Unfolding the Determinants of COVID-19 Vaccine Acceptance in China

Abstract

Background China is at the forefront of global efforts to develop COVID-19 vaccines and has five fast-tracked candidates at the final-stage, large-scale human clinical trials testing phase. Vaccine-promoting policymaking for public engagement is a prerequisite for social mobilization. However, making an informed and judicious choice is a dilemma for the Chinese government in the vaccine promotion context. Objective In this study, public opinions in China were analyzed via dialogues on Chinese social media, based on which Chinese netizens’ views on COVID-19 vaccines and vaccination were investigated. We also aimed to develop strategies for promoting vaccination programs in China based on an in-depth understanding of the challenges in risk communication and social mobilization. Methods We proposed a novel behavioral dynamics model, SRS/I (susceptible-reading-susceptible/immune), to analyze opinion transmission paradigms on Chinese social media. Coupled with a meta-analysis and natural language processing techniques, the emotion polarity of individual opinions was examined in their given context. Results We collected more than 1.75 million Weibo messages about COVID-19 vaccines from January to October 2020. According to the public opinion reproduction ratio (R0), the dynamic propagation of those messages can be classified into three periods: the ferment period (R01=1.1360), the revolution period (R02=2.8278), and the transmission period (R03=3.0729). Topics on COVID-19 vaccine acceptance in China include price and side effects. From September to October, Weibo users claimed that the vaccine was overpriced, making up 18.3% (n=899) of messages; 38.1% (n=81,909) of relevant topics on Weibo received likes. On the contrary, the number of messages that considered the vaccine to be reasonably priced was twice as high but received fewer likes, accounting for 25.0% (n=53,693). In addition, we obtained 441 (47.7%) positive and 295 (31.9%) negative Weibo messages about side effects. Interestingly, inactivated vaccines instigated more heated discussions than any other vaccine type. The discussions, forwards, comments, and likes associated with topics related to inactivated vaccines accounted for 53% (n=588), 42% (n=3072), 56% (n=3671), and 49% (n=17,940), respectively, of the total activity associated with the five types of vaccines in China. Conclusions Most Chinese netizens believe that the vaccine is less expensive than previously thought, while some claim they cannot afford it for their entire family. The findings demonstrate that Chinese individuals are inclined to be positive about side effects over time and are proud of China’s involvement with vaccine development. Nevertheless, they have a collective misunderstanding about inactivated vaccines, insisting that inactivated vaccines are safer than other vaccines. Reflecting on netizens’ collective responses, the unfolding determinants of COVID-19 vaccine acceptance provide illuminating benchmarks for vaccine-promoting policies.

Factors Influencing Public Attitudes towards COVID-19 Vaccination: A Scoping Review Informed by the Socio-Ecological Model

“…An online (web-based) survey was the most common data collection method applied in the cross-sectional studies in our review, of which: Some studies reported using social media platforms including Facebook, Twitter, and LinkedIn to collect data [ 26 , 38 , 41 , 62 , 72 ]; Some studies reported using specific platforms to upload surveys including crowdsourcing platform Amazon Mechanical Turk (mTurk, Amazon, Seattle, WA, USA) [ 32 , 61 ], computer-assisted web interviewing (CAWI) and computer-assisted telephone interviewing (CATI) [ 34 , 53 ], and Qualtrics (Seattle, WA, USA) [ 47 , 55 ]; One study used an online questionnaire to examine public attitudes towards COVID-19 vaccines in three phases: pre-lockdown, during lockdown, and post lockdown with different participants in every phase [ 41 ], and another study conducted two-wave follow-up online surveys [ 55 ]; One study used an online survey with a semi-structured questionnaire following the snowball sampling technique [ 60 ]; One study used open-ended questions to ask about the factors influencing attitudes towards vaccines [ 47 ]; One study used an Internet survey and telephone interviews [ 35 ]; One study used a face-to-face-administered questionnaire [ 37 ]. …”

“…Some studies reported using social media platforms including Facebook, Twitter, and LinkedIn to collect data [ 26 , 38 , 41 , 62 , 72 ];…”

“…The reported vaccine acceptance rate in the reviewed articles ranged from 29.4% to 86% [ 23 , 24 , 26 , 45 , 46 , 47 , 48 , 49 , 51 , 72 ]. A study from the Middle East [ 49 ] reported a low rate of acceptance among the public from Jordan, Kuwait, and Saudi Arabia (29.4%), while a higher acceptance of 53.1% was reported in a study from Kuwait [ 48 ].…”

“…The studies were divided by design into one experimental study [23], 39 cross-sectional studies , five literature reviews [63][64][65][66][67], one systematic review [68], one randomized controlled trial [69], one longitudinal survey with two experiments [70], one Gallup panel [71], one media analysis study through a proposed novel behavioral dynamics model SRS/I (susceptible-reading-susceptible/immune) for the microblogging platform Weibo on social media [72], and one conference paper [73]. The majority of these crosssectional studies reported their findings from one country, one study reported data from 19 countries [25], another study conducted legal analysis for several countries [40], and others reported findings from two or three countries from Europe, America, Canada, and the Middle East [29,49,59].…”

“…-Vaccine development is being pushed -COVID-19 vaccine antigen-carrying platforms have never been used -The production of new COVID-19 vaccines will not meet demand -Conspiracy theories -More than one type of COVID-19 vaccines is likely to be used within a country. Thus, the safety and efficacy profiles may vary Furthermore, immunity duration [68], timeframe of vaccination [63], fake or lowquality vaccines [46], country of vaccine origin [24,68] and information about inactivated vaccines [72] were other public concerns in the selected studies. The individuals who believed that immunity boosted by a vaccine would be for a short period, vaccine development was expedited, and the production process was pushed, and that the vaccines are most probably fake would report negative attitude towards COVID-19 vaccines.…”