COVID-19 Vaccine Hesitancy Among Chinese Population: A Large-Scale National Study

Jian Wu, Quanman Li, Clifford Silver Tarimo, Meiyun Wang, Jianqin Gu, Wei Wei, Mingze Ma, Lipei Zhao, Zihan Mu, Yudong Miao, Jian Wu, Quanman Li, Clifford Silver Tarimo, Meiyun Wang, Jianqin Gu, Wei Wei, Mingze Ma, Lipei Zhao, Zihan Mu, Yudong Miao

Abstract

Globally, vaccine hesitancy is a growing public health problem. It is detrimental to the consolidation of immunization program achievements and elimination of vaccine-targeted diseases. The objective of this study was to estimate the prevalence of COVID-19 vaccine hesitancy in China and explore its contributing factors. A national cross-sectional online survey among Chinese adults (≥18 years old) was conducted between August 6, 2021 and August 9 via a market research company. We collected sociodemographic information; lifestyle behavior; quality of life; the knowledge, awareness, and behavior of COVID-19; the knowledge, awareness, and behavior of COVID-19 vaccine; willingness of COVID-19 vaccination; accessibility of COVID-19 vaccination services; skepticism about COVID-19 and COVID-19 vaccine; doctor and vaccine developer scale; and so on. Odds ratios (OR) with 95% confidence intervals (CI) were used to estimate the associations by using logistic regression models. A total of 29,925 residents (48.64% men) were enrolled in our study with mean age of 30.99 years. We found an overall prevalence of COVID-19 vaccine hesitancy at 8.40% (95% CI, 8.09-8.72) in primary vaccination and 8.39% (95% CI, 8.07-8.70) in booster vaccination. In addition, after adjusting for potential confounders, we found that women, higher educational level, married residents, higher score of health condition, never smoked, increased washing hands, increased wearing mask, increased social distance, lower level of vaccine conspiracy beliefs, disease risks outweigh vaccine risk, higher level of convenient vaccination, and higher level of trust in doctor and developer were more willing to vaccinate than all others (all p < 0.05). Age, sex, educational level, marital status, chronic disease condition, smoking, healthy behaviors, the curability of COVID-19, the channel of accessing information of COVID-19 vaccine, endorsement of vaccine conspiracy beliefs, weigh risks of vaccination against risks of the disease, making a positive influence on the health of others around you, and lower trust in healthcare system may affect the variation of willingness to take a COVID-19 vaccine (all p < 0.05). The prevalence of COVID-19 vaccine hesitancy was modest in China, even with the slight resulting cascade of changing vaccination rates between the primary and booster vaccination. Urgent action to address vaccine hesitancy is needed in building trust in medical personnel and vaccine producers, promoting the convenience of vaccination services, and spreading reliable information of COVID-19 vaccination via the Internet and other media.

Keywords: COVID-19 vaccine hesitancy; China; booster vaccination; contextual factors); factors (individual factors; primary vaccination.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Wu, Li, Silver Tarimo, Wang, Gu, Wei, Ma, Zhao, Mu and Miao.

Figures

Figure 1
Figure 1
The flowchart of participant selection.
Figure 2
Figure 2
Age- and sex-standardized prevalence of COVID-19 vaccine hesitancy by province in primary vaccination (left) and booster vaccination (right). Qinghai and Xinjiang province were not shown.

References

    1. Abbas K, Procter SR, van Zandvoort K, Clark A, Funk S, Mengistu T, et al. . Routine Childhood Immunisation During the COVID-19 Pandemic in Africa: A Benefit–Risk Analysis of Health Benefits Versus Excess Risk of SARS-CoV-2 Infection. Lancet Global Health (2020) 8(10):e1264–72. doi: 10.1016/s2214-109x(20)30308-9
    1. Debellut F, Clark A, Pecenka C, Tate J, Baral R, Sanderson C, et al. . Evaluating the Potential Economic and Health Impact of Rotavirus Vaccination in 63 Middle-Income Countries Not Eligible for Gavi Funding: A Modelling Study. Lancet Global Health (2021) 9(7):e942–56. doi: 10.1016/s2214-109x(21)00167-4
    1. Jentsch PC, Anand M, Bauch CT. Prioritising COVID-19 Vaccination in Changing Social and Epidemiological Landscapes: A Mathematical Modelling Study. Lancet Infect Dis (2021) 21(8):1097–106. doi: 10.1016/s1473-3099(21)00057-8
    1. Sandmann FG, Davies NG, Vassall A, Edmunds WJ, Jit M. The Potential Health and Economic Value of SARS-CoV-2 Vaccination Alongside Physical Distancing in the UK: A Transmission Model-Based Future Scenario Analysis and Economic Evaluation. Lancet Infect Dis (2021) 21(7):962–74. doi: 10.1016/s1473-3099(21)00079-7
    1. Schaffer DeRoo S, Pudalov NJ, Fu LY. Planning for a COVID-19 Vaccination Program. JAMA (2020) 323(24):2458–59. doi: 10.1001/jama.2020.8711
    1. Amanat F, Krammer F. SARS-CoV-2 Vaccines: Status Report. Immunity (2020) 52(4):583–89. doi: 10.1016/j.immuni.2020.03.007
    1. MacDonald NE. Vaccine Hesitancy: Definition, Scope and Determinants. Vaccine (2015) 33(34):4161–4. doi: 10.1016/j.vaccine.2015.04.036
    1. WHO . (2019). Available at: .
    1. Fisher KA, Bloomstone SJ, Walder J, Crawford S, Fouayzi H, Mazor KM, et al. . Attitudes Toward a Potential SARS-CoV-2 Vaccine : A Survey of U.S. Adults. Ann Intern Med (2020) 173(12):964–73. doi: 10.7326/M20-3569
    1. Gardner L, Dong E, Khan K, Sarkar S. Persistence of US Measles Risk Due to Vaccine Hesitancy and Outbreaks Abroad. Lancet Infect Dis (2020) 20(10):1114–15. doi: 10.1016/s1473-3099(20)30522-3
    1. Solis Arce JS, Warren SS, Meriggi NF, Scacco A, McMurry N, Voors M, et al. . COVID-19 Vaccine Acceptance and Hesitancy in Low- and Middle-Income Countries. Nat Med (2021) 27(8):1385–94. doi: 10.1038/s41591-021-01454-y
    1. Sallam M. COVID-19 Vaccine Hesitancy Worldwide: A Concise Systematic Review of Vaccine Acceptance Rates. Vaccines (Basel) (2021) 9(2):160. doi: 10.3390/vaccines9020160
    1. Freeman D, Loe BS, Yu L-M, Freeman J, Chadwick A, Vaccari C, et al. . Effects of Different Types of Written Vaccination Information on COVID-19 Vaccine Hesitancy in the UK (OCEANS-III): A Single-Blind, Parallel-Group, Randomised Controlled Trial. Lancet Public Health (2021) 6(6):e416–27. doi: 10.1016/s2468-2667(21)00096-7
    1. Wang K, Wong EL-Y, Ho K-F, Cheung AW, Yau PS, Dong D, et al. . Change of Willingness to Accept COVID-19 Vaccine and Reasons of Vaccine Hesitancy of Working People at Different Waves of Local Epidemic in Hong Kong, China: Repeated Cross-Sectional Surveys. Vaccines (2021) 9(1):62. doi: 10.3390/vaccines9010062
    1. Kumar D, Chandra R, Mathur M, Samdariya S, Kapoor N. Vaccine Hesitancy: Understanding Better to Address Better. Isr J Health Policy Res (2016) 5:2. doi: 10.1186/s13584-016-0062-y
    1. Dube E, Ward JK, Verger P, MacDonald NE. Vaccine Hesitancy, Acceptance, and Anti-Vaccination: Trends and Future Prospects for Public Health. Annu Rev Public Health (2021) 42:175–91. doi: 10.1146/annurev-publhealth-090419-102240
    1. Broadbent JJ. Vaccine hesitancy: Misinformation on Social Media. BMJ (2019) 3(366):14457. doi: 10.1136/bmj.l4457
    1. Quinn SC, Andrasik M. Addressing Vaccine Hesitancy in BIPOC Communities - Toward Trustworthiness, Partnership, and Reciprocity. N Engl J Med (2021) 385(2):97–100. doi: 10.1056/NEJMp2103104
    1. Simas C, Larson HJ. Overcoming Vaccine Hesitancy in Low-Income and Middle-Income Regions. Nat Rev Dis Primers (2021) 7(1):41. doi: 10.1038/s41572-021-00279-w
    1. Razai MS, Chaudhry UAR, Doerholt K, Bauld L, Majeed A. Covid-19 Vaccination Hesitancy. BMJ (2021) 373:n1138. doi: 10.1136/bmj.n1138
    1. Our World in Data (2021). Available at: .
    1. The National People’s Congress of the People’s Republic of China . Available at: .
    1. WHO . (2021). Available at: .
    1. Su S, Du L, Jiang S. Learning From the Past: Development of Safe and Effective COVID-19 Vaccines. Nat Rev Microbiol (2021) 19(3):211–19. doi: 10.1038/s41579-020-00462-y
    1. Phelan AL, Eccleston-Turner M, Rourke M, Maleche A, Wang C. Legal Agreements: Barriers and Enablers to Global Equitable COVID-19 Vaccine Access. Lancet (2020) 396(10254):800–02. doi: 10.1016/s0140-6736(20)31873-0
    1. Ratzan S, Schneider E, Hatch H, Cacchione J. Missing the Point - How Primary Care Can Overcome Covid-19 Vaccine "Hesitancy". N Engl J Med (2021) 384(25):e100. doi: 10.1056/NEJMp2106137
    1. Wouters OJ, Shadlen KC, Salcher-Konrad M, Pollard AJ, Larson HJ, Teerawattananon Y. Challenges in Ensuring Global Access to COVID-19 Vaccines: Production, Affordability, Allocation, and Deployment. Lancet (2021) 397(10278):1023–34. doi: 10.1016/s0140-6736(21)00306-8
    1. Du F, Chantler T, Francis MR, Sun FY, Zhang X, Han K, et al. . The Determinants of Vaccine Hesitancy in China: A Cross-Sectional Study Following the Changchun Changsheng Vaccine Incident. Vaccine (2020) 38(47):7464–71. doi: 10.1016/j.vaccine.2020.09.075
    1. Hofer U. Make It Personal to Beat Vaccine Hesitancy. Nat Rev Microbiol (2021) 19(7):406. doi: 10.1038/s41579-021-00579-8
    1. Tanne JH. Covid-19: US Doctors Suggest New Ways to Target Vaccine Hesitancy. BMJ (2021) 25(373):n1640. doi: 10.1136/bmj.n1640
    1. Freeman D, Loe BS, Chadwick A, Vaccari C, Waite F, Rosebrock L, et al. . COVID-19 Vaccine Hesitancy in the UK: The Oxford Coronavirus Explanations, Attitudes, and Narratives Survey (OCEANS) II. Psychol Med (2020) 11:1–34. doi: 10.1017/S0033291720005188

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi