Availability of Hib, Pneumococcal, Rotavirus, and HPV vaccines in China: Implication for equity in access to immunization services

Vaccines are cornerstones of public health, yet equitable access remains a major global challenge. While China has achieved sustained high coverage of National Immunization Program (NIP) vaccines, some WHO-recommended cost-effective non-NIP vaccines, such as Hib, pneumococcal conjugate (PCV), rotavirus, and human papillomavirus vaccines (HPV) are not universally accessible and often require out-of-pocket payment. This study examines geographic and urban-rural disparities in the availability of these four vaccines across China using data from a nationally representative China's National Health Accounts survey in 2022, covering 355 district- and county-level disease control centers and 2,609 public primary health facilities across 27 provinces. Availability was defined as the presence of at least one dose delivered or administered. Inequality was assessed using Slope Index of Inequality (SII) and the Erreygers-corrected Concentration Index (CI), based on provincial GDP per capita. We found significant disparities in vaccine availability across economic development levels and urban-rural settings in China. Overall, HPV vaccines were most available (96.9%) and PCV13 the least (86.5%) at the district/county level. Urban areas had markedly higher availability than rural areas, particularly for PCV13 (94.2% vs. 79.1%). At the clinic level, over 70% of urban clinics provided all four vaccine types, compared to just 40% in rural areas. The vaccines with the highest inequality were DTaP-IPV-Hib (CI: 0.408), PCV13 (CI: 0.362), and RV5 (CI: 0.343), indicating strong pro-rich distribution. In contrast, the Hib vaccine demonstrated the lowest inequality (CI: 0.209). These findings highlight significant inequities in the availability of WHO-recommended non-NIP vaccines across China, particularly affecting rural and economically disadvantaged regions underscoring the need of expanding vaccine provision in underserved areas, strengthening rural service capacity, and considering the inclusion of these vaccines in the NIP.