SARS-CoV-2 vaccine hesitancy in China: A national cross-sectional survey in community setting (Preprint)

BACKGROUND The effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine hesitancy tendency to have community aggregation, the vaccine hesitancy induces high proportion of unvaccinated population, resulting in potentially more frequent community-level outbreak. Overcoming community-setting vaccine hesitancy should be a priority. OBJECTIVE To identify the major contributing factors to refusals and delays of vaccination behavior in community. METHODS A cross-sectional online questionnaire survey was conducted in June and July 2022. Ten sites were set up in eastern, central, and western China, from where residents were recruited in a community setting. RESULTS In total 7 241 residents from 71 communities were included. 7.0% of the residents had refusal administration, 30.4% had delayed administration, and the variation attributable to community clustering was 2.4-3.7% and 8.5-9.6%, respectively. The reasons for primary dose refusal were diseases, pregnancy, or lactation, whereas the main reasons for booster dose refusal were diseases, no time, and unnecessary. Stepwise regressions showed that the factors for refusal were being younger than 60 years (OR=2.05, 95%CI:1.67,2.53), female sex (OR=1.74, 95%CI:1.43,2.12), living in urban communities (OR=1.77, 95%CI:1.47,2.13), having a monthly income of more than 5,000 RMB (OR=1.47, 95%CI:1.13,1.91), and having self-reported diseases (OR=3.18, 95%CI:2.61,3.87). In the health belief model of refusal to vaccinate, there was a positive impact on refusal from perceived barriers (β=0.08) and a negative impact from perceived benefits (β=-0.09). CONCLUSIONS Concerns regarding the impact of delayed vaccination on the spread of SARS-CoV-2 should be raised, and it should be tailored to different groups, stages, and doses when developing interventions and health policies. Vigilance is needed because the perceived threat is downplayed and the scope of vaccine misperceptions has widened.