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Understanding COVID-19 vaccine demand and hesitancy: A nationwide online survey in China

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  • Yulan Lin
  • Zhijian Hu
  • Qinjian Zhao
  • Haridah Alias
  • Mahmoud Danaee
  • Li Ping Wong

Abstract

Background: This study attempts to understand coronavirus disease 2019 (COVID-19) vaccine demand and hesitancy by assessing the public’s vaccination intention and willingness-to-pay (WTP). Confidence in COVID-19 vaccines produced in China and preference for domestically-made or foreign-made vaccines was also investigated. Methods: A nationwide cross-sectional, self-administered online survey was conducted on 1–19 May 2020. The health belief model (HBM) was used as a theoretical framework for understanding COVID-19 vaccination intent and WTP. Results: A total of 3,541 complete responses were received. The majority reported a probably yes intent (54.6%), followed by a definite yes intent (28.7%). The perception that vaccination decreases the chances of getting COVID-19 under the perceived benefit construct (OR = 3.14, 95% CI 2.05–4.83) and not being concerned about the efficacy of new COVID-19 vaccines under the perceived barriers construct (OR = 1.65, 95% CI 1.31–2.09) were found to have the highest significant odds of a definite intention to take the COVID-19 vaccine. The median (interquartile range [IQR]) of WTP for COVID-19 vaccine was CNY¥200/US$28 (IQR CNY¥100–500/USD$14–72). The highest marginal WTP for the vaccine was influenced by socio-economic factors. The majority were confident (48.7%) and completely confident (46.1%) in domestically-made COVID-19 vaccine. 64.2% reported a preference for a domestically-made over foreign-made COVID-19 vaccine. Conclusions: The findings demonstrate the utility of HBM constructs in understanding COVID-19 vaccination intent and WTP. It is important to improve health promotion and reduce the barriers to COVID-19 vaccination. Author summary: This study investigated vaccine demand and hesitancy by assessing the intention to vaccinate against COVID-19 and willingness-to-pay. We found that a considerable proportion of the public in China has a definite intention to receive the COVID-19 vaccine; a higher proportion expressed a probable intention. Perceived benefits and barriers to vaccination (namely vaccine efficacy and adverse event concerns) of the health belief model constructs were significant predictors of COVID-19 vaccination intent. A substantial proportion was concerned about fake or faulty COVID-19 vaccines; however, this was not a significant predictor of vaccination intention. The willingness-to-pay for the COVID-19 was determined and was found to be positively associated with income. Higher confidence in domestically-made COVID-19 vaccines was also found in this study. The preference for domestically-made over foreign-made COVID-19 vaccines indicates that a future COVID-19 vaccine developed by domestic companies will receive a favourable response from the public in China.The findings of this study provide useful guidance for tailored interventions to enhance the acceptance of a new COVID-19 vaccine once it is available. Promotional messages framing the benefit of vaccination and concerns about new vaccine safety to enhance vaccine uptake is warranted.

Suggested Citation

  • Yulan Lin & Zhijian Hu & Qinjian Zhao & Haridah Alias & Mahmoud Danaee & Li Ping Wong, 2020. "Understanding COVID-19 vaccine demand and hesitancy: A nationwide online survey in China," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 14(12), pages 1-22, December.
    • Handle: RePEc:plo:pntd00:0008961
    DOI: 10.1371/journal.pntd.0008961
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    1. Tsutsui, Yoshiro & Benzion, Uri & Shahrabani, Shosh, 2012. "Economic and behavioral factors in an individual's decision to take the influenza vaccination in Japan," Journal of Behavioral and Experimental Economics (formerly The Journal of Socio-Economics), Elsevier, vol. 41(5), pages 594-602.
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    1. Meng Wang & Mengying Li & Xinghui Li & Xiaoli Chen & Feng Jiang & Kezhong A & Zhiguo Wang & Liping Zhang & Yihan Lu & Wenjia Peng & Weibing Wang & Chaowei Fu & Ying Wang, 2022. "Intention and Attitude to Accept a Pertussis Cocooning Vaccination among Chinese Children’s Guardians: A Cross-Sectional Survey," IJERPH, MDPI, vol. 19(23), pages 1-12, December.
    2. Klemeš, Jiří Jaromír & Jiang, Peng & Fan, Yee Van & Bokhari, Awais & Wang, Xue-Chao, 2021. "COVID-19 pandemics Stage II – Energy and environmental impacts of vaccination," Renewable and Sustainable Energy Reviews, Elsevier, vol. 150(C).
    3. Weixin Zhang & Xin Shen & Ting Li & Nan Li & Yanyan Sun & Siyu Zhu & Nana Liu & Huifang Song & Kun Tang & Yujia Wang & Ying Zhang & Hui Cao & Yibo Wu & Yong Gan & Xinyao Zhang, 2022. "Intention to Pay for Vaccination and Influencing Factors of General Residents: A National Cross-Sectional Study," IJERPH, MDPI, vol. 19(18), pages 1-9, September.
    4. Abayomi Samuel Oyekale, 2021. "Willingness to Take COVID-19 Vaccines in Ethiopia: An Instrumental Variable Probit Approach," IJERPH, MDPI, vol. 18(17), pages 1-11, August.
    5. Phi-Hung Nguyen & Jung-Fa Tsai & Ming-Hua Lin & Yi-Chung Hu, 2021. "A Hybrid Model with Spherical Fuzzy-AHP, PLS-SEM and ANN to Predict Vaccination Intention against COVID-19," Mathematics, MDPI, vol. 9(23), pages 1-26, November.
    6. Ramy Mohamed Ghazy & Marwa Shawky Abdou & Salah Awaidy & Malik Sallam & Iffat Elbarazi & Naglaa Youssef & Osman Abubakar Fiidow & Slimane Mehdad & Mohamed Fakhry Hussein & Mohammed Fathelrahman Adam &, 2022. "Acceptance of COVID-19 Vaccine Booster Doses Using the Health Belief Model: A Cross-Sectional Study in Low-Middle- and High-Income Countries of the East Mediterranean Region," IJERPH, MDPI, vol. 19(19), pages 1-16, September.
    7. Alessandro Sapienza & Rino Falcone, 2022. "The Role of Trust in COVID-19 Vaccine Acceptance: Considerations from a Systematic Review," IJERPH, MDPI, vol. 20(1), pages 1-17, December.
    8. Rubeena Zakar & Ain ul Momina & Ruhma Shahzad & Sara Shahzad & Mahwish Hayee & Muhammad Zakria Zakar & Florian Fischer, 2022. "COVID-19 Vaccination Acceptance in the Context of the Health Belief Model: Comparative Cross-Sectional Study in Punjab, Pakistan," IJERPH, MDPI, vol. 19(19), pages 1-14, October.
    9. Jumana Alibrahim & Abdelmoneim Awad, 2021. "COVID-19 Vaccine Hesitancy among the Public in Kuwait: A Cross-Sectional Survey," IJERPH, MDPI, vol. 18(16), pages 1-21, August.
    10. Andrea López-Cepero & McClaren Rodríguez & Veronica Joseph & Shakira F. Suglia & Vivian Colón-López & Yiana G. Toro-Garay & María D. Archevald-Cansobre & Emma Fernández-Repollet & Cynthia M. Pérez, 2022. "Religiosity and Beliefs toward COVID-19 Vaccination among Adults in Puerto Rico," IJERPH, MDPI, vol. 19(18), pages 1-12, September.
    11. Talia Goren & Dana R. Vashdi & Itai Beeri, 2022. "Count on trust: the indirect effect of trust in government on policy compliance with health behavior instructions," Policy Sciences, Springer;Society of Policy Sciences, vol. 55(4), pages 593-630, December.
    12. Samar Abd ElHafeez & Iffat Elbarazi & Ramy Shaaban & Rony ElMakhzangy & Maged Ossama Aly & Amr Alnagar & Mohamed Yacoub & Haider M El Saeh & Nashwa Eltaweel & Sulafa T Alqutub & Ramy Mohamed Ghazy, 2021. "Arabic validation and cross-cultural adaptation of the 5C scale for assessment of COVID-19 vaccines psychological antecedents," PLOS ONE, Public Library of Science, vol. 16(8), pages 1-18, August.
    13. Davaalkham Dambadarjaa & Gan-Erdene Altankhuyag & Unurtesteg Chandaga & Ser-Od Khuyag & Bilegt Batkhorol & Nansalmaa Khaidav & Oyunbileg Dulamsuren & Nadmidtseren Gombodorj & Avirmed Dorjsuren & Prami, 2021. "Factors Associated with COVID-19 Vaccine Hesitancy in Mongolia: A Web-Based Cross-Sectional Survey," IJERPH, MDPI, vol. 18(24), pages 1-13, December.
    14. Griffin, Bethany & Conner, Mark & Norman, Paul, 2022. "Applying an extended protection motivation theory to predict Covid-19 vaccination intentions and uptake in 50–64 year olds in the UK," Social Science & Medicine, Elsevier, vol. 298(C).
    15. Gabin F. Morillon & Thomas G. Poder, 2022. "Public Preferences for a COVID-19 Vaccination Program in Quebec: A Discrete Choice Experiment," PharmacoEconomics, Springer, vol. 40(3), pages 341-354, March.
    16. Chiang, Chun-Fang & Kuo, Jason & Liu, Jin-Tan, 2022. "Cueing quality: Unpacking country-of-origin effects on intentions to vaccinate against COVID-19 in Taiwan," Social Science & Medicine, Elsevier, vol. 314(C).
    17. Ravichandran Moorthy & Sarjit S. Gill & Sivapalan Selvadurai & Angelina Gurunathan, 2022. "Vaccine Justice and Bioethical Reflections of COVID-19 Immunization in Malaysia," Sustainability, MDPI, vol. 14(19), pages 1-15, October.
    18. Kristijonas Puteikis & Rūta Mameniškienė, 2021. "Factors Associated with COVID-19 Vaccine Hesitancy among People with Epilepsy in Lithuania," IJERPH, MDPI, vol. 18(8), pages 1-9, April.
    19. Chiara Achangwa & Tae-Jun Lee & Moo-Sik Lee, 2021. "Acceptance of the COVID-19 Vaccine by Foreigners in South Korea," IJERPH, MDPI, vol. 18(22), pages 1-12, November.
    20. Antonio Rosa de Sousa Neto & Ana Raquel Batista de Carvalho & Márcia Daiane Ferreira da Silva & Marly Marques Rêgo Neta & Inara Viviane de Oliveira Sena & Rosângela Nunes Almeida & Francidalma Soares , 2023. "Bibliometric Analysis of Global Scientific Production on COVID-19 and Vaccines," IJERPH, MDPI, vol. 20(6), pages 1-14, March.
    21. Grace M. Turner & Neil Heron & Jennifer Crow & Eirini Kontou & Sally Hughes, 2022. "Stroke and TIA Survivors’ Perceptions of the COVID-19 Vaccine and Influences on Its Uptake: Cross Sectional Survey," IJERPH, MDPI, vol. 19(21), pages 1-16, October.
    22. Aloyce R. Kaliba & Donald R. Andrews, 2023. "The Impact of Meso-Level Factors on SARS-CoV-2 Vaccine Early Hesitancy in the United States," IJERPH, MDPI, vol. 20(13), pages 1-27, July.
    23. Takeshi Yoda & Nagisa Iwasaki & Hironobu Katsuyama, 2023. "Willingness to Pay for COVID-19 Vaccines in Japan," IJERPH, MDPI, vol. 20(22), pages 1-11, November.
    24. Rosalina Palanca-Tan, 2023. "Willingness to pay for an annual vaccine in an endemic COVID-19 scenario: a contingent valuation study in Metro Manila, Philippines," Swiss Journal of Economics and Statistics, Springer;Swiss Society of Economics and Statistics, vol. 159(1), pages 1-12, December.

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