Effects of Pilot Policies on Human Papillomavirus Vaccination Recommendations From Community Healthcare Workers – a Case Study in Two Chinese Cities

Abstract

Background: In China, human papillomavirus (HPV) vaccination was not incorporated into the National Immunization Program until November 2025, resulting in low vaccination uptake due to high costs. To alleviate financial barriers and promote vaccination, many provinces or cities have implemented HPV vaccination pilot programs since 2020, offering free or subsidized HPV vaccines to adolescent girls. This study aims to examine the knowledge and attitudes of community healthcare workers toward HPV vaccination, their perceptions of the subsidized pilot policy content, and the effect of pilot policies on their willingness to introduce HPV vaccination, with comparisons between two cities with different economic status. Methods: The study was conducted in Suzhou and Chongqing, both of which introduced city-specific HPV subsidized pilot policies in 2023. Quantitative data were collected in June 2025 via an online survey administered to healthcare workers in vaccination roles at community health centers within selected districts. Dependent variables were “willingness to introduce HPV vaccination-related knowledge” and “willingness to introduce the difference between valent types”, which were all treated as binary variables. Key independent variables included “knowledge of the pilot policy”, “whether received training”, which were treated as binary variables, as well as “information channels”, which was measured as a categorical variable. Control variables included health belief attitudes and other sociodemographic factors. Logistic regression was employed to analyze the influence of knowledge of the pilot policy on healthcare workers’ willingness to introduce HPV vaccination. Results: A total of 1,298 responses were received, of which 1,195 (92.06%) passed quality checks and were included in the analysis. Healthcare workers had high knowledge and attitudes toward HPV vaccination. Among all participants, policy awareness was about 94.31%. Healthcare workers’ willingness to introduce the HPV vaccine was not statistically significantly associated with knowledge of the pilot policy (OR=1.15, 95% CI: 0.49–2.71) but was statistically associated with information channels and positive health belief attitudes toward the HPV vaccine (OR=1.29, 95% CI: 1.16-1.43). Willingness to introduce based on distinctions between the 2-valent, 4-valent and 9-valent HPV vaccines was statistically significantly associated with knowledge of the pilot policy (OR=1.99, 95% CI: 1.16-3.39) and information channels. Conclusions: Healthcare workers’ willingness to introduce HPV vaccination was primarily influenced by their attitudes toward HPV rather than their knowledge of the policy. However, policy knowledge was significantly associated with higher willingness to introduce the difference between valent types.