Peer-reviewed article

HPV vaccination scenario and parental willingness to pay among girls aged 9-14 y in the Yangtze River Delta, China.

Xiaoya Fu, Qian Zhang, Jia Lu, Lianqin Shi, Yihan Lu · 2 Jun 2026

Abstract

Human papillomavirus (HPV) vaccine uptake remains suboptimal among adolescent girls in China. In November 2025, bivalent HPV vaccine was included in China's National Immunization Program for girls aged 13. This study examined girls' vaccination scenario and parental willingness to pay (WTP) for HPV vaccine. A cross-sectional survey was conducted among parents of girls aged 9-14 in the Yangtze River Delta, one of the socioeconomically developed regions in China, between March and August 2025. The survey investigated HPV vaccination scenarios among mothers and their daughters. Contingent valuation method was used to estimate parental WTP. A total of 4,595 parents participated. Overall, 62.6% intended to vaccinate their daughters (39.9% for themselves or their wives), and 8.1% had completed/scheduled HPV vaccination in daughters (35.5% in mothers). It remained inconsistent between mothers and daughters (Kappa = 0.38). Daughters receiving influenza vaccine, parents being informed through schools or community health centers, and greater HPV knowledge were associated with both HPV vaccine intent and uptake (each P < .05). HPV vaccine uptake in daughters was associated with parents endorsing teacher engagement (P = .004). The average WTP was CNY 2,373 for daughters; it was higher among higher-income parents and those with daughters who received influenza vaccine, but lower among parents expecting governmental funding or unwilling to vaccinate daughters (each P < .05). School-based settings are key drivers of HPV vaccine intent and uptake among girls in the Yangtze River Delta. Multi-channel communication and stakeholder engagement may enhance parental decision-making. Improving vaccine financing strategies may promote health equity as China expands HPV vaccination.