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

Abstract

Background It is vital to summarize the experiences of mass COVID-19 vaccination practice in countries with high vaccination coverage and provide implications for other countries. This study aimed to investigate COVID-19 vaccination system and summarize the implementation experiences from health system perspectives in China.Methods We conducted a qualitative study to summarize the implementation experiences from health system perspectives in five representative cities in China late 2021. Semi-structured interviews and COVID-19 vaccination policy documents were collected and coded by thematic analysis approach. Interview guideline was developed according to six building blocks of health systems framework proposed by the WHO, including leadership and governance, health workforce, vaccination service delivery, financing, access to vaccines, and information system; and a new system building block, vaccination mobilization and communication, was added to the interview guideline.Results Totally 61 participants (nine vaccination program directors of CDCs, four government staffs, and 48 vaccination service workers) were interviewed. We found that China adopted a whole-of-society approach with adequate government engagement and linked health and non-health sectors as a whole to promote COVID-19 vaccination. Key measures included the collaboration of multi-system and multi-department from the governance perspective, allocation of sufficient health workers and resources, large-scale vaccination mobilization and communication, expansion of vaccine financing channels, localized production, and digital information systems. With vaccination system strengthening, the two-doses vaccination coverage reached 89.5% as of July 2022.Conclusions Our study stresses the importance of a government-led whole-of-society approach to promote mass vaccination, and the low vaccination coverage among the elderly should be paid the highest attention. The experiences and lessons from China may serve as a reference for other countries.