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. 2021 May 18;39(21):2833-2842.
doi: 10.1016/j.vaccine.2021.04.020. Epub 2021 Apr 13.

Vaccination willingness, vaccine hesitancy, and estimated coverage at the first round of COVID-19 vaccination in China: A national cross-sectional study

Chao Wang  1 , Bingfeng Han  1 , Tianshuo Zhao  1 , Hanyu Liu  1 , Bei Liu  1 , Linyi Chen  1 , Mingzhu Xie  1 , Jiang Liu  1 , Hui Zheng  1 , Sihui Zhang  1 , Yu Wang  1 , Ninghua Huang  2 , Juan Du  2 , Ya-Qiong Liu  2 , Qing-Bin Lu  3 , Fuqiang Cui  4
Affiliations

Vaccination willingness, vaccine hesitancy, and estimated coverage at the first round of COVID-19 vaccination in China: A national cross-sectional study

Chao Wang et al. Vaccine. .

Abstract

Background: Vaccination against coronavirus disease 2019 (COVID-19) has become an important public health solution. To date, there has been a lack of data on COVID-19 vaccination willingness, vaccine hesitancy, and vaccination coverage in China since the vaccine has become available.

Methods: We designed and implemented a cross-sectional, population-based online survey to evaluate the willingness, hesitancy, and coverage of the COVID-19 vaccine among the Chinese population. 8742 valid samples were recruited and classified as the vaccine-priority group (n = 3902; 44.6%) and the non-priority group (n = 4840; 55.4%).

Results: The proportion of people's trust in the vaccine, delivery system, and government were 69.0%, 78.0% and 81.3%, respectively. 67.1% of the participants were reportedly willing to accept the COVID-19 vaccination, while 9.0% refused it. 834 (35.5%) reported vaccine hesitancy, including acceptors with doubts (48.8%), refusers (39.4%), and delayers (11.8%). The current coverage was 34.4%, far from reaching the requirements of herd immunity. The predicted rate of COVID-19 vaccination was 64.9%, 68.9% and 81.1% based on the rates of vaccine hesitancy, willingness, and refusal, respectively.

Conclusions: The COVID-19 vaccine rate is far from reaching the requirements of herd immunity, which will require more flexible and comprehensive efforts to improve the population's confidence and willingness to vaccinate. It should be highlighted that vaccination alone is insufficient to stop the pandemic; further efforts are needed not only to increase vaccination coverage but also to maintain non-specific prevention strategies.

Keywords: COVID-19 vaccine; Confidence; Vaccination; Vaccine hesitancy; Willingness.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Distribution of sample sizes, scores of vaccine confidence, rate of willingness or hesitancy to accept vaccination, and current coverage of vaccination in the mainland of China by province. Sample sizes of each province were symbolized by different colors on the map. A, Scores of confidence to the COVID-19 vaccination. Scores ranged from 17.26 to 20.14 and were classified into five categories based on their distribution and symbolized by different sizes. B, The rate of willingness to the COVID-19 vaccination. The rate of willingness ranged from 57.6% to 79.9% and was classified into five categories based on their distribution and symbolized by different sizes. C, Vaccine hesitancy rate to the COVID-19 vaccination. The rate of willingness ranged from 21.1% to 58.8% and was classified into six categories based on their distribution and symbolized by different sizes. D, Vaccination rate of the COVID-19 vaccination in the present survey. The rate of willingness ranged from 10.0% to 70.0% and was classified into six categories based on their distribution and symbolized by different sizes.
Fig. 2
Fig. 2
Distribution of occupations, current vaccination rate, and vaccine confidence. A, Occupations and sample sizes among the priority and non-priority groups. B, The current vaccination rates of different priority occupations. C, The rate of trust in the COVID-19 vaccine among the total population. D, The rate of trust in the vaccine delivery system among the total population. E, The rate of trust in the government among the total population.
Fig. 3
Fig. 3
Distribution of willingness to accept the COVID-19 vaccine among different study participants. A, Rate of willingness to accept the COVID-19 vaccination among the total participants. B, Odds ratios comparing the rate of willingness to accept the COVID-19 vaccination within populations with different characteristics. C, Rate of willingness to accept the COVID-19 vaccination among the priority group. D, Odds ratios comparing within different characteristics the rate of willingness to accept the COVID-19 vaccination among the priority group. E, Rate of willingness to accept the COVID-19 vaccination among the non-priority group. F, Odds ratios comparing within different characteristics the rate of willingness to accept the COVID-19 vaccination among the non-priority group.
Fig. 4
Fig. 4
Distribution, reasons for vaccine hesitancy, and the predicted coverage rates based on vaccine hesitancy, vaccine willingness, and vaccine refusal rate. A, Proportion of vaccine hesitancy among the priority group. B, Reasons for hesitancy to the COVID-19 vaccine. C, Rate of vaccine hesitancy among populations with different characteristics and confidence D, Odds ratios comparing within different characteristics on the rate of hesitancy to vaccination among the priority group. E, The predicted vaccination coverage based on vaccine hesitancy, vaccine willingness, and vaccine refusal rate.
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References

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