PCV vaccination is an effective and cost-efficient measure for preventing PDs [22]. The execution of the innovative PCV13 vaccination strategy by the People's Government of Weifang City has proven initially efficacious. Subsequent to the strategy's implementation, a noteworthy escalation in vaccination coverage among children was evident across all counties within Weifang City. Specifically, full-course vaccination coverage ascended significantly from a mere 0.67% to a commendable 6.59%. Furthermore, it is worth noting that only 29.70% of the participants exhibited hesitancy towards PCV13 vaccination for their children, a figure that is notably lower when juxtaposed with hesitancy rates documented in prior research endeavors concerning varicella vaccine (51.20%), enterovirus 71 inactivated vaccine (33.84%), and HPV vaccine (37.20%) [2]. Additionally, 70.51% of caregivers expressed willingness to have their children receive pneumococcal vaccines under the aegis of the one-free-dose policy in Weifang. The acceptance rate observed in our study surpasses analogous field surveys conducted in Shanghai and Guangzhou [23]. The implementation of a PCV13 vaccination innovative strategy by the People’s Government of Weifang City, including offering one dose of PCV13 free of charge and exploring commercial insurance models, can serve as a valuable experience for other regions planning to provide free PCV13. This case study presents the details of the implementation process and initial outcomes of the PCV13 vaccination strategy in Weifang City. Several valuable insights can be gained from this study for policymakers and public health professionals considering the implementation of similar vaccination strategies in other regions.

First, we found that the vaccination coverage of children aged 5 years significantly increased after the implementation of the strategy, although it was still comparatively lower than that in developed countries. This study provides only preliminary insights into the effectiveness of innovation strategies in the early stages. Some parents are hesitant to vaccinate their children because of financial constraints as PCV13 is not included in China’s NIP. The procurement price of PCV13 in China is much higher than that of international organizations, such as United Nations International Children's Emergency Fund (UNICEF). While UNICEF’s procurement price is only USD 3.30, the price range in China is between USD 67.59–101.17 [24]. Each dose of the domestic vaccine costs approximately CNY 630, equivalent to approximately USD 91, based on the current exchange rate. The cost of administering a single dose of PCV13 or completing the entire vaccination schedule is comparatively high. A comparative analysis of the multi-agent co-payment financing mechanism of the four doses of children's PCV13 in Weifang City shows that when the purchase price drops to CNY 456.40, the individual out-of-pocket cost is zero. Therefore, we propose that the People’s Government of Weifang City focus on financing mechanisms that reduce vaccine prices, and which involves three approaches: (1) The city should explore reasonable and feasible financing methods such as government sharing mechanisms, commercial insurance, society, and private individuals. This may include the incorporation of PCV13 into medical and commercial insurance systems. (2) Centralized procurement, which integrates the payer and purchaser to maximize negotiations and make the price of PCV13 affordable, should be adopted to reduce the cost of vaccine procurement. (3) Manufactures should be encouraged to develop novel vaccines and technologies at lower costs to increase PCV13 coverage.

The second key lesson identified was that health authorities should strengthen vaccine publicity for parents of children through multiple channels, popularize knowledge of PD prevention and treatment, and increase awareness and acceptance of PCV13. Medical personnel are always listed as the most trustworthy sources of vaccine-related recommendation information [25]. In a contemporaneous article published in China CDC Weekly in 2022, parental inclination to vaccinate their children with PCV13 or incur expenses related to PCV13 vaccination was appraised. This inquiry also delved into the pivotal role played by healthcare professionals in amplifying vaccine acceptance and augmenting the willingness of the general populace to partake in vaccination. The study revealed that 94.38% of participants conveyed trust in vaccine information disseminated by healthcare practitioners, and this cohort exhibited significantly greater willingness in contrast to those who harbored reservations regarding information imparted by healthcare professionals [23]. Therefore, the publicity approach should include medical staff conducting standardized training, encouraging medical staff to learn communication skills, and providing information on the safety and effectiveness of PCV13 in vaccinated groups. During the campaign, the Health Commission of Weifang and the CDC released information on free PCV13 vaccination on their official websites and WeChat public accounts, popularized PCV13 and medical knowledge of PDs, and provided information on precautions and contraindications for vaccination. Vaccination units informed parents of eligible children in their jurisdictions about relevant policies and routine immunization schedules via telephone. It is worth highlighting that this intervention strategy has proven to be efficacious within the context of Weifang's experience.

The third key lesson was the importance of standardizing the vaccination procedure and providing guidance to ensure effective implementation. All stakeholders in China strictly follow regulations and laws [26]. Manufacturers should be strict in quality control of production and supply. City- and county-level CDCs purchased PCV13 from statutory channels, and standardized training on specific implementation plans was conducted for all vaccination sites. These measures ensure smooth implementation of the vaccination service and contribute to the overall success of the PCV13 vaccination innovative strategy.

Additionally, countries or areas that are introducing PCV for the first time should establish surveillance systems for PDs burden and monitor the impact of vaccination programs [27]. Therefore, the People’s Government of Weifang City should reinforce the surveillance and monitoring of PDs in the future.

The implementation of the PCV13 innovative immunization strategy in Weifang is a good pilot and initial strategy in Chinese mainland, which represents an important exploration of non-NIP vaccines. This long-term strategy can significantly reduce the morbidity, mortality, hospitalization duration, and medical costs, thereby providing a cost-effective solution for preventing PCV-related diseases.

In addition, the experiences learned from this vaccination demonstration project, particularly in communication campaign logistics arrangements and vaccine administration are consistent with the experience of many countries that have included PCV13 in their immunization programs, such as India and Indonesia. However, Weifang has made a new exploration in multi-agent copayment financing mechanisms of vaccines. This is different from countries that have included PCV13 in their immunization programs, with the help of the Global Alliance for Vaccines and Immunization. Different regions may have unique experiences and models for implementing novel vaccine strategies; however, each region should consider its own circumstances, learn from the pilot project’s implementation experiences, and develop a feasible plan for the local context.