For the nine-valent HPV vaccine, some people sighed, "Compromised to the scalper, paid three thousand more HPV vaccines ... Some people are angry, "Is it now a competition between scalpers and scalpers, we ordinary people are leeks, let others slaughter." ”
Article/Reporter Deng Yu Intern Reporter Zhang Ziwei Peng Sicong Sent from Beijing
Intern reporter Guo Wanying zhao enthalpy lu from Guangzhou
Edited/Jian Huang [email protected]
As the only vaccine that can prevent malignancy, the HPV (Human Papillomvirus) vaccine has attracted much attention since its introduction. This vaccine is mainly used to prevent cervical cancer in women.
Since 2016, the British GSK bivalent vaccine Cervarix, the Us Us Using Merck quadrivalent vaccine Gardasil 4 and Jiadasil 9 have successively entered the Chinese market. More than two years later, cecolin (Wantai Biology R&D), the first bivalent HPV vaccine independently developed in China, was also officially listed.
However, the reporter of this magazine found that a large number of women of the right age in China are most eager to be labeled with the highest price HPV nine-valent vaccine ("price" represents the vaccine's preventable viral genotype).
Due to the long R&D and trial time, temporary capacity constraints, and the impact of the new crown epidemic, China's HPV vaccine gap is huge. A large number of appointment intermediaries ("scalpers") have emerged, and there is no shortage of malicious high-priced purchasing agents and fraudsters.
The experts interviewed said that do not miss the bivalent and quadrivalent vaccines with considerable efficacy because of the excessive pursuit of the nine-valent HPV vaccine; cervical cancer screening, immunization planning and other issues also need to be paid attention to by the whole society.
Anxious
At the age of 26, the girl Kairo was a little upset.
Two years ago, she heard a friend suggest that she wanted to get the HPV nine-valent vaccine. As a result, A circle of phone calls, the Guangzhou company where the company and the community hospital near the residence said that there was no seedling, and the appointment on the APP "Zhimiao Yiyue" also showed "lack of seedlings".
Later, the nearby shenzhen city began to implement the HPV vaccine appointment lottery, and she did not shake it.
Seeing that the 26-year-old was approaching, or there was still no appointment with Miao, Kai Ruo was anxious, "If you can't make an appointment again, it will be miserable." ”
The nine-valent vaccine requires a total of three injections. On the APP every Friday afternoon, she remembers that in the first half of 2020, it was a little more, and the rush was not so intense. "Zhanjiang and Shantou can grab it." Dongguan also has more. "Prioritizing the nearest place - Kairuo chose Zhaoqing.
Just over a month after the age of 26, she finally grabbed the first dose of the nine-valent vaccine. The hospital is located in Fengkai County, Zhaoqing. She took a day off from the company. First take an hour and a half high-speed rail from Guangzhou to Yunan County, get off the high-speed rail and find that the bus is too difficult to wait, and then spend twenty or thirty yuan, and the locals fight for "black cars", all the way to Fengkai a community health service center.
Because the location is remote, there are not many people queuing up. One stitch down, no special reaction. "Tired point is nothing, the hospital is formal, the needle is on, better than anything." Kairo said.
In April 2021, Kairuo took a high-speed train from Guangzhou to Yunan County, and then took a taxi to Fengkai County Hospital for the third dose of nine-valent HPV vaccine (the characters in the picture are other vaccinators) Photo/Respondent provided
However, after more than a month, she wanted to get a second shot, and she couldn't grab it with "hand speed" alone. She had to spend 300 yuan to find a "scalper" and grabbed the second stitch.
By the third dose, catching up with the repeated outbreaks, vaccines became more and more difficult to grab. In April 2021, Kairo turned 27. In principle, the age of allowing the domestic nine-valent HPV has passed. She said, "I really can't do it, so I will go to Macau for a third injection (the applicable age for the nine-valent vaccine in Hong Kong, Macao and abroad is 9-45 years old)." ”
84.5% or 90%
Kairo's obsession with the HPV vaccine is related to his family.
In her sophomore year, she went to her hometown hospital to visit her cousin, who was terminally ill with cancer. "People are thin, very pale, and have a hard time talking. My stomach hurt so badly that I felt my heart pounding. Not long after, my cousin died at the age of 45. That was the first time Carrow learned about cervical cancer. A few years later, as soon as she heard that the HPV vaccine was on the market, she immediately decided to "fight early and be safe early".
According to the data, cervical cancer has ranked first in The malignant tumor of the female genital tract in China. In 2020, there were more than 600,000 new cases of cervical cancer in the world, of which nearly 110,000 were in China. The HPV infection rate of adult healthy women in China has exceeded 15% (most viruses can be cleared by themselves), and the incidence of cervical cancer is still gradually getting younger, but the HPV vaccination rate of women aged 9 to 45 in the country is less than 0.05%.
In 1990, sexually transmitted infection with HPV was identified as a cause of cervical cancer. 84.5% of cervical cancers in the Chinese population are caused by two high-risk viruses, HPV-16 and HPV-18, which are prevented by the bivalent HPV vaccine. Quadrivalent vaccines can also prevent HPV types 6 and 11 in addition to types 16 and 18 (the latter two are not high-risk types that do not cause cancer). The nine-valent vaccine can prevent more high-risk HPV and "can prevent more than 90% of cervical cancers."
Qiao Youlin, Professor of the School of Medicine and Public Health of the Chinese Academy of Medical Sciences and Peking Union Medical College Photo/Reporter Liang Chen
Experts Qiao Youlin and Zhao Fanghui (who work at the Chinese Academy of Medical Sciences-Peking Union Medical College, school of medicine and public health, and epidemiological research laboratory of the National Cancer Center) and Sui Long (director of the Cervical Disease Center of the Obstetrics and Gynecology Hospital Affiliated to Fudan University) interviewed by this journal pointed out that "from the perspective of public health, there is not much difference in the immunogenicity of bivalent, quadrivalent and nine-valent vaccines in terms of immunogenicity and the prevention of HPV-16/18-related cervical cancers." ”
China's low HPV vaccination rate is related to insufficient production capacity and lack of understanding of vaccines, but there are also reasons for ethical bias against HPV infection.
"The boys in the class asked me directly, didn't I get the vaccine because of that (venereal) disease?" A female college student interviewed cried and laughed. Because there is a view in society that "HPV infection is a chaotic sexual life", some cervical inflammation and cancer patients will have psychological stress and anxiety. "In fact, only one sexual partner may also be infected with HPV. In this regard, prejudices need to be broken. That's what the experts say.
In the interview, several women asked if they were single and had no sexual partners, was there no need to get the HPV vaccine? One expert pointed out that the HPV vaccine is to prevent future viral infections, "reducing unsafe sex will relatively reduce the risk of this aspect, but it does not mean that there is no risk." "There are also women who say that they are twenty or thirty years old, have already had sex, and may be infected, is it not meaningful to get vaccinated? The expert responded: "This is true for older women relative to adolescent girls. But the preventive effect of vaccines is still there. ”
In China, HPV vaccines are self-funded class II vaccines. The price of imported HPV vaccines is generally high, the price of Jiada Xiu 9 single injection is 1298 yuan, and the three injections are nearly 4000 yuan; Xi Ruishi three injections are about 1800 yuan. The domestic two-priced Xinkoning is priced at 329 yuan / needle, and girls under the age of 15 only need two injections.
However, few people have made an appointment for cheaper and large bivalent vaccines, and there is a rush for nine-valent vaccines. "Now girls want to give themselves better and don't care to spend more money." The "chasing nine-price girls" interviewed had the same tone. Kai ruo felt that if he could hit the nine price earlier, of course, he could prevent it more comprehensively. "The two prices can be played until the age of 45, there is no hurry." About nine prices, back can always be about two prices. ”
Sui Long reminded that women who compete for nine-priced seedlings should not miss the precious opportunity to hit two-price and four-priced seedlings because they blindly wait for seedlings - not hitting nine-price is not the "end of the world", you can start with "guaranteed bottom" (playing two-price, four-price).
The hpvide vaccine that is just freshly "baked" is far from meeting the huge market demand. The size of China's potential HPV vaccine population aged 9-45 is about 356 million. According to the statistics of the China Food and Drug Control Institute, from 2017 to the present, the total batch of HPV vaccines issued in China is only about 29 million, and there is still a market gap of more than 1 billion to be met according to the calculation of 3 injections per person.
The age limit for vaccination for the nine-valent vaccine is 16 to 26 years. As a result, many women in their early 20s "panicked".
Good business for booking platforms
The cause of panic is that it is extremely difficult to make appointments through formal appointment channels, and the situation in different provinces, cities and hospitals varies widely.
The reporter of this magazine has called more than twenty community hospitals in Beijing, Guangzhou, Shenzhen and other cities, and the appointment methods are various: some only accept telephone appointments and report local mobile phone numbers and ID cards; some require me to take my ID card directly to the hospital door to queue up, the staff said "because someone took a fake certificate"; some can only grab online, pay attention to the hospital's public number, send a push to call immediately, "first through the first to get"; some emphasize that only residents in the jurisdiction can play, do not accept non-local household registration; and also say "if you grab the first shot, The last two needles also need to see the public number to grab "...
All localities said that vaccines are distributed by the CDCs in urban areas. For inventory, community hospitals in Beijing have said that "the nine-valent seedling platform has been out of stock for a long time (a few months to a year), and the four-price has been broken for half a year"; a community health service center in Guangzhou's Liwan District said that "the two-valent seedlings are in stock, and there is no restriction on household registration to fight"; another directly said "the second price is not beaten; all HPV vaccines have no seedlings, stop the appointment".
Data Collation / Peng Sicong Deng Yu Drafting / Lu Junjie
Shenzhen city in 2020 trial nine-valent HPV vaccine lottery, in August that year the winning rate of only 2.58%. In March this year, the adult vaccination clinic staff in Luohu District revealed to this magazine, "Whether to continue to shake the number or each district is responsible for making an appointment, we must wait for the notice of the Health Commission." "Because of the large number of appointments, Xi'an's HPV vaccine online appointment system has even collapsed twice in two years.
In the year or two of waiting for Miao, Kairuo entered four or five WeChat groups through the local Baogong account in Guangzhou. A colleague of the company learned in the group that there were seedlings in Xiaolan Town, Zhongshan City, and rushed to the local area overnight. "They waited at 5 a.m. at the entrance of the hospital to start queuing, and everyone who came back seemed to be scattered." Each region has its own routines and rules, like Foshan, which seems to require a resident card to make an appointment. Xiaolan won't. ”
It is not uncommon for inter-provincial and outbound nine-valent vaccines to be administered. But it all comes at a time and material cost. The interval between each two needles is one to several months, and it is not acceptable to ordinary people to go back and forth to Laoton. Suki, whose family runs a pharmacy in Guangdong, recalls that a few years ago her parents took her and three sisters, who had just turned 18, to Hong Kong to get the HPV vaccine. "The first time the whole family took a van, and then twice took the high-speed train to the Nathan Road private clinic in Hong Kong to get injections. We all thought it was novel. Later, she learned that each person would spend more than eight thousand yuan for three stitches, "It's really expensive." But it saves the trouble of grabbing seedlings now. Good thanks to Mom and Dad. ”
Under the shortage of nine-valent vaccines, "little ghosts" and "big immortals" have appeared. As long as you spend money, you can find an intermediary or "scalper" who helps you make appointments and grab numbers.
According to the scale, they can be divided into large institutions and small (group/individual) "scalpers"; according to the mode of operation, they can be divided into substitution and "substitution". The contract is to "get the number" from the hospital, and most of them have cooperative relations with the hospital. "Proxy robbery" is to achieve "program snatching" through network technical means.
Log on to a webpage called "Physical Examination 8 Network", which displays the HPV vaccine appointment information of each city. Customer service quoted to the reporter of this magazine, "16-26 years old vaccination nine price 5380 yuan, over-aged nine price 6380 yuan", and said that they are an appointment platform, not an intermediary.
"Why is it that making an appointment for hpvide is one or two thousand yuan more expensive than the hospital's offer?"
"We added an installation fee."
The appointment agency "Rainbow Parenting" customer service said: "We pay each hospital in advance to queue, there are hundreds of (nine prices + physical examination) package money, every month each hospital will have a part of the quota to us, arrange customers who want to vaccinate as soon as possible." Much earlier than the customer goes to the appointment themselves. In its Taobao flagship store, the cooperative private hospitals in Shanghai and Hangzhou have been quoted for about 7,000 yuan for the "nine-valent HPV vaccine 3 injections + physical examination package", and it is expected to wait for 3-9 months after placing an order. Other platforms such as Olive Branch Health and Jumandong Medical are similar.
In the spring of 2021, the group owners of certain nine-valent HPV vaccine appointment groups released news
Jiangxi female college students have no ill feelings for this kind of "intermediary", believing that there is a market if there is demand, at least there is one more way out for the vaccinators.
She saw the public account of "Flower Health" on the Little Red Book, felt "quite reliable", consulted customer service, and the other party reported a reservation fee of 1400 yuan to pack three injections (excluding injection fees), and electronic receipts could be provided. "It feels cheaper than many Taobao stores, which are basically dated within 1-3 months." I made an appointment at the Maternal and Child Health Hospital in Jiangxi, and I had to wait a year to have seedlings. However, according to the "China Business Daily", this company, which has formed its own brand and has a registered capital of more than 8 million yuan, the customer service will still advise customers, after making an appointment, "Do not talk much when you go to the hospital (when you are injected). ”
E-commerce and medical platforms, including Pinduoduo, Taobao, Ali Health, etc., have opened online appointment portals for HPV vaccines, and even launched marketing activities such as group buying and second sales. Some small "scalpers" mostly operate in the form of WeChat groups and QQ groups to private chat. According to the China Business Daily, these institutions and individuals are similar to "trumpet dealers", earning "gray income", which belongs to "unfair competition and disrupting market order", but the current supervision is weak, even if there is a punishment, it is only detained for a few days and fined a few hundred yuan.
leak
In the "nine-valent HPV" topic comment on Weibo, some people sighed, "Compromised to scalpers, paid three thousand more HPV vaccines... Mindfulness matters! Some people are angry, "Is it now a competition between scalpers and scalpers, we ordinary people are leeks, let others slaughter?" ”
In the midst of a "wail," there were also people who "did not believe in evil."
In April 2020, Bei Bei, who was still a senior in college, found that the HPV vaccine was always not available at Jiangsu Community Hospital, and later heard that with a physical examination fee of more than 1,000 yuan, the vaccine could be administered within three months. ”
She immediately called the local 12345 and found out at noon the next day that the "scalper" herd had been urgently disbanded. "It can be said that the processing speed is very fast. But it also shows that there are loopholes in hospital management, which violates our legitimate rights. ”
Two days after the complaint and report, Babe was really angry, dragged her sister to the hospital, and went directly to the director of the preventive health department, "At that time, they were scolded by me, and they didn't even refute me." "Half a month later, Babe finally got her first shot." By the time of the second shot, I saw that they had a normal appointment and should no longer cooperate with scalpers. ”
In May 2020, a reporter from Modern Express secretly visited and followed the transaction process of vaccine intermediaries. Just a few days after the reporter paid the "service fee" of 3,000 yuan, he successfully received the nine-valent HPV vaccine at the Fangshan Community Health Service Center in Jiangning District, Nanjing. The day before the vaccination, the other party sent the specific vaccination location and the contact information of the docking person, and reminded the reporter: "Remember, go to the door, call, meet, and then enter the hospital, bring your ID card and three injections (injection fee) cash." Go to the vaccination room to the registration desk and register the words directly... If there is any problem you can call me, don't say agency and price. ”
However, when the vast majority of community hospitals say that there are no "existing seedlings", how do these places release seedlings?
Some "scalpers" once told customers, "To be honest, the cost is to send things to the director of hospital XX, and there are other departments, from time to time to visit, the cost is calculated to be hundreds of needles." A "scalper" L in Henan also revealed a similar statement to this reporter.
"The hospital has internal needles. If you know the leaders in the hospital, you invite someone to eat, send some gifts, you can also get this injection. Like we go through the channel, that is to give money (rebates) to it. "L said." Why can't we get a needle now, that is, even if the hospital has a needle, it will not give us a large-scale quota. It's now (March) around June. ”
L also provides "proxy robbery" services. "We'll set up the server about two hours before the rush starts. At that time, you only need to scan the code to authorize the login Mini Program. Grab the payment, open for about 10 minutes to get the result. "But compared to the contract, the proxy is more about luck." Six or seven hundred people are estimated to be able to hit seven or eight. The order of the appointment is not in order, and who grabs it counts as who. 850 yuan in Henan Province, the price of foreign countries varies. ”
Cartography/Lu Junjie
In the second half of 2020, Kairuo obviously felt that there were more and more guests who wanted to find "scalpers", and "scalpers" were becoming more and more "cattle". Taking Guangdong as an example, in the past month, the "scalper" three-needle appointment fee quotation ranged from 1300 yuan to 2500 yuan, and the tide rose. "In the past, a community hospital put 30 needles (seedlings), and it could be grabbed in two seconds. Then it's gone in less than half a second, and you can't even see their stock (the number of needles). Some 'scalpers' will pay more than two thousand yuan for a needle instead of a contract fee. I said 'so high', and he said directly, if you don't have money, don't fight. We have no shortage of customers. Kai ruo recalled angrily.
The worst are scammers who "take money and don't do anything."
Shandong girl Xiaoxi's first two injections of nine-valent seedlings were vaccinated at Qingdao Community Hospital. In 2020, the third stitch was really not numbered, she revealed on Weibo that she could not grab the seedlings, and soon someone sent her a private message.
He said that he was in Jinan, and the hospital had channels, so he could insert the number in advance and let me transfer a deposit of 600 yuan to him. I was in a hurry, didn't think about it so much, and transferred the money. He does not accept WeChat or Alipay, as long as the bank card transfer. Let me also leave a note: the first few stitches. Later, he said that I was wrong and asked me to transfer another 400 yuan. The next day, I didn't think right, he had blocked me. ”
Xiao Xi later found out that many girls on the Internet had the same experience. She also thought about calling the police, but when the Internet police classmates advised her to "forget it": the amount involved in the case was too small, and the police would not take care of it. The third needle, Xiao Xi is also looking for a "substitute robbery".
When interviewed, some girls felt that the introduction and popularization of HPV vaccines by public opinion have aggravated the difficulty of booking. A post-90s netizen "begged" this reporter: "We have a lot of unmarried girls, if you report on this matter, the remaining sisters will not have a chance." Big Gemini said that the HPV vaccine is difficult to find and the awakening of women's consciousness in recent years, "independent women have the financial ability and will pay more attention to protecting themselves." ”
It's a long road, is it possible to speed up
In Qiao Youlin's view, today's efforts to meet Miao are not only the embodiment of the surge in women's desire for self-protection, but also have historical reasons.
Before the HPV vaccines of GSK, Merck and Wantai Biologics were listed in China, Qiao Youlin was the main investigator of the endpoint index for the evaluation of the clinical efficacy of such vaccines. Clinical trials of each of these vaccines are a long way to go, he said.
HPV vaccines, known as HPV-like particles (VLPs), are genetically engineered to recombine L1 proteins into pseudovirus-like particles that produce a powerful immune response after intramuscular injection. "Unlike COVID-19 (viruses) which are RNA viruses, HPV is a DNA virus that is much more stable. The test is to find two groups of normal people, one group to vaccinate, one group not to vaccinate, and then regularly collect blood, collect secretions, and send them to the laboratory for testing. What are the difficulties in HPV detection? Generally, for vaccines made of infectious agents, we only look at whether it has antibodies to produce, but how much protective effect the antibodies have, and then we need to observe the 'persistent infection' and 'precancerous lesions' to see the protective effect. Qiao Youlin introduced.
The premise of "infection" is that sexual activity occurs. The subjects have their own values and behavior views. For the experimental team, the only thing left was to wait. "After [the subjects] finished the vaccination, they returned to their own lives, what to do." Then, once every six months, and then once a year, they are recruited back for sampling and testing. ”
After seven or eight years of observation, the final effective cases did not exceed 10. "Some people have the opportunity to be infected with the virus, they can get rid of it, and the part that can't be removed may slowly progress to precancerous lesions and cancers, so this time is very long." Qiao Youlin introduced that Merck and GSK have been doing phase III experiments in China for 8 years. The Wantai Biobial Vaccine launched a clinical trial in 2012 with a total of 7372 participants. On December 31, 2019, Xinkoning obtained the "Drug Registration Approval Document" from the Food and Drug Administration. If you count from the research and development in 2002, it took 17 years to obtain marketing approval.
Cervical shedding of cells and tissue specimens requires HPV typing with a fully automated LiPA instrument. The specimens are first subjected to DNA extraction, PCR amplification, and then the products and reagents are placed into an Auto-LiPA instrument, and after several hours of hybridization, the bands are colored in the corresponding position. In this figure, the staff in charge of the phase III clinical trial of the HPV vaccine in the Epidemiology Research Laboratory of the Cancer Hospital of the Chinese Academy of Medical Sciences is pasting the reaction strip in the corresponding interpretation template. Finally, according to the color rendering position, according to the interpretation standard, the HPV of different specimens was determined figure / reporter Liang Chen of this magazine
On the road to preventing and treating cancer, time is more expensive than gold. Qiao Youlin once asked doctoral students to make a hypothesis: "(Without effective screening measures), for every year that cervical cancer vaccination is postponed, 55,000 people will suffer from cervical cancer and 30,000 people will die from cervical cancer." ”
However, clinical trials often take 5-10 years. Merck has said in an interview with the media that the supply of HPV vaccines is affected by factors such as the complexity of production, the four-year production cycle, the indispensable strict quality control and major infrastructure investments. The approval process of the management department is also another long journey.
Is it possible to speed up?
On April 11, 2018, when Premier Li Keqiang visited Huashan Hospital affiliated to Fudan University in Shanghai, the person in charge of the hospital reported to the premier: At present, the supply of HPV bivalent vaccine in China can be basically guaranteed, and the supply of quadrivalent vaccine needs to be booked in advance, while the nine-valent vaccine has not yet been listed in the mainland, and the demander must travel to and from overseas regions and countries several times to be vaccinated. Li Keqiang immediately asked relevant departments to speed up examination and approval to ensure supply.
After that, based on the previous approval data of Jiada Xiu 4, the State Food and Drug Administration conditionally approved the import registration of Jiada Xiu 9 in the shortest time (8 days). "That time it was a quick track. At present, the testing of the end point index of the phase III test of merck nine-valent seedlings in our laboratory is equivalent to 'making up'. Qiao Youlin said. But perhaps it is precisely because of the "rapid" listing of Jiada Xiu 9 that the momentum of the market to grab seedlings has been stimulated.
Free Vaccinations and Screening: Control the Upper and Middle Streams
For the phenomenon of competing for nine-priced seedlings, Qiao Youlin said, "The health products of high-income groups also have differences, and we must recognize this difference." But at the national level, emphasis is placed on basic health services for all. ”
Two years ago, Zhao Fanghui posted in The Lancet that if China did not set a ceiling on cervical cancer prevention and control and implemented the optimal strategy, China's urban and rural areas could eliminate cervical cancer by 2057 and 2060, respectively.
One of the best strategies is to implement immunization programmes (free vaccinations) for young people. Studies have shown that 5 years after the first sexual encounter is a high risk period for HPV infection, and HPV vaccination is preferably before the woman's first substantial sexual contact. In 2020, Yu Luming, a member of the National Committee of the Chinese People's Political Consultative Conference, submitted a proposal to the two sessions of the National People's Congress, proposing to include the HPV vaccine in the national immunization program (free vaccination for girls aged 9-14).
"If the upstream is not controlled, there will be fish flowing down continuously. You have to do the upstream dam well to make less and less fish down. A child, just spending a few hundred dollars, will have a good impact on her life. Qiao Youlin said.
To the surprise of many people, the first in China to "eat crabs" is the city of Ordos in Inner Mongolia, a non-first-line developed area. In August 2020, as one of the high incidence areas of cervical cancer and breast cancer, Ordos took the Jungar Banner as a pilot to provide free bivalent HPV vaccine to about 8,500 girls aged 13-18 years old. The municipal health commission said: From 2021, women who meet the requirements for free vaccination will voluntarily go to the community to be vaccinated, the government will bear the cost of the vaccine, and individuals will only pay for the injection.
In 2020, medical staff of the Huxi Community Party group service center in Yingze Street, Jungar Banner, vaccinated free HPV bivalent vaccine for female students aged 13 to 18 Years old Photo/Yan Huijiao
Immediately after Ordos, Xiamen proposed that from 2020 to 2022, female middle school students aged 13-14.5 be given free domestic bivalent HPV vaccine. Guangdong Province also proposed in 2021 to become the first province (in the province) to receive free HPV vaccines.
Some adult women sighed, "The children are happy, we can't catch up with this dial." Experts respond that cervical cancer screening also works very well – like control in the middle reaches of a "river."
No amount of vaccination can prevent infection with all types of HPV. However, regular screening can detect precancerous lesions in time, and early intervention can also prevent the occurrence of diseases before they occur and avoid the development of cervical cancer.
In China, there are two peaks in the age of HPV infection in women, one is in their 20s and the other is after the age of 40, "which is related to the active social activities of these two age groups." Sui Long believes that the implementation of foreign immunization programs is early, adult women are screened regularly, and high-risk groups appear in time at the first peak. Chinese adult women are not well screened, resulting in the virus not being cleared after infection when they are young, accumulating to the second peak.
In 2008, Qiao Youlin led the team to develop an accurate, rapid and inexpensive rapid screening technology, careHPV, which was recognized by the World Health Organization as "a cervical cancer screening technology very suitable for economically underdeveloped countries and regions". The following year, the "two cancers (breast cancer cervical cancer) screening" was written into the government work report.
Zhao Fanghui introduced that in more than ten years, about 80 million Chinese women aged 35-64 have been screened, and the coverage rate has exceeded 30%. "Every year, from the town government to the village, there are people who notify, sometimes advertise on TV, and in recent years, they will send messages in the WeChat circle of friends." There are still many people who come to do screening, and there are hundreds of people a day. The person in charge of a maternal and child health hospital in a county in Hubei described it to this journal.
However, Zhao Fanghui also pointed out that in the past few years, most women's and children's hospitals have used cytology detection technology and Pap smears, relying on the doctor's naked eye judgment, and the accuracy rate is not high ("false negative" results are more). "Even if you look at the cells through a microscope, you still need medical resources, you need to train doctors. These conditions are not met, and it is not difficult to imagine that the high incidence areas of cervical cancer are both rural and developing countries. ”
In large and medium-sized cities in China, many women of the right age are not clear about cervical cancer screening and do not have a strong willingness. Since 2019, free screening for "two cancers" has been included in public health services, but in many places it is still "limited, first-come, first-served".
In 2020, Women in Ordos wait in line at the hospital for free cervical cancer screening Photo/Yan Huijiao
Xiao Yan, a post-90s and former trading company employee in Zhuhai, even if he had heard of screening, he did not want to go. "The gynecology department in the hospital has been difficult to register, and I am very reluctant to go to the hospital to check this." To do screening, is it necessary to do scraping, right? It's a minor surgery. ”
Hubei Aunt Qiuping, who works in property management in Guangzhou, said she had never seen a popular science poster about the "two cancers" screening, and no one in the company or community had notified her. "I'm very interested, but I'm afraid the procedures are too complicated for me to understand." 350 pieces for screening? Very expensive, not willing. But if it is cancer screening, I also hope to buy a peace of mind. Hearing the reporter of this magazine say that Tianhe District can now be screened for free, she hurriedly said, "Then I will ask tomorrow." ”
"Vaccine shortage will ease"
The 71st World Health Assembly called on member states to achieve 90% HPV vaccination coverage for girls under 15 years of age by 2030.
"It seems that it is only 9 years, can China achieve this 90% goal?" The reporter asked several experts, who were both optimistic and cautious about the prospects.
Free HPV vaccination requires significant investment. In the eyes of industry insiders, the reason why the Jungar Banner can start first is not only the vision and courage of local leaders, but also because the place is small, the population is small, and the cost is not much. "Secondary prevention (screening) cannot be paid for by the government. Free vaccinations, the price is higher, how many cities have such funds? Sui Long said that he has also recently communicated with the relevant departments in Shanghai, and may take "social coverage as the mainstay and poor families as the bottom" in the future, first ensuring that the lowest-income groups can be vaccinated (free of charge).
So how long will the "difficulty of approximating seedlings" continue?
Although the different price HPV vaccines of many domestic companies such as Wantai Biology and Watson Biology have entered the clinical trial stage, and there are constantly companies that hope to get a piece of the pie, as of now, the Chinese market can still provide four-valent and nine-valent HPV vaccines only one merck. According to AI Finance and Economics, even if Merck increases production capacity, its HPV vaccine production capacity will not be able to keep up with the growth of global demand until 2023, and vaccine imports will take a year to go through the process of production, quality control, country of origin and China testing and release.
At the beginning of 2020, Zhang Jun, deputy dean of the School of Public Health of Xiamen University, one of the core members of the research and development team of the domestic bivalent vaccine, told the media that the design capacity of the plant (Xiamen Wantai Bio) was 30 million doses (sticks) per year. "Enterprises will arrange for the expansion of production capacity in a timely manner to ensure the timely supply of vaccines."
Zhao Fanghui estimates that the shortage of vaccines in China will be alleviated by 2025 and no later than 2030. "After mass production, maybe everyone can beat the seedlings. It is not likely to be a uniform upward situation, but to which point, 'snapping' breakthrough, to the back is accelerated. By 2030, it is possible that the nine-valent seedling will replace the bivalent and quadrivalent. ”
Zhao Fanghui, Director/Professor of the Epidemiology Research Office of the National Cancer Center Photo/Reporter Liang Chen
Both she and Qiao Youlin pointed out that immunization programs use government procurement to reduce costs, but businesses have different production lines. "In China, what is done for children is a public good (free vaccination). Adults who want to hit high-priced seedlings can pay their own expenses, which is also a channel. Even if you are over 45 years old, even if the preventive effect is slightly worse, you can still fight. However, due to the influence of the 'age line of the clinical trial subject population', the domestic limit is within 45 years old. Sui Long also said that with the deepening of research, the interval between possible screenings will be extended accordingly. If scientific research can prove that the anti-cancer effect of "early HPV + screening" is better than only doing one of them, more people will choose such an "optimal solution".
One day in mid-April, Kairuo sent a few WeChat messages to the reporter of this magazine, and there was an unconcealed excitement in his tone:
"The community hospital where I used to get the injection said that I had recently received the injection and could give priority to those we had previously given. In principle, they did not take a single needle, communicated for a few days, and agreed that I could get one last shot after 26 years old. It's exactly 27 today, which is really the best birthday present.
Also, my 'proxy robbery' said in the circle of friends: Xi'an, Yulin, Hanzhong temporarily do not take orders, 'Zhimiao Yiyo' software now has the function of shielding the brush number, some customers manually grab, do not waste time here. ”
(Thanks to Professor Qiao Youlin and Yan Huijiao for their great help in this article.) Trainee journalist Fang Qin also contributed to this article)