Preamble

Expert Consensus on Health Promotion Strategies for Adult Vaccination in China

Affiliations: Institute for Healthy China, Tsinghua University; School of Public Health, Peking University; School of General Practice, Southern University of Science and Technology; Public Health Security and Health Professional Committee of the China Society of Public Safety.

Vaccine-preventable diseases impose a heavy health burden on the adult population. Currently, China faces numerous shortcomings in its adult immunization programs that require urgent attention and resolution. The Expert Consensus on Health Promotion Strategies for Adult Vaccination in China was spearheaded by the Institute for Healthy China at Tsinghua University, the School of Public Health at Peking University, the School of General Practice at Southern University of Science and Technology, and the Public Health Security and Health Professional Committee of the China Society of Public Safety, in collaboration with experts and scholars from multiple domestic institutions.

This consensus integrates evidence-based scientific data with the practical wisdom and experience of multidisciplinary experts in fields related to immunization promotion. It addresses the necessity and health value of adult vaccination, analyzes the current status and challenges of China's adult vaccination service system, and applies the theory of integrating clinical medicine with prevention. Furthermore, it establishes an expert consensus on promoting vaccine prescriptions by general practitioners and constructing a strategic framework for adult immunization. By providing scientific, systematic, and actionable recommendations, this document aims to offer guidance for government decision-makers, public health agencies, healthcare providers, and health promotion practitioners. Ultimately, it seeks to advance vaccination efforts for key adult populations through a life-cycle perspective.

Keywords: Adult vaccination; Health promotion; Expert consensus; Immunization program

1 Introduction

Vaccination is one of the most successful and cost-effective public health interventions in human history. While pediatric immunization programs have achieved remarkable success globally, the burden of vaccine-preventable diseases (VPDs) among adults remains significant due to population aging, the prevalence of chronic diseases, and the waning of vaccine-induced immunity over time. In China, as the demographic structure shifts and the "Healthy China 2030" initiative progresses, the importance of adult vaccination has become increasingly prominent.

2 The Necessity and Health Value of Adult Vaccination

Adult vaccination is a critical component of healthy aging and life-cycle health management. For adults, particularly the elderly and those with underlying medical conditions, vaccines for influenza, pneumococcal disease, herpes zoster, and hepatitis B can significantly reduce morbidity, hospitalization rates, and mortality. Beyond individual protection, high uptake of adult vaccines contributes to herd immunity, reduces the economic burden on the healthcare system, and prevents the exacerbation of chronic diseases triggered by infectious agents.

3 Current Status and Challenges of Adult Vaccination in China

Despite the established benefits, adult vaccination coverage in China remains suboptimal compared to pediatric programs. Several systemic challenges persist:
- Policy and Funding: Unlike the primary immunization program for children, most adult vaccines are classified as non-immunization program vaccines (Category II), requiring out-of-pocket payment, which limits accessibility for low-income populations.
- Service Delivery: The current vaccination system is primarily designed for children, and the service capacity for adults in primary healthcare settings needs strengthening.
- Public Awareness: There is a widespread misconception that vaccines are only for children, leading to low vaccine literacy and hesitancy among the adult population.
- Provider Engagement: Clinical physicians, particularly general practitioners (GPs), often lack the standardized training and incentives to proactively recommend or prescribe vaccines to their adult patients.

4 Strategies for Integrating Clinical Medicine and Prevention

To address these challenges, this consensus emphasizes the "integration of medical treatment and prevention" (医防融合). A core strategy is the implementation of "vaccine prescriptions" by general practitioners. As the gatekeepers of community health, GPs are uniquely positioned to assess the immunization status of adult patients during routine consultations for chronic disease management or general check-ups.

4.1 Promoting Vaccine Prescriptions by General Practitioners

General practitioners should incorporate vaccination history into electronic health records and provide personalized immunization recommendations based on the patient's age, health status, and occupation. Standardizing the process of "ask, advise, and refer" within the clinical workflow can significantly increase vaccine uptake.

4.2 Strengthening the Adult Immunization Service System

It is essential to optimize the layout of vaccination clinics to make them more "adult-friendly." This includes extending service hours, utilizing digital platforms for appointment scheduling, and ensuring that specialized clinics (such as hepatitis or respiratory departments) can provide on-site vaccination services for high-risk groups.

5 Constructing a Strategic Framework for Adult Immunization

The consensus calls for the development of a comprehensive national strategy for adult immunization. This includes:
- Evidence-Based Policy Making: Utilizing health economic evaluations to gradually incorporate cost-effective adult vaccines into the national or regional immunization programs or medical insurance coverage.
- Multi-Sectoral Collaboration: Fostering cooperation between government agencies, academic institutions, and community organizations to create a supportive environment for adult vaccination.
- Health Education and Promotion: Implementing targeted health communication strategies to improve vaccine literacy among adults and healthcare providers, addressing specific concerns regarding vaccine safety and efficacy.

6 Conclusion

The promotion of adult vaccination is a vital task for achieving the goals of the Healthy China initiative. By strengthening the service system, empowering general practitioners, and enhancing public awareness, China can build a robust defense against vaccine-preventable diseases across the entire life course. This consensus serves as a scientific roadmap for stakeholders to collaborate in protecting the health and well-being of the adult population.

Abstract

Vaccine-preventable diseases impose a significant health burden on adults in China，highlighting urgent needs to address gaps in the current adult immunization program. The Expert Consensus on Health Promotion Strategies for Adult Vaccination in China was developed through collaboration among experts from multiple institutions，led by the Institute for Healthy China at Tsinghua University，the School of Public Health at Peking University，the School of General Practice and Health Management at the Southern University of Science and Technology，and the Public Health Security and Health Committee of the China Society of Public Security Science and Technology. Integrating evidence-based scientific research and practical insights from multidisciplinary experts in immunization promotion，this consensus addresses the necessity and health value of adult vaccination，the current status and challenges of adult vaccination services in China，and expert recommendations for advancing strategies such as integrating medical and preventive care，promoting vaccine prescriptions by general practitioners， and developing a national adult immunization strategy. The consensus aims to provide scientific，systematic，and actionable guidance for government policymakers，public health agencies，healthcare providers，and health promotion practitioners to facilitate vaccination efforts for key adult groups from a life-cycle perspective.

Key words Adult vaccination；Health promotion；Expert consensus；Immunization program

1 共识制订方法

This consensus was jointly initiated by the Institute for Healthy China at Tsinghua University, the School of Public Health at Peking University, and the Public Health Safety and Health Professional Committee of the China Association for Public Safety. The project was launched in April 2025.

Institute for Healthy China, Tsinghua University; School of Public Health, Peking University; Southern University of Science and Technology, et al. Expert consensus on health promotion strategies for adult vaccination in China [J]. Chinese General Practice, 2026. [Epub ahead of print].

Editorial Office of Chinese General Practice. This is an open access article under the CC BY-NC-ND 4.0 license.

Chinese General Practice. The review period is 5 months, with the external review scheduled for September 2025 and finalization set for September 2025.

Intended Users and Target Population
The intended users of this consensus include government decision-making departments, public health agencies, healthcare providers, and health promotion practitioners. It aims to guide these stakeholders in scientifically formulating and implementing vaccination strategies for the adult population from a life-course perspective.

Consensus Development Group
The development group for this consensus consists of a consensus expert panel, a writing group, and a secretariat. The consensus expert panel comprises 47 members selected based on their extensive theoretical and practical experience in vaccination and related disciplines. Their expertise spans multiple fields, including health policy, health promotion, vaccine immunology, and guideline methodology. Their primary responsibilities include the overall evaluation, demonstration, revision, and refinement of the consensus.

The writing group is composed of experts with backgrounds in general medicine, guideline methodology, and immunization program research and practice. They are responsible for the initial drafting, revision, and improvement of the consensus. The academic secretariat is responsible for literature retrieval, coordination, manuscript integration, and proofreading.

Using keywords such as "adult vaccination," "adult immunization," "immunization program," "immunization service system," "adult vaccine uptake," "vaccine uptake among adults," "vaccines for adults," "immunization policy," "immunization strategy," "vaccination policy," "vaccination program," "immunization delivery system," "vaccination infrastructure," and "immunization service provision," we systematically searched databases including PubMed, Web of Science, Embase, Scopus, CNKI, and Wanfang Data. Additionally, relevant materials were retrieved from the websites of the National Health Commission, the National Disease Control and Prevention Bureau, and the Chinese Center for Disease Control and Prevention. Evidence was incorporated from domestic and international guidelines, consensuses, systematic reviews, meta-analyses, and randomized controlled trials. The search period extended from the inception of each database to July 30, 2025, with no language restrictions. Based on the evidence-based medical findings and summarized recommendations from the retrieved literature, the writing group drafted the initial consensus. The expert panel held multiple rounds of meetings to discuss, review, and finalize the document, ultimately forming the final consensus.

Quality of Evidence and Strength of Recommendation
The consensus expert panel scored each individual recommendation. For every recommendation, experts used a 5-point Likert scale, where 5 points represented "strongly agree," 4 points "agree," 3 points "neutral," 2 points "disagree," and 1 point "strongly disagree." The degree of consensus was defined as the proportion of experts who gave a score of 5 (with a total of 43 experts voting). A recommendation was considered to have reached consensus if the agreement rate exceeded 80%, resulting in a "strong recommendation" status. This consensus distilled a total of 18 recommendations, all of which reached the required level of consensus.

Conflict of Interest Statement
During the development of this consensus, all participating experts and members of the consensus working group signed written declarations of interest. No conflicts of interest related to pharmaceutical companies exist in connection with this consensus.

Publication, Dissemination, and Update of the Consensus
To promote the dissemination and application of this consensus in vaccination efforts, it will be published in professional journals. Following publication, it will be disseminated nationwide through academic conferences, training courses, and other formats. The consensus development group will regularly conduct literature searches and evidence updates, with plans to update the consensus every 3 to 5 years.

2 成人疫苗接种的必要性与健康价值

Recommendations and Evidence

Recommendation: Vaccination is the most cost-effective means of preventing and controlling infectious diseases. It can reduce the incidence of various infectious diseases and certain chronic conditions, as well as the risk of severe illness and death. As infectious diseases increasingly challenge public health emergency systems and the population aging process accelerates, the public health value of adult immunization has become increasingly prominent. It is essential to promote adult vaccination efforts in a comprehensive and robust manner. (Consensus level: 95.7%)

Interpretation and Evidence: Under the grand blueprint of the "Healthy China" strategy, General Secretary Xi Jinping has emphasized that people's health must be placed in a strategic position of priority development, ensuring health protection across the entire life cycle and in all aspects. This programmatic instruction points the way for the development of China's public health undertakings. As a key means of preventing infectious diseases and ensuring national health, immunization programs should be fully and deeply implemented. Currently, numerous shortcomings in China's adult immunization planning must be addressed and resolved.

Vaccine-preventable diseases impose a heavy health burden on adults. Vaccination is the most economical and effective public health measure for preventing and controlling infectious diseases; it can prevent more than 30 types of life-threatening diseases and infections, saving 3.5 to 5 million lives annually from diseases such as diphtheria, tetanus, pertussis, influenza, and measles. In cases of co-infection, the mortality burden is even more severe. Vaccination not only effectively prevents and controls relevant acute infectious diseases but is also increasingly used to prevent and control certain chronic diseases, significantly reducing disease burden and mortality rates. For example, the incidence of herpes zoster increases significantly with age; seasonal influenza vaccination can reduce hospitalization and mortality rates among elderly patients with diabetes by 45% and 38%, respectively, and is associated with a lower risk of cardiovascular death. Compared to unvaccinated individuals or those with unknown status, recipients of the 23-valent pneumococcal polysaccharide vaccine (PPV23) experience shorter hospital stays and a reduced risk of serious in-hospital adverse events. Among patients hospitalized for acute heart failure, influenza vaccination during hospitalization can improve survival rates and reduce the risk of readmission within the following 12 months.

At the same time, while infectious diseases pose a serious threat to elderly people and adults, public awareness regarding the use of vaccines to prevent infection and reduce the risk of severe illness and death remains low. Professional groups, including medical personnel, still exhibit "vaccine hesitancy," and the adult vaccination service system remains incomplete. The World Health Organization's (WHO) Immunization Agenda 2030 (IA2030) emphasizes life-course immunization and the goal of "leaving no one behind." Similarly, the "Healthy China 2030" Planning Outline explicitly states that the strategy must shift from a "child-centered" focus to an immunization strategy covering the entire population and the full life cycle \cite{13-14}, thereby achieving additional public health benefits at a relatively low incremental cost.

As the challenges posed by infectious diseases to the public health emergency system increase and the aging of the population accelerates, the public health value of adult immunization has become more prominent. Globally, millions of people still fail to benefit from vaccines that prevent severe illness and death each year. Furthermore, the "anti-vaccination" phenomenon persists, and "vaccine hesitancy" has been listed by the WHO as one of the top ten threats to global health. Although China has achieved significant success in the prevention and control of vaccine-preventable infectious diseases,

adult vaccination coverage remains at an extremely low level \cite{16}. In 2021, the vaccination rates for PPSV23 among people aged 18–59 and those aged $\ge 60$ were only 0.06% and 1%, respectively. The first-dose coverage of the Human Papillomavirus (HPV) vaccine among adult women was 2.34%, with the full-course completion rate under 1%. Influenza vaccination rates were 0.52% for those aged 18–59 and 4.63% for those aged $\ge 60$.

Adult vaccination primarily relies on individual out-of-pocket payments, as coverage from medical insurance and government subsidies is limited. Only a few regions have included specific vaccines for the elderly or high-risk groups in public-funded programs or medical insurance reimbursement pilots, making it difficult to establish a nationwide system. On September 26, 2025, the Epidemic Prevention and Control Group of the State Council's Joint Prevention and Control Mechanism issued the "Notice on Strengthening the Prevention and Treatment of Key Infectious Diseases such as COVID-19 during the 2025 National Day and Mid-Autumn Festival and the Autumn/Winter Season." This document explicitly stated the need to strengthen vaccination and medical treatment, actively mobilize key populations to proactively receive vaccines for influenza, COVID-19, and pneumococcal disease, explore the use of "vaccine prescriptions" for suitable populations, and encourage regions with the necessary resources to implement free vaccinations for high-risk groups. It also emphasized maintaining high vaccination rates for the National Immunization Program, strengthening catch-up vaccinations in areas with weak routine immunization, and conducting targeted emergency vaccinations.

Internationally, the pneumococcal vaccination rate among people aged 65 and older in the United States reached 64% in 2022, yet the comprehensive coverage rate for all adults completing age-appropriate vaccinations remained only 22.8%. The United States has established a national-level adult vaccination program, strengthening infrastructure and regular recommendation mechanisms. Japan has designated 18 vaccines as statutory "routine vaccinations"; following this inclusion, varicella vaccine coverage rapidly rose to over 95%, while the coverage for the pneumococcal vaccine for the elderly (which requires partial out-of-pocket payment) was only 33.5%. Although European Union countries generally recommend free influenza and pneumococcal vaccinations for people aged $\ge 65$, the average influenza vaccination rate in 2018 was only 45%, falling far short of the 75% policy target. In Western Europe and the United States, the influenza vaccination rate among patients with heart failure is relatively high at approximately 60%; however, in China, the influenza vaccination rate for heart failure patients is estimated to be below 1%. Most developed countries promote adult immunization through multiple measures such as medical insurance coverage, financial subsidies, and proactive recommendations by medical staff. In contrast, China is still in the initial stages, and the relevant institutional systems urgently require systematic construction and strategic exploration.

3 中国成人疫苗接种服务体系的现状与挑战

[Recommendation: China's current immunization program focuses primarily on children. It is essential to actively expand adult immunization channels and improve the service delivery system. (Consensus: 93.6%)]

Interpretation and Evidence: China's current immunization program is centered on children, and adult vaccination services rely mainly on vaccination units within medical institutions. The traditional model involves providing adult vaccinations during time slots staggered with pediatric clinics. In recent years, some regions have established independent adult vaccination clinics or utilized rabies clinics to expand adult services. Certain provinces and cities have explored broadening financing channels by encouraging high-risk groups to receive non-immunization program vaccines—such as influenza, pneumococcal, and HPV vaccines—through free programs or medical insurance reimbursement (e.g., free influenza vaccination for the elderly, children, and healthcare workers). During 2020–2021, the nationwide mobilization for COVID-19 vaccination rapidly established a four-tier service network covering national, provincial, municipal, and county levels. This effort accumulated significant experience in digital management and achieved the integration of immunization information systems across levels and provinces. This experience demonstrates the capacity to rapidly expand immunization service systems during public health emergencies and provides a valuable reference for the future construction of routine adult vaccination systems. In recent years, the state has strengthened primary healthcare institutions and the general practitioner (GP) system. Some regions are exploring the integration of adult vaccination into community health and chronic disease management workflows. For instance, pilot "vaccine prescription" models allow GPs to assess vaccination needs during routine consultations and issue recommendations. At the informatics level, efforts are underway to establish electronic vaccination records and reminder systems, incorporating adult vaccination records into public health information platforms to achieve data interconnectivity.

While promoting adult vaccination, it is equally important to upgrade and expand the National Immunization Program (NIP) for children. If resources are relatively limited, priority should be given to enhancing pediatric immunization. This includes transitioning from oral poliovirus vaccines (OPV) to inactivated poliovirus vaccines (IPV) and adding vaccines with a high disease burden and proven safety and efficacy—such as influenza and varicella vaccines—to the pediatric NIP.

[Recommendation: The primary challenges facing adult vaccination include insufficient accessibility and convenience of services, high costs, and vaccine hesitancy. Non-immunization program vaccination units face issues regarding sustainable development and multiple burdens, leading to a lack of motivation among vaccination personnel. (Consensus: 85.1%)]

Interpretation and Evidence: Currently, immunization services face multiple burdens. The number of vaccination units is decreasing, and there is a shortage of units in remote areas. Vaccination tasks are increasing, with growing demands for catch-up immunizations, routine vaccinations, and influenza and COVID-19 vaccinations, placing higher requirements on the service capacity of vaccination units. During large-scale vaccination campaigns, units must possess stronger organizational coordination and service delivery capabilities.

From the public's perspective, the low rate of adult vaccination in China is primarily due to issues regarding trust in vaccines and services, public complacency, and service convenience. (1) Trust: This refers to confidence in the safety and efficacy of vaccines, the healthcare system, and vaccination personnel. Concerns about vaccine safety are a major driver of "vaccine hesitancy." (2) Complacency: This refers to an underestimation of the risks posed by diseases and skepticism regarding the necessity of vaccination. (3) Convenience: This includes vaccine supply capacity, affordability, and the accessibility of immunization services. The willingness to receive adult vaccinations is closely linked to health education and promotion. There is a common misconception that vaccination is only necessary for children. Furthermore, recommendations from clinical experts significantly influence patient choices. Therefore, it is essential to involve clinicians in the immunization service system and ensure multi-departmental collaboration for health promotion to correct these misconceptions.

Overall, adult vaccination in China still faces multiple bottlenecks. (1) Low vaccination rates: Non-immunization program vaccines must be paid for out-of-pocket, leading to a general lack of willingness to vaccinate. (2) Inadequate payment mechanisms: Most adult vaccines are not covered by medical insurance or public programs, and government subsidies are insufficient. Only a few regions have launched pilot programs (e.g., free influenza vaccines or insurance reimbursement for pneumonia vaccines), but these have limited coverage and poor sustainability. (3) Imperfect service systems: Existing adult vaccination sites are mostly concentrated in municipal and county Centers for Disease Control (CDCs) and general hospitals. Coverage in primary community health centers and township health centers is low, and vaccination sites are scarce in rural areas. (4) Insufficient professional workforce: Existing personnel and equipment primarily serve pediatric immunization, with minimal investment in training for adult vaccination services. (5) Lack of public awareness: Awareness of vaccines among adults is generally low, with insufficient understanding of infection risks and the benefits of immunity. (6) Low recommendation rates: Some medical personnel pay little attention to adult immunization and rarely recommend it. (7) Lack of legal and policy frameworks: The current Vaccine Administration Law of the People's Republic of China focuses on pediatric immunization and lacks systematic institutional design for adult vaccines. There is no unified national adult immunization program or recommended schedule, leading to inconsistent standards across regions. (8) Difficulties in institutional development: Medical institutions lack clear policy support and incentives to open adult vaccination clinics. Resource constraints, a clinical-heavy/prevention-light mindset among staff, and "vaccine hesitancy" further restrict the development of the adult immunization system. In summary, China's adult immunization system started late and remains incomplete, requiring top-level design and departmental synergy modeled after the experience of the pediatric immunization program.

Existing practices prove that standardized promotion of adult vaccination clinics not only improves efficiency but also ensures the safety and efficacy of vaccination. Furthermore, it increases public attention toward vaccines. In particular, the awareness, recognition, and acceptance of influenza, pneumococcal, and herpes zoster vaccines among the elderly have significantly improved. Long-term vaccination plans, quantified strategies, and stable demand are essential to fostering sustainable development.

4 医防融合与成人免疫协调共进

Recommendations for Enhancing Immunization Services through Medical-Preventive Integration

Recommendation: Enhance the quality and standards of immunization services through the integration of medical and preventive care. This should involve establishing vaccination clinics within medical institutions according to appropriate standards, improving supporting facilities, and integrating Hospital Information Systems (HIS) with immunization information systems to streamline internal payment and vaccination workflows. (Consensus: 85.1%)

Interpretation and Evidence: Medical personnel should possess fundamental knowledge of vaccines and immunization, consciously raise their awareness of preventive care, and proactively seek vaccination for themselves while actively recommending it to patients. When designing information management modules for adult immunization, developers should include fields for chronic disease history. This allows clinicians to recommend tailored vaccination schedules based on a patient’s specific health status. Furthermore, medical institutions must improve supporting infrastructure and bridge the gap between HIS and immunization planning systems. By sharing data on vaccination history, health status, and contraindications for key populations, these integrated systems can rapidly estimate vaccination coverage and disease incidence. This provides a robust platform for evaluating immunization effectiveness and offers scientific evidence for government decision-making.

Recommendation: Expand the scope of adult immunization services by extending service hours, establishing mobile vaccination sites, and strengthening personnel training and technical guidance. (Consensus: 85.1%)

Interpretation and Evidence: To improve the service capacity of vaccination units, service hours should be extended based on demand. Considering the convenience of different populations, adult vaccination clinics should be opened on weekends and holidays to enhance accessibility. In rural areas, mobile vaccination units (such as specialized vehicles) should provide regular services to resolve accessibility issues for residents in remote or underdeveloped regions. Regular training and technical guidance—delivered through workshops and online learning platforms—should be provided to ensure staff are updated on the latest vaccine knowledge and administration techniques, thereby improving professional quality and service standards.

Recommendation: Promote the integration of diagnosis, testing, consultation, and vaccination services to bridge the "last mile" of healthcare delivery. (Consensus: 89.4%)

Interpretation and Evidence: Under the framework of medical-preventive integration, vaccination consultation windows should be established in hospital outpatient departments to provide a "one-stop" service. General practitioners (GPs) should provide on-site vaccination services for collective units and special populations. To further bridge the "last mile," green channels and priority vaccination mechanisms should be established for key groups such as the elderly and children, reducing waiting times and enhancing convenience.

Recommendation: Drive medical-preventive integration based on the responsibility list for infectious disease prevention and control in medical institutions. (Consensus: 91.5%)

Interpretation and Evidence: Performance appraisals should serve as a guiding mechanism by establishing key performance indicators (KPIs). Process indicators should include vaccination rates and family doctor contract coverage, while outcome indicators should include regional disease incidence rates. Strengthening the development of public health and preventive medicine departments is essential to ensure adequate staffing and departmental infrastructure, supporting institutions in fulfilling their responsibilities. A dynamic adjustment mechanism should be implemented to update appraisal weights based on epidemiological data, such as increasing the weight of vaccination targets during influenza season.

Recommendation: The government should lead policy restructuring, including revising laws and regulations to clarify financial guarantee mechanisms for medical-preventive integration and removing policy bottlenecks regarding the use of medical insurance for vaccines and other preventive drugs. (Consensus: 89.4%)

Recommendation: Remove vaccines from the "drug-to-total-revenue ratio" (drug-to-income ratio) assessment in public hospitals. Vaccines for influenza, pneumonia, tetanus, and HPV should be included in the Basic Medicine List or excluded from the drug ratio assessment. (Consensus: 86.0%)

Recommendation: Achieve a "win-win" cycle of sustainable medical insurance funds and enhanced primary healthcare capacity by increasing investment in preventive care to reduce the overall disease burden. (Consensus: 89.4%)

Interpretation and Evidence: Under a closed-loop policy model of "Prevention - Cost Control - Development," strengthening preventive medical investment increases vaccination coverage. This effectively reduces the incidence of infectious diseases and complications from chronic diseases, thereby alleviating service pressure on primary healthcare.

Simultaneously, the medical insurance global budget system can provide "empowerment funds" in advance to improve the cash flow and service capacity of medical institutions. As a reduction in medical demand translates into fund surpluses, these funds can be used for primary care staff training and performance incentives. This strengthens the preventive and diagnostic capabilities of primary healthcare institutions. As primary care capacity improves, disease prevention and control become more robust, allowing medical insurance funds to be sustained and reinvested into primary care. This creates a virtuous cycle between medical-preventive integration, insurance sustainability, and primary service capacity.

Recommendation: Utilizing medical insurance payment policy as a lever to shift focus from "treating illness" to "preventing illness," and from "lowering fees" to "lowering incidence," is a critical and necessary step in promoting adult immunization programs. (Consensus: 85.1%)

Interpretation and Evidence: Currently, there is a conflict in policy objectives: the short-term goal of medical insurance cost control (annual totals) contradicts the long-term returns of preventive investment (which typically manifest in 3–5 years). Furthermore, some regions still include vaccine costs in the "drug ratio" calculations, which disincentivizes their use.

During the process of system integration, data standards for medical care and public health remain unaligned. For instance, International Classification of Diseases (ICD) codes are often disconnected from infectious disease reporting systems, and hospital information silos make it difficult to connect with vaccination systems. Because prescribing authority is often separated from appraisal authority, the general practitioner system has not yet fully integrated diagnostic and preventive functions.

Regarding innovation in payment mechanisms, pilot programs for "capitation-based prepaid packages" or "pay-for-health-outcomes" should be implemented. Exploration of multi-party co-payment models for vaccines—involving medical insurance, government finance, and individual contributions—is recommended. By allowing integrated medical communities to retain surpluses from global budgets, they are incentivized to invest in preventive services to reduce long-term expenditures. Specific budgets should be set to avoid short-term cost-cutting behaviors. Through coordination with Diagnosis-Related Groups (DRG) or Diagnosis-Intervention Packet (DIP) reforms, vaccination should be incorporated into the cost accounting of disease types to reduce expenditures for related DRG groups. Finally, medical insurance settlement systems must be interfaced with immunization planning information platforms.

5 推进全科医生疫苗处方

Recommendations and Evidence

Recommendation: Leverage the role of general practitioners (GPs) in integrating clinical medicine with preventive care and adult immunization. Implement national basic public health services by incorporating vaccination into the entire continuum of health management. Gradually introduce "vaccination prescriptions" issued by GPs, and strengthen the responsibility of medical personnel to recommend vaccines by integrating these actions into performance appraisals and training programs. (Consensus: 87.2%)

Interpretation and Evidence: Adhering to the strategy of integrating clinical and preventive medicine, GPs in primary healthcare institutions should simultaneously conduct disease diagnosis, treatment, and health education. This approach achieves a seamless connection between medical care and prevention, helping patients gain an objective and scientific understanding of vaccine safety and efficacy. GPs should recommend vaccinations to elderly populations and patients with chronic diseases, conduct in-depth assessments of health status and contraindications, and monitor post-vaccination health to build confidence in immunization. To increase coverage, prevention must be integrated into clinical practice in accordance with the Healthy China Action and the Technical Guidelines for Seasonal Influenza Vaccination in China. Personalized health management, collective health education, and immunization services should be implemented for patients with hypertension, diabetes, pregnant women, children aged 0–6, and the elderly as part of national basic public health projects.

Vaccination should be embedded into the entire health management process, including physical examinations, chronic disease management, and family doctor contract services. Secondary and higher-level general hospitals may establish adult immunization clinics or set up vaccination areas in conjunction with maternal and child health or health examination departments. During peak influenza seasons, centralized vaccination activities should be organized to allow target populations to complete their shots in a single visit. It is essential to promote the construction of integrated "General Practice + Immunization" clinics, upgrade information systems to improve data interoperability, and refine resident health records.

The implementation of GP vaccination prescriptions should be supported by professional competency evaluations. Training should be provided to ensure doctors and primary healthcare workers master adult vaccination guidelines, enabling them to actively inquire about vaccination history and provide recommendations during outpatient visits, physical exams, and chronic disease follow-ups. By promoting "vaccine prescriptions," GPs can include specific vaccine recommendations within a comprehensive health plan; once a prescription is issued, patients can complete the process at a vaccination clinic or a partner pharmacy. Furthermore, influenza and pneumonia vaccination rates among the elderly and chronic disease patients managed by GPs should be included in professional competency evaluations and performance appraisal standards. Medical education should introduce "Integrated Clinical and Preventive Practice" courses, such as simulation training for vaccine prescribing. Building on the pilot system for public health physicians, their role in the vaccine prescription process should also be explored.

Recommendation: Prepare the necessary infrastructure for vaccine-prescribing units, expand the delivery formats of adult vaccination services, and fully utilize information technology and Artificial Intelligence (AI) auxiliary tools. (Consensus: 83.0%)

Interpretation and Evidence: Units authorized to prescribe vaccines must have clearly defined service areas and populations, the capacity to provide both adult immunization and clinical services simultaneously, a robust Hospital Information System (HIS), and a solid foundation in adult immunization and disease management. Under effective supervision, the delivery of adult vaccination services should be expanded to private clinics, pharmacies, workplaces, community health centers, and schools to improve convenience and utilize clinical injection rooms effectively. Leveraging information technology and AI-assisted prescribing tools will allow "intelligent GPs" to play a vital role in generating personalized vaccine prescriptions.

Recommendation: Advance the implementation of Large Language Models (LLMs) and intelligent monitoring and early warning systems to identify, monitor, and evaluate key populations, providing evidence-based support for their vaccination. (Consensus: 87.2%)

Interpretation and Evidence: By integrating intelligent active surveillance and early warning systems for infectious diseases, key populations can be identified to develop stratified and categorized vaccination strategies.

Priority must be given to ensuring that high-risk groups—including the elderly, patients with chronic diseases, healthcare workers, and women of childbearing age—receive vaccines for influenza, pneumonia, and HPV. Convenient vaccination channels should be provided for mobile populations and specific occupational groups (e.g., medical staff, livestock farmers, and military personnel). A data-driven risk monitoring and evaluation system should be established, alongside a target management system for adult vaccination rates, incorporating these rates into the performance evaluations of local governments and health institutions. Furthermore, the construction of a unified national adult vaccination information system is necessary to achieve real-time data monitoring and inter-regional comparative feedback.

Adopting a "peacetime-wartime integration" approach, timely assessments should be conducted during specific periods (such as influenza season) to organize centralized vaccination activities for key populations.

Recommendation: Establish incentive mechanisms to increase fees or subsidies for vaccine prescriptions, and further promote a hierarchical vaccine prescription system in the future. (Consensus: 85.1%)

Interpretation and Evidence: Clear and actionable incentive mechanisms should be established to increase subsidies for GPs and clinicians who issue vaccine prescriptions.

The "Vaccine Prescription" model holds different significance for primary healthcare units versus general hospitals. As the system matures, primary healthcare institutions will primarily focus on issuing vaccine prescriptions for common conditions such as hypertension and diabetes. In contrast, general hospitals will focus on prescriptions for complex clinical cases, such as those involving rheumatology and immunology.

6 构建成人免疫战略规划

[Recommendation: Promote regional, school-local, and international cooperation; strengthen evidence-based research and vaccine R&D; clarify the importance and priority of vaccines; and establish a consensus on prioritization. (Consensus level: 85.1%)]

Interpretation and Evidence: Cooperation should be strengthened between national and provincial disease control agencies and think tanks—including universities, academic societies, and research institutes—to foster scientific innovation in immunization programs and health promotion. Collaborative efforts should be undertaken to monitor disease burden and vaccine demand among high-risk populations (e.g., the elderly, patients with chronic diseases, and pregnant women). Furthermore, evidence-based research should be conducted on adult vaccination interventions, immune efficacy evaluations, and cost-benefit analyses. This research should demonstrate sustainable development models for "vaccine prescription" services, including mechanisms to reduce the financial burden on residents through government subsidies, medical insurance payments, and commercial insurance. Costs should be further reduced by optimizing resource allocation and improving service efficiency.

It is essential to clarify the importance and priority of various vaccines to reach a consensus on implementation. Drawing on effective international practices while encouraging innovative implementation, stakeholders should conduct in-depth investigations and pilot programs tailored to China's specific conditions. These efforts should be scientifically evaluated to create a "China Experience" that is replicable and scalable. High-quality data must be utilized to track immunization progress, advance the digitalization of immunization programs, and support scientific decision-making. International cooperation and exchange regarding immunization programs should be expanded, alongside the cultivation and training of specialized research talent to ensure robust innovation capabilities. Finally, the R&D of new vaccines—including nucleic acid vaccines, combination vaccines, multivalent vaccines, and therapeutic vaccines—must be further strengthened to provide technical support for expanding the National Immunization Program and reducing the burden of vaccine-preventable diseases.

[Recommendation: Health departments and disease control agencies should take the lead, with multi-departmental synergy, to jointly construct a strategic plan for adult immunization. (Consensus level: 87.2%)]

Interpretation and Evidence: An inter-departmental linkage mechanism should be established to integrate adult immunization into strategic plans for healthy aging, chronic disease prevention and control, and the "Healthy Cities" initiative. The respective scopes of work for the Health Commission, the Bureau of Disease Control, and the Centers for Disease Control (CDC) must be scientifically defined and their coordination strengthened.

The health departments should lead coordination with the Ministry of Industry and Information Technology, Civil Affairs, Medical Insurance, Human Resources and Social Security, Finance, Education, and private enterprises. This coordination should focus on defining the priorities of the immunization program, managing existing and incremental resources, and promoting the inclusion of new vaccines into the National Immunization Program. Efforts should be made to layout an adult vaccination network, create policy synergy for adult immunization, and ensure supply and sustainability. Furthermore, monitoring and response strategies for vaccine rumors and misinformation should be strengthened. Authoritative channels should be used to release timely information to improve public vaccine literacy and ensure vaccine production capacity, transportation capabilities, and primary-level vaccination service capacity.

[Recommendation: It is suggested that content related to the adult immunization strategic plan be incorporated into the "15th Five-Year Plan," with strengthened continuous supervision and evaluation of policies. (Consensus level: 89.4%)]

Interpretation and Evidence: With the acceleration of population aging and the increasing burden of chronic diseases, the current prevention and control system—centered on childhood immunization—is no longer sufficient to meet health needs across the entire life cycle. Systematically incorporating the adult immunization strategic plan into the "15th Five-Year Plan" is not only a profound implementation of the "Healthy China 2030" strategy but also a necessary measure to respond to demographic changes and reduce the disease burden.

List of Experts for the "Expert Consensus on Health Promotion Strategies for Adult Vaccination in China"

Consensus Group Chair: Liang Wannian (Vanke School of Public Health and Health, Tsinghua University; School of General Practice, Southern University of Science and Technology; Public Health Security and Health Professional Committee of the China Association for Public Safety).

Lead Author: Liu Jue (School of Public Health, Peking University).

Consensus Expert Group (Ordered by Pinyin surname): Chen Tao (Institute of Public Safety Research, Tsinghua University), Chen Zhiping (Zhejiang Provincial Center for Disease Control and Prevention), Cheng Feng (Vanke School of Public Health and Health, Tsinghua University), Chi Chunhua (Peking University First Hospital), Deng Yunfeng (Emergency Management Training Center of the Central Party School of the CPC), Feng Zhanchun (School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology), Guang Ming (Shanxi Provincial Center for Disease Control and Prevention), Huang Cunrui (Vanke School of Public Health and Health, Tsinghua University), Huang Yixiang (School of Public Health, Sun Yat-sen University), Jin Ronghua (Beijing Ditan Hospital, Capital Medical University), Lei Jie (Shandong Provincial Center for Disease Control and Prevention), Li Chang (Midwest Regional Business Cluster Building Research Center), Li Qun (Chinese Center for Disease Control and Prevention), Liang Wannian (Institute for Healthy China, Tsinghua University; School of General Practice, Southern University of Science and Technology), Liang Xian (Chengdu Center for Disease Control and Prevention), Liu Jihong (Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology), Liu Min (School of Public Health, Peking University), Liu Jue (School of Public Health, Peking University), Liu Yanjun (School of Chemical and Environmental Engineering, China University of Mining and Technology), Lyu Zhiyue (Zhongshan School of Medicine, Sun Yat-sen University), Mao Ying (School of Public Policy and Administration, Xi'an Jiaotong University), Niu Yan (Health Emergency Center, Chinese Center for Disease Control and Prevention), Ou Jianming (Institute of Emergency Response and Epidemic Management, Fujian Provincial Center for Disease Control and Prevention), Pan Peng (Scientific Research Department, Second Affiliated Hospital of Harbin Medical University), Pang Jinman (Emergency Department, Jinan Third People's Hospital), Shi Jian (Emergency Office, Hebei Provincial Center for Disease Control and Prevention), Tu Wenxiao (Health Emergency Center, Chinese Center for Disease Control and Prevention), Wang Caiping (Department of Emergency Technology and Management, Xi'an University of Science and Technology), Wang Chenguang (School of Law, Tsinghua University), Wang Yadong (School of Public Health, Capital Medical University), Wu Huanyu (Shanghai Municipal Center for Disease Control and Prevention), Wu Jiabing (Anhui Provincial Center for Disease Control and Prevention), Wu Yonghao (Beijing Community Health Promotion Association), Xu Youchun (School of Biomedical Engineering, Tsinghua University), Yan Hui (Emergency Office, West China Hospital, Sichuan University), Yang Ting (China-Japan Friendship Hospital), Yao Jianyi (Health Communication Center, Chinese Center for Disease Control and Prevention), Yao Laishun (Jilin Provincial Center for Disease Control and Prevention), Yin Zundong (National Immunization Program, Chinese Center for Disease Control and Prevention), Yu Wenzhou (National Immunization Program, Chinese Center for Disease Control and Prevention), Zeng Huatang (Shenzhen Center for Health Development Research and Data Management), Zhang Lulu (Department of Health Service, Naval Medical University of the PLA), Zhang Weiyan (Institute of Immunization and Prevention Management, Shandong Provincial Center for Disease Control and Prevention).

Chinese General Practice

Kun (National Center for Comprehensive Assessment of Drugs and Health Technology), Zhou Lizhi (Beijing Institute of Minimally Invasive Orthopedics), Zhou Mengge (Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences).

Consensus Academic Secretariat: Yan Wenxin (Vanke School of Public Health and Health, Tsinghua University).

The authors declare no conflicts of interest.

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Introduction

Immunization is one of the most successful and cost-effective health interventions in human history. To further advance global immunization efforts, the World Health Organization (WHO) and its partners have developed the "Immunization Agenda 2030: A Global Strategy to Leave No One Behind" (IA2030). This strategic framework aims to ensure that everyone, everywhere, at every age, fully benefits from vaccines for good health and well-being. This paper analyzes the core components of IA2030 and explores its implications for the future of immunization programs in China.

1. Overview of the Immunization Agenda 2030 (IA2030)

IA2030 was designed to address the remaining challenges in global immunization while responding to emerging threats. Unlike previous decades-long strategies, IA2030 emphasizes a bottom-up approach, focusing on community needs and the integration of immunization into primary health care.

1.1 Core Vision and Goals

The vision of IA2030 is a world where everyone, everywhere, at every age, fully benefits from vaccines. Its primary goals include:
- Reducing mortality and morbidity from vaccine-preventable diseases (VPDs).
- Increasing equitable access to new and existing vaccines.
- Strengthening immunization systems as a fundamental part of primary health care and universal health coverage.

1.2 Strategic Priority Areas

The framework is built around seven strategic priority areas:
1. Primary Health Care and Universal Health Coverage: Integrating immunization into the broader health system.
2. Commitment and Demand: Building public trust and ensuring political will.
3. Coverage and Equity: Reaching "zero-dose" children and marginalized populations.
4. Life-course Immunization: Expanding vaccination beyond childhood to include adolescents, adults, and the elderly.
5. Outbreaks and Emergencies: Strengthening the capacity to respond to infectious disease outbreaks.
6. Supply and Sustainability: Ensuring a stable supply of high-quality vaccines and sustainable financing.
7. Research and Innovation: Advancing new vaccine technologies and delivery methods

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