The successes have been striking, but the remaining challenges faced by the China program are quite daunting. Although greatly reduced in incidence, the indigenous H1 genotype of measles still circulates in most China provinces. The national goal is to eliminate measles by 2015, an effort that will require a very strong routine immunization program. Once measles is eliminated, the China program will be faced with imported cases until measles is eradicated globally, just like the current situation in the United States.
The China Ministry of Health’s EPI[Expanded Program on Immunization] provides all children in China with free vaccines that protect against 12 diseases: polio, measles, mumps, rubella, diphtheria, tetanus, pertussis, hepatitis B, hepatitis A, Japanese encephalitis, invasive meningococcal disease, and tuberculosis. There is a very good immunization delivery infrastructure for these vaccines, all of which are domestically manufactured.
However, there are several vaccines in use in the US system that are not part of China EPI: Hib, pneumococcal conjugate (PCV), rotavirus, influenza, inactivated poliovirus vaccine (IPV), and human papillomavirus (HPV) vaccines. All of these vaccines except HPV vaccine are licensed and available in China, but parents need to pay out-of-pocket for the non-EPI vaccines. Because these vaccines can be relatively expensive, financially vulnerable children have diminished access to them.