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Table 1 A summary of key findings on Shenzhen’ context and policy content

From: The feasibility of universal HPV vaccination program in Shenzhen of China: a health policy analysis

Context/Categories Key findings
 Situational factor Recent HPV vaccine approval and availability with high demand caused by a decade’s lag
 Structural factors China’s unitary system--Through a Top-down system, National Immunization Program Department in China Center for Disease Control (CDC) disseminates administrative orders and documents including guidelines, regulations and technical proposals to provincial, municipal and district CDC along with the vertical administration system after policies or recommendations are made.
The Municipal People Committee of Shenzhen has legislative authority endowed by the National People Committee as this Special Economic Zone was founded in 1980s. Regarding immunization, Shenzhen has the authority on policy-making of providing other essential vaccines in line with the epidemiological profile of local population.
High-speed economic developments at the frontline of national reform from planned economy to socialist market economy. Growing needs of the citizens come with these economic developments and their voice need to be heard in this city where young immigrants and migrant workers dominate.
 Cultural factors Local population’s acceptance of immunization as prevention measures, attention on children health and increasing awareness of sexuality related issues
 Exogenous influence Impact of program implementation in early adopter countries
International agencies including Bill & Melinda Gates Foundation was cited to play important roles in promoting HPV DNA testing kit and vaccine evaluation despite China is not eligible for the support from the Global Alliance for Vaccines and Immunization.
Content/Themes Key findings
 Role of schools No precedent to immunize adolescents so effectiveness may not be achieved without school coordination but any promotion would be suspected to have a link with business benefits
 Health education to adolescents and parents Concerns on whether integrating HPV into sexual health education by health departments so educational events organized by CDC staff in parent gatherings were recommended to raise awareness
 Private sector engagement Concerns about low quality and low standard service and the capacity of these facilities is questionable to implement such a program of nonprofit nature
Most of civil society organizations in China have administrative level and are framed in a similar top-down structure and their leaders are commissioned by the government.
Pharmaceutical company is responsible and accountable for coping with adverse events and reimbursing sufferers as well as has an important role in surveillance strengthening.
 Catch-up program Benefits from a population-level perspective -- the catch-up program will improve the coverage of target population
Vaccination age indicated in the product instruction-- crucial factor for setting vaccination age and choosing vaccine products in combination with indicators on vaccine safety and effectiveness
 HPV vaccination financing Strong measure of government commitment so the guiding principle to allocate health care resources is to focus on the population with maximized benefits.
Possible strong resistance for a fully-funded program by government for HPV vaccination is not seen as a top priority on policy agenda
 Program initiation Calling for an establishment of rational understanding and assessment of HPV vaccination as an additional measure for cervical cancer prevention based on scientific evidence
Policy advocacy should be taken to influence the government leaders on national priority-setting while in Shenzhen the key step was viewed to lobby someone or a certain organization