Two domestic companies are also independently developing HPV vaccines. The candidate vaccine developed by Xiamen Innovax Biotech in southeast China's Fujian Province has also entered Phase III trials. An anonymous executive from the company said that if persistent HPV infections are used as a measure, rather than pre-cancerous disease, the company's clinical trials can be shortened by two to three years and the vaccine can be expected to become available in 2018.

Although the vaccine is approved for women up to the age of 26 in most countries, it is generally considered to be best administered between 9 to 15 years old in China, before girls become sexually active and are potentially exposed to HPV.

Without other preventive measures such as screening, a national HPV vaccination program for all 9-15-year-old girls between 2006 and 2012 could have prevented 381,000 cervical cancer cases and 212,000 related deaths in the future when they begin to age. Furthermore, if vaccines are unavailable each additional year will cause 8.43 million girls in this age group to lose their opportunity for vaccination, according to a paper authored by two experts from the Cancer Institute/Hospital, Chinese Academy of Medical Sciences. The paper, titled The Impact of HPV Vaccination Delays in China, was published in the Netherlands-based journal Vaccine in June 2013.

However, some people believe that the prudence exhibited by the Chinese regulatory authority is nothing but necessary.

Liu Peng, an associate professor at the School of Public Administration and Policy of Beijing-based Renmin University of China, told Southern Weekly that the approval of imported drugs has to consider the factors of genetic differences, a domestic population's medication habits and drug risk tolerance as well as trial results from other countries. He said that with China's vast population, even a small rate of side effects could affect a large number of people.

Last June, the Japanese Ministry of Health, Labor, and Welfare instructed local governments not to promote the use of HPV vaccines, citing concerns from the public about adverse effects, such as long-lasting pain and numbness.

Guangzhou-based Nanfang Daily on May 13 quoted a joint study on HPV infections conducted by the Chinese Center for Disease Control and Prevention and Peking University First Hospital. The study concluded that HPV 16, HPV 52 and HPV 58 are the most common HPV types found among high-risk groups on the Chinese mainland—a stark difference from developed countries, where HPV 18 is the most common.

But the HPV vaccines being developed by two Chinese companies also target HPV 16 and HPV 18.

Cost effectiveness

Even after the use of HPV vaccines is ratified on the Chinese mainland, the costs could become a major barrier to making them widely used.

According to the U.S. Centers for Disease Control and Prevention, as of July 2012, the retail price for either vaccine is about $130 per dose ($390 for full series), making it expensive even by the standards in developed countries. According to a survey on the acceptability of HPV vaccination among 2,895 parents of young adolescents across China between November 2011 and May 2012, in respect to vaccine pricing, 71.6 percent were willing to pay 300 yuan ($48) or below, and only 11.8 percent accepted a price of 500 yuan ($81) or above.

In the same survey, only 25.1 percent of the parents had heard of HPV and only 15.6 percent had heard of HPV vaccines. The survey also found that acceptance of HPV vaccination for young adolescents among parents was only 36.2 percent.

With the approval of HPV vaccines around the corner in China, health policy makers will have to weigh up their options for the best ways to prevent cervical cancer. Like other developing countries, China has to decide whether to invest more in vaccination or in screening, which is cheaper and proves effective in reducing the majority of cervical cancer cases.

Researchers said that cervical cancer screening will continue to be needed for the foreseeable future as current vaccines include only certain high-risk HPV types and a large number of women are already infected.

Local governments in China launched free screening programs for breast and cervical cancers for women in 2008. However, participation rates are generally low due to the lack of campaigns advertising the programs.

"Since cervical cancer is the only cancer with a clearly identified cause, we need to eliminate it through vaccination, regular screening and earlier diagnosis," said Lang Jinghe, head of the Department of Obstetrics and Gynecology at Peking Union Medical College Hospital, at a national seminar on cervical cancer prevention in April.

Email us at: lili@bjreview.com