Acceptability of and barriers to human papillomavirus vaccination in China: A systematic review of the Chinese and English scientific literature

Du Wang, Jing Wu, Jianshu Du, Haley Ong, Biwei Tang, Marshall Dozier, David Weller, Christine Campbell, Du Wang, Jing Wu, Jianshu Du, Haley Ong, Biwei Tang, Marshall Dozier, David Weller, Christine Campbell

Abstract

Introduction: Widespread adoption of the human papillomavirus (HPV) vaccine will require population acceptance and tailoring of immunisation services to community needs and preferences. We examined peer-reviewed publications on the acceptability of and barriers to the HPV vaccine across China.

Methods: We searched English (MEDLINE, Embase, and Web of Science) and Chinese (CNKI, VIP, Wanfang data) databases between 1 January 2006 and 31 December 2017. We adopted a narrative approach for data synthesis.

Results: We identified 73 studies. The overall median acceptability of HPV vaccine was 71.8% (Q1-Q3: 58.6%-81%). Low levels of acceptability (<40%) of HPV vaccine were found in eastern regions of China. The largest differences of acceptability were observed between rural western regions (all >90%) and urban eastern regions (all <35%). Despite these regional variations, common barriers to HPV vaccine acceptance were concerns about vaccine safety, uncertainty over vaccine effectiveness, low perceived risk of cervical cancer and the price of the vaccine. The level of willingness to pay for the HPV vaccine (over 153 US dollars) was very low (<7%).

Conclusion: The acceptability of and attitudes towards HPV vaccine vary by regions and populations across China. HPV vaccination programmes will need to tailor service delivery as well as information materials to take account of regional concerns.

Keywords: HPV vaccine; mainland China; safety concerns; vaccine acceptability; vaccine hesitancy.

Conflict of interest statement

All authors declared no conflicts of interests. The funder of the study had no role in the study design, data collection, data analysis, data interpretation or writing of the report. The corresponding authors had full access to all the data in the study and had final responsibility for the decision to submit for publication.

© 2022 The Authors. European Journal of Cancer Care published by John Wiley & Sons Ltd.

Figures

FIGURE 1
FIGURE 1
Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) flow diagram for selection of studies
FIGURE 2
FIGURE 2
Map of mainland China, showing the number of studies in each province and region
FIGURE 3
FIGURE 3
Acceptability of human papillomavirus (HPV) vaccine by region
FIGURE 4
FIGURE 4
Acceptability of human papillomavirus (HPV) vaccine between domestic and imported supplier at different prices

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