School of Public Health, NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China.
Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom.
Vaccine. 2020 Nov 3;38(47):7464-7471. doi: 10.1016/j.vaccine.2020.09.075. Epub 2020 Oct 9.
Vaccine hesitancy is cited as one of the top threats to global health. The Changchun Changsheng Biotechnology Company was found to have violated good manufacturing practices in July 2018, leading to widespread distribution of sub-potent vaccines in China. We estimated the prevalence and determinants of vaccine hesitancy following the Changchun Changsheng vaccine incident (CCVI).
We conducted a cross-sectional survey in China in January 2019, and 2,124 caregivers of children < 6 years old completed self-administered questionnaires. Multinomial logistic regression was used to assess the determinants of vaccine hesitancy; the potential determinants included demographics, socioeconomic status, vaccine confidence, and knowledge of the CCVI. Adjusted Odds Ratios (AORs) and 95% confidence intervals (CI) are reported.
Around 89% of caregivers had heard of the CCVI. Although 83% and 88% of caregivers agreed that vaccines are safe and effective, respectively, 60% expressed some hesitancy about vaccination. Of those hesitant, 26% vaccinated their children at times with doubts, 31% delayed vaccination and 3% refused specific vaccines. Multinomial regression analysis showed that confidence in vaccine safety was associated with a reduced odds of doubts on vaccination (AOR = 0.64; 95%CI = 0.44-0.94), whereas caregivers who had heard of the CCVI had a significantly higher odds of doubts on vaccination (AOR = 1.61; 95%CI = 1.05-2.45). Confidence in the vaccine delivery system and government were associated with a lower odds of vaccine hesitancy. Caregivers with higher education and Buddhism or other religions were significantly more hesitant to vaccinate their children.
Vaccine hesitancy was prevalent following the CCVI. Over half the caregivers either accepted childhood vaccination with doubts or delayed vaccines; only a small number were active refusers. Our findings highlight the importance of addressing vaccine hesitancy, especially following vaccine incidents. Tailored communications are needed to reduce vaccine hesitancy, especially among the highly educated and Buddhist caregivers.
疫苗犹豫被认为是全球卫生的头号威胁之一。2018 年 7 月，长春长生生物技术公司被发现违反了良好生产规范，导致中国广泛分发效力不足的疫苗。我们在长春长生疫苗事件（CCVI）后估计了疫苗犹豫的流行率和决定因素。
我们于 2019 年 1 月在中国进行了一项横断面调查，2124 名 6 岁以下儿童的照顾者完成了自我管理的问卷。多变量逻辑回归用于评估疫苗犹豫的决定因素；潜在的决定因素包括人口统计学、社会经济状况、疫苗信心和对 CCVI 的了解。报告了调整后的优势比（AOR）和 95%置信区间（CI）。
约 89%的照顾者听说过 CCVI。尽管 83%和 88%的照顾者分别认为疫苗是安全有效的，但仍有 60%的人对疫苗接种表示有些犹豫。在犹豫不决的人中，26%在有疑虑时为孩子接种疫苗，31%延迟接种疫苗，3%拒绝特定疫苗。多变量回归分析表明，对疫苗安全性的信心与对疫苗接种的疑虑减少有关（AOR=0.64；95%CI=0.44-0.94），而听说过 CCVI 的照顾者对疫苗接种的疑虑明显增加（AOR=1.61；95%CI=1.05-2.45）。对疫苗接种系统和政府的信心与较低的疫苗犹豫率相关。受过高等教育和佛教或其他宗教的照顾者更不愿意为孩子接种疫苗。
CCVI 后疫苗犹豫情绪普遍存在。超过一半的照顾者对儿童接种疫苗持怀疑态度或推迟疫苗接种；只有少数人是积极的拒绝者。我们的研究结果强调了在疫苗事件后解决疫苗犹豫的重要性。需要有针对性的沟通来减少疫苗犹豫，尤其是在高学历和佛教照顾者中。
