Willingness to receive the COVID-19 vaccine booster shot: a cross-sectional study in China Yongqing Deng 1# , Xiaoqin Qiu 2# , Caixian Huang 3# , Weiwei Li 4# , Liying Dai 4# , Miaomiao
Trang 1Figure 1 Click here to access/download;Figure;Figure 1.jpg
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Trang 4Willingness to receive the COVID-19 vaccine booster shot: a
cross-sectional study in China
Yongqing Deng 1# , Xiaoqin Qiu 2# , Caixian Huang 3# , Weiwei Li 4# , Liying Dai 4# , Miaomiao Xie 5 , Chaofeng Chen 4 , Runlin Han 6 , Yan Chen 4 , Shishan Huang 7 , Sujiao Qin 2 , Jiayin Ou 8 , Ting Shi 9 ,
Li Zhang 10 , Yuechou Nong 10 , Jianrong Yang 5 , Wensheng Lu 10*
1 The Family Planning Office, Guangxi Academy of Medical Sciences and the People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, P.R.China
2 The Nursing Department, Guangxi Academy of Medical Sciences and the People’s Hospital
of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, P.R.China
3 Department of Hematology, Guangxi Academy of Medical Sciences and the People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, P.R.China
4 The Office of Guangxi Academy of Medical Sciences and the People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, P.R.China
5 Department of Hepatobiliary Surgery, Guangxi Academy of Medical Sciences and the People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, P.R.China
6 Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, 530021, P.R.China
7 The Scientific Research Department, Guangxi Academy of Medical Sciences and the People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, P.R.China
8 Department of Medical Administration, Guangxi Academy of Medical Sciences and the People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, P.R.China
9 Department of Prevention and Health Care, Guangxi Academy of Medical Sciences and the People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, P.R.China
10 Department of Endocrinology and Metabolism, Guangxi Academy of Medical Sciences and the People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi,
530021, P.R.China
# They contributed equally to this work;
∗ Corresponding author: Prof Wensheng Lu, E-mail: Lws2613676@sohu.com; ORCID ID:
0000-0003-4179-1171
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Trang 5Summary
Background As the coronavirus disease 19 (COVID-19) global pandemic continues,
safe and effective vaccines and high vaccination coverage are still the most effective
way to the control of the COVID-19 epidemic This study aimed to explore the
influencing factors of the willingness to receive the COVID-19 vaccine booster shot
in Chinese residents
Methods This was a cross-sectional study and a total of 1100 residents participated in
the anonymous questionnaire survey The data collected included demographic
characteristics, residents’ awareness of COVID-19 epidemic, the attitude towards
COVID-19 vaccine and vaccination willingness The multivariate logistic regression
analyses were used to assess the factors influencing the Chinese residents' willingness
to receive the COVID-19 vaccine booster shot
Findings In total, 1006 valid questionnaires were collected with a response rate of
91.45% Among them, 77.3% believed that the COVID-19 epidemic was serious, 88.8%
responded that the COVID-19 vaccine was safe and effective, 93.6% received the
two-dose COVID-19 vaccination and 86% were willing to receive COVID-19 vaccine
booster shot The concerns about vaccine safety were the main reason for willing to
the two-dose COVID-19 vaccination schedule and the COVID-19 vaccine booster
shot, accounting for 45% and 67%, respectively Multivariate logistic regression
analyses revealed that male was less willingness to take COVID-19 vaccine booster
shot (OR = 0.630, 95%CI: 0.436 - 0.910, P = 0.014) But the residents of the 18 - 29
years of age group (OR = 2.708, 95%CI: 1.243 - 5.896, P = 0.012), the residents who
had received the two-dose COVID-19 vaccination (OR = 2.066, 95%CI: 1.120 - 3.811,
P = 0.020) and who were afraid of being infected (OR =1.801, 95%CI: 1.230 - 2.638,
P = 0.002) were more willingness to take COVID-19 vaccine booster shot
Interpretation Most residents were willing to receive the COVID-19 vaccine booster
shot Being female, younger age and the residents who had received the two-dose
COVID-19 vaccination and who were afraid of being infected were statistically
significantly associated with willingness to receive COVID-19 vaccine booster shot
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Trang 6Fundings Natural Science Foundation of China (81560044, 30860113, 82160052),
Guangxi Medical and Health Appropriate Technology Research and Development
Project (S201315-03, S201422-01), Guangxi Zhuang Autonomous Region Health
Committee Project (Z20190209), Shanxi Health Research Project (2019165)
Introduction
Corona Virus Disease 2019 (COVID-19) is an emerging infectious disease caused by
a novel corona virus, Severe Acute Respiratory Coronavirus 2 (SARS-COV-2) It is a
global pandemic that has seriously threatened human health and has hindered
socio-economic development.1,2 As of October 2021, the cumulative number of
confirmed COVID-19 cases worldwide has exceeded 240 million, with more than 4.9
million deaths For most countries, developing a safe and effective vaccine is urgently
required to protect against the COVID-19 pandemic, and a total of more than 6.6
billion doses of COVID-19 vaccine have been received.3 Currently, 275 COVID-19
vaccine candidates are being tested around the world and 24 of these have been
approved In China, four COVID-19 vaccines have been approved for marketing.4
However, vaccine-induced levels of neutralizing antibody are decreasing over time
and then the protective efficacy is declined In this situation, the increase in the
vaccination number is to provide long-lasting immunity.5,6 The Israeli study7,8showed
that people who received the COVID-19 vaccine booster shot had a lower rate
ofsevere illness by a factor of 19.5 Recently, China has taken COVID-19 vaccination
programs of a booster shot, and people aged 18 or over who have received two dose
of COVID-19 vaccination can receive a booster dose.9
The COVID-19 vaccine acceptance varies across the world About 81.1% of Chinese were willing to take the vaccine before mass vaccination.10,11,12,13 A study in
the United States14 found that the COVID-19 vaccination rate dropped from 74% to
56%, which may be related to low educational background A community-based study
in India found that about 19.5% of residents refused to be vaccinated and 40.7% of
residents had vaccine hesitancy.15 Improving vaccination coverage is the key to
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Trang 7controlling the COVID-19 pandemic,16,17 but vaccine hesitancy is the main factor
affecting vaccination coverage.18,19 Therefore, it is very important to know whether
people are willing to receive the COVID-19 vaccine booster shot, which can develop
an effective strategy to facilitate COVID-19 vaccine booster shot rollout
Therefore, we conducted a cross-sectional study to assess Chinese residents’
attitude, acceptance to receive the COVID-19 vaccine booster shot, and influencing
factors associated with Chinese residents’ willingness to receive the COVID-19
vaccine booster shot To our knowledge, it is the first cross-sectional study for
willingness to receive the COVID-19 vaccine booster shot based on Chinese
population
Methods
Survey design
The cross-sectional study was conducted from July 20, 2021 to September 30, 2021
We conducted an anonymous questionnaire survey of 1,100 residents aged 18 years or
above who have received the two-dose COVID-19 vaccination in 5 communities
including the Forestry Academy, Beihu, Lianchou, Xijin, and Yongning, Guangxi
Province, China We excluded those who had difficulties in listening, speaking,
understanding and communication, and those who were unable to complete the
questionnaire due to mental illness All participants voluntarily participated in this
study and signed an informed consent form before inclusion in this study This study
was approved by the Ethics Committee of the People’s Hospital of Guangxi Zhuang
Autonomous Region
Sample size estimation
We used the Cochran formula20 to estimate the sample size: n = z2pq/e2 =1.962 × 0.5
(1-0.5)/0.052 = 384 Where, n = sample size, z = 1.96 [95% confidence interval (CI)],
p = an estimated incidence rate (50%), q = (1- p), e = the absolute allowable error
(5%) Assuming a 10% non-response rate, the total sample size is 423.5 ≈ 424 Our
sample size is larger than this estimate
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Trang 8Survey design
According to the published literature21,22 and the actual situation, we designed the
questionnaire with four main sections: (1) demographic characteristics; (2) the
cognition of COVID-19 epidemic situation; (3) the attitudes towards COVID-19
vaccine; (4) willingness to receive COVID-19 vaccination Demographic
characteristics comprised 10 items, including gender, age group, place of residence,
marital status, education level, medical insurance type, monthly income, occupation,
whether they suffer from chronic diseases, and whether they have received other
vaccinations in the past year The questionnaire about residents’ awareness of the
COVID-19 epidemic had 7 items, including infection risk, severity of the outbreak,
and the impact of the COVID-19 outbreak on quality of life The third section
discussed about residents’ attitudes towards the COVID-19 vaccine, including
concerns about vaccine safety Vaccination intentions included the willingness or
unwillingness to take COVID-19 vaccine booster shot, the reasons for unwillingness
(sub-item), whether you have received the two-dose COVID-19 vaccination, the
reasons for not completing the two-dose COVID-19 vaccination (sub-item) and the
reluctance to receive COVID-19 vaccine booster shot
Quality control
The anonymous questionnaire survey was conducted by professionally trained
investigators The participants were selected in accordance with the strict inclusion
and exclusion criteria The relevant basic information was collected, then the
participants were given questionnaires and were asked to fill in the questionnaire as
completely and accurately as possible After the questionnaire was completed, the
investigators would check the questionnaire in time and erroneous or inconsistent data
were excluded to ensure the reliability of the data
Statistical analysis
All statistical analyses were performed using IBM Statistical Package for the Social
Sciences software (SPSS Version 21, IBM, Chicago, USA) Descriptive statistics were
calculated as frequency, percentage, mean, standard deviation (SD) The one-way
analysis of variance was used to examine the relationship between variables and the
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Trang 9COVID-19 vaccination The multivariate logistic regression model was applied to
analyze the influencing factors of the willingness to take the COVID-19 vaccine
booster shot and the statistically significant variables (P value < 0.1) in the one-way
ANOVA were further enrolled into the multivariate logistic regression analysis P
value < 0.05 was considered statistically significant
Results
In this study, a total of 1006 valid questionnaires were collected with an effective
response rate of 91.45% (1006/1100) The demographic characteristics of survey
respondents were shown in the Table 1 The majority of the respondents were female
(54.4%), married (83.3%), were in the age group 30 - 39 years (36.4%) and lived in
rural areas (58.9%) The educational level of the present samples was mainly junior
high school (48.8%) The majority of the group were migrant workers (61.7%) and
47.5% had monthly incomes of less than 3000 RMB Besides, 62.9% have rural
insurance, 94% had no chronic disease and 99.1% hadn’t received other vaccines in
the past year
In terms of survey responses, the data revealed that 61.5% (619/1006) of residents agreed or strongly agreed that they were at high risk of contracting the COVID-19,
and 77.3% (778/1006) believed that the COVID-19 epidemic was serious Of these,
41.6% (418/1006) believed that the COVID-19 epidemic continues to spread, but 41.3%
disagreed or strongly disagreed that the COVID-19 epidemic would rebound Most
residents (678/1006 (67.4%)) took the initiative to focus on the updated data about the
COVID-19 epidemic at home and abroad In addition, 67.4% (678/1006) agreed or
strongly agreed that the quality of life was severely affected by the COVID-19
epidemic in the past year About 35.3% (355/1006) indicated that the quality of life
would be severely affected by the COVID-19 epidemic in the next year, however,
47.3% (476/1006) remained neutral (Table 2)
We used four questions to assess the residents' attitudes towards the COVID-19 vaccine and the results were listed in the Table 3 A total of 893 residents (893/1006
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Trang 10(88.8%)) agreed or strongly agreed that the COVID-19 vaccine was safe and effective,
89% (895/1006) also agree or strongly agreed that the COVID-19 epidemic can be
effectively prevented by vaccination Among them, 84% (845/1006) believed that
there were differences between domestic and imported vaccines, and 84.9%
(854/1006) strong agreed that they can accept self-paid vaccine
Among the residents surveyed, 942 (93.6%) received the two-dose COVID-19 vaccination, and 64 (6.4%) did not received it In the meanwhile, the results indicated
that 865 (86%) were willing to receive COVID-19 vaccine booster shot, only 14%
were unwilling (Figure 1)
According to our survey, the concerns about vaccine safety was the main reason for the two-dose COVID-19 vaccination schedule, accounting for 45%, followed by
pregnancy, lactation and work trip, accounting for 42% and 13%, respectively (Figure
2a) Besides, concerns about vaccine safety were also the major reason accounting for
residents’ unwillingness to receive the COVID-19 vaccine booster shot, accounting
for 67%, followed by pregnancy and lactation and contraindications for vaccination,
accounting for 21% and 12% respectively (Figure 2b)
The results showed that gender and age were significantly associated with the
willingness to receive the COVID-19 vaccine booster shot (both P < 0.05) Moreover,
most residents were willing to receive the two-dose COVID-19 vaccination (P =
0.021) However, they hadn't received the COVID-19 vaccine booster shot yet
because of fear of infection (P = 0.001) The residents who obtained information
about COVID-19 vaccine booster shot through various ways were more willing to be
vaccinated (P = 0.026) (Table 4)
A multivariate logistic regression model was used to analyze the relevant factors of the willingness to take the COVID-19 vaccine booster shot and the statistically
significant variables in the one-way analysis of variance were included The results
showed that male, age, and the residents who had received the two-dose COVID-19
vaccination or were afraid of being infected were statistically significantly associated
with willingness to receive COVID-19 vaccine booster shot Specifically, male was
less willingness to take COVID-19 vaccine booster shot (OR = 0.630, 95%CI: 0.436 -
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Trang 110.910, P = 0.014) But the residents of the 18 - 29 years of age group (OR = 2.708,
95%CI: 1.243 - 5.896, P = 0.012), the residents who had received the two-dose
COVID-19 vaccination (OR = 2.066, 95%CI: 1.120 - 3.811, P = 0.020) and who
were afraid of being infected (OR =1.801, 95%CI: 1.230 - 2.638, P = 0.002) were
more willingness to take COVID-19 vaccine booster shot (Table 5)
Discussion
The COVID-19 pandemic has posed unprecedented burdens to healthcare systems
worldwide, and COVID-19 vaccination is considered to be the most effective
intervention to control the pandemic The success of the vaccination schedule depends
on the vaccination coverage rate,23 but vaccine hesitancy is the major factor affecting
the coverage rate of COVID-19 vaccination.18 As a result, understanding the
willingness and influencing factors of COVID-19 vaccination is uniquely important
and can guide effective measures to fight the COVID-19 pandemic.24,25 To date, few
study explored Chinese residents’ willingness to receive the COVID-19 vaccine
booster shot As far as we know, it is the first cross-sectional study for willingness to
receive the COVID-19 vaccine booster shot based on Chinese population In our study,
77.3% of residents believed that the COVID-19 epidemic was serious, 88.8% agreed
or strongly agreed that the COVID-19 vaccine was safe and effective and 89%
thought that the COVID-19 epidemic can be effectively prevented by vaccination
Next, we found that 93.6% received the two-dose COVID-19 vaccination and 86%
were willing to receive COVID-19 vaccine booster shot The results of one-way
ANOVA showed that gender and age were significantly associated with the
willingness to receive the COVID-19 vaccine booster shot, most residents were
willing to receive the two-dose COVID-19 vaccination However, they haven't
received the COVID-19 vaccine booster shot yet because of fear of infection The
residents who obtained information about COVID-19 vaccine booster shot through
various ways were more willing to be vaccinated Multivariate logistic regression
analyses revealed that male was less willingness to take COVID-19 vaccine booster
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