Parent and caregiver perceptions about the safety and effectiveness of foreign and domestic vaccines in Shanghai, China

Institutional trust, scientific literacy, and information sources: What factors determine people's attitudes toward COVID-19 vaccines of different origins in China?

Objective

This study aimed to investigate the different attitudes of Chinese residents toward COVID-19 vaccines produced in China and the United States in an emergency context, and then explored possible explanations for these different attitudes.

Methods

Using data collected online in May 2021, we compared Chinese citizens' attitudes toward vaccines originating from China and the US and then adopted ordered logistic models to examine how trust in institutions, scientific literacy, and information sources influence their attitudes toward different vaccines.

Results

A total of 2038 respondents completed the survey. Participants reported very different levels of trust in Chinese and American vaccines. The main finding of this paper is that individuals who trust in Chinese institutions, especially those who trust in domestic scientists, typically feel encouraged to also place their trust in domestic vaccines and to distrust those from the US. These individuals' higher evaluation of Chinese government performance makes them more willing to vaccinate with domestic vaccines and less likely to seek US vaccines. Levels of scientific literacy, furthermore, seem to have little influence on attitudes toward different vaccines. Meanwhile, respondents who acquire health information from biomedical journals are more likely to hold a positive view of US vaccines, and these individuals contribute to bridging the gap between levels of trust in Chinese and US vaccines.

Conclusions

In contrast with previous findings about Chinese attitudes toward imported vaccines, our respondents are more convinced of the safety and effectiveness of domestic vaccines than of US ones. This trust gap does not arise out of actual disparity in the quality and safety of the different vaccines per se. Instead, it is a cognition concern that is closely bound up with individuals' trust in domestic institutions. People's attitudes toward vaccines of different origins in an emergency context are more influenced by socio-political beliefs than by concern with objective information and knowledge.

Factors affecting childhood immunization: Thematic analysis of parents and healthcare workers' perceptions

Immunization against common childhood diseases is an important strategy as it is critical for reducing the global child morbidity and mortality. This review explores the perceptions of parents and HCWs toward childhood immunization. The PRISMA guideline was used to search and include the studies. Relevant electronic databases were systemically searched for the years ranging from 2000 to 2021 to identify studies reported in English. Themes were then identified using thematic analysis. A total of 44 studies met the review criteria and were summarized and categorized into 4 themes: barriers to immunization, parental knowledge, attitude and behavior (KAB), health system factors and HCWs' KAB. This review found that immunization decision-making is a complex process. Parental KAB leads to immunization decisions. HCWs were also noted to be the trusted sources of immunization information. Further research can be conducted on how to improve parents' perceptions of immunization and immunization practices.

Avoidance of the Threats of Defective Vaccines: How a Vaccine Scandal Influences Parents' Protective Behavioral Response

This study examined the key factors underlying parents' protective responses to avoid the threats of defective vaccines. We constructed a hypothetical model to explore this issue based on the protective action decision model and risk information perspective. A questionnaire survey involving 584 respondents was conducted in Anhui and Jiangsu provinces, China, after the 2018 vaccine scandal broke. The results indicate that perceived vaccine knowledge is a vital determinant of perceived negative publicity, information forwarding, risk perception, and systematic processing. Moreover, perceived negative publicity significantly predicts information forwarding and risk perception. Perceived negative publicity and information forwarding both positively influence systematic processing. Furthermore, parents' protective responses are motivated by risk perception but fail to be stimulated by systematic processing.

Parental Vaccine Preferences for Their Children in China: A Discrete Choice Experiment

Vaccination is one of the most cost-effective health investments to prevent and control communicable diseases. Improving the vaccination rate of children is important for all nations, and for China in particular since the advent of the two-child policy. This study aims to elicit the stated preference of parents for vaccination following recent vaccine-related incidents in China. Potential preference heterogeneity was also explored among respondents. Methods: A discrete choice experiment was developed to elicit parental preferences regarding the key features of vaccines in 2019. The study recruited a national sample of parents from 10 provinces who had at least one child aged between 6 months and 5 years old. A conditional logit model and a mixed logit model were used to estimate parental preference. Results: A total of 598 parents completed the questionnaire; among them, 428 respondents who passed the rational tests were analyzed. All attributes except for the severity of diseases prevented by vaccines were statistically significant. The risk of severe side effects and protection rates were the two most important factors explaining parents’ decisions about vaccination. The results of the mixed logit model with interactions indicate that fathers or rural parents were more likely to vaccinate their children, and children whose health was not good were also more likely to be vaccinated. In addition, parents who were not more than 30 years old had a stronger preference for efficiency, and well-educated parents preferred imported vaccines with the lowest risk of severe side effects. Conclusion: When deciding about vaccinations for their children, parents in China are mostly driven by vaccination safety and vaccine effectiveness and were not affected by the severity of diseases. These findings will be useful for increasing the acceptability of vaccination in China.

Public preference for COVID-19 vaccines in China: A discrete choice experiment

Background

As the coronavirus disease 2019 (COVID‐19) pandemic is sweeping across the globe, there is an urgent need to develop effective vaccines as the most powerful strategy to end the pandemic. This study aimed to examine how factors related to vaccine characteristics, their social normative influence and convenience of vaccination can affect the public's preference for the uptake of the COVID‐19 vaccine in China.

Methods

An online discrete choice experiment (DCE) survey was administered to a sample of China's general population. Participants were asked to make a series of hypothetical choices and estimate their preference for different attributes of the vaccine. A mixed logit regression model was used to analyse the DCE data. Willingness to pay for each attribute was also calculated.

Results

Data of 1236 participants who provided valid responses were included in the analysis. There was strong public preference for high effectiveness of the vaccine, followed by long protective duration, very few adverse events and being manufactured overseas. Price was the least important attribute affecting the public preference in selecting the COVID‐19 vaccine.

Conclusions

The strong public preferences detected in this study should be considered when developing COVID‐19 vaccination programme in China. The results provide useful information for policymakers to identify the individual and social values for a good vaccination strategy.

Patient or Public Contribution

The design of the experimental choices was fully based on interviews and focus group discussions participated by 26 Chinese people with diverse socio‐economic backgrounds. Without their participation, the study would not be possible.