https://orcid.org/0000-0003-3458-8386
ABSTRACT
The 2nd China Vaccinology Integrated Innovation & Teaching Development Conference was held in Sun Yat-sen University, Shenzhen, 18–19, November 2023. Over 200 participants in the field of Vaccinology gathered together to address challenges and issues relevant to vaccine education and training courses, research, and public health programs in China. The conference themed “Promoting the Integrated and Innovative Development of Vaccinology through Collective Efforts.” The conference was organized by the China Association of Vaccine (CAV) and hosted by Vaccinology Education Professional Committee of CAV, and School of Public Health (Shenzhen), Sun Yat-sen University. Other partners included the Medical Virology Branch of the Chinese Medical Association, the editorial committee of the Chinese Journal of Preventive Medicine, Human Vaccines & Immunotherapeutics, and the People’s Medical Publishing House. The 1st conference was held in Hangzhou, in October 2020.
Introduction
The Vaccinology Education Professional Committee, the China Association of Vaccine (CAV) was established in 2021. The committee compiled and published a series of vaccinology textbooks including Vaccines and Immunization,Citation1 and promoted the establishment of vaccinology courses in universities. The Vaccinology education has a broad coverage, including both specialized courses and general education courses, encompassing students in clinical medicine, preventive medicine, and all other majors at the bachelor’s, master’s, and doctoral degrees. We have also developed online free instructional videos on Vaccinology, with a total course duration of 499 minutes. We initiated and organized the Chinese University Vaccinology Project Design and Knowledge Promotion program, and received a total of 55 submissions from universities across the country. After multiple rounds of intense competition, the professional and popular science categories ultimately selected the top three entries.
One of our objectives in conducting Vaccinology education at universities is to educate clinical medical students, helping them understand the value of vaccines and how to scientifically manage adverse reactions to vaccination. In our research,Citation2,Citation3 we have found that in China, guardians and elderly individuals, when seeking advice on vaccine administration, tend to trust the recommendations of clinical doctors rather than those of public health professionals. Although it’s hard to say whether it’s a minority or a majority, some clinical doctors in China, lack understanding of vaccines, and some even buy into the anti-vaccination mind-set. This is a challenge that must be addressed in the process of building healthy China. We hope to work at the source, educating today’s medical students who will become tomorrow’s clinical doctors. This is aimed at narrowing the gap between medical treatment and prevention, promoting the integration of medicine and prevention, and ultimately improving vaccination practices in China.
The rise of digital Vaccinology marks the beginning of a new era.Citation4 Vaccine science is advancing at an unprecedented pace. Through reverse vaccinology, we are able to delve into the genetic structure and functions of pathogens;Citation5 structural vaccinology allows us to unlock the mechanisms of interaction between pathogenic proteins and the immune system;Citation6 and the application of synthetic Vaccinology enables us to rapidly and accurately synthesize key components of pathogens, significantly accelerating the development of vaccines. On January 10, 2020, China released the genetic sequence of the novel coronavirus online. This information was downloaded by 350 labs worldwide, initiating the research and development of vaccines. This pivotal moment facilitated the rapid development of mRNA vaccines – a process that traditionally took 10 to 20 years, now achieved in just 8 months. Traditionally, virus strains need to be acquired and cultivated during the process of vaccine design, and pathogens are required from other countries or regions to design vaccines. However, as long as the information of genetic sequence is known, the geographic location of virus has no impact on the ability to immediately start designing vaccines now, even if it’s on Mars. Therefore, we have every reason to expect that more novel vaccines will be developed at an incredibly fast pace.
Vaccinology covers the entire lifecycle of vaccines, starting from the onset of infectious diseases, precise assessment of disease burdens, research and development of vaccines, manufacture, vaccination, and management, all the way to vaccine market withdrawal. With the development of digitization in Vaccinology, digital public health has proven its crucial role in curbing the COVID-19 pandemic.Citation7 As vaccination information technology enters a new phase, research in vaccine public health also needs to be more efficient and precise in its design. In the current golden age of digital public health, digital Vaccinology is opening unprecedented new horizons with almost, limitless possibilities. As pioneers in this innovative field, we must carefully consider and collectively explore how to keep taking leaps forward to achieve mutual progress in vaccinology.
Opening
Academician Yunde Hou warmly welcomed all specialists and academics to Shenzhen for the conference, hoping that everyone could contribute more to the development of China’s vaccine research, infectious disease prevention and control, and overall public health. Vice President Xiangming Li of the CAV introduced the development of the association and discussed the prospects for vaccine research and education development in China. Vice President Ping Lan of Sun Yat-sen University introduced the construction and development of the Shenzhen campus and the establishment of the School of Public Health (Shenzhen), extending a warm welcome to all experts and guests attending. Ronald Ellis, the editor-in-chief of the journal Human Vaccines & Immunotherapeutics, encouraged increasing attention to the field of vaccines and continuous support for vaccine-related research to better safeguard global public health. Zhenwei Zhang, from the editorial department of the Chinese Journal of Preventive Medicine, expressed the continuation of strong support for the development of the vaccine discipline, hoping that more academics will publish their research findings. Professor Yuelong Shu, Director of National Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College and the founding dean and chair professor of the School of Public Health (Shenzhen) at Sun Yat-sen University, emphasized that pathogen and infectious disease control has been a key development direction since the founding of the School of Public Health (Shenzhen). He pledged to continue adhering to the original aspiration and supporting research on new vaccines and related topics. Professor Chuanxi Fu, the Director-General of the Vaccinology Education Professional Committee, CAV, reviewed the committee’s development, achievements, and future work plans, hoping that more colleagues will work together to promote the development of vaccine education and public health in China.
Vaccinology teaching symposium
The session was hosted by Hui Zheng from the Chinese Center for Disease Control and Prevention, and Tao Wu from Peking University.
Vaccine hesitancy and Vaccinology education
Chuanxi Fu introduced the value of vaccines, followed by exploring various definitions of vaccine hesitancy. He explained a series of typical vaccine hesitancy events from ancient to modern times across various countries, including MMR vaccine in the UK and thiomersal in the USA;Citation8 Polio Vaccine and Adult Infertility in Nigeria; Hepatitis B Vaccine and the Onset of Multiple Sclerosis in France; HPV vaccine and health impairment in Japan. Dr. Fu presented global research advancements in COVID-19 vaccine hesitancy.Citation9–11 He started by discussing the establishment of university Vaccinology courses and provided an overview of the progress in Vaccinology education in China, including strategies for addressing vaccine hesitancy. He also demonstrated his team’s work and achievements in vaccine hesitancy research.
Small vaccines, big impact - reflections on the general education course ‘Vaccines and Health’
Professor Wanhong Liu from Wuhan University shared his experience in offering the general education course ‘Vaccines and Health’ at Wuhan University.Citation12 He showed the main teaching content of the general education course, teaching development and reform, and innovative methods for assessing course performance. Professor Liu emphasized that Vaccinology is a discipline with a strong biomedical focus. He also highlighted the importance of course structure and content design based on student types and characteristics for the effective promotion of general education in Vaccinology.
The Power of Vaccines - real people, real stories in the real world
Xuanling Shi from Tsinghua University discussed the general education course ‘The Power of Vaccines’, offered by professor Linqi Zhang and his teaching team. She elaborated on the course’s philosophy, objectives, teaching content, and design for undergraduate students. The presentation highlighted a new teaching model, featuring a host and course leader mechanism. The course incorporated video interviews with experts from the forefront of vaccine research, both domestic and international. This approach aimed to guide students to appreciate the power of vaccines from a more practical perspective.
From general education to specialized courses – a discussion on Vaccinology education
Starting with the undergraduate course ‘Vaccines and Health’ and the graduate course ‘Practical Vaccinology,’ professor Caijun Sun discussed the need for universities to offer courses with different teaching content for different student groups. Through the implementation of these two courses with different positioning and teaching objectives, professor Sun stated that although the construction of the Vaccinology discipline currently faces many challenges, there are still excellent opportunities for development in the post-pandemic era.
Plenary session report
The session was hosted by professor Chuanxi Fu and professor Yuelong Shu.
Advancements in China’s immunization program and Vaccinology education
The presentation was given by professor Xiaofeng Liang, vice president of the Chinese Preventive Medicine Association and director of the Vaccine Industry Research Institute, Jinan University(Guangdong). His report covered China’s vaccination policies, the status of vaccine-preventable diseases, opportunities and challenges in vaccination, and vaccine education. Starting from the Immunization Agenda 2030 (IA2030) strategic framework,Citation13,Citation14 he shared China’s 70-year immunization experience, addressing vaccine-related morbidity and mortality data. He also described the remaining challenges for measles and polio eradication, elimination of hepatitis B, control of pertussis, meningitis, and pneumococcal diseases.
Concept and measurement tools of vaccine hesitancy
Dan Wu, professor of the Social Medicine and Health Education at Nanjing Medical University, shared the evolution of the concept of vaccine hesitancy. The Strategic Advisory Group of Experts on Immunization of the World Health Organization defined vaccine hesitancy as ‘delay in acceptance or refusal of vaccination despite availability of vaccination services’.Citation15,Citation16 However, confusion about this concept and the lack of measurement tools concurrently exist. In recent years, academics started to challenge this widely accepted definitionCitation17 and tended to endorse an alternative concept as “a psychological state of indecisiveness that people may experience when making a decision regarding vaccination”. Simply, vaccination behaviors (e.g., already been vaccinated or determined to be not vaccinated) and emotions/affections (e.g., concerns, doubts, or reluctance) are not equal to vaccine hesitancy. But those factors can be treated as integral constructs to shape vaccine hesitancy and might be important targets to change to address vaccine hesitancy issues.
Development strategies and progress in novel influenza vaccine
Professor Yuelong Shu, director of the National institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, reported his team’s latest achievements on novel strategies of universe influenza vaccines, especially that a kind of mosaic virus-like particles (VLPs) immunization elicited robust cross-reactive neutralizing antibody responses against H1N1 and H3N2 viruses in mice.Citation18,Citation19
Economic attributes of vaccines and vaccine pricing strategies in China
The presentation was given by professor Hai Fang, China Center for Health Development Studies at Peking University. His report covered economic attributes of vaccines and vaccine pricing strategies in China. Vaccines generate positive externalities, resulting in their under-consumption. Globally, governments and international organizations usually provide free vaccines to the public. In China, there are two types of vaccines: National Immunization Program (NIP) vaccines and non-NIP vaccines. The prices of NIP vaccines in China are very low, equivalent to prices set by The Global Alliance for Vaccines and Immunisation (GAVI). On the other hand, non-NIP vaccines in China are considerably more expensive, with some prices comparable to those in developed countries. The high prices of non-NIP vaccines contribute to their low coverage rates.
Research on COVID-19 and SARS antibody responses: implications for the development of universal coronavirus vaccines
Professor Linqi Zhang, from Tsinghua University, talked about their promising work on pan-betacoronavirus antibodies and vaccines, and they discovered some broadly neutralizing human nanobodies which can neutralize SARS-CoV-1/2 and MERS-CoV in hamster infection model.Citation20,Citation21
Development of nanoparticle vaccines inducing mucosal immune responses
Professor Hui Zhang, from Sun Yat-sen University, focused on novel mucosal vaccine study. The team developed a mosaic nanoparticle SARS-CoV-2 vaccine, which effectively elicited robust mucosal immunity against multiple SARS-CoV-2 variants.Citation22
Vaccine and public health sub-session
The session was jointly hosted by Hui Zheng, Yuansheng Chen, and Na Liu from the Chinese Center for Disease Control and Prevention, and Sheng Wei from the Southern University of Science and Technology.
Immunization management and research in the era of big data
Hongbo Lin (Director, Yinzhou Center for Disease Control and Prevention) shared their experience in constructing vaccination facilities. He demonstrated the Smart Vaccination Clinic project, which includes voice-image systems, facial recognition, AI cold chain, and integrated vaccination stations. He shared their practices in assessing immunization for floating children, self-checking vaccination certificates, smart services, and an intelligent integrated management platform. He also shared their experience in building a vaccine research data platform and a series of research achievements based on the platform.
Exploration and practice with the mechanisms of disease surveillance and early warning based on Urban big data in Yichang City, Hubei Province
The presentation was given by Jianhua Liu, Deputy Director of the Yichang Center for Disease Control and Prevention. The report mentioned a new mechanism and application system have been established for disease surveillance and early warning in order to prevent the next pandemic.Citation23 The system was constructed based on 16 years of smart city development. It integrated data from over 20 departments including health departments, education departments, public security, etc. The platform has now collected data from 2,927 hospitals, 524 pharmacies, and 862 schools. After eight years of exploration and practice, the number of infectious disease outbreaks per year in schools has decreased by 86.9%. The mechanism will provide innovative models and standards for other regions to conduct disease surveillance and issue early warnings.Citation24,Citation25
Exploring HPV vaccine immunization strategies from public health perspective
Fang Huang, Shenzhen Center for Disease Control and Prevention, explored HPV vaccine immunization strategies from public health perspective. She mentioned that the global burden of cervical cancer was extremely severe. The WHO cervical cancer elimination acceleration strategyCitation26 emphasizes that large-scale HPV vaccination is one of the key measures to eliminate cervical cancer. At the same time, China’s new cervical cancer cases and deaths account for nearly 20% of the global total.Citation27 The disease burden is very serious,Citation28,Citation29 which also brings a huge economic burden on society and families. Adopting a HPV vaccine inoculation program can greatly reduce the disease and economic burden.Citation30 Finally, she suggested adopting a HPV vaccine inoculation combined with a screening prevention and control modelCitation31 and encouraged more cities to formulate HPV vaccine immunization programs, which would accelerate the achievement of cervical cancer elimination.
Value and application status of combination vaccines
Li Li from National Immunization Program of the Chinese Center for Disease Control and Prevention introduced combination vaccines status. Childhood vaccination faces several challenges in current immunization model, which include the increasing number of vaccines recommended for young children, the discomfort experience when receiving multiple vaccines, and parental concerns. Despite these challenges, the goal remains to maintain equal access of vaccines and high coverage of vaccination.Citation32 A combination vaccine offers protection against multiple diseases with one shot and makes it more convenient for both parents and healthcare providers. It improves compliance with vaccination schedules, which is crucial in maintaining high collective immunity and protecting public health.Citation33 Although there are numerous benefits, challenges still exist in the development and innovation of combination vaccines, as well as their application. Factors such as awareness of combination vaccines, healthcare providers’ and parents’ preferences, willingness to pay, and vaccine production and supply all have impacts on their application. China actively promotes the development of innovative vaccines, including combination vaccines, and recognizes the significant potential for future research and development to ensure fair and equal access to these vaccines. Efforts should be made to enhance innovation and accessibility of combination vaccines for childhood immunization in China.Citation34
Prevention and control of pneumococcal diseases in influenza seasons
This presentation was given by professor Li Li from Shenzhen Luohu District Maternal and Child Health Hospital. She began with common respiratory diseases such as pneumonia and influenza and explored scientific advancements in the prevention and control of pneumococcal diseases and influenza from the perspective of vaccine administration.
Can primary care physician recommendation improve influenza vaccine uptake among older adults? A community health centre‐based on experimental study in China
This presentation was given by professor Gang Liu, a section chief of the Shenzhen Center for Disease Control and Prevention. His report introduced the program of offering free influenza vaccination services to the residents aged 60 years and older through community health centers (CHCs) in Shenzhen, an international tech hub as well as a mega-city in China with more than 0.94 million older adults. Alongside this free influenza vaccination program, Shenzhen Centres for Disease Prevention and Control also conducted a CHCs-based experiment. This experiment asked primary care physicians (PCPs) working in CHCs to proactively recommend influenza vaccination to their older patients in their routine work. These PCPs were chosen because they are responsible for providing health management and follow-up services to older adults under the national basic public health program. Older patients may be more likely to accept and follow vaccination recommendations during their visits to PCPs in CHCs. The results revealed that PCP recommendations improved influenza vaccine coverage as well as knowledge, attitude, and practice levels regarding influenza vaccination among older adults.Citation35,Citation36 More health policies and health education should be made to improve vaccination willingness and vaccination coverage among older adults.
Real-world research expert consensus on the effectiveness of influenza vaccines
Associate professor Yawen Jiang, a faculty member at Sun Yat-sen University, conducted a review of pivotal concepts of evidence-based studies on the vaccine effectiveness (VE) of influenza vaccines, focusing particularly on those relevant to real-world applications. He commented on the conventional and emerging data sources, methodologies, and analytical approaches that are frequently used by Chinese public health researchers. He emphasized the noticeable lack of evidence regarding the vaccine effectiveness of influenza vaccines in mitigating clinical outcomes among vulnerable populations in China. This observation was underscored by the critical need to generate robust evidence through real-world studies, which was essential for informing and shaping future immunization policies.Citation37
Vaccine research and development sub-session
The session was jointly hosted by Caijun Sun from Sun Yat-sen University, and Jintao Wang from Shanxi Medical University, and Kezhong A from Qinghai province disease prevention control center.
Analyzing factors influencing vaccine efficacy: from population observations to immunological mechanism studies
Weak immunogenicity is the main bottleneck restricting the translation of DNA vaccines into clinical applications. Dr. Yanmin Wan, from Fudan University, shared their work on improving DNA vaccine immunogenicity via successive site translocating inoculation (SSTI).Citation38,Citation39 They found that successively changing the inoculation site during multiple-dose vaccination could improve the immunogenicity of both DNA and viral vector vaccines via a mechanism of counteracting the suppression in vivo antigen expression.Citation38
Analysis of protective immune factors in COVID-19 vaccines
Professor Jingyou Yu, from Guangzhou Laboratory, assessed both humoral and cellular immune responses against SARS-CoV-2 in humans and nonhuman primates, and revealed critical roles of durable and cross-reactive T cell responses in vaccine-mediated protection against severe diseases. Specifically, adenoviral vector-based vaccines elicited greater CD8+ T cell responses than two mRNA vaccines in humans.Citation40,Citation41 In addition, depletion of CD8+ T cells by antibody infusion partially abrogates vaccine-mediated protection against heterologous SARS-CoV-2 challenge in NHP models.Citation42
The role of immunome profiling technologies in vaccine development
Professor Yaoqing Chen, from Sun Yat-sen University, elucidated their research findings regarding neuraminidase-specific antibodies with broadly cross-protective efficacy against various influenza strains via single B cell sequencing.Citation43 Additionally, Chen presented a comprehensive comparison of the B cell receptor repertoire in the contexts of SARS-CoV-2 infection and vaccination, aiming to inform the development of an innovative COVID-19 vaccine.Citation43–45
Innovative adjuvants leading vaccine innovation
Professor Yuming Jin, chief expert of health emergency in Hainan Provincial Center for Disease Control demonstrated adjuvant’s role in vaccine development. Adjuvants are a common type of immune stimulant added to vaccines to enhance and regulate immune response to vaccine antigens. During the improvement of vaccine science, vaccine development faces new technical challenges, which not only come from the low immune level of specific target populations, but also from the limited protective efficacy of antigens themselves. Innovative adjuvant systems, adding the immune enhancer to traditional adjuvants, have been developed to enhance the synergic effect to achieve higher immune response and provide stronger protective efficacy.Citation46,Citation47
Development and evidence-based research of novel coronavirus vaccines
Professor Jiufeng Sun, from Guangdong Provincial Center for Disease Control and Prevention, talked about their systematic work on the development of the inactivated SARS-CoV-2 vaccine and evidence-based assessment (EBA) of both inactivated and subunit vaccines against to prototype and VOCs. The data supports boost vaccination of SARS-CoV-2 inactivated vaccine with subunit vaccine, as well as mRNA vaccine in either domestic or returned populations in China.Citation48–50
Taking stock of the ‘similarities’ and ‘differences’ in rotavirus and norovirus
Dr. Zhaorui Chang from the Chinese Center for Disease Control and Prevention, compared the two common enteric viruses, norovirus and rotavirus, in terms of their pathogenesis and control measures in public health events.Citation51 She particularly highlighted the prevention of these two viruses and placed significant emphasis on the role of rotavirus vaccines in diarrhea control.Citation52 These vaccines have made significant contributions and have been included in the national immunization programs in several countries.Citation53,Citation54 In China, where the vaccination rate is relatively low, effectively using rotavirus vaccines holds great value.Citation55,Citation56
Development of innovative mucosal immunization vaccines
Professor Caijun Sun, from Sun Yat-sen University, reported the novel work for the development of mucosal vaccine delivery system. The team prepared oligosaccharide-encapsulated nanoparticle vaccine with potential ability to induce strong mucosal immunity,Citation57,Citation58 and further developed a thermostable microneedle-mediated nanoparticle vaccine, which effectively induced a rapid and long-lasting systemic and mucosal immunity with enhanced magnitude, polyfunctionality, and persistence in mice.Citation59
Summary
Consensus on Promoting the Integration and Innovation of Vaccinology and Building Disciplinary Systems:
Collaborative Innovation among high schools, research institutes, disease control institutions, enterprises, etc., to establish a disciplinary system covering the entire lifecycle of vaccines. Conduct in-depth research on the fundamental and applied aspects of vaccinology, providing support for maintaining public health security and ensuring the well-being of the public.
Universities offer general and specialized courses in Vaccinology, gradually establishing a major in Vaccinology to cultivate professionals in the field. Governments and various sectors of society actively disseminate and popularize knowledge about Vaccinology, enhancing public literacy on vaccines.
Acknowledgments
The authors would like to thank all the speakers of the conference, whose lectures formed the basis of this report.
Disclosure statement
This conference received funding support from vaccine manufacturers. These companies had no input into the conference agenda or selection of speakers, with the exception of the Industry Symposia.
Additional information
Funding
References
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