HPV is one of the most common sexually transmitted infections in the world. There are more than 100 strains of the virus, but some of them are especially dangerous as they can cause cancers.

Hundreds descend on Hong Kong clinic which gave dubious HPV vaccines

While both men and women can get HPV, women face an additional, potentially lethal risk: the virus is responsible for more than 95 per cent of cervical cancer cases, according to the World Health Organization (WHO).

HPV is especially dangerous for women, as it may cause pathological changes to a woman’s cervix, a gynaecologist from the eastern Chinese city of Hangzhou told the Post.

“If the virus remains in the body for a long time, it might lead to these parts developing genital warts or even cancer,” she said.

According to the HPV Information Centre, cervical cancer ranks as the third most common cancer among women between 15 and 44 years of age in China, and the sixth most common among women in the country overall.

The WHO-affiliated centre estimates that almost 110,000 women in China are diagnosed with cervical cancer each year and more than 59,000 die from the disease.

Private hospital closed after dozens of patients given fake HPV vaccines

For years, women like Li have scrambled to get vaccines through word of mouth.

Some are also willing to pay a high price to buy vaccine slots from scalpers on the black market. In one extreme case, a computer programmer in the eastern province of Jiangxi was detained by police in December accused of writing a computer program to automatically book vaccine slots from the official site, and then selling the appointments for a profit.

In China, HPV vaccine prices range from 1,800 yuan (US$282) to 3,900 yuan for imported doses, and under 1,000 yuan for domestic shots.

HPV vaccines are referred to as either 2-valent, 4-valent or 9-valent, depending on the number of viral strains they protect against. All four vaccines that have been pre-qualified by the WHO protect against types 16 and 18 – known to cause at least 70 per cent of cervical cancers – but the 9-valent vaccine – the one Li eventually received – is the most comprehensive and sought after, as it protects against at least five more HPV strains which cause a further 20 per cent of cervical cancers.

Cervarix, a 2-valent HPV vaccine by British pharmaceutical company GlaxoSmithKline, was the first to be available in China in 2017. Gardasil 9, a 9-valent vaccine produced by US company Merck, was approved for use in the country in 2018 – four years after it was approved for medical use in the United States.

China’s first locally produced HPV vaccine, the 2-valent Cecolin by Innovax, was officially launched in the country in 2020, and last year became the first China-manufactured HPV vaccine to gain WHO prequalification status. The vaccine is now available through Chinese hospitals.

In China, the 9-valent vaccine against HPV is only allowed for those aged between 16 and 26 due to a lack of domestic clinical data, even though it is approved for nine to 45-year-olds in other countries.

Li first learned about the vaccines and their impact on cervical cancer in a lecture at her hospital and knew immediately that she had to have one herself. Through her job, Li has seen many women ravaged by the disease and treatment. “I felt so sorry for them,” she said. “That’s why I needed to get that vaccine as soon as possible.”

The fight to rid Hong Kong of cervical cancer

The clock was also ticking for Beijing resident Chen Jingjing, who first read about the vaccine on blogs five years ago when she was 27. By then it was already too late for her to get the 9-valent shot. So last year, she finally decided to try for the 4-valent, which China allows for ages 9 to 45. But even getting that one was just as difficult, “like a battle”.

She set a reminder on the medical information app Dingxiangyuan, which sent her alerts when vaccines became available at different hospitals. When an alert came in, Chen would drop everything she was doing, log on to that hospital’s website and try to sign up.

She tried four times last year. Every time, as soon as she entered her personal information, the system would say the vaccines had run out.

But the fifth time, she got lucky. “Someone must’ve dropped their request,” she said.

According to a report from industry analyst Huaxi Securities last month, there is still huge potential for the HPV vaccine market in China, with just 7 per cent of the roughly 381 million women aged nine to 45 in China vaccinated.

On lifestyle app Xiaohongshu and microblogging site Weibo, HPV vaccines are much-discussed topics and users have developed their own language for them, calling successfully booking a shot “getting to shore”, and not “drifting in the sea”.

Hong Kong-based insurance agent Annie Lin used to receive many inquiries each day from mainland-based clients wanting the vaccine.

Lin said insurance agents often maintained a good relationship with private clinics, bringing them clients for surgery. With the Hong Kong-mainland border still closed, she is now helping clients to register for shots in Macau, which reopened to some mainland tourists in August 2020.

Currently, the shortage on the mainland is mostly caused by a lack of supply.

Qiao Youlin, a professor of epidemiology at the Chinese Academy of Medical Sciences’ Cancer Hospital, told state broadcaster CCTV that previously, approvals for the 2-valent and 4-valent vaccines from GlaxoSmithKline and Merck took eight years.

In 2018, China approved the 9-valent from Merck within nine days, but production for the vaccine is still catching up with demand.

“The domestic market had 10 years of accumulated demand,” he said.

Merck previously announced it is speeding up its production and is expected to increase supply to China this year. At the same time, more than 10 medical companies are developing domestic vaccines.

In the face of shortages, experts and media have been advocating for women to not wait to book the 9-valent vaccine, but get any available.

A commentary in state-run Workers’ Daily in December said “it’s hard to change the supply shortage within a short time”, suggesting authorities come up with a better allocation system as well as promote the 2-valent and 4-valent vaccines to relieve pressure on supply for the 9-valent.

“Get any shot you can make an appointment for,” the Hangzhou-based gynaecologist said. “It’s definitely better than having no shots.”

In line with the WHO’s call to eliminate cervical cancer in 2018, China has introduced free shots of a domestic 2-valent vaccine for girls under 14 in multiple cities and pushed to increase awareness.

Qiao told CCTV that his suggestion was to have free shots for girls under 15, the age when vaccines were most effective and protection most needed.

Meanwhile, for other women in China, it is a game of survival, with the quickest securing a slot.

Even though she missed the chance to receive the 9-valent vaccine, Chen said she was glad to have at least some protection against the most dangerous strains through the 4-valent vaccine.

“At least now I’m protected,” she said.