研究目的：新型冠状病毒疫苗的高接种率对于控制新冠疫情传播、防止新冠变异毒株侵袭以及改善感染新冠后的预后至关重要，而疫苗犹豫可能是建立充分群体免疫的障碍。本研究旨在调查中国新冠疫苗犹豫现状，探索影响新冠疫苗犹豫的因素，并分析新冠疫苗接种的共同障碍和促进因素。为制定有效提升人群新冠疫苗接种意愿的宣传培训手段及沟通策略提供依据。

研究方法：本次调查于2021年1月至3月在中国7个城市的学生、公共卫生专业人员、医务工作者和一般人群中进行网络调查。问卷包括社会人口学信息、对感染新冠的担忧、一般接种行为和态度、普通疫苗犹豫量表、新冠疫苗犹豫量表、HBM相关因素和其他潜在因素。对相关因素进行描述统计，计量资料的变量组间比较采用t检验或方差分析，分类资料的变量组间比较采用卡方检验。然后将单因素分析有显著性或其单因素分析P值小于0.10的变量纳入多变量回归模型。

研究结果：在本研究中，4227个研究对象中新冠疫苗犹豫率为15.64%。在调查的人群中，有23.90%的学生、21.20%的一般人群、13.14%的医务工作者和10.42%的公共卫生专业人员存在新冠疫苗犹豫。经分析，年龄越大的人越不易产生新冠疫苗犹豫；与男性相比，女性更易产生新冠疫苗犹豫（P<0.01）。在一般接种行为相关变量中，不认为疫苗可以保护其免受疾病侵袭伤害的参与者（OR: 2.26, 95%CI: 1.67-3.04）更易产生新冠疫苗犹豫。未曾犹豫接种疫苗的参与者（OR: 0.59, 95%CI: 0.46-0.75）更不易产生新冠疫苗犹豫。此外，普通疫苗犹豫量表得分高的参与者更易产生新冠疫苗犹豫（OR: 1.03, 95%CI: 1.01-1.04）。不采纳医生建议接种新冠疫苗的参与者更易产生新冠疫苗犹豫（OR: 5.12, 95%CI: 3.85-6.81）。不受家庭成员和朋友意见影响接种新冠疫苗的参与者（OR: 0.66, 95%CI: 0.52-0.84），不对新冠疫苗信息的来源持怀疑态度（OR: 0.47, 95%CI: 0.37-0.60），以及未收到或听到过有关新冠疫苗的负面信息（OR: 0.63, 95%CI: 0.50-0.81）的参与者更不易产生新冠疫苗犹豫。在健康信念模型相关因素中，感知益处得分更高的参与者更不易产生新冠疫苗犹豫（OR: 0.92, 95%CI: 0.86-0.99）；感知障碍得分更高的参与者更易产生新冠疫苗犹豫（OR: 1.18, 95%CI: 1.11-1.25）。

研究结论：鉴于提高感知益处可以减少人们的新冠疫苗犹豫，相关公共卫生部门需进行疫苗相关宣传活动，向公众提供有关新冠疫苗的充分和适当的信息，以新冠疫苗的安全性，有效性和益处的可靠证据来提高疫苗的感知益处。而感知障碍会使人们更容易产生新冠疫苗犹豫，对于人们在实际接种过程中会产生的障碍，相关部门应做好沟通及准备工作以提高接种疫苗的便利性。医务工作者对疫苗接种的建议可以促使人们接种新冠疫苗，因此有必要对他们进行适当的疫苗知识和沟通技巧培训，通过医务工作者向公众传递正确信息以提高公众接种疫苗的意愿。此外，减少错误信息的传播，及时准确地传播事实，将可能减少疫苗的犹豫。在政府和公众之间建立适当的沟通策略和信息交流平台，以及建立不实信息传播的预警系统，将有助于提高公众对疫苗接种的信心。

Objectives: High vaccination rate of COVID-19 vaccine is critical for controlling the COVID-19 pandemic, preventing infection with variant strains of COVID-19, and improving the prognosis after infection of COVID-19, whereas vaccine hesitancy may be a barrier to establishing adequate herd immunity. The aim of this study is to investigate the status of COVID-19 vaccine hesitancy in China, to explore factors influencing COVID-19 vaccine hesitancy, and to analyze barriers and facilitators of COVID-19 vaccination. This study provided a basis for developing promotional and educational materials and communication strategies to effectively enhance people’s willingness to receive the COVID-19 vaccine.

Methods: The survey was conducted with a web-based survey among students, public health professionals, medical workers, and the general population in 7 cities in China from January to March 2021. The questionnaire included sociodemographic information, concerns about the COVID-19 infection, general vaccination behaviors and attitudes, the General Vaccine Hesitancy Scale, the COVID-19 Vaccine Hesitancy Scale, factors associated with HBM, and other potential factors. Descriptive statistics were performed for relevant factors, and t-test or ANOVA was utilized for quantitative variables comparisons, and chi-square test was used for categorical variables comparisons. Variables with significant univariate analysis or whose P-values for univariate analysis were less than 0.10 were then included in the multivariate regression model.

Results: COVID-19 vaccine hesitancy was 15.64% of the 4227 study participants in this investigation. Among the populations surveyed, 23.90% of students, 21.20% of the general population, 13.14% of medical workers and 10.42% of public health professionals had COVID-19 vaccine hesitancy. The older individuals were less likely to have COVID-19 vaccine hesitancy; female was more likely to have COVID-19 vaccine hesitancy compared to male (P<0.01). Among the variables related to general vaccination behavior, participants who did not believe that the vaccine would protect them from disease attack (OR: 2.26, 95%CI: 1.67-3.04) were more likely to have COVID-19 vaccine hesitancy. Participants who had not hesitated to receive the vaccine (OR: 0.59, 95%CI: 0.46-0.75) were less likely to have COVID-19 vaccine hesitancy. In addition, participants with higher scores on the General Vaccine Hesitancy Scale were more likely to have COVID-19 vaccine hesitancy (OR: 1.03, 95%CI: 1.01-1.04). Participants who did not follow their doctor’s recommendation for vaccination were more likely to be hesitant to receive the COVID-19 vaccine (OR: 5.12, 95%CI: 3.85-6.81). Participants who were not influenced by the opinions of family members and friends to receive the COVID-19 vaccine (OR: 0.66, 95%CI: 0.52-0.84), who were not doubt about the source of information about the COVID-19 vaccine (OR: 0.47, 95%CI: 0.37-0.63), and had not received or heard negative information about the COVID-19 vaccine (OR: 0.63, 95%CI: 0.50-0.81) were less likely to be hesitant about the COVID-19 vaccine. Among the Health Belief Model correlates, participants with higher perceived benefits scores were less likely to have COVID-19 vaccine hesitancy (OR: 0.92, 95%CI: 0.86-0.99); participants with high perceived barriers scores were more likely to have COVID-19 vaccine hesitancy (OR: 1.18, 95%CI: 1.11-1.25).

Conclusions: Given that increasing the perceived benefits could reduce COVID-19 vaccine hesitancy, relevant public health authorities should conduct vaccine-related campaigns to provide the public with adequate and appropriate information about the COVID-19 vaccine and to increase the perceived benefits of the vaccine with reliable evidence of its safety, efficacy, and benefits. While perceived barriers can make people more likely to be hesitant about the COVID-19 vaccine, the relevant authorities should communicate and be prepared to improve access for those who may have barriers to the actual vaccination process. Medical workers’ advice on vaccination can motivate people to get vaccinated with the COVID-19 vaccine, it is necessary to train them on proper vaccine knowledge and communication skills, and to improve the public’s willingness to be vaccinated by delivering the correct information to the public through medical workers. In addition, reducing the spread of misinformation and disseminating facts in a timely and accurate manner will likely reduce vaccine hesitancy. Establishing appropriate communication strategies and information exchange platforms between the government and the public, as well as establishing an early warning system for infodemic, will help increase public confidence in vaccination.