Looking for scalpers to grab seedlings at high prices and being deceived many times, they go overseas for vaccination at all costs

  Do you have to get HPV nine-valent vaccine before the age of 26?

  "500 places for the nine-valent HPV vaccine! What kind of 'fairy' school is this!" an interviewee wrote in a circle of friends.

  March 8th this year is the 112th International Women's Day. Zhejiang University launched a special reservation activity for the nine-valent vaccine to enter the campus, which is a campaign to care for women's health. 500 nine-valent HPV (human papillomavirus) vaccination places were distributed to all Zhejiang University from 16 to 16 26-year-old female students are open.

It is reported that this activity is voluntary and self-funded. The vaccination price is 1298 yuan/injection + 28 yuan inoculation fee/time. Three injections are given in the whole process, and the total cost is 3978 yuan, which is the same as the vaccination price in public hospitals.

  The topic of "Zhejiang University celebrates Women's Day with nine prices as a gift" immediately exploded on the Internet and "dominates the list" on many social media platforms that day.

Zhejiang University became the "top stream" on this day, which also reflects the continued popularity of the current nine-valent HPV vaccine market.

  Many school-age women lamented, "Why didn't I catch up with this 'fairy' school".

Some women who are about to turn 26 years old are very anxious, and it is difficult to find a seedling after increasing the price by more than a thousand yuan. Some people even accidentally fall into a "scam".

  To get HPV vaccine, you must "grab" the nine-price before the age of 26?

What is the difference between the effect of bivalent and quadrivalent vaccines and that of 9-valent vaccines?

How to prevent falling into the "trap" by making an appointment for vaccination online?

With these questions, Xinhua Daily Telegraph reporter launched an investigation.

Nine prices are hard to grab, traps are hard to prevent

  At 1:30 in the afternoon, Xiaoting secretly took out her mobile phone in class, opened a WeChat applet of a private hospital, and clicked "My Order" over and over again.

After more than a dozen times, the words "to be paid" finally came out.

Before she could check the order information, Xiaoting hurried to pay, and when the words "payment successful" for the three-injection nine-valent HPV vaccine appeared on the screen of her mobile phone, a "big rock" in her heart fell to the ground.

  Before exiting the payment page, Xiaoting received a message from the Taobao merchant: "Have you paid successfully? Don't forget to click to receive!" Xiaoting clicked "Confirm Receipt", and the 600 yuan vaccine was snapped up instantly. Enter a merchant account...

  Xiaoting, a 21-year-old from Wenzhou, Zhejiang, is a sophomore at a university in Beijing. She has included the nine-valent HPV vaccine on her must-do list this semester.

  The HPV vaccine can prevent certain types of HPV infection, thereby reducing the chance of developing diseases such as cervical cancer in women, vaginal cancer in women, penile cancer in men, and anal cancer in men and women.

There are currently three types of HPV vaccines on the market: bivalent, quadrivalent, and ninevalent, corresponding to the number of HPV types that can be prevented.

  "I feel that the shortage of vaccines has been particularly serious recently. In my freshman year, there was a batch of nine-valent HPV vaccines in the school hospital, but I didn't get them. I also tried to get the vaccines in public hospitals and private hospitals, but every time I got no results. In the end, I really had no choice but to find someone online to grab it." Xiaoting talked about her experience.

  The business that provided Xiaoting with "snatching" services is actually a "technical scalper", which can not only snatch vaccines, but also tickets for concerts, train tickets and other tickets.

Before the vaccine of the private hospital is released, the merchant and Xiaoting log in to Xiaoting's account in the private hospital's applet at the same time. After the merchant grabs the vaccine for the first time through technical means, the order information will appear on Xiaoting's mobile phone synchronously. Just pay.

  "Even if you don't get it, the 600 yuan snatch fee will not be refunded. It depends on whether you dare to gamble. Fortunately, I won the bet." Xiaoting said.

  The total price of the three-needle nine-valent HPV vaccine Xiaoting received was as high as 5,680 yuan.

The reporter opened an HPV vaccine appointment applet and found that the three-needle nine-valent HPV vaccine in private hospitals is generally between 5,300 and 6,400 yuan, and they are all out of stock.

  The reporter asked about the situation of the nine-valent HPV vaccine in a community health service center in Xicheng District, Beijing, and the reply was that the price of each injection is 1,323 yuan, and there is no need to increase the price, but the earliest appointment time for vaccination is May 2023, and the vaccinator The household registration must be in the community.

  At present, the nine-valent HPV vaccine is suitable for women aged 16 to 26 in the Mainland.

In the national government service platform and other online channels, many women who are about to turn 26 years old have "spit out" their experience of catching seedlings, and many of them have been deceived.

  Seeing that she will be 26 years old, Xiaodai is a little anxious, "I make an appointment by calling the community, and every time I am told that there is a shortage of seedlings, I have also tried to grab seedlings on the App several times, but every time it is 'second light'..."

  In desperation, Xiaodai searched for an intermediary who claimed to be able to book vaccines on Weibo.

"The other party promised to pay a deposit of 500 yuan to help make the appointment. After the appointment is successful, the full amount will be paid, and a week later, the vaccination will be arranged at the nearby community health service center." Xiaodai didn't think much, and after paying the deposit, sure enough Received a successful appointment text message prefixed with "medical deer", and then paid the balance of more than 4,500 yuan.

  When Xiaodai sent the payment screenshot to the intermediary, the other party began to "find faults".

"Said that I didn't remark 'name + final payment' when paying, the backstage couldn't recognize it and couldn't match the seedlings, and promised to automatically refund within an hour, and asked me to pay again."

  Xiaodai, who was eager to seek Miao, transferred another 4,500 yuan according to the request of the other party.

She kept urging the other party to refund, but the other party disappeared.

Only then did Xiaodai realize that she had been deceived.

  After Xiaodai posted her deceived experience on social media, she did not expect that there were not a few people with similar experiences, and some people were even cheated of more than 30,000 yuan.

  "I saw a blogger on Xiaohongshu sharing a case of asking a scalper to make an appointment for vaccination. Thinking that the blogger had been successfully vaccinated, I contacted the scalper according to her method, and I was cheated of nearly 10,000 yuan. Only then did I find out that the blogger and the scalper are in the same group." 25-year-old Wenwen revealed to reporters.

  A friend once suggested that Wenwen go to Hong Kong or Macau to get vaccinated, "The nine-valent vaccine requires three injections, several round trips, and the transportation and accommodation costs are not low. In addition to the impact of the epidemic, I still choose to vaccinate locally, but I didn't expect such a trap. A lot." Wenwen said angrily.

  Behind the phenomenon of many vaccine seekers is the concern about HPV infection.

In December 2019, the "Expert Consensus on Immunoprevention of Human Papillomavirus-Related Diseases (Simplified Version)" (hereinafter referred to as the "Consensus") published by the "Chinese Journal of Epidemiology" proposed that the occurrence of cervical cancer is a Incidental events following HPV infection.

  The "Consensus" mentioned that the vast majority of HPV infections are asymptomatic transient infections, which can be histologically manifested as low-grade cervical lesions, and more than 80% of infections can be cleared by the body within 6 to 24 months.

More than 60% of low-grade lesions will improve spontaneously, and only about 1% of low-grade lesions can progress to cervical cancer.

Usually persistent HPV infection takes 10 to 20 years of natural evolution to develop into cancer.

  "The sooner the better, not the more expensive the better"

  "If you want to get the HPV vaccine, you can get the nine-valent vaccine", "I would rather spend more money and improve the vaccine's protection against the virus"... The reporter's survey found that many young women generally choose "high or low" when receiving the HPV vaccine.

  According to public information, about 200 HPV types have been identified from the human body. According to their carcinogenic potential, they are divided into high-risk types and low-risk types. High-risk types include HPV16/18/31/33/35/39/45/51/ 52/56/58/59/68, a total of 13 types.

Among them, HPV16/18 is "at risk".

Studies have shown that bivalent, quadrivalent and 9-valent vaccines are basically equivalent in preventing HPV16/18 infection.

  Taking cervical cancer as an example, it can be divided into squamous cell carcinoma and adenocarcinoma according to the pathological type.

The results of two studies in China showed that among patients with cervical squamous cell carcinoma, the infection rate of high-risk HPV was 97.6%, and HPV16/18 was the most common type, with a total infection rate of 84.5%; among patients with cervical adenocarcinoma, high-risk HPV was The infection rate was 74.5%, and HPV16/18 were also the most common types, with a combined infection rate of 65.7%.

  The "Consensus" mentioned that three imported HPV vaccines (British GlaxoSmithKline bivalent HPV vaccine, US Merck quadrivalent HPV vaccine, US Merck 9-valent HPV vaccine) can provide high protection against HPV16/18.

Moreover, bivalent and quadrivalent HPV vaccines can provide a certain degree of cross-protection against high-risk HPV types other than HPV16/18, especially against HPV31/33/45. The domestic bivalent HPV vaccine approved for marketing in December 2019, It also has a strong persistent protective effect on HPV16/18.

  "For HPV vaccination, it is recommended that the sooner the better, not the more expensive the better." said Zhang Yu, director of the Department of Obstetrics and Gynecology at Xiangya Hospital of Central South University.

  Related studies also show that the antibody titer (a measure of the minimum concentration required for an antibody to recognize a specific epitope) after receiving the bivalent HPV vaccine in women aged 9 to 17 is 2 to 3 times higher than that in women aged 18 to 25. .

Antibody titers after quadrivalent HPV vaccine in women aged 9 to 15 were 1.4 to 2.8 times higher than in women aged 16 to 26.

  Zhang Yu also reminded that many people think that after receiving the HPV vaccine, they no longer need to worry about cervical cancer, but this is not the case.

Women who have been vaccinated still need to undergo regular cervical cancer screening to further reduce the incidence of cervical cancer.

On the one hand, some women may have been infected with HPV when they are vaccinated, and on the other hand, the HPV vaccine cannot cover all high-risk HPV infections.

  "Vaccinations are no longer recommended for people over 45 years old, and it is particularly important to insist on screening." Zhang Yu said.

 Where does the 26-year-old limit come from?

  Due to the idea that "the nine-valent HPV vaccine must be vaccinated before the age of 26", many women who are about to reach the age of 26 would rather spend high prices on cattle to be vaccinated with the nine-valent HPV vaccine, rather than vaccinated with bivalent and quadrivalent in regular channels.

The latter two vaccines were administered to women aged 9 to 45 and women aged 20 to 45, respectively.

  What's more, the bivalent vaccine has been vaccinated, and it is still hoped that the nine-valent vaccine can be replanted before the age of 26, in order to strengthen the preventive effect.

"What if I can't get the nine-price vaccination after the age of 26?" has become a problem for many people.

  The reporter checked the data and found that some nine-valent HPV vaccines in the United States, Hong Kong and other countries and regions are applicable to the vaccination age range not from 16 to 26 years old, but from 9 to 45 years old.

Therefore, there are also many women over 26 years old who are willing to spend more time and money to travel overseas to receive the nine-valent HPV vaccine.

  Merck, maker of the nine-valent HPV vaccine, mentioned in the "HPV Vaccination Recommendations" published on its official website: "The nine-valent HPV vaccine is recommended for all boys and girls aged 11 or 12 years (but can start at the age of 9). And those who were not vaccinated or adequately vaccinated before age 26. All adults 27 to 45 years should have a shared decision-making discussion with a clinician to determine if they should be vaccinated.”

  This means that according to the vaccination recommendations given by Merck's official website, the nine-valent HPV vaccine can be vaccinated between the ages of 9 and 45.

It is worth mentioning that the reporter checked the instructions of Merck's nine-valent HPV vaccine listed in the mainland, but found words such as "this product is suitable for vaccination of women aged 16 to 26".

  So how is the age limit of 16 to 26 years determined?

The reporter found the application technology for the "Nine-valent Human Papillomavirus Vaccine (Saccharomyces cerevisiae) (JXSS1800008/9)" issued by the Drug Evaluation Center of the State Food and Drug Administration after Merck's nine-valent HPV vaccine was approved for marketing in the mainland in October 2018. Review Report, which states the following:

  "This product's import registration application is based on overseas clinical research data, and no clinical trials have been carried out in China. In accordance with the spirit of the General Office of the Communist Party of China and the General Office of the State Council No. 42, we will consider using overseas clinical research data to support the import registration of this product. This product is globally The clinical trial data basically confirmed that the safety, immunogenicity and protective efficacy of the East Asian population and the general population are consistent, and this product can be considered for conditional approval based on overseas data.

  "In view of the current overseas clinical data of this product, there is insufficient evidence for the East Asian population (especially the Chinese population) in the younger age group, and the sex life of women in my country is later than that in Western countries, taking into account many factors such as health economics, it is tentatively scheduled for 16 to 26 This product is suitable for vaccination for females aged 12 years, and the instructions will be updated after the applicant submits domestic clinical trial data to fully prove the efficacy and safety of this product in the younger age group."

  The age of application of the nine-valent HPV vaccine was thus determined in the mainland and continues to this day.

At the same time, this statement also means that the applicable age of 16 to 26 years old is not unchangeable. At least with the accumulation of domestic clinical trial data, it is possible to be able to receive the nine-valent HPV vaccine before the age of 16.

  In fact, trials of the nine-valent HPV vaccine targeting a larger age range of mainland women are being carried out in an orderly manner.

According to public information, Merck has launched a phase 3 open clinical trial entitled "Evaluation of the immunogenicity and safety of nine-valent human papillomavirus vaccine (V503) in Chinese women aged 9 to 45 years old in March 2019." A total of 1,990 mainland women will be recruited to participate in the trial, which aims to test the safety of the company's nine-valent HPV vaccine in mainland women aged 9 to 45.

  Recruitment of subjects for this study has now been completed and the trial is ongoing.

 Bivalent free vaccination is on the way

  This year's National People's Congress, the vaccination of HPV vaccine and the prevention and treatment of cervical cancer have been hotly debated by representatives. Several deputies to the National People's Congress have submitted suggestions on free vaccination of HPV vaccine for school-age women.

Xu Ping, deputy to the National People's Congress, suggested that the domestic bivalent HPV vaccine should be included in the immunization plan; Cai Weiping, deputy to the National People's Congress, suggested that the non-immunization plan vaccines including HPV vaccine and rabies vaccine should be included in the payment scope by amending the social insurance law.

  According to data released by the International Agency for Research on Cancer in 2021, there will be 604,000 new cases of cervical cancer worldwide in 2020, of which nearly 110,000 are in China.

In 2020, there will be about 342,000 cervical cancer deaths worldwide, of which nearly 60,000 are in China.

In the past 20 years, the incidence and mortality of cervical cancer in China have been increasing year by year, and tend to be younger.

  The birth of HPV vaccine makes cervical cancer expected to become the first malignant tumor that can be completely eliminated.

As of January 2020, more than 104 countries and regions around the world have included HPV vaccines in their national immunization programs.

At present, the HPV vaccine still belongs to the second-class vaccine of the non-immunization program in the Mainland, and the vaccinators follow the principle of "informed consent and voluntary self-pay".

  In 2019, 10 departments including the National Health Commission jointly formulated the "Healthy China Action - Cancer Prevention and Control Implementation Plan (2019-2022)", which clearly stated that it is necessary to promote the scientific publicity of HPV vaccination and promote the vaccination of appropriate age groups.

Accelerate the review and approval process of domestic HPV vaccines and improve the accessibility of HPV vaccines.

Through price negotiation, centralized procurement, etc., HPV vaccine suppliers will be encouraged to set reasonable prices, and various channels will be explored to ensure the vaccination of people of appropriate age in poverty-stricken areas.

  Since 2020, the free vaccination of domestic bivalent HPV vaccines has been carried out in many places across the country. Inner Mongolia, Fujian, Shandong, Sichuan, Jiangsu, Hainan and other places have successively carried out this work.

  The National Health Commission said that China will fully support the World Health Organization's "Global Strategy to Accelerate the Elimination of Cervical Cancer", which clearly states that by 2030, 90% of girls in the world will be vaccinated against HPV before the age of 15.

Promote the global goal of eliminating cervical cancer through a three-tiered prevention and control pathway, including vaccination, screening and treatment.

  In response to the persistent high price and shortage of imported HPV vaccines, Wu Ting, a professor at the School of Public Health of Xiamen University, said that the domestic bivalent HPV vaccine "Xin Ke Ning" is produced using an independent innovative E. Large-scale production of vaccines is possible.

  In 2021, "Xin Ke Ning" passed the pre-certification of the World Health Organization, which means that domestic HPV vaccine products have the opportunity to enter the overseas market for procurement by the United Nations system.

The nine-valent HPV vaccine developed by the Xiamen University team has also entered Phase III clinical trials. It is expected to obtain preliminary efficacy data in 2023 and is expected to be launched in 2023 or 2024.

(Xiaoting, Xiaodai and Wenwen in the article are all pseudonyms) (Reporters Mo Xin and Xie Ying participated in the writing: Zhang Silin, Liu Chen, Zhang Yiran)