b304d4d875457ea3151069a3cdc5b8.shtml. [45] 江苏广电总台·融媒体新闻中心. 江苏无锡、连云港已启动HPV疫苗免费接种[EB/OL]. (2021 – 12 – 12)[2021 – 12 – 29]. http://news.jstv.com/a/20211212/1639287034633.shtml. [46] 海南省卫生健康委员会, 海南省教育厅. 关于印发《2022年海南省适龄女生HPV疫苗接种项目实施方案》的通知[EB/OL]. (2022 – 02 – 23)[2022 – 03 – 25]. http://wst.hainan.gov.cn/swjw/ywdt/tzgg/202202/t20220223_3146323.html. [47] 宁波晚报. 鄞州区适龄人群将免费接种HPV疫苗[EB/OL]. (2022 – 02 – 20)[2022 – 03 – 25]. http://www.ningbo.gov.cn/art/2022/2/20/art_1229099768_59044055.html. [48] 河南新闻广播. 郑州新密市免费试点开展12~14岁女孩HPV疫苗接种 疾控专家提醒及早预防有必要[EB/OL]. (2022 – 02 – 24)[2022 – 03 – 25]. http://news.hnr.cn/djn/article/1/1496625842446610434. [49] 石家庄新闻网. 国产2价HPV疫苗免费接种全面展开[EB/OL]. (2022 – 03 – 15)[2022 – 03 – 25].https://www.sjz.gov.cn/col/1641437541200/2022/03/15/1647307255909.html. [50] 重庆发布. 免费接种宫颈癌疫苗, 重庆年内将启动[EB/OL]. (2022 – 02 – 14)[2022 – 03 – 25]. http://www.cq.gov.cn/zwgk/zfxxgkzl/fdzdgknr/zdmsxx/yl/yl_ssqk/202202/t20220214_10390736.html. [51] 南方日报. 广东符合条件的14周岁以下女生 —— 明年起可免费接种HPV疫苗[EB/OL]. (2021 – 10 – 27)[2021 – 11 – 20]. http://czt.gd.gov.cn/mtgz/content/post_3586032.html. [52] Chen RR, Wong E. The feasibility of universal HPV vaccination program in Shenzhen of China: a health policy analysis[J]. BMC Public Health, 2019, 19(1): 781. doi: 10.1186/s12889-019-7120-7 [53] 魏文强, 张思维, 李敏娟. 中国肿瘤登记发展历程[J]. 中国肿瘤, 2021, 30(9): 641 – 647. doi: 10.11735/j.issn.1004-0242.2021.09.A001 [54] Piñeros M, Znaor A, Mery L, et al. A global cancer surveillance framework within noncommunicable disease surveillance: making the case for population-based cancer registries[J]. Epidemiologic Reviews, 2017, 39(1): 161 – 169. doi: 10.1093/epirev/mxx003 [55] Wei FX, Sheng W, Wu X, et al. Incidence of anogenital warts in Liuzhou, south China: a comparison of data from a prospective study and from the national surveillance system[J]. Emerging Microbes and Infections, 2017, 6(1): 1 – 8. [56] 石菊芳, 石春雷, 岳馨培, 等. 1996 — 2014年中国恶性肿瘤经济负担的系统评价[J]. 中华肿瘤杂志, 2016, 38(12): 929 – 941. doi: 10.3760/cma.j.issn.0253-3766.2016.12.010 [57] 牛艺臻, 尹如铁, 冯海欢, 等. 子宫颈癌直接经济负担系统综述[J]. 现代预防医学, 2017, 44(24): 4447 – 4453. [58] Ding WP, Ma Y, Ma C, et al. The lifetime cost estimation of human papillomavirus-related diseases in China: a modeling study[J]. Journal of Translational Internal Medicine, 2021, 9(3): 200 – 211. doi: 10.2478/jtim-2021-0039 [59] 来晓真, 彭质斌, 秦颖, 等. 中国老年人群流感疫苗接种筹资共付机制探索与费用测算[J]. 中华医学杂志, 2021, 101(26): 2029 – 2036. doi: 10.3760/cma.j.cn112137-20210205-00365 [60] 中国新闻网. 多地开展HPV疫苗免费接种工作 接种应尽早尽小[EB/OL]. (2022 – 03 – 04)[2022 – 03 – 25].https://politics.gmw.cn/2022-03/04/content_35561885.htm. -