Gong Dan, Jiang Qiyun, Chantler Tracey, Sun Fiona Yueqian, Zou Jiatong, Cheng Jiejie, Chen Yuqian, Li Chengyue, Sun Mei, Howard Natasha
Department of Health Policy and Management, School of Public Health, Fudan University, 130 Dong'an Road, Shanghai 200032, China.
Research Institute of Health Development Strategies, Fudan University, 130 Dong'an Road, Shanghai 200032, China.
Vaccines (Basel). 2021 May 8;9(5):476. doi: 10.3390/vaccines9050476.
In China, there are two categories of vaccines available from the Chinese Center for Disease Control and associated public health agencies. Extended Program of Immunization (EPI) vaccines are government-funded and non-EPI vaccines are voluntary and paid for out-of-pocket. The government plans to transition some non-EPI vaccines to EPI in the coming years, which may burden public health system capacity, particularly in terms of budget, workforce, supply chains, and information systems. Our study explored vaccinator and caregiver perspectives on introducing non-EPI vaccines into routine immunization and perceived facilitators and barriers affecting this transition. We conducted a qualitative study from a realist perspective, analysing semi-structured interviews with 26 vaccination providers and 160 caregivers in three provinces, selected to represent regional socioeconomic disparities across Eastern, Central, and Western China. Data were analysed thematically, using deductive and inductive coding. Most participants were positive about adding vaccines to the national schedule. Candidate EPI vaccines most frequently recommended by participants were varicella, mumps vaccine, and hand-foot-mouth disease. Providers generally considered existing workspaces, cold-chain equipment, and funding sufficient, but described frontline staffing and vaccine information systems as requiring improvement. This is the first qualitative study to explore interest, barriers, and facilitators related to adding vaccines to China's national schedule from provider and caregiver perspectives. Findings can inform government efforts to introduce additional vaccines, by including efforts to retain and recruit vaccine programme staff and implement whole-process data management and health information systems that allow unified nationwide data collection and sharing.
在中国，中国疾病预防控制中心及相关公共卫生机构提供两类疫苗。扩大免疫规划（EPI）疫苗由政府资助，非EPI疫苗为自愿接种且需自费。政府计划在未来几年将部分非EPI疫苗转为EPI疫苗，这可能给公共卫生系统能力带来负担，尤其是在预算、人力、供应链和信息系统方面。我们的研究探讨了接种人员和照料者对于将非EPI疫苗纳入常规免疫接种的看法，以及影响这一转变的有利因素和障碍。我们从现实主义角度开展了一项定性研究，分析了对来自中国东部、中部和西部三个省份的26名疫苗接种提供者和160名照料者进行的半结构化访谈。采用演绎和归纳编码对数据进行了主题分析。大多数参与者对将疫苗纳入国家计划持积极态度。参与者最常推荐的候选EPI疫苗是水痘疫苗、腮腺炎疫苗和手足口病疫苗。疫苗接种提供者普遍认为现有的工作空间、冷链设备和资金充足，但表示一线人员配备和疫苗信息系统需要改进。这是第一项从疫苗接种提供者和照料者角度探讨与将疫苗纳入中国国家计划相关的兴趣、障碍和有利因素的定性研究。研究结果可为政府引入更多疫苗的工作提供参考，包括努力留住和招募疫苗计划工作人员，以及实施能够实现全国统一数据收集和共享的全过程数据管理和健康信息系统。
