Peer-reviewed article
Vaccine Hesitancy Among Caregivers in China: Associations of Misinterpreted AEFI, Compensation Awareness, and Institutional Trust.
Binyue Xu, Qing Wang, Jiawei Xu, Ningpei Bai, Chunbei Zhou ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined vaccine hesitancy among 3,497 caregivers of young children in China. While 90% of caregivers were aware of adverse events following immunization, only 26% correctly understood that coincidental illnesses are not caused by vaccines. The research found that better understanding of vaccine safety, awareness of compensation mechanisms, and trust in institutions were associated with lower vaccine hesitancy. National immunisation programme coverage exceeded 90%, but uptake of self-paid vaccines was lower.
Key points
- Vaccine hesitancy prevalence was 8.6% among caregivers, with mean WHO VHS score of 23.2
- Although 90% were aware of AEFI, only 25.7% correctly understood that coincidental illnesses are unrelated to vaccines
- Higher AEFI knowledge and compensation awareness were associated with lower hesitancy scores
- Distrust in compensation mechanisms and perceived vaccine unsafety were associated with higher hesitancy
- NIP vaccine coverage exceeded 90%, but self-paid vaccine uptake ranged from 46.7% to 89.7%
Limitations
This is a cross-sectional survey, so causality cannot be established between factors and vaccine hesitancy. The study measures reported hesitancy and behaviours, which may not fully reflect actual vaccination decisions.
Abstract
BACKGROUND: Vaccine hesitancy remains a major global public health challenge despite high immunization coverage. While concerns about adverse events following immunization (AEFI) are widely recognized, limited attention has been paid to caregivers' ability to distinguish vaccine-related adverse reactions from coincidental illnesses, as well as to the associations of compensation awareness and institutional trust with vaccination decisions. METHODS: A cross-sectional survey was conducted between January and March 2025 among 3497 caregivers of children aged 0-6 years using multistage random sampling. Data were collected on AEFI knowledge (including understanding of coincidental illnesses), compensation mechanism awareness, institutional trust, and vaccination behaviors. Vaccine hesitancy was assessed using a self-reported measure and the WHO SAGE Vaccine Hesitancy Scale (VHS). Multivariable linear regression models were used to estimate factors associated with hesitancy scores. RESULTS: The prevalence of vaccine hesitancy was 8.6%, with a mean VHS score of 23.2 ± 4.2. Although general awareness of AEFI reached 90.0%, correct understanding of coincidental illnesses was only 25.7%. Higher AEFI knowledge and compensation awareness were associated with lower hesitancy scores, whereas distrust in compensation mechanisms and perceived vaccine unsafety were associated with higher hesitancy. Coverage of national immunization program (NIP) vaccines exceeded 90%, while uptake of self-paid vaccines varied from 46.7% to 89.7%. CONCLUSIONS: Vaccine hesitancy among caregivers was associated with cognitive understanding, economic considerations, and institutional trust. Limited understanding of coincidental illnesses may be associated with increased concerns about vaccine safety, while compensation awareness and institutional trust were associated with lower levels of vaccine hesitancy. Strengthening communication on AEFI causality and improving transparency of compensation policies may help reduce vaccine hesitancy and support immunization programs in settings with mixed public-private financing systems.