COVID-19 vaccination and concerns regarding vaccine hesitancy after ending the zero-COVID policy in China: a nationwide online study (Preprint)
Authors: Meng Xiaojun , Yang Min , Lu Zhen , Wang Xuwen , Fan Song , Jiang Jingfeng , Ma Wenjuan 
Published: July 2023

BACKGROUND

Coronavirus disease 2019 (COVID-19) vaccine hesitancy is prevalent among various populations worldwide. In early December 2022, the Chinese government ended the zero-COVID policy and relaxed mandatory nonpharmaceutical interventions. However, data on COVID-19 vaccine hesitancy in the general population after adjusting the zero-COVID policy in China are scarce.

OBJECTIVE

We aimed to determine the rate and determinants of COVID-19 vaccine hesitancy to date in the Chinese population

METHODS

In March 2023, we performed a nationwide cross-sectional survey of Chinese adults aged ≥18 years. Participants were recruited using the snowball sampling method. They were asked to complete an online questionnaire containing several questions related to COVID-19, including sociodemographic characteristics, COVID-19 knowledge, risk perception of infection, confidence in vaccines, experience of COVID-19, previous influenza and COVID-19 vaccinations, reasons for receiving or rejecting COVID-19 vaccines, and attitude toward future COVID-19 vaccinations. Descriptive statistics were used to describe COVID-19 vaccine coverage overall and within predefined subgroups. Furthermore, univariate and multiple logistic regression analyses were used to explore the determinants of COVID-19 vaccine hesitancy in Chinese adults after ending the zero-COVID-19 policy. We reported odds ratio (OR) with 95% confidence intervals (CIs).

RESULTS

In total, 4966 participants from nationwide provinces in China were recruited in this study. Among these participants, 94.2% (4680/4966) had received the first dose of the COVID-19 vaccine, 83.4% (4144/4966) had completed primary vaccination, and 39.4% (1597/4966) had been vaccinated with a booster dose. Overall, 43.8% (2173/4966) participants expressed COVID-19 vaccine hesitancy after ending the zero-COVID policy in China. Multivariable analysis revealed that the predictors of a high rate of COVID-19 vaccine hesitancy were marriage (married: OR 1.36, 95%CI 1.17-1.57; other marriage status: OR 1.86, 95%CI 1.36-2.55), being healthcare workers (OR 1.64, 95%CI 1.38-1.96), having both minors and older adults (OR 1.45, 95%CI 1.20-1.75), having no minors and older adults (OR 1.44, 95%CI 1.17-1.77), having chronic disease (OR 1.42, 95%CI 1.23-1.64), experiencing adverse events after vaccination (OR 1.39, 95%CI 1.19-1.61), time interval since the last dose (6-12 months: OR 1.42, 95%CI 1.20-1.67; >12 months: OR 1.44, 95%CI 1.20-1.72), and unsure of COVID-19 infection ((OR 1.45, 95%CI 1.13-1.86). In contrast, participants who were less likely to be hesitant about COVID-19 vaccination were previous recipients of an influenza vaccine in the last three years (OR 0.62, 95%CI 0.54-0.72), had taken the COVID-19 vaccine (OR 0.44, 95%CI 0.32-0.59), and had more confidence in the vaccines (OR 0.63, 95%CI 0.60-0.67). Individuals considered relieving infection symptoms as their major reason for getting vaccinated. Furthermore, the predominant reason for their hesitancy was doubting the efficacy of the vaccine in preventing infection after ending the zero-COVID policy.

CONCLUSIONS

Our findings suggest a high rate of COVID-19 vaccine hesitancy in the Chinese population, implying that there are challenges in the continuous promotion of COVID-19 vaccination after ending the zero-COVID policy in China. It is imperative to comprehensively understand public opinion on their major concerns and factors associated with their hesitancy when developing further vaccine communication strategies.