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Lin SY, Zhang SY, Chantler T, Sun FY, Zou JT, Cheng JJ, Chen YQ, Sun M, Howard N. Vaccination coverage determinants in low uptake areas of China: a qualitative study of provider perspectives in Sichuan, Guangdong, and Henan Provinces. Hum Vaccin Immunother 2022; 18:2030623. [PMID: 35176962 PMCID: PMC8993075 DOI: 10.1080/21645515.2022.2030623] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
China’s immunization programme is relatively strong, with latest WHO-UNICEF monitoring rates for 2019 showing national vaccination coverage over 90%. However, vaccination coverage is heterogeneous, varying across geographic regions, rural–urban communities, and sub-populations. We conducted a qualitative study from a critical realist perspective, analyzing semi-structured interviews with 26 vaccination providers in three provinces, selected to represent regional socioeconomic disparities across Eastern, Central, and Western China. We analyzed data thematically, using deductive and inductive coding. Providers reported vaccination coverage in their areas had increased significantly, but remained lower among migrant and left-behind children. Main coverage determinants were child-related (i.e. gender, number, health status), caregiver-related (i.e. socioeconomic status, role, education level, ethnicity), institution-related (i.e. vaccinator numbers, information system, appointment process), and system-related (i.e. vaccine supply, intersectoral cooperation, vaccine ‘hesitancy’). Potentially effective measures to promote vaccination coverage included using routine maternal and child health-care visits for catch-up vaccination, providing additional health education, conducting follow-up family visits by village doctors, and requiring vaccination verification at school enrollment. This is the first qualitative study to examine potential determinants of low vaccination coverage in these areas of China. Findings can inform policies to strengthen the role of schools, develop the national immunization information system, and promote appointment apps. More consideration is needed to improve service quality and eliminating inequities, such as strengthening health education and service provision for migrant and left-behind children.
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Affiliation(s)
- Shi-Yu Lin
- Department of Health Policy and Management, School of Public Health, Fudan University, Shanghai, China.,NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Shi-Ya Zhang
- Department of Health Policy and Management, School of Public Health, Fudan University, Shanghai, China.,NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Tracey Chantler
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Fiona Yueqian Sun
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, University of London, London, UK
| | - Jia-Tong Zou
- Department of Organization and Personnel, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Jie-Jie Cheng
- Department of Health Policy and Management, School of Public Health, Fudan University, Shanghai, China.,NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Yu-Qian Chen
- Department of Health Policy and Management, School of Public Health, Fudan University, Shanghai, China.,NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Mei Sun
- Department of Health Policy and Management, School of Public Health, Fudan University, Shanghai, China.,NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Natasha Howard
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.,Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
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