A Comparison of Vaccine Hesitancy of COVID-19 Vaccination in China and the United States

  1. Taoran Liu
  2. Zonglin He
  3. Jian Huang
  4. Ni Yan
  5. Qian Chen
  6. Fengqiu Huang
  7. Yuejia Zhang
  8. Omolola M. Akinwunmi
  9. Babatunde O. Akinwunmi
  10. Casper J. P. Zhang
  11. Yibo Wu
  12. Wai-Kit Ming

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Abstract

Objectives: To investigate the differences in vaccine hesitancy and preference of the currently available COVID-19 vaccines between two countries, namely, China and the United States (U.S.). Method: A cross-national survey was conducted in both China and the United States, and discrete choice experiments, as well as Likert scales, were utilized to assess vaccine preference and the underlying factors contributing to vaccination acceptance. Propensity score matching (PSM) was performed to enable a direct comparison between the two countries. Results: A total of 9077 (5375 and 3702 from China and the United States, respectively) respondents completed the survey. After propensity score matching, over 82.0% of respondents from China positively accepted the COVID-19 vaccination, while 72.2% of respondents from the United States positively accepted it. Specifically, only 31.9% of Chinese respondents were recommended by a doctor to have COVID-19 vaccination, while more than half of the U.S. respondents were recommended by a doctor (50.2%), local health board (59.4%), or friends and families (64.8%). The discrete choice experiments revealed that respondents from the United States attached the greatest importance to the efficacy of COVID-19 vaccines (44.41%), followed by the cost of vaccination (29.57%), whereas those from China held a different viewpoint, that the cost of vaccination covered the largest proportion in their trade-off (30.66%), and efficacy ranked as the second most important attribute (26.34%). Additionally, respondents from China tended to be much more concerned about the adverse effect of vaccination (19.68% vs. 6.12%) and have a lower perceived severity of being infected with COVID-19. Conclusion: Although the overall acceptance and hesitancy of COVID-19 vaccination in both countries are high, underpinned distinctions between these countries were observed. Owing to the differences in COVID-19 incidence rates, cultural backgrounds, and the availability of specific COVID-19 vaccines in the two countries, vaccine rollout strategies should be nation-dependent.

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  1. Version published to 10.3390/vaccines9060649
  2. ScreenIT

    SciScore for 10.1101/2021.04.29.21256317: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    NIH rigor criteria are not applicable to paper type.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    The data were analyzed using STATA, version
    STATA
    suggested: (Stata, RRID:SCR_012763)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strength and limitations: The present study has limitations. The inherent nature of cross-sectional studies renders it difficult to establish causality or to generalize the results in a long-term manner, especially when vaccination acceptance is variable, dynamic and multifactorial. Hence the results of the study should be interpreted with cautions. But the present study implemented the PSM to minimize the confounding effects, and it may somehow enhance the interpretability of the results. Still, the present study is the first study to directly compare the acceptance and preference of the respondents from two distinctly different representative countries, and the results of the study may provide insights for the vaccination promotion strategy based on different national situations globally. And the present study used multiple study methods to provide the most comprehensive and updated investigation, especially on the influencing factors contributing to the decision making about vaccination. In conclusion, great variability in the preference of COVID-19 vaccines was found between respondents from China and the United States, and the influencing factors for the hesitancy as well as the attributes for their preferences for the vaccines varied, hence multi-disciplinary and international collaboration should be established and strengthened based on specific national conditions to further reduce vaccine hesitancy and increase vaccination coverage.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a protocol registration statement.

    Results from scite Reference Check: We found no unreliable references.

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  3. Version published to 10.1101/2021.04.29.21256317v1 on medRxiv