title: Seasonal influenza vaccination in China: Landscape of diverse regional reimbursement policy, and budget impact analysis.
abstract: To explore the current landscape of seasonal influenza vaccination across China, and estimate the budget of implementing a national "free-at-the-point-of-care" vaccination program for priority populations recommended by the World Health Organization.
  
  
  
  In 2014 and 2016, we conducted a survey across provincial Centers for Disease Control and Prevention to collect information on regional reimbursement policies for influenza vaccination, estimated the national uptake using distributed doses of influenza vaccines, and evaluated the budget using population size and vaccine cost obtained from official websites and literatures.
  
  
  
  Regular reimbursement policies for influenza vaccination are available in 61 mutually exclusive regions, comprising 8 provinces, 45 prefectures, and 8 counties, which were reimbursed by the local Government Financial Department or Basic Social Medical Insurance (BSMI). Finance-reimbursed vaccination was offered mainly for the elderly, and school children for free in Beijing, Dongli district in Tianjin, Karamay, Shenzhen and Xinxiang cities. BSMI-reimbursement policies were limited to specific medical insurance beneficiaries with distinct differences in the reimbursement fractions. The average national vaccination coverage was just 1.5-2.2% between 2004 and 2014. A free national vaccination program for priority populations (n=416million), would cost government US$ 757million (95% CI 726-789) annually (uptake rate=20%).
  
  
  
  An increasing number of regional governments have begun to pay, partially or fully, for influenza vaccination for selected groups. However, this small-scale policy approach has failed to increase national uptake. A free, nationwide vaccination program would require a substantial annual investment. A cost-effectiveness analysis is needed to identify the most efficient methods to improve coverage.
authors.affiliation: Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China. Electronic address: yangjuan@chinacdc.cn.
authors.forename: Juan
authors.initials: J
authors.lastname: Yang
authors.affiliation: Modelling and Economics Unit, Public Health England, United Kingdom; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom. Electronic address: katherine.atkins@lshtm.ac.uk.
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Atkins
authors.affiliation: Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China. Electronic address: fenglz@chinacdc.cn.
authors.forename: Luzhao
authors.initials: L
authors.lastname: Feng
authors.affiliation: Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States. Electronic address: pangmingfan@gmail.com.
authors.forename: Mingfan
authors.initials: M
authors.lastname: Pang
authors.affiliation: Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China. Electronic address: zhengym@chinacdc.cn.
authors.forename: Yaming
authors.initials: Y
authors.lastname: Zheng
authors.affiliation: Economics, Department of Economics, Emory University, Atlanta, United States. Electronic address: xinxin.liu@emory.edu.
authors.forename: Xinxin
authors.initials: X
authors.lastname: Liu
authors.affiliation: WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Hong Kong Special Administrative Region. Electronic address: bencowling88@gmail.com.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Cowling
authors.affiliation: School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China. Electronic address: cfetpyhj@vip.sina.com.
authors.forename: Hongjie
authors.initials: H
authors.lastname: Yu
mesh_terms: D000368:Aged; D002648:Child; D002681:China / Q000453:epidemiology; D003365:Costs and Cost Analysis; D018588:Fee-for-Service Plans; D005260:Female; D005380:Financing, Government / Q000191:economics; D006282:Health Personnel; D006801:Humans; D017589:Immunization Programs / Q000191:economics*; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000453:epidemiology / Q000517:prevention & control*; D011156:Population Density; D011247:Pregnancy; D012621:Seasons; D011795:Surveys and Questionnaires; D014611:Vaccination / Q000191:economics*; D000073887:Vaccination Coverage; D014944:World Health Organization
chemical_list: D007252:Influenza Vaccines
keywords: China; Financial management; Influenza vaccination; Subsidization policy