Portrayals of 2v, 4v and 9vHPV vaccines on Chinese social media: a content analysis of hot posts on Sina Weibo

Figures & data

Figure 1. Data collection and coding process.

1,731 raw data were obtained, and 1,164 data were valid. First, two coders independently coded 150 posts, and DivoMiner was used to code the remaining posts. Then, 192 (16.3%) of the 1,164 data were randomly extracted via DiVoMiner, and these were encoded manually again. The Krippendorf’s alpha exceeded 0.7, indicating that the machine coding had good reliability.

Table 1. Numbers of collected hot posts by various creators

Creators	Number
News media	648
Government agencies	24
Professional organizations	115
Other publishers (Individuals)	377

Table 2. Numbers of collected hot posts by year

Year	2013	2014	2015	2016	2017	2018	2019	2020	2021
Number	3	0	2	16	231	11	86	686	129

Figure 2. Number of collected hot posts per month and key time points of human papillomavirus vaccine news coverage in China.

(a) The approval of imported 2vHPV vaccine Cervarix® and 4vHPV vaccine Gardasil® did not receive significant coverage on Weibo. (b) More hot posts appeared when Cervarix® became available, and a peak of hot posts resulted from the start of Gardasil® vaccination. (c) No attention was drawn neither when imported 9vHPV vaccine was approved nor launched. (d) The approval and official launch of domestic 2vHPV vaccine Cecolin® were both widely discussed on Weibo. (e) The interference between SARS-CoV-2 vaccines and HPV vaccines led to the greatest number of hot Weibo posts on HPV vaccination.

Table 3. Numbers of collected hot posts by region mentioned in the post content

Region	Number
Northeast China	21
North China	72
Northwest China	86
Southwest China	94
Central China	117
South China	144
East China	247

Table 4. Trending themes in host posts included in the analysis (N = 1164)

Coverage dates^a	Trending themes	Quotations	Effect^b	n (%)
15/05/2018-25/02/2021	4v and 9vHPV vaccination appointments	“Online appointments can be made for 4v and 9vHPV vaccination, and 2vHPV vaccination appointments can be made at people’s nearest vaccination clinic. A total of 2,990 people will be vaccinated with the 4vHPV vaccine, and a total of 2,090 people will be vaccinated with the 9vHPV vaccine. Twelve vaccination units in Shaanxi Province will be available for vaccination.”	325629	128 (11%)
24/04/2020-25/11/2020	Domestic 2vHPV vaccination	“On 22 August, the first domestically produced cervical cancer vaccine was launched in Shanghai. It has the same ability as the imported vaccine to prevent HPV 16 and 18-related precancerous lesions and persistent infection, but is cheaper.”	238277	119 (10%)
24/05/2017-01/02/2021	Imported 4vHPV vaccination	“The first 4 v cervical cancer vaccine approved in China was placed on the market a few days ago. 4vHPV vaccination in Yunnan Province will officially begin tomorrow. Women no longer have to go abroad for HPV vaccination. Instead, they can get the prevention of cervical cancer vaccines at home.”	32776	104 (9%)
05/12/2020-13/02/2021	Interference between SARS-CoV-2 vaccines and HPV vaccines	“Wang Huaqing, the chief expert of the National Immunization Program of the Chinese Center for Disease Control and Prevention, said, ‘Because the research and development time of SARS-CoV-2 vaccines has been so short, it is not recommended that SARS-CoV-2 vaccines and HPV vaccines are given at the same time.’”	325498	94 (8%)
19/07/2016-30/12/2017	Imported 2vHPV vaccination	“Recently, the first cervical cancer vaccine approved in mainland China, Cervarix, has been placed on the market. Residents can be vaccinated in community hospitals and community health service centers. Is the HPV vaccine effective? Who needs to be vaccinated? How safe is it? What’s the difference between 2v, 4v and 9vHPV vaccines?”	119677	71 (6%)
13/11/2017-15/11/2020	Price of domestic HPV vaccines	“The price of Cecolin, produced by Xiamen Wantai Canghai Biotechnology Co., Ltd., is 329 yuan per dose. Girls aged 9–14 only need two injections and women aged 15–45 only need three injections.”	360379	56 (5%)
16/10/2017-25/02/2021	Shortage of HPV vaccines	“HPV vaccines are too difficult to get. It’s especially hard to get a dose of 9vHPV vaccine. In Shenzhen, 225,000 people competed for 8,790 appointments to receive the 9vHPV vaccine in October 2020. HPV vaccination coverage in China is too low, and the overall vaccination rate is less than 1%.”	55399	56 (5%)
31/12/2019-03/05/2020	Domestic 2vHPV vaccine approved	“Recently, the State Drug Administration approved the application for registration of the 2vHPV vaccine Cecolin, which is the first approved domestically produced HPV vaccine for women aged 9–45. Cecolin, targeted at HPV 16 and 18, has been supported by national special funds for major new drug development.”	28912	41 (4%)
09/07/2019-22/02/2021	Free HPV vaccination	“The British government announced on the 9th that from September this year, the coverage of its HPV vaccination programme will be expanded from girls to boys. It is estimated that this will result in tens of thousands of cancer cases being prevented in the next 40 years.”	87839	37 (3%)
03/02/2017-25/02/2021	HPV screening	“In recent years, HPV vaccines have received heated discussion. Vaccination can reduce future infection. However, to prevent cervical cancer, HPV screening is also necessary. Proper screening methods can detect precancerous lesions early and intervene in time. Cervical cancer vaccination is not a substitute for HPV screening.”	8766	28 (2%)
15/12/2020-17/12/2020	Cervical cancer rising in young Chinese people	“Cervical cancer is the largest malignant tumor of female reproductive tract in China. There are 110,000 new cases and 50,000 deaths every year. In recent years, cervical cancer is rising in young Chinese people. At the same time, HPV vaccination has become a hot topic.”	17059	16 (1%)
20/12/2017-22/12/2017	Experts against HPV vaccination	“Wang Jian, chairman of the Beijing Genomics Institute (BGI), objects to Chinese women going abroad for HPV vaccination. ‘The price of a HPV vaccine in Hong Kong is about 4,000 yuan, and one needs to be reinjected every five years. However, genetic testing only costs 50 yuan every three years. Moreover, whether foreign vaccines are suitable for Chinese people need further consideration.’”	25055	15 (1%)
15/08/2017-15/01/2021	Men and HPV vaccination	“Harald zur Hausen, the father of HPV vaccines, said that although men do not suffer from cervical cancer, they are the main carriers of HPV virulence factors. Vaccinating men can both protect their partners and themselves, because HPV can also cause other cancers.”	9879	15 (1%)
18/07/2016-29/05/2018	Imported 2vHPV vaccine approved	“GSK said that the ‘Cervarix’ they produced was approved by the State Drug Administration, and became the first HPV vaccine in China to prevent cervical cancer. Women aged 9–25 can obtain vaccination earlier next year. HPV vaccines, which have been widely inoculated in over 100 countries globally, finally enter mainland China.”	3730	9 (1%)

^add/mm/yy.

^bEffect (Disseminative effect) = the sum of retweets, likes and comments.

Table 5. The descriptions of different types of HPV vaccines in hot Weibo posts

		Criteria	Type of HPV vaccine			Sum
			2v	4v	9v
Content	Security	The proven safety of the HPV vaccine, and its	105	97	76	278
Categories		Lack of severe adverse effects, are discussed.	(14.0%)	(14.2%)	(11.9%)	(13.4%)
	Effectiveness	The significant ability of the HPV vaccine to	175	161	146	482
		Prevent cervical cancer and related diseases is	(23.3%)	(23.6%)	(22.8%)	(23.3%)
		Mentioned, supported by statistical data or
		News stories.
	Affordability	The price of the HPV vaccine is objectively	170	86	60 (9.4%)	316
		Stated, and its affordability is emphasized by	(22.6%)	(12.6%)		(15.3%)
		Descriptions such as “expensive” or “cheap.”
	Appointment	HPV vaccine appointment methods and	301	338	357	996
		Vaccination sites are stated, and the difficulty	(40.1%)	(49.6%)	(55.9%)	(48.1%)
		In making appointments is emphasized.
Sum			751	682	639	2072
			(100.0%)	(100.0%)	(100.0%)	(100.0%)

χ² = 64.443***, φ = 0.176, Cramer’s V = 0.125.