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

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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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Most cited references 59

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Noni MacDonald (2015)

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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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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Vaccine "hesitancy" is an emerging term in the literature and discourse on vaccine decision-making and determinants of vaccine acceptance. It recognizes a continuum between the domains of vaccine acceptance and vaccine refusal and de-polarizes previous characterization of individuals and groups as either anti-vaccine or pro-vaccine. The primary aims of this systematic review are to: 1) identify research on vaccine hesitancy; 2) identify determinants of vaccine hesitancy in different settings including its context-specific causes, its expression and its impact; and 3) inform the development of a model for assessing determinants of vaccine hesitancy in different settings as proposed by the Strategic Advisory Group of Experts Working Group (SAGE WG) for dealing with vaccine hesitancy. A broad search strategy, built to capture multiple dimensions of public trust, confidence and hesitancy around vaccines, was applied across multiple databases. Peer-reviewed studies were selected for inclusion if they focused on childhood vaccines [≤ 7 years of age], used multivariate analyses, and were published between January 2007 and November 2012. Our results show a variety of factors as being associated with vaccine hesitancy but they do not allow for a complete classification and confirmation of their independent and relative strength of influence. Determinants of vaccine hesitancy are complex and context-specific - varying across time, place and vaccines. Copyright © 2014 Elsevier Ltd. All rights reserved.

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Author and article information

Contributors

Xiaoyou Su:

ORCID: http://orcid.org/0000-0002-4216-2142

suxiaoyou@hotmail.com

Journal

Journal ID (nlm-ta): BMC Infect Dis

Journal ID (iso-abbrev): BMC Infect Dis

Title: BMC Infectious Diseases

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2334

Publication date (Electronic): 14 February 2022

Publication date PMC-release: 14 February 2022

Publication date Collection: 2022

Volume: 22

Electronic Location Identifier: 153

Affiliations

[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

Author information

Xiaoyou Su http://orcid.org/0000-0002-4216-2142

Article

Publisher ID: 7111

DOI: 10.1186/s12879-022-07111-0

PMC ID: 8845236

PubMed ID: 35164700

SO-VID: c4b57cbc-c72c-42da-b7c3-bc95cabdd39c

License:

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