From local pilots to national policy: key issues and challenges in implementing nationwide HPV vaccination in China.

Abstract

In October 2025, China announced the inclusion of human papillomavirus (HPV) vaccination into the National Immunization Program (NIP), marking the first expansion of the national immunization schedule since 2008 and the first to explicitly target adolescents rather than young children. This landmark policy reflects a strategic development in China's public health priorities, recognizing cervical cancer prevention as a public good and aligning national action with the World Health Organization's global strategy for cervical cancer elimination. This Viewpoint examines the multi-faceted development of China's HPV vaccination policy, highlighting the integrated roles of domestic research and manufacturing, local pilots, model-informed policy simulation, public discourse, and strategic alignment in shaping a scalable national strategy. It further analyses key challenges facing nationwide implementation, including sustainability of service delivery financing, vaccine hesitancy and misinformation, public preferences for higher-valency vaccines, and barriers to achieving equitable coverage beyond school-based delivery platforms. Drawing on lessons from local pilots and international experience, we propose policy recommendations to strengthen fiscal coordination, institutionalize school-based delivery, invest in strategic risk communication, and embed monitoring and implementation research within program rollout. China's experience offers timely lessons for other middle-income countries seeking to scale up HPV vaccination while balancing equity, sustainability, and public trust. Gates Foundation (INV-031449, INV-003174).