Assessing the impact of the 2018 Changchun Changsheng vaccine incident on childhood vaccination in China

Zhiyuan Hou; Xiaozhen Lai; Yang Liu; Mark Jit; Heidi J Larson; Hai Fang

doi:10.1038/s43856-023-00339-0

Assessing the impact of the 2018 Changchun Changsheng vaccine incident on childhood vaccination in China

Commun Med (Lond). 2023 Aug 22;3(1):114. doi: 10.1038/s43856-023-00339-0.

Authors

Zhiyuan Hou^#¹, Xiaozhen Lai^#^{2

3}, Yang Liu^{4

5}, Mark Jit^{4

5

6}, Heidi J Larson⁴, Hai Fang^{7

8}

Affiliations

¹ School of Public Health, NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China.
² Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China.
³ Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
⁴ Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
⁵ Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK.
⁶ School of Public Health, University of Hong Kong, Hong Kong SAR, China.
⁷ China Center for Health Development Studies, Peking University, Beijing, China. hfang@hsc.pku.edu.cn.
⁸ Peking University Health Science Center-Chinese Center for Disease Control and Prevention Joint Research Center for Vaccine Economics, Peking University, Beijing, China. hfang@hsc.pku.edu.cn.

^# Contributed equally.

Abstract

Background: The 2018 Changchun Changsheng vaccine incident is an emergent public health event in China with reports of DTaP vaccines with compromised efficacy. This study aimed to estimate the impact of the vaccine incident on real-world vaccination behaviors in China.

Methods: A cross-sectional survey was conducted in ten provinces in 2019. Vaccination records were collected from 5294 children aged 6-59 months, with information on 75,579 vaccine doses for seven National Immunization Program (NIP) vaccines and two non-NIP vaccines received from 2014 to 2019. Chi-square test, interrupted time series, and logistic regression were used to evaluate the impacts of vaccine incident on vaccination delay, measured as the proportion of delayed doses out of total doses in schedule.

Results: Here we show significant increases in doses delayed ≤ 3 months (19.12% to 22.51%, p = 0.000) and > 3 months (7.17% to 11.82%, p = 0.000) for DTaP vaccine after the incident. By scaling nationally, there will be extra 2.1 million doses delayed ≤ 3 months and 2.8 million doses delayed > 3 months in the year following this incident. More guardians choose expensive private-market substitutes containing DTaP elements over government-funded DTaP vaccines. Controlling for socio-demographic factors, doses scheduled after the incident have higher odds of delays for DTaP vaccine (OR: 3.49, 95% CI: 3.08-3.96) and other NIP vaccines (OR: 2.76, 95% CI: 2.55-2.99), but not for non-NIP vaccines.

Conclusions: The observed delays in the incident-involved DTaP vaccine immunization reflect the negative effects of the vaccine incident on vaccination behaviors under the NIP. However, its effects seem minimal for non-NIP vaccines.

Plain language summary

In the 2018 Changchun Changsheng vaccine incident, the vaccine manufacturer was accused of producing substandard vaccines with compromised efficacy. This study assessed the impacts of the vaccine incident on subsequent vaccination of children in China. We found that vaccinations occurred later than normal for the specific vaccine involved in the incident, but there was no impact on the timing of other childhood vaccines. Children’s guardians also chose different vaccines from that involved in the vaccine incident. Information about how children’s guardians reacted to this incident could be used to improve the information provided in future about childhood vaccination, and be used to decide how vaccination programs could respond following similar incidents.