NIHR Evidence to Policy pathway to Immunisation in China: the EPIC Synopsis

Background In China, many vaccines that are free in other countries have to be paid out of pocket. This makes them inaccessible to low-income and vulnerable people who often have the highest disease burden. China has been investigating whether to increase the range of central government-funded vaccines, but this will require considerable investment and manufacturing capacity. Objectives The National Institute for Health Research Group on Evidence to Policy Pathway to Immunisation in China brought together leading academic and public health institutions in the United Kingdom and China to conduct joint vaccine research to help decision-makers in China develop a vaccination programme that ensures reliable, affordable, equitable and uninterrupted supply of vaccines to the Chinese population. It was also able to address two events with vaccine-related implications in China: the Changchun Changsheng vaccine incident (where a company knowingly sold substandard vaccines) and the COVID-19 pandemic. Design and methods National Institute for Health Research Group on Evidence to Policy Pathway to Immunisation in China established 33 subprojects using different methods, including laboratory testing, qualitative and quantitative surveys of the public and patients, systematic reviews, database searches and modelling (including statistical, mechanistic, geospatial and economic modelling). Setting and participants National Institute for Health Research Group on Evidence to Policy Pathway to Immunisation in China was a United Kingdom–China collaboration involving reciprocal exchanges of research students, scientists and government experts. The four main partners were the London School of Hygiene (2) understanding vaccine supply, demand and decision-making and (3) projecting the health and economic impact that vaccine introduction could have, particularly among the worst off. Results Vaccine-preventable diseases have the potential to spread rapidly in China. New vaccines against diseases like hand, foot and mouth disease, respiratory syncytial virus and seasonal influenza could have large health benefits and be cost-effective. Public confidence in vaccines was high and recovered quickly after the Changchun Changsheng incident, but awareness and uptake of vaccines that were not centrally funded were low. Non-pharmaceutical interventions and vaccine prioritisation strategies contributed to COVID-19 control in China and elsewhere. Limitations Some subprojects and stakeholder engagement activities were curtailed during the COVID-19 pandemic. Conclusions Results provided evidence of the feasibility, acceptability, potential health benefits, equity impact, budget impact and value for money of funding new vaccines. Future work National Institute for Health Research Group on Evidence to Policy Pathway to Immunisation in China aims to inspire similar models of collaborative research to inform immunisation policy elsewhere in Asia and around the world. Funding This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Global Health Research programme as award number 16/137/109.