China-Singapore Jingwei Client, October 20 (Lin Wansi) At the end of 2019, Yang Feng, who had just turned 25, took the last train of the nine-valent HPV cervical cancer vaccine.

However, after finishing the first two shots, she is now facing a difficult problem. The third shot will not be scheduled for a long time. When she is about to be over-aged, should she continue to wait for the nine-valent vaccine or switch to the four-valent or bivalent vaccine?

  During the interview, a reporter from China-Singapore Jingwei learned that there is a shortage of HPV vaccines in many places, and there are many people who face this problem like Yang Feng.

  Nine-valent vaccine packaging box.

Photo courtesy of respondents

"The price of nine is less than that, and the price of four will have to wait more than a year"

  Yang Feng, who lives in Taiyuan, Shanxi, recalled that when making an appointment for the nine-valent HPV vaccine, the community doctor said that the hospital would reserve the three-dose vaccine for her for the cost of three doses in one appointment.

  It is understood that the nine-valent HPV vaccine must be injected in 0, 2, and June.

In March 2020, Yang Feng completed the second injection of the nine-valent vaccine. When Yang Feng made an appointment for the third injection, the community doctor told her that she was short of vaccines and did not know when she could make an appointment.

  According to the staff of Yang Feng’s community hospital, there are a lot of people who have recently made appointments for the nine-valent HPV vaccine. Some received the first shot and some received the first two shots. In order to ensure that the vaccinated population would receive 3 shots within a year, the community The hospital arranged for Yang Feng, who had been vaccinated for the third dose in July, to October, but if Yang Feng was vaccinated successfully in October, the staff dare not pack the tickets.

  Since the nine-valent vaccine is only suitable for women aged 16-26, and the shortage of vaccines, Yang Feng is easily over-aged at the last shot.

If there is no vaccine for the nine-valent vaccine, and if you want to change to the four-valent vaccine, you have to wait a year.

  26-year-old Tu Hui began to make an appointment for the nine-valent HPV vaccine in March last year. “At the time, the community hospital staff told me that I had to wait at least one year to make an appointment, but I couldn’t wait that long, so I decided to get a four-valent HPV vaccine.”

  However, replacing the quadrivalent HPV vaccine did not allow Tu Hui to catch the "express". Staff at many community hospitals in Beijing told Tu Hui that he would have to wait at least 18 months to make an appointment.

"I can't make the price of nine, and now I can't even hit the price of four," Tu Hui sighed.

  On October 13th, Xiang Lan came to Beijing from Tianjin. She said that she originally wanted to make an appointment for the quadrivalent HPV vaccine, but the staff of the Tianjin secondary hospital told her that there have been more than 5,000 appointments for the quadrivalent HPV vaccine. "No show this year, we have to wait for next year."

  A doctor in a private hospital in Tianjin told her that the quadrivalent HPV vaccine in the hospital is now out of stock, but the Beijing branch has a bivalent vaccine that can be applied when it arrives.

"But I can't make appointments with four-valent seedlings, and I still feel uneasy." Xiang Lan said.

  Public reports show that there is a shortage of vaccines in Beijing, Shanghai, Shenzhen and other places.

According to statistics from China-Singapore Jingwei reporters, from June to September 2020, the number of batches of 9-valent HPV vaccine issued by China Food and Drug Control Institute totaled 2.4276 million.

According to the three-shot vaccination procedure per person, there is a huge gap between the supply of vaccines and the actual demand.

  Shenzhen and other places have even adopted the "lottery lottery" method to decide who can be vaccinated.

According to a report from China Business News, the staff of the Shenzhen Centers for Disease Control and Prevention's Immunization Planning Institute revealed that there were 222,951 nine-price HPV vaccine lottery applicants in August, and the number of winning places was 5,761. The winning rate of the lottery was only 2.58%.

Some netizens jokingly claim that the nine-valent HPV vaccine is shaken, which is the "three luck in life" along with the license plate and the house number.

The intermediary agent increases the price to sell three needles and nine prices for nearly 7,000 yuan

  The shortage of HPV vaccines has also given birth to "vaccine scalpers", who connect with consumers in hospitals to earn intermediary fees.

Some intermediary agencies transmit information on behalf of others through Weibo and e-commerce platforms.

  The customer service of a nine-price HPV vaccination platform on an e-commerce platform introduced to Yang Feng that after making an online order, the person who made an appointment can go to the designated hospital in the city for vaccination. The price of three doses is close to 7,000 yuan, and it is expected to be available in 1 to 2 months. Vaccination, but currently only pre-sale, there is a risk of out of stock.

The third needle that Yang Feng consulted was also nearly 2,000 yuan, but the area where Yang Feng is still lacks seedlings.

  Compared with community hospitals at around 1,300 yuan for a needle and 3,900 yuan for three needles, the price of three needles on the e-commerce platform is nearly double the price of 7,000 yuan.

  Desperate, Yang Feng found a scalper who had ordered a nine-valent vaccine. The scalper said that his vaccine came from a community hospital and could get the third shot, but there are city restrictions and the cost is about 2,500 yuan.

"Pay now and you can sign up in November. This is only available through internal channels, so you can ask yourself if it will happen."

  Shi Lichen, the founder of Beijing Dingchen Management Consulting Co., Ltd., told the China-Singapore Jingwei reporter that my country will conduct mandatory inspections and audits for each batch of vaccines when they leave the factory or are imported. There are also certain restrictions on the number of vaccines imported and produced. A certain number is given to production enterprises for production and allocated to each province and city.

After the “Longevity Biology Incident” in 2018, the number of vaccine batches has dropped rapidly. Shi Lichen suggested that the batch issuance should be liberalized as much as possible. At the same time, a supply-demand dialogue platform should be established to summarize the needs of various regions, and adjust the number of batches to be issued according to market demand. The free circulation of low-priced HPV vaccines can benefit more people.

Is it feasible to replace the 9 price with the second price and the fourth price?

  According to the Bohai Securities Research Report, HPV has more than 100 subtypes. Among the many subtypes, HPV16 and HPV18 are the most important high-risk types. About 70% of cervical cancers are caused by these two subtypes, so they were initially listed. The bivalent HPV vaccine mainly prevents these two subtypes.

  However, in response to the role of the bivalent vaccine, Qu Xiaoliang, the former vice president of WeDoctor-Wuzhen Internet Hospital, explained in an interview with a reporter from Sino-Singapore Jingwei that some medical evidence shows that for Asian populations, cervical cancer susceptibility virus is not related to HPV16 and HPV16. HPV18 is the main type, and the coverage of the bivalent vaccine for Asian population is not as wide as that of the nine-valent HPV vaccine.

  Therefore, Qu Xiaoliang believes that the nine-valent vaccine has grabbed most of the HPV vaccine market, and the price-performance ratio of the nine-valent vaccine is higher than that of the bivalent and quadrivalent vaccines. Everyone has received the nine-valent HPV vaccine.

  Whether the 9-valent HPV vaccine, the quadrivalent HPV vaccine, and the bivalent HPV vaccine can be substituted for each other? The instructions of the 9-valent HPV vaccine show that there is currently no clinical data to support the interchangeability of this product with other HPV vaccines. If 3 doses of quadrivalent are used You need to use this product after HPV vaccination, at least 12 months before you can start the vaccination, and the number of doses is 3 doses.

  Nine-valent vaccination card.

Photo by Lin Wansi, China-Singapore Jingwei

  In an interview with a reporter from Sino-Singapore Jingwei, Qu Xiaoliang pointed out that from an international perspective, there is no clear statement on whether the bivalent or quadrivalent HPV vaccine can be vaccinated after the nine-valent HPV vaccine.

  Taking the hepatitis B vaccine as an example, Qu Xiaoliang pointed out that some people who have been vaccinated with hepatitis B vaccine, but the antibody still shows negative, then the doctor will consider an additional injection of hepatitis B vaccine, the purpose is to stimulate the body through the vaccine to produce an antibody response.

  If the fee for three doses is paid, but the subsequent two and three doses of the nine-valent HPV vaccine cannot be vaccinated in time, Qu Xiaoliang suggests to apply for a refund.

Is it possible to use bivalent HPV vaccine or quadrivalent HPV vaccine to replace the unfinished second and third injections of nine-valent HPV vaccine?

Qu Xiaoliang said that in theory, the two HPV vaccines can replace each other from a biological point of view, but they may be different in technology, so there is no clear conclusion.

"I personally think that if the subsequent one or two shots of the 9-valent HPV vaccine cannot be vaccinated on time, and face the risk of overage, a bivalent vaccine can be used instead." Qu Xiaoliang said.

  Public information shows that the quadrivalent and 9-valent HPV vaccines currently on the market in China are all developed and produced by Merck & Co., Ltd., and are represented by Zhifei Biological. The bivalent HPV vaccine manufacturers except GlaxoSmithKline, the domestic Bivalent HPV vaccine Xinke Ning went public in January 2020 and received approval for the first time in April.

Wantai Biotech has also become the first in China and the third HPV vaccine manufacturer in the world after Merck and GlaxoSmithKline.

  The 2020 semi-annual report of Wantai Biotech shows that its nine-valent vaccine, a key project under development, has completed the first and second phases of clinical trials. The third phase of clinical trials is currently in preparation and will be implemented in the second half of the year.

Regarding the progress of its preparations, Sino-Singapore Jingwei successively called and wrote to Wantai Biotechnology on October 13th, but did not receive a reply as of the time of publication.

  However, apart from Wantai Bio, HPV vaccines from other domestic manufacturers have not yet been approved for marketing.

In June 2020, the Tianfeng Securities Research Report showed that Watson Biotech's bivalent HPV vaccine officially entered the registration review and review process, and it is expected to be approved by the end of next year, becoming the second domestic bivalent HPV vaccine to be listed.

(Zhongxin Jingwei APP)

  (At the request of interviewees, Yang Feng, Tu Hui, and Xiang Lan are all pseudonyms)

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