Is HPV vaccination single dose feasible?What is the effectiveness of the nine -valent vaccine?

not

Behind vaccine supply

Amendments to the business of manufacturers and vaccination

To how much HPV vaccine can really prevent cervical cancer, it is also doubtful

The 24 -year -old Shanghai girl Wang Han did not expect that the grand occasion of grabbing concert tickets will be reproduced when making an appointment for HPV nine -valent vaccine.

At noon on April 19th, the staff of the private hospital in the harmonious hospital issued a snap -up link in the vaccine appointment group. Wang Han opened the purchase page 5 minutes in advance and purchased a nine -price package of 5,000 yuan. At the point, the payment page immediately became a blank loading. After a few seconds, the word "no goods" jumped out. Wang Han did not give up and continued to refresh the page. After more than ten minutes, she picked up a "leak". At the moment of paying the payment, Wang Han felt "a major event in life."

In April last year, Ordos, Inner Mongolia, became the first city of the HPV vaccine for girls 13 to 18 years old in the Mainland. Today, more than 12 provincial and municipal governments have bidded and procurement in China, and the two -valent HPV vaccine is vaccinated for the people for free.

On May 30, the National Health Commission held a press conference. Wang Linhong, chairman of the Women's Health Branch of the Chinese Prevention Medical Association and chronic diseases of the Chronic Diseases of the China Centers for Disease Control and Prevention, mentioned that "the state will promote the free HPV vaccination policy to cover more people. Question, strive to meet the needs of vaccination. "

Behind the insufficient vaccine supply, many problems involving the business of manufacturers, the amendments to vaccination specifications, and changes in the concept of prevention.

On March 12, 2022, some girls at the age of the mayor of Haikou, Haikou, Hainan Province were free of charge. Figure/Zhongxin

The rules of 3 doses are being corrected

In early April, the WHO Immunization Strategic Consultation Expert Group (SAGE) announced the results of a meeting saying: "A single -dose HPV vaccine can provide reliable protection, which is equivalent to the effect of 2 or 3 doses." At the same time Girls between 9 and 14 years old and 15 to 20 -year -old women choose 1 or 2 doses.

HPV vaccine is an important measure to prevent cervical cancer caused by continuous infection caused by high -risk human papilloma virus (HPV). The price of HPV vaccine refers to the type of HPV virus type that can be prevented by vaccines. At present, the HPV vaccine circulating on the market includes three types: two -valent, four -valent and nine -prices. Generally, the number of HPV vaccination doses is 3 doses.

The binary vaccine can prevent nearly 70 % of cervical cancer caused by Type 16 and 18 HPVs. Based on this, the quasal vaccine increases the protection of two HPV viruses of type 6 and 11 types. Based on the four -valent vaccine, the nine -valent vaccine has increased the prevention of five types of cervical cancer virus subtypes. It is currently the world's most widely protected HPV virus.

The domestic HPV vaccine market has long been monopolized by the British Grammomg and the United States. In March of this year, Watson's Bi Chi yeast reorganized protein cervical cancer binary vaccine "Wokze" was approved to be listed. Prior to this, on New Year's Day in 2020, the restructuring of E. coli reorganized protein cancer "Xin Kening" jointly developed by Wantai and Xiamen University was approved by the State Drug Administration, with a single issue price of 329 yuan.

After the WHO announced the one to two doses of the vaccination plan, from April 14th to April 25th, Wantai's stock price fell 20 %, and the stock price of Chinese agent Zhifei biological in Meroshadong fell by 31 %. Watson was also implicated. From April 19th to 25th, the stock price continued to fall for five trading days.

From the perspective of clinical trials, single -dose vaccination has the same protection effect. Zhang Jun, the dean of the School of Public Health of Xiamen University and a member of the "Xin Kening" R & D team, said in an interview with "China News Weekly": "The current experimental results show the protection effect of single -agent vaccination in a large extent. Three doses are equivalent. "

In June 2018, the National Institute of Health and the University of Washington, a professor of Washington University, led a study that lasted two and a half years and tracked 2,275 research on women's research on women's HPV vaccines. The results show that after two and a half years, the retention rate of HPV antibodies is 98 %. Another follow -up study published in the "National Cancer Research Institute" in February 2020 showed that 134 people's prevention effects on HPV infection and vaccination of HPV infection after a single vaccination of Glane Sonsk were inoculated in a single vaccination. 2 doses or 3 doses, and can last at least 7 years. When vaccination HPV vaccines, the first needle and the second needle usually interval for 1 to 2 months, and the second needle and the third needle are separated by 6 months.

However, the ideal time of HPV vaccine is not less than 40 years. Zhang Jun made a hypothesis: "If the vaccine is vaccinated at the age of 10, it is necessary to ensure that it has a protective effect from the frequent period of HPV virus infection from the initial life to about 50 years old." And the current research cannot prove a single agent to a single agent. The long -term effective protection period for vaccination is equivalent to multiple inoculation. Aimée Kreimer, a senior researcher in the National Cancer Institute infection and immunophistologist, also pointed out that the sustainable time of the single in vaccination requires more research and evidence.

As far as the mainland of China is concerned, domestic vaccines can partially alleviate the tension of supply, but the "HPV Vaccine Application of Cervical Cancer Elimination of Cervical Cancer Application Guangdong Expert Consensus" released in September 2021 mentioned that the current domestic HPV vaccine immunization is low, young people, young people, young people, young people, young people, young people, young people, young people, young people, and teenagers. The vaccination rate of the crowd is less than 3 %, and the vaccination rate of the whole population is less than 6 %. Due to the shortage of supply, like Wang Han needs to rely on grabbing and luck to get the vaccine, it often occurs. Last year, 420,000 people participated in the second nine -valent HPV vaccine in Shenzhen. In the end, only 7093 people were signed, with a probability of less than 1.7 %. Behind "26 -year -old panic"

"Before the age of 26, I did n’t have the opportunity to fight again, and I never have a chance." Liu Si, a Shanghai girl who was about to reach the age of 26 in November, continued to swipe similar information on social media. However, due to the epidemic, her community has been closed for nearly two months since March 24. "No more inoculation, there will be regrets in her life." In those two months, she was often surrounded by inoculation anxiety nearly 26 years old.

On June 1, Shanghai officially resumed work. Liu Si made an appointment call to Wusong Hospital of Zhongshan Hospital affiliated to Fudan University for the first time. But the other party told her that she had to go to the nine -price price and had to rank 1 to 2 years.

For domestic women, the vaccination of the nine -valent vaccine was mostly generated at the age of 26. Meridas is an exclusive manufacturer of the world's nine -valent HPV vaccine. In 2018, the Merida East Nine Valentine HPV vaccine was approved in Mainland China, with a vaccination scope of women aged 16 to 26.

The applicable people approved by HPV vaccines in Mainland China are not completely consistent with other countries. In the United States, the Food and Drug Administration has expanded the scope of the nine price to men and women aged 9 to 45. Many countries allow men and women over the age of 26 or even more than 45 to vaccine in private hospitals. Zhang Jun analyzed that due to the late research and development and late listing, the lack of research data has caused the scope of the nine -valent vaccine to be more strictly controlled in the Mainland.

Zhang Jun explained that Merck's nine -valent vaccine's previous clinical data of East Asian crowd was concentrated in the age of 16 to 26. This is why people who have not been approved in the Mainland who have not been approved in the Mainland are not yet approved in the Mainland. The nine -price price does not have a protective effect. " Wei Lihui, chairman of the China Eugenics Science Association's vaginal and cervical cancer pathology branches (CSCCP), said that my country is currently conducting clinical trials of HPV preventive vaccines, including the age group of nine -valent vaccines and clinical trials of young men's clinical trials Some domestic HPV vaccines are also entering the stage of clinical trials. Zhang Jun added that as long as the sexual life specifications and protection of the protection after vaccination, delaying the inoculation of subsequent injections will not have a much impact on the protection effect.

However, many studies have proved that the sooner the vaccination, the better the protection effect of the HPV vaccine. In March 2022, a study published in the journal of Natural Publishing Group pointed out that the performance of related antibodies after vaccination with HPV vaccines aged 10 to 14 years old is generally better than adults aged 18 to 53, which means that the HPV vaccine is HPV vaccine Can produce better protection effects among young people. At the same time, the study found that the adolescent vaccine inoculation is stronger than adults. WHO also suggested that girls aged 9 to 14 should be vaccinated. "Don't postpone the vaccination for the nine prices. The protection of the second and fourth prices is sufficient." Wei Lihui told China News Weekly.

The differences in groups at home and abroad have made many more than 26 -year -old groups willing to spend high prices to go abroad to vaccine. Last year, Xiao Lin, who worked as a market analysis at a cross -border trading company, has been waiting for a market analysis. After more than two months of waiting, he finally ranked in a private hospital in Tokyo. I thought that the vaccinations were Japanese, but she talked with "more than a dozen inoculaers in Chinese" -the opponent who grabbed the nine -valent vaccine was still the Chinese who could not grab the seedlings.

But even overseas, the hospital's attitude towards the nine -price vaccine is still cautious. Meridon mentioned in his official website's "HPV vaccine vaccination suggestion": "All 27 to 45 -year -old adults should jointly decide and discuss with clinicians to determine whether they should vaccinate nine -valent vaccines." American Disease Control and Prevention Center (CDC) Explain that most adults of this age have been infected with HPV, and the protection that the vaccine can provide is more limited than those 9 to 26 years old. "HPV vaccines can only prevent new infections, but they cannot treat existing infections." Essence Before the vaccination, Xiao Lin was also informed by Japanese doctors many times. Due to the late listing, the test results of the nine -valent vaccine can only ensure the effective protection period of more than 7 years. In

Not only for women, but also studies have confirmed that HPV quadrangers and nine -valent vaccines also have a protective effect on men. Earlier research by the US CDC found that type 6 and 11 HPV viruses included in the scope of priced vaccine protection are the culprit that triggers 90 % of genital warts for men and women. However, the Canadian Pediatric Association, the Infectious Diseases and Immunization Commission's "Suggestions for the use of children's and adolescent HPV vaccines" updated in 2018 pointed out that compared with the four valence, men's performance has not benefited much from the five serum types of the nine -valent vaccine, after all, after all, after all, after all, after all, after all, after all, after all These five viruses can only cause less than 1 % of oral blood cancer.

In 2015, the Consultation Committee of the Immunium Implementation of the United States CDC suggested that the nine -valent HPV vaccine was included in the national immunization plan. One year later, the CDC was eliminated from the procurement list. CDC explains that this is because the incidence of condyloma acuminatum is higher than that of cervical cancer, and the purchase of nine -valent vaccine is in line with the choice of national conditions. Moreover, this is also related to the degree of economic development in the United States. Except for several existing HPV vaccines, the domestic eleven prices, fourteen valences, and fifteen -valent HPV vaccines are currently under development. As one of the research and development of the domestic fifteen -price HPV vaccine, Liaoning Chengda Biological Co., Ltd. introduced that on the basis of nine valences, the fifteen -price vaccine can prevent all high -risk and HPV viruses related to condyloma acuminatum. Zhang Jun revealed: "It is expected that in the next 2 to 4 years, we may see that domestic nine -valent cervical cancer vaccines are listed. Within 10 years, higher -priced vaccines are also likely to be available."

Inoculation does not mean that the prevention and control is over

In July 2020, Harvard School of Public Health School, Emily Burger, and others analyzed the 48 countries that were aid for the Global Vaccine Immune Union (GAVI) and found that the binary HPV vaccine with cross -protection effect was 63 % ~ 83 % of low -income and medium -income countries are more cost -effective than nine prices.

The research of Hamburg and others was promoted for such a set of data: By 2100, in the case of 48 Gavi assisting countries vaccination rates reaching 70 %, binary vaccines with cross -protection effects can avoid 17.2 million cervical cancer, and and and and and and. The number of 18.5 million examples of nine -price avoidance is equivalent.

"Most of the countries with centralized procurement and public immunization plans, the expenditure of each HPV vaccine will not exceed $ 30." Eduardo Franco Franco Franco Franco Franco Franco Franco Franco, the Department of Cancer Popularization, Medical College, Montrey, Montreal is It is regarded as a scale economy. As long as the coverage rate is higher, the unit cost can be reduced through centralized procurement.

However, under the current situation of supply, a significant price reduction may only wait for the "patent cliff". Lin Yuancheng, deputy director of the Patent Division of the China Trade Council Patent and Trademark Office, told China News Weekly that the so -called "patent cliff" refers to the sales of the patent once the technology and products are copied, and the sales of the pharmaceutical factory and related commercial institutions The profit will decline sharply.

From 2006 to 2008, this is the first time that different institutions and manufacturers apply for HPV vaccine -related patents in China. Studies have found that 43 % of the world's HPV vaccine -related patents are applied in China, and the United States ranks second, accounting for 28 %. The Patent Law of the People's Republic of China stipulates that the period of invention patent rights is 20 years. This also means that from 2026 to 2028, a large number of HPV vaccines related patents will fail.

But after the HPV vaccine does not mean the end of the prevention and control. A patient who suffered from cervical cancer due to HPV virus infected for the first ten years or even twenty years would live like a healthy person. In 2003, a cervical cancer prevention alliance, jointly established by 8 public health international organizations, published a "Cervical Cancer Prevention Specifications", which pointed out that the cervical pre -body lesions generated by continuous infection of high -risk HPVs are usually 7. ~ 20 years. As soon as the lesion period, the patient may find that his vagina began to contact sex bleeding one day, and the lumbosacral region often pain.

But few people care about changes in their bodies at this stage. Most HPVs are infected through sexual communication. The taboos of "sex" have made many women miss the best time to screen cervical cancer screening.

"Women with sexual life have 80 % of the probability of HPV infection in their lives. This is not a matter of style, but a normal phenomenon." Wei Lihui told China News Weekly that "cervical cancer is not like most other cancers. It can be found through regular screening to find pre -cancer lesions and effectively prevent it through active treatment. Therefore, it is also necessary to eliminate a sense of shame and establish a sense of regular screening. "

In Italy, all women from 25 to 64 will receive an email from the National Health Bureau every three years. The procedures, check -in time, and place of cervical cancer coating test are written on it. Similarly, the "Prevention and Early Discovery of Cervical Cancer", which is revised by the American Cancer Association on April 22, 2021, proposed that cervical cancer screening should start at the age of 25 for every 5 years. The Japanese National Cancer Center has earned the age of cervical cancer to 20, and the frequency increases to every 2 years.

At the end of 2025, the screening rate of 50 % of women's cervical cancer was a short -term target formulated by the National Health and Health Commission. In 2021, the "Cervical Cancer Screening Work Plan" released by the National Health and Health Commission shows that domestic cervical cancer screening will cover women aged 35 to 64.

This is not an easy -to -achieve goal. Wei Lihui believes that the primary guarantee of women at the peak period of the age of 35 ~ 45 years old. But for individuals, as long as you start to have sex, it is best to do regular screening. Even if an adult woman is vaccinated with HPV vaccines, screening is still important. After all, there is a possibility of infection before vaccination.

According to WHO's suggestions, as of 2030, the global female cervical cancer screening coverage should reach 70 %.This number was once again mentioned in the implementation plan of the 2021 ~ 2030 of the Chinese Women's and Children's Development issued by the National Health and Health Commission in April this year.Qiao Youlin, director of the Cancer Popularity Research Office of the Institute of Cancer Institute of the Institute of Cancer Hospital of the Academy of Medical Sciences, mentioned in an interview with the media, "If this number cannot be reached, the control of the disease is insignificant."(The requirements of the interview objects, Wang Han, Liu Si, and Xiao Lin in the text are all pseudonyms)

Send 2022.7.4 Total Issue 1050 "China News Weekly" magazine

Magazine Title: HPV vaccine purchased

Author: Zhou Xinyu

Edit: Du Wei

- END -