Dynamic Trends and Underlying Factors of COVID-19 Vaccine Booster Hesitancy in Adults: Cross-Sectional Observational Study

Abstract

Background COVID-19 vaccine hesitancy reduces vaccination rates, which is detrimental to building herd immunity and halting the spread of COVID-19 and its variations. Most researches have simply identified the reasons affecting COVID-19 vaccination reluctance without delving into its dynamics, which makes forecasting future trends difficult. Objective This study aimed to examine the current COVID-19 vaccine booster hesitancy rate in Chinese adults as well as the dynamics of vaccine hesitancy and its influencing factors. The results of this study will have practical implications for policy responses in mainland China, and effective COVID-19 booster vaccination in specific populations. Methods The web-based survey was completed by creating questionnaires and using a stratified random sampling method to collect information from adults (≥18 years old) among 2556 households in 4 geographical regions of China. We collected sociodemographic information, health status, awareness of COVID-19 and its vaccine, self-perceptions, trust in medical staff and vaccine developers, and so on. The odds ratios and 95% CI for the statistical associations were estimated using logistic regression models. Results Overall, 6659 participants (females: n=3540, 53.2%; males: n=3119, 46.8%) responded. In total, 533 (8%; 95% CI 7.4%-8.7%) participants presented a clear hesitancy in receiving the COVID-19 booster vaccination, while 736 (11.1%; 95% CI 10.3%-11.8%) expressed hesitancy in regular booster vaccination. A higher prevalence of vaccine hesitancy in both booster vaccination and regular booster vaccination was observed among participants with a history of allergies, experiencing chronic disease, lower levels of public health prevention measures or susceptibility or benefits or self-efficiency, higher levels of severity or barriers, and lower trust in both medical staff and vaccine developers (P<.05). The females and participants with higher education levels, higher levels of barriers, lower levels of susceptibility, and lower trust in vaccine developers preferred to have attitudinal changes from acceptance to hesitancy, while people with higher education levels, lower self-report health conditions, experiencing chronic disease, history of allergies, and lower trust in medical staff and developers were all positively associated with constant COVID-19 booster hesitancy. Conclusions The prevalence of COVID-19 vaccine booster hesitancy is not high in mainland China. However, there is a slight increment in hesitancy on regular booster vaccination. Conducting targeted information guidance for people with higher education levels and chronic diseases, as well as improving accessibility to booster vaccination and increasing trust in medical staff and vaccine producers may be highly effective in reducing vaccine hesitancy.

Temporal changes in factors associated with COVID-19 vaccine hesitancy among Chinese adults: Repeated nationally representative survey

“…In both the baseline and follow-up surveys, after adjustment for potential confounding variables, we found that participants with higher levels of education, chronic disease, a history of allergies, and lower levels of trust in medical staff and vaccine developers were more likely to be VH. Previous studies have found that people with higher levels of education instead exhibit higher VH ( Lazarus et al, 2022 ; Wu, Ma, et al, 2023 ). This may be because people with higher levels of education tend to have higher health literacy and healthier lifestyles, so that they do not consider further vaccination.…”

“…This may be because people with higher levels of education tend to have higher health literacy and healthier lifestyles, so that they do not consider further vaccination. Another possible reason is that the well-educated population has more medical resources to protect themselves against the risk of disease ( Wu, Ma, et al, 2023 ). People with chronic diseases (hypertension, diabetes, etc.)…”

“…However, COVID-19 vaccination remains an effective means of protection during the current low-level COVID-19 epidemic ( Lazarus et al, 2023 ). Unlike the mechanisms underlying conventional vaccine hesitancy, the COVID-19 vaccine is highly accessible and affordable in mainland China ( Wu, Ma, Li, et al, 2023 ), Wu, Xia, et al, 2023 , but people still have high levels of VH.…”

How urban versus rural population relates to COVID-19 booster vaccine hesitancy: A propensity score matching design study

“…Some studies have shown that regular vaccination with booster shots can also lead to an increase in vaccine hesitation. 36 This study mainly discussed the effect of vaccine booster on vaccine hesitation，our future research may further explore the effect of the number of vaccine booster doses about vaccine hesitation and other possible influencing factors.…”

Dynamic evolution of COVID‐19 vaccine hesitancy over 2021–2023 among Chinese population: Repeated nationwide cross‐sectional study

“…More details on the research design, survey process, and sample size selection is published elsewhere. 15,30 The public was not involved in setting the research question, the outcome measures, or the design or implementation of the study. In addition, all participants were invited to complete the digital informed consent and questionnaires.…”