Introduction: Rapidly urbanizing communities in middle-income countries could be sources of vaccine hesitancy, and could create hot spots of low vaccination coverage. This study characterizes vaccine hesitancy in Shanghai and identifies disparities in vaccine safety and efficacy concerns by residency status-a marker for recent migration into the city. Methods: Parents of children aged ≤18 years from immunization clinics in Shanghai were enrolled in summer 2019, with the data analyzed during winter 2019−2020. The paper questionnaire used the Parental Attitudes towards Childhood Vaccines scale, which included questions about vaccine safety and efficacy concerns. The primary independent variable was residency-whether an individual was a Shanghai local or a recent migrant (i.e., non-local). Linear regression models assessed the relationship between residency and vaccine safety and efficacy concerns. Results: Among 1,021 participants, 65.4% had local residency, and the remainder were urban non-locals (13.1%) or rural non-locals (21.5%). A majority of parents expressed concerns about vaccine side effects (73.8%), vaccine safety (63.9%), and vaccine effectiveness (52.4%). Compared with locals, rural non-locals were more concerned about vaccine side effects (b=0.26, 95% CI=0.07, 0.46), vaccine safety (b=0.42, 95% CI=0.19, 0.65), and vaccine effectiveness (b=0.37, 95% CI=0.16, 0.58). Conclusions: Differences in vaccine hesitancy by residency could lead to geographical and sociodemographic disparities in vaccination coverage and outbreaks of vaccine-preventable disease.

Controlling the spread of SARS-CoV-2 will require high vaccination coverage, but acceptance of the vaccine could be impacted by perceptions of vaccine safety and effectiveness. The aim of this study was to characterize how vaccine safety and effectiveness impact acceptance of a vaccine, and whether this impact varied over time or across socioeconomic and demographic groups. Repeated cross-sectional surveys of an opt-in internet sample were conducted in 2020 in the US, mainland China, Taiwan, Malaysia, Indonesia, and India. Individuals were randomized into receiving information about a hypothetical COVID-19 vaccine with different safety and effectiveness profiles (risk of fever 5% vs. 20% and vaccine effectiveness 50% vs. 95%). We examined the effect of the vaccine profile on vaccine acceptance in a logistic regression model, and included interaction terms between vaccine profile and socioeconomic/demographic variables to examine the differences in sensitivity to the vaccine profile. In total, 12,915 participants were enrolled in the six-country study, including the US (4054), China (2797), Taiwan (1278), Malaysia (1497), Indonesia (1527), and India (1762). Across time and countries, respondents had stronger preferences for a safer and more effective vaccine. For example, in the US in November 2020, acceptance was 3.10 times higher for a 95% effective vaccine with a 5% risk of fever, vs a vaccine 50% effective, with a 20% risk of fever (95% CI: 2.07, 4.63). Across all countries, there was an increase in the effect of the vaccine profile over time (p < 0.0001), with stronger preferences for a more effective and safer vaccine in November 2020 compared to August 2020. Sensitivity to the vaccine profile was also stronger in August compared to November 2020, in younger age groups, among those with lower income; and in those that are vaccine hesitant. Uptake of COVID-19 vaccines could vary in a country based upon effectiveness and availability. Effective communication tools will need to be developed for certain sensitive groups, including young adults, those with lower income, and those more vaccine hesitant.

Several COVID-19 vaccines have been on the market since early 2021 and may vary in their effectiveness and safety. This study characterizes hesitancy about accepting COVID-19 vaccines among parents in Shanghai, China, and identifies how sensitive they are to changes in vaccine safety and effectiveness profiles. Schools in each township of Minhang District, Shanghai, were sampled, and parents in the WeChat group of each school were asked to participate in this cross-sectional Internet-based survey. Parents responded to questions about hesitancy and were given information about five different COVID-19 vaccine candidates, the effectiveness of which varied between 50 and 95% and which had a risk of fever as a side effect between 5 and 20%. Overall, 3673 parents responded to the survey. Almost 90% would accept a vaccine for themselves (89.7%), for their child (87.5%) or for an elderly parent (88.5%) with the most ideal attributes (95% effectiveness with 5% risk of fever). But with the least ideal attributes (50% effectiveness and a 20% risk of fever) these numbers dropped to 33.5%, 31.3%, and 31.8%, respectively. Vaccine hesitancy, age at first child’s birth, and relative income were all significantly related to sensitivity to vaccine safety and effectiveness. Parents showed a substantial shift in attitudes towards a vaccine based on its safety and effectiveness profile. These findings indicate that COVID-19 vaccine acceptance may be heavily influenced by how effective the vaccine actually is and could be impeded or enhanced based on vaccines already on the market.

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ObjectiveTo characterise studies which have used Demographic and Health Survey (DHS) datasets to evaluate vaccination status.DesignScoping review.Data sourcesElectronic databases including PubMed, EBSCOhost and POPLINE, from 2005 to 2018.Study selectionAll English studies with vaccination status as the outcome and the use of DHS data.Data extractionStudies were selected using a predetermined list of eligibility criteria and data were extracted independently by two authors. Data related to the study population, the outcome of interest (vaccination) and commonly seen predictors were extracted.ResultsA total of 125 articles were identified for inclusion in the review. The number of countries covered by individual studies varied widely (1–86), with the most published papers using data from India, Nigeria, Pakistan and Ethiopia. Many different definitions of full vaccination were used although the majority used a traditional schedule recommended in the WHO’s Expanded Programme on Immunisation. We found studies analysed a wide variety of predictors, but the most common were maternal education, wealth, urbanicity and child’s sex. Most commonly reported predictors had consistent relationships with the vaccination outcome, outside of sibling composition.ConclusionsResearchers make frequent use of the DHS dataset to describe vaccination patterns within one or more countries. A clearer idea of past use of DHS can inform the development of more rigorous studies in the future. Researchers should carefully consider whether a variable needs to be included in the multivariable model, or if there are mediating relationships across predictor variables.