Health System Barriers and Facilitators to Delivering Additional Vaccines through the National Immunisation Programme in China: A Qualitative Study of Provider and Service-User Perspectives

Abstract

In China, there are two categories of vaccines available from the Chinese Center for Disease Control and associated public health agencies. Extended Program of Immunization (EPI) vaccines are government-funded and non-EPI vaccines are voluntary and paid for out-of-pocket. The government plans to transition some non-EPI vaccines to EPI in the coming years, which may burden public health system capacity, particularly in terms of budget, workforce, supply chains, and information systems. Our study explored vaccinator and caregiver perspectives on introducing non-EPI vaccines into routine immunization and perceived facilitators and barriers affecting this transition. We conducted a qualitative study from a realist perspective, analysing semi-structured interviews with 26 vaccination providers and 160 caregivers in three provinces, selected to represent regional socioeconomic disparities across Eastern, Central, and Western China. Data were analysed thematically, using deductive and inductive coding. Most participants were positive about adding vaccines to the national schedule. Candidate EPI vaccines most frequently recommended by participants were varicella, mumps vaccine, and hand–foot–mouth disease. Providers generally considered existing workspaces, cold-chain equipment, and funding sufficient, but described frontline staffing and vaccine information systems as requiring improvement. This is the first qualitative study to explore interest, barriers, and facilitators related to adding vaccines to China’s national schedule from provider and caregiver perspectives. Findings can inform government efforts to introduce additional vaccines, by including efforts to retain and recruit vaccine programme staff and implement whole-process data management and health information systems that allow unified nationwide data collection and sharing.

Investigate Non-EPI Vaccination Recommendation Practice from a Socio-Ecological Perspective: A Mixed-Methods Study in China

“…Moreover, a lack of electronic information systems also contributed to the overload of the VSPs. Dan Gong et al found that insufficient infrastructure was one of the main barriers of delivering additional vaccines through the national EPI schedule [36]. While most provinces have an immunization information system capable of managing vaccine stocks and keeping official vaccination records, it cannot support vaccination services [37].…”

“…In addition, VSPs have to take on additional responsibilities, such as chronic disease management [38,39], and this extended work scope has exacerbated the shortage of the VSPs. Therefore, to ensure the reasonable workload of VSPs and leave time for health communications, the government should promote the construction of the whole-process health information system and strengthen the public health workforce through both retaining and recruiting staff, using financial and nonfinancial incentives [36].…”

The whole-of-society approach of mass COVID-19 vaccination in China: a qualitative study

“…Extremely heavy workloads with extended working hours had caused fatigue, exhaustion, and psychological disturbances [36] . It is important to take economic and non-economic incentives for vaccination workers to ensure their enthusiasm [37] . Arranging reasonable working hours might be vital to their e ciency and mental status [36] .…”

The whole-of-society approach of mass COVID-19 vaccination in China: a qualitative study

“…Hefty workloads with extended working hours have caused fatigue, exhaustion and psychological disturbances [ 44 ]. It is essential to offer economic and noneconomic incentives for vaccination workers to ensure their enthusiasm [ 45 ]. Arranging reasonable working hours might be vital to their efficiency and mental status [ 44 ].…”