Non-EPI Vaccine Hesitancy among Chinese Adults: A Cross-Sectional Study

Abstract

Vaccination against coronavirus disease 2019 (COVID-19) is paramount to curtailing the pandemic. However, the impact of the Non-Expanded Program on Immunization (non-EPI) and COVID-19 vaccine hesitancy on vaccine uptake among Chinese adults remain unclear. This study was an online survey performed in Eastern, Central, and Western China between February 2021 and March 2021 using proportional sampling (n = 7381). Adults aged ≥ 18 years were included, especially younger people (aged < 65). Vaccine hesitancy was assessed using the 3C model and relative scales; logistic regression was used to explore the factors affecting vaccination uptake; structural equation modeling was used to evaluate the correlations between variables. Overall, 67.6% and 24.7% of adults reported vaccine hesitancy toward the non-EPI and COVID-19 vaccines, respectively. Participants (66.3%) reported taking the vaccine mainly based on recommendations from medical staff. Vaccine-hesitant participants (60.5%) reported a fear of side effects as the deciding factor in vaccine rejection. Vaccine hesitancy interacted negatively with confidence (β = −0.349, p < 0.001) and convenience (β = −0.232, p < 0.001), and positively with complacence (β = 0.838, p < 0.001). Nonmedical personnel, adults who had previously received the influenza vaccine, and older people had lower vaccine hesitancy than their counterparts. Most Chinese adults have non-EPI but not COVID-19 vaccine hesitancy. Vaccine safety remains a concern.

Global COVID-19 Vaccine Acceptance: A Systematic Review of Associated Social and Behavioral Factors

“…Significant differences between vaccine-acceptance rates were also found between North America and Asia. Lower vaccine-acceptance rates in Asia were due to factors including low educational levels, a lack of awareness regarding the potential benefits of vaccination, low levels of income and a lack of confidence among the individuals [39][40][41][42][43]. Concerns regarding virus mutation were also prevalent in Asia [44].…”

“…The general population, HCWs and pregnant women exhibited high vaccine-acceptance rates. The factors associated with higher acceptance rates included an enhanced trust in government initiatives, an employer's advice regarding vaccination, and valuing a health professional's recommendation due to being at higher risk of infection [39][40][41]46,47,72,73]. The factors associated with lower acceptance rates were a lack of confidence in the effectiveness of the vaccine, its side effects, and a lack of knowledge or misinformation among the participants regarding the potential harms of the vaccines [42,43,74].…”

Factors influencing COVID-19 vaccination uptake among community members in Hong Kong: a cross-sectional online survey

“…Likewise, this factor has been found to predict the intention of vaccination against COVID-19 among the general population in China. 26 and actual vaccination uptake in a sample of the elderly population in Germany. 17 It could be possible that people who perceive they were in poor health might be more worried about the vaccine’s side effects, which would become a major obstacle to vaccination.…”

Factors Influencing Vaccine Hesitancy in China: A Qualitative Study

“…In a subsequent online post-vaccination survey from February to March 2021 across China, approximately three-fifths reported no adverse events, whereas fatigue (19.2%) and local pain (18.5%) were the most reported reactions [13]. Another online survey on medical staff also showed a low incidence of adverse reactions, around 15%.…”