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      COVID-19 vaccine hesitancy among different population groups in China: a national multicenter online survey


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          COVID-19 vaccine has been available in China since the beginning of the 2021, however, certain numbers of people are reluctant for some reasons to vaccinate. The high vaccine coverage is crucial for controlling disease transmission, however, the vaccine hesitancy might be a barrier to the establishment of sufficient herd immunization. This study aims to investigate the prevalence of the COVID-19 vaccine hesitancy among different population groups, and explore common barriers and facilitators to vaccination decisions.


          The current survey was performed among Chinese students, public health professionals, medical workers and general population from January to March 2021 from seven cities in China. The questionnaire contained sociodemographic information, concerns about infection with COVID-19, general vaccination behaviors and attitudes, the General Vaccine Hesitancy Scale, the COVID-19 Vaccine Hesitancy Scale and other potential factors. Univariate analysis was conducted by chi-squared test, and variables significant at P < 0.10 were then included in a multivariable regression model.


          The prevalence of COVID-19 vaccine hesitancy was 15.6% in our study, and 23.9% of students, 21.2% of the general population, 13.1% of medical workers, and 10.4% of public health professionals had vaccine hesitancy. The results of multivariate analysis indicated that participants who had received negative information of COVID-19 vaccine (OR: 1.563, 95% CI: 1.229–1.986) and who had doubts about the information source (OR: 2.157, 95% CI: 1.697–2.742) were more likely to have vaccine hesitancy. While those who needed transparent information about COVID-19 vaccine (OR: 0.722, 95% CI: 0.535–0.973) and who would get COVID-19 vaccine if doctors recommended (OR: 0.176, 95% CI: 0.132–0.234) were less likely to have COVID-19 vaccine hesitancy.


          Given recommendations from medical workers about vaccination can motivate people to accept COVID-19 vaccination, appropriate training in knowledge about vaccines and communication skills are necessary for them to increase public’s willingness of vaccination. Reducing the spread of misinformation and disseminating facts in a timely and accurate way will likely reduce vaccine hesitancy. Moreover, to establish suitable communication strategies and information exchange platforms between the government and the public and a warning system on infodemic would be helpful to improve public’s confidence in vaccination.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12879-022-07111-0.

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          Vaccine hesitancy: Definition, scope and determinants.

          The SAGE Working Group on Vaccine Hesitancy concluded that vaccine hesitancy refers to delay in acceptance or refusal of vaccination despite availability of vaccination services. Vaccine hesitancy is complex and context specific, varying across time, place and vaccines. It is influenced by factors such as complacency, convenience and confidence. The Working Group retained the term 'vaccine' rather than 'vaccination' hesitancy, although the latter more correctly implies the broader range of immunization concerns, as vaccine hesitancy is the more commonly used term. While high levels of hesitancy lead to low vaccine demand, low levels of hesitancy do not necessarily mean high vaccine demand. The Vaccine Hesitancy Determinants Matrix displays the factors influencing the behavioral decision to accept, delay or reject some or all vaccines under three categories: contextual, individual and group, and vaccine/vaccination-specific influences.
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            A global survey of potential acceptance of a COVID-19 vaccine

            Several coronavirus disease 2019 (COVID-19) vaccines are currently in human trials. In June 2020, we surveyed 13,426 people in 19 countries to determine potential acceptance rates and factors influencing acceptance of a COVID-19 vaccine. Of these, 71.5% of participants reported that they would be very or somewhat likely to take a COVID-19 vaccine, and 61.4% reported that they would accept their employer’s recommendation to do so. Differences in acceptance rates ranged from almost 90% (in China) to less than 55% (in Russia). Respondents reporting higher levels of trust in information from government sources were more likely to accept a vaccine and take their employer’s advice to do so.
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              Determinants of COVID-19 vaccine acceptance in the US

              Background The COVID-19 pandemic continues to adversely affect the U.S., which leads globally in total cases and deaths. As COVID-19 vaccines are under development, public health officials and policymakers need to create strategic vaccine-acceptance messaging to effectively control the pandemic and prevent thousands of additional deaths. Methods Using an online platform, we surveyed the U.S. adult population in May 2020 to understand risk perceptions about the COVID-19 pandemic, acceptance of a COVID-19 vaccine, and trust in sources of information. These factors were compared across basic demographics. Findings Of the 672 participants surveyed, 450 (67%) said they would accept a COVID-19 vaccine if it is recommended for them. Males (72%) compared to females, older adults (≥55 years; 78%) compared to younger adults, Asians (81%) compared to other racial and ethnic groups, and college and/or graduate degree holders (75%) compared to people with less than a college degree were more likely to accept the vaccine. When comparing reported influenza vaccine uptake to reported acceptance of the COVID-19 vaccine: 1) participants who did not complete high school had a very low influenza vaccine uptake (10%), while 60% of the same group said they would accept the COVID-19 vaccine; 2) unemployed participants reported lower influenza uptake and lower COVID-19 vaccine acceptance when compared to those employed or retired; and, 3) Black Americans reported lower influenza vaccine uptake and lower COVID-19 vaccine acceptance than all other racial groups reported in our study. Lastly, we identified geographic differences with Department of Health and Human Services (DHHS) regions 2 (New York) and 5 (Chicago) reporting less than 50 percent COVID-19 vaccine acceptance. Interpretation Although our study found a 67% acceptance of a COVID-19 vaccine, there were noticeable demographic and geographical disparities in vaccine acceptance. Before a COVID-19 vaccine is introduced to the U.S., public health officials and policymakers must prioritize effective COVID-19 vaccine-acceptance messaging for all Americans, especially those who are most vulnerable.

                Author and article information

                BMC Infect Dis
                BMC Infect Dis
                BMC Infectious Diseases
                BioMed Central (London )
                14 February 2022
                14 February 2022
                : 22
                [1 ]GRID grid.506261.6, ISNI 0000 0001 0706 7839, School of Population Medicine and Public Health, , Chinese Academy of Medical Sciences and Peking Union Medical College, ; Beijing, China
                [2 ]GRID grid.449428.7, ISNI 0000 0004 1797 7280, School of Nursing, , Jining Medical University, ; Jining, Shandong China
                [3 ]GRID grid.13394.3c, ISNI 0000 0004 1799 3993, Affiliated Tumor Hospital, , Xinjiang Medical University, ; Urumqi, China
                [4 ]GRID grid.411971.b, ISNI 0000 0000 9558 1426, Public Health School, , Dalian Medical University, ; Dalian, China
                [5 ]GRID grid.412601.0, ISNI 0000 0004 1760 3828, Department of Clinical Research, , The First Affiliated Hospital, Jinan University, ; Guangzhou, China
                [6 ]GRID grid.414008.9, ISNI 0000 0004 1799 4638, Henan Cancer Hospital, Affiliate Cancer Hospital of Zhengzhou University, ; Zhengzhou, China
                [7 ]GRID grid.13291.38, ISNI 0000 0001 0807 1581, Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, , Sichuan University, ; Chengdu, Sichuan China
                [8 ]GRID grid.410594.d, ISNI 0000 0000 8991 6920, School of Public Health, Department of Clinical Research, , Baotou Medical College, ; Baotou, China
                [9 ]GRID grid.506261.6, ISNI 0000 0001 0706 7839, Department of Cancer Epidemiology, , National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, ; 17 South Panjiayuan, Chaoyang District, Beijing, China
                © The Author(s) 2022

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                Funded by: the Asian Regional Special Cooperation Fund of National Health Commission of the People’s Republic of China
                Award ID: BLXM01
                Award Recipient :
                Research Article
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                © The Author(s) 2022

                Infectious disease & Microbiology
                vaccine hesitancy,covid-19,infodemic,medical workers,china
                Infectious disease & Microbiology
                vaccine hesitancy, covid-19, infodemic, medical workers, china


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