Chickenpox and Two Other Vaccines Likely to Be Added to National Immunization Program—How Will the Public Benefit?

After HPV vaccines were included in the national immunization program, there have been new developments in subsequent expansion.

On March 11, according to Southern Metropolis Daily, Shen Hongbing, Deputy Director of the National Health Commission and Director of the National Center for Disease Control and Prevention, revealed that the CDC, together with relevant departments, will gradually include vaccines with high disease prevention needs, good cost-effectiveness, affordable finances, and international consensus—such as type B Haemophilus influenzae, varicella, pneumococcal, and other WHO-prioritized vaccines—into the national immunization plan.

Shen Hongbing stated that, besides adding new vaccines, ongoing efforts to optimize the national immunization plan include refining immunization procedures and establishing a vaccine withdrawal mechanism. The goal is to make the prevention and control of targeted infectious diseases more scientific and precise.

The core reasons for choosing these three vaccines are still based on disease burden, international vaccination consensus, and practical prevention benefits.

On March 11, an industry insider explained to JiJie News that from a cost-effectiveness and public health management perspective, including these three vaccines in the immunization plan aligns with international public health policy directions.

He noted that the mention of the type B Haemophilus influenzae vaccine and pneumococcal vaccine mainly reflects their long-standing status as key childhood vaccines promoted by the global health system. As for the varicella vaccine, it is based on practical prevention needs. Varicella tends to spread in schools, kindergartens, and communities, and outbreaks often impose significant pressure on public health management.

The vaccines mentioned—type B Haemophilus influenzae and pneumococcal vaccines—are both recommended by WHO for inclusion in national immunization programs.

Currently, WHO recommends 10 key vaccines for inclusion in immunization plans worldwide. China has yet to include three of them: type B Haemophilus influenzae vaccine, pneumococcal conjugate vaccine, and rotavirus vaccine.

The overall vaccination rates for type B Haemophilus influenzae and pneumococcal vaccines remain relatively low in China, especially in economically underdeveloped areas, which often bear a heavier disease burden.

On March 11, Du Heng, Chief Program Officer at the Gates Foundation Beijing Office, told JiJie News that vaccination rates for pneumococcal conjugate vaccines and others are still low in some economically underdeveloped regions, with some areas reporting rates below 10%. Pneumococcal infections are considered a major cause of death among children under five. Due to relatively high vaccine prices, vaccination rates vary significantly across regions and between urban and rural areas. Particularly in low-resource areas, the disease burden is even greater.

Du Heng added that increasing vaccination coverage can help reduce related infections, thereby lowering antibiotic use and alleviating antimicrobial resistance issues. Higher pneumococcal vaccination rates among children can also indirectly reduce pneumonia risks for cohabiting elderly and other children through herd immunity, effectively protecting more groups simultaneously.

Including these two vaccines in the national immunization plan is expected to reduce the economic burden caused by related diseases.

The Vaccine Delivery Innovation Laboratory at Duke Kunshan University’s “Strategic Thinking on Strengthening the National Immunization Program” report states that in 2017, China reported 570,000 cases of pneumococcal disease in children under five, with 8,010 deaths. The economic burden of pneumococcal disease in China that year was 7.29 billion yuan.

In 2017, China had 252,000 cases of type B Haemophilus influenzae in children under five, with 2,888 deaths. The economic burden caused by this disease was 2.71 billion yuan.

For example, including the type B Haemophilus influenzae vaccine in the immunization plan could lead to disease reduction and decreased medical expenses, with overall benefits potentially exceeding the costs of investment.

Peking University’s China Health Development Research Center published a report titled “Significant Benefits of Including the Type B Haemophilus influenzae Vaccine in China’s Immunization Program,” which estimates that in 2017, vaccinating children against this disease could prevent approximately 2,700 deaths among children under five (a 93% reduction) and 235,700 cases of disease (a 92% reduction).

The report also evaluated the economic benefits from a health economics perspective.

Compared to the per capita GDP, the cost-effectiveness of the type B Haemophilus influenzae vaccine across China is 54,407 yuan per QALY gained, with 15 provinces showing favorable cost-effectiveness, especially in western regions where net benefits are possible.

In simple terms, investing about 54,000 yuan more on average could buy an additional year of healthier, higher-quality life. The study considers this cost acceptable, indicating good cost-effectiveness.

Although the varicella vaccine is not prioritized by WHO for inclusion in immunization programs, outbreaks of chickenpox in China pose serious public health concerns.

Peking University’s China Health Development Research Center’s economic evaluation of including the varicella vaccine in China’s immunization plan reports that in 2019, there were 1,318 outbreaks involving 40,147 cases, with 95.94% occurring in schools. Varicella cases have become the leading vaccine-preventable infectious disease among children not covered by the immunization plan.

Data from Duke Kunshan University’s Vaccine Delivery Innovation Laboratory shows that from 2016 to 2019, varicella incidence increased from 35.50 per 100,000 to 70.14 per 100,000, with an average annual reported incidence of 55.05 per 100,000. The per capita economic burden is 1,195.34 yuan, and the per hospitalization case burden is 6,038.09 yuan, accounting for 2.81% and 14.18% of average disposable income, respectively.

The disease burden model from Peking University indicates that without vaccination, China could see over 127 million cases of varicella from 2019 to 2049. Including a single dose of varicella vaccine with a 95% coverage rate could reduce the total cases by 63.94 million over 30 years. Adding a booster dose could cut cases by 104 million, and a two-dose strategy could reduce cases by 124 million.

This study also evaluated the economic aspects of including the varicella vaccine in the immunization plan.

Results show that if the varicella vaccine is included in the national immunization plan, the incremental cost-effectiveness ratio (ICER) for a single dose is $2,357.25 per QALY, which is well below China’s 2019 per capita GDP. Compared to no vaccination, including the vaccine is economically justified.

In simple terms, investing about $2,357 more on average could buy an additional year of healthier, higher-quality life. The study considers this cost acceptable, indicating the strategy is “cost-effective” or “worth the investment.”