Acceptance of COVID-19 Vaccination during the COVID-19 Pandemic in China

"The high acceptance of and positive attitude toward COVID-19 vaccination among the Chinese population reflected the strong demand for the vaccine and the high recognition of the importance of vaccines in controlling pandemics."

Among the challenges associated with future immunisation against COVID-19 is uncertainty about vaccine acceptance, which is critical for attaining high vaccination coverage rates. Previous studies and theories of health behaviour, such as the health belief model (HBM), have identified factors that influence the acceptance or uptake of a pandemic vaccine, including the risk perception of the disease, perception of vaccine safety and efficacy, general vaccination attitudes, past vaccination history, recommendations from doctors, price, vaccination convenience, and socio-demographic characteristics. This study aimed to evaluate the acceptance of future COVID-19 vaccination, the preference for vaccine attributes and vaccination schedules, and influencing factors on vaccination acceptance among the Chinese adult population. The aim is to help inform design of effective strategies for future vaccination strategies and immunisation programmes against COVID-19.

In March 2020, an anonymous cross-sectional survey was conducted online using a stratified random sampling method on the Chinese online survey platform Wen Juan Xing. The final sample consisted of 2,058 respondents aged 18 years and above residing in Mainland China. Multivariate logistic regression was performed to identify the influencing factors of vaccination acceptance.

Table 2 in the paper presents the acceptance of the future COVID-19 vaccine and its impact factors among all respondents, as well as vaccination preferences in the vaccine accept group. In brief, of the 2,058 participants, 1,879 (91.3%) stated that they would accept COVID-19 vaccination after the vaccine becomes available, among whom 980 (52.2%) wanted to get vaccinated as soon as possible, while others (47.8%) would delay the vaccination until the vaccine's safety was confirmed.

Logistic regression (see Table 3 in the paper) showed that being male, being married, perceiving a high risk of infection, being vaccinated against influenza in the past season, believing in the efficacy of COVID-19 vaccination or valuing a doctor's recommendations could increase the probability of accepting COVID-19 vaccination as soon as possible, while having confirmed or suspected cases in local areas, valuing vaccination convenience or vaccine price in decision-making could hinder participants from immediate vaccination.

As reported in this study, the pandemic has had a profound impact on the work, income, and/or daily life of Chinese residents. To address these challenges, China has taken drastic measures and public health interventions to control the transmission of COVID-19 since the outbreak of the disease. Therefore, although 74.7% of respondents reported having confirmed or suspected cases in the county in which they lived, only a small portion (12.2%) perceived a high or very high risk of the disease. In comparison, Chinese residents held strong beliefs about the efficacy of COVID-19 vaccination, as 89.5% thought that vaccination is an effective way to prevent and control COVID-19, even though the vaccine is still under development. This positive attitude towards COVID-19 vaccination and the large perceived pandemic impact may explain the high acceptance of COVID-19 vaccination among Chinese adults, as they perceive strong benefits from vaccination compared with the risk according to the HBM.

The researchers stress that, although the study found a high acceptance rate, there are still barriers in moving from the vaccination intention to real uptake behaviour. Around half of respondents with vaccination intention would delay vaccination until the safety of the vaccine is confirmed, and concerns or uncertainty about vaccine safety led to their vaccine hesitancy. Public concern about vaccine safety has frequently been reported as the major obstacle to vaccination decision-making, especially for newly introduced vaccines that have not been fully tested outside a laboratory setting. This finding indicates the need for an increased focus on vaccine safety in the research and development of new vaccines.

Based on the findings, the researchers offer suggestions for designing effective vaccination strategies and immunisation programmes for those with vaccine hesitancy:

• The vaccine should be affordable; China has stated that it aims to make its COVID-19 vaccine a global public good when it is ready for application.
• Measures should be taken to increase vaccine convenience and accessibility in terms of vaccine manufacture, distribution, supply, immunisation service, etc.
• Vaccine safety information should be made public on a regular basis after the application of the vaccine, along with timely health education and communication conducted by authoritative sources, such as healthcare professionals, to alleviate public concerns about vaccine safety.
• In response to future possible pandemics, health departments and other sectors should consider regular vaccination and education programmes for established vaccines for non-pandemic infectious diseases (e.g., influenza) to improve overall vaccine confidence and the compliance of the public.