Willingness to receive in the covid 19 vacine booster shot a case study from china

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Manuscript

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Willingness to receive the COVID-19 vaccine booster shot: a
cross-sectional study in China

Yongqing Deng1#, Xiaoqin Qiu2#, Caixian Huang3#, Weiwei Li4#, Liying Dai4#, Miaomiao Xie5,
Chaofeng Chen4, Runlin Han6, Yan Chen4, Shishan Huang7, Sujiao Qin2, Jiayin Ou8, Ting Shi9,
Li Zhang10, Yuechou Nong10, Jianrong Yang5, Wensheng Lu10*

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1 The Family Planning Office, Guangxi Academy of Medical Sciences and the People’s
Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, P.R.China
2 The Nursing Department, Guangxi Academy of Medical Sciences and the People’s Hospital
of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, P.R.China

3 Department of Hematology, Guangxi Academy of Medical Sciences and the People’s
Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, P.R.China
4 The Office of Guangxi Academy of Medical Sciences and the People’s Hospital of Guangxi
Zhuang Autonomous Region, Nanning, Guangxi, 530021, P.R.China
5 Department of Hepatobiliary Surgery, Guangxi Academy of Medical Sciences and the
People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021,
P.R.China
6 Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, 530021,
P.R.China
7 The Scientific Research Department, Guangxi Academy of Medical Sciences and the
People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021,
P.R.China
8 Department of Medical Administration, Guangxi Academy of Medical Sciences and the
People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021,
P.R.China
9 Department of Prevention and Health Care, Guangxi Academy of Medical Sciences and the
People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021,
P.R.China
10 Department of Endocrinology and Metabolism, Guangxi Academy of Medical Sciences
and the People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi,
530021, P.R.China

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# They contributed equally to this work;
∗ Corresponding author: Prof. Wensheng Lu, E-mail: ; ORCID ID:
0000-0003-4179-1171

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Summary
Background As the coronavirus disease 19 (COVID-19) global pandemic continues,
safe and effective vaccines and high vaccination coverage are still the most effective

way to the control of the COVID-19 epidemic. This study aimed to explore the
influencing factors of the willingness to receive the COVID-19 vaccine booster shot
in Chinese residents.

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Methods This was a cross-sectional study and a total of 1100 residents participated in
the anonymous questionnaire survey. The data collected included demographic
characteristics, residents’ awareness of COVID-19 epidemic, the attitude towards
COVID-19 vaccine and vaccination willingness. The multivariate logistic regression
analyses were used to assess the factors influencing the Chinese residents' willingness
to receive the COVID-19 vaccine booster shot.

Findings In total, 1006 valid questionnaires were collected with a response rate of
91.45%. Among them, 77.3% believed that the COVID-19 epidemic was serious, 88.8%
responded that the COVID-19 vaccine was safe and effective, 93.6% received the

two-dose COVID-19 vaccination and 86% were willing to receive COVID-19 vaccine

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booster shot. The concerns about vaccine safety were the main reason for willing to
the two-dose COVID-19 vaccination schedule and the COVID-19 vaccine booster

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shot, accounting for 45% and 67%, respectively. Multivariate logistic regression
analyses revealed that male was less willingness to take COVID-19 vaccine booster
shot (OR = 0.630, 95%CI: 0.436 - 0.910, P = 0.014). But the residents of the 18 - 29
years of age group (OR = 2.708, 95%CI: 1.243 - 5.896, P = 0.012), the residents who
had received the two-dose COVID-19 vaccination (OR = 2.066, 95%CI: 1.120 - 3.811,

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P = 0.020) and who were afraid of being infected (OR =1.801, 95%CI: 1.230 - 2.638,
P = 0.002) were more willingness to take COVID-19 vaccine booster shot.
Interpretation Most residents were willing to receive the COVID-19 vaccine booster

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shot. Being female, younger age and the residents who had received the two-dose
COVID-19 vaccination and who were afraid of being infected were statistically
significantly associated with willingness to receive COVID-19 vaccine booster shot.
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Fundings Natural Science Foundation of China (81560044, 30860113, 82160052),
Guangxi Medical and Health Appropriate Technology Research and Development

Project (S201315-03, S201422-01), Guangxi Zhuang Autonomous Region Health
Committee Project (Z20190209), Shanxi Health Research Project (2019165).

Introduction

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Corona Virus Disease 2019 (COVID-19) is an emerging infectious disease caused by
a novel corona virus, Severe Acute Respiratory Coronavirus 2 (SARS-COV-2). It is a
global pandemic that has seriously threatened human health and has hindered
socio-economic development.1,2 As of October 2021, the cumulative number of
confirmed COVID-19 cases worldwide has exceeded 240 million, with more than 4.9

million deaths. For most countries, developing a safe and effective vaccine is urgently
required to protect against the COVID-19 pandemic, and a total of more than 6.6
billion doses of COVID-19 vaccine have been received.3 Currently, 275 COVID-19
vaccine candidates are being tested around the world and 24 of these have been
approved. In China, four COVID-19 vaccines have been approved for marketing.4

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However, vaccine-induced levels of neutralizing antibody are decreasing over time
and then the protective efficacy is declined. In this situation, the increase in the

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vaccination number is to provide long-lasting immunity.5,6 The Israeli study7,8 showed
that people who received the COVID-19 vaccine booster shot had a lower rate
ofsevere illness by a factor of 19.5. Recently, China has taken COVID-19 vaccination
programs of a booster shot, and people aged 18 or over who have received two dose
of COVID-19 vaccination can receive a booster dose.9

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The COVID-19 vaccine acceptance varies across the world. About 81.1% of
Chinese were willing to take the vaccine before mass vaccination.10,11,12,13 A study in
the United States14 found that the COVID-19 vaccination rate dropped from 74% to

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56%, which may be related to low educational background. A community-based study
in India found that about 19.5% of residents refused to be vaccinated and 40.7% of
residents had vaccine hesitancy.15 Improving vaccination coverage is the key to
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controlling the COVID-19 pandemic,16,17 but vaccine hesitancy is the main factor
affecting vaccination coverage.18,19 Therefore, it is very important to know whether

people are willing to receive the COVID-19 vaccine booster shot, which can develop
an effective strategy to facilitate COVID-19 vaccine booster shot rollout.

Therefore, we conducted a cross-sectional study to assess Chinese residents’
attitude, acceptance to receive the COVID-19 vaccine booster shot, and influencing

factors associated with Chinese residents’ willingness to receive the COVID-19

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vaccine booster shot. To our knowledge, it is the first cross-sectional study for

willingness to receive the COVID-19 vaccine booster shot based on Chinese
population.

Methods
Survey design

The cross-sectional study was conducted from July 20, 2021 to September 30, 2021.
We conducted an anonymous questionnaire survey of 1,100 residents aged 18 years or
above who have received the two-dose COVID-19 vaccination in 5 communities

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including the Forestry Academy, Beihu, Lianchou, Xijin, and Yongning, Guangxi
Province, China. We excluded those who had difficulties in listening, speaking,

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understanding and communication, and those who were unable to complete the
questionnaire due to mental illness. All participants voluntarily participated in this
study and signed an informed consent form before inclusion in this study. This study
was approved by the Ethics Committee of the People’s Hospital of Guangxi Zhuang
Autonomous Region.

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Sample size estimation

We used the Cochran formula20 to estimate the sample size: n = z2pq/e2 =1.962 × 0.5
(1-0.5)/0.052 = 384. Where, n = sample size, z = 1.96 [95% confidence interval (CI)],

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p = an estimated incidence rate (50%), q = (1- p), e = the absolute allowable error
(5%). Assuming a 10% non-response rate, the total sample size is 423.5 ≈ 424. Our
sample size is larger than this estimate.
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Survey design
According to the published literature21,22 and the actual situation, we designed the

questionnaire with four main sections: (1) demographic characteristics; (2) the
cognition of COVID-19 epidemic situation; (3) the attitudes towards COVID-19
vaccine;

(4)

willingness

to

receive

COVID-19

vaccination.

Demographic

characteristics comprised 10 items, including gender, age group, place of residence,

marital status, education level, medical insurance type, monthly income, occupation,

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whether they suffer from chronic diseases, and whether they have received other

vaccinations in the past year. The questionnaire about residents’ awareness of the
COVID-19 epidemic had 7 items, including infection risk, severity of the outbreak,
and the impact of the COVID-19 outbreak on quality of life. The third section
discussed about residents’ attitudes towards the COVID-19 vaccine, including
concerns about vaccine safety. Vaccination intentions included the willingness or
unwillingness to take COVID-19 vaccine booster shot, the reasons for unwillingness
(sub-item), whether you have received the two-dose COVID-19 vaccination, the
reasons for not completing the two-dose COVID-19 vaccination (sub-item) and the

Quality control

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reluctance to receive COVID-19 vaccine booster shot.

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The anonymous questionnaire survey was conducted by professionally trained
investigators. The participants were selected in accordance with the strict inclusion
and exclusion criteria. The relevant basic information was collected, then the
participants were given questionnaires and were asked to fill in the questionnaire as
completely and accurately as possible. After the questionnaire was completed, the
investigators would check the questionnaire in time and erroneous or inconsistent data

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were excluded to ensure the reliability of the data.
Statistical analysis

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All statistical analyses were performed using IBM Statistical Package for the Social
Sciences software (SPSS Version 21, IBM, Chicago, USA). Descriptive statistics were
calculated as frequency, percentage, mean, standard deviation (SD). The one-way
analysis of variance was used to examine the relationship between variables and the
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COVID-19 vaccination. The multivariate logistic regression model was applied to
analyze the influencing factors of the willingness to take the COVID-19 vaccine

booster shot and the statistically significant variables (P value < 0.1) in the one-way
ANOVA were further enrolled into the multivariate logistic regression analysis. P
value < 0.05 was considered statistically significant.

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Results

In this study, a total of 1006 valid questionnaires were collected with an effective
response rate of 91.45% (1006/1100). The demographic characteristics of survey
respondents were shown in the Table 1. The majority of the respondents were female
(54.4%), married (83.3%), were in the age group 30 - 39 years (36.4%) and lived in
rural areas (58.9%). The educational level of the present samples was mainly junior
high school (48.8%). The majority of the group were migrant workers (61.7%) and
47.5% had monthly incomes of less than 3000 RMB. Besides, 62.9% have rural
insurance, 94% had no chronic disease and 99.1% hadn’t received other vaccines in
the past year.

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In terms of survey responses, the data revealed that 61.5% (619/1006) of residents
agreed or strongly agreed that they were at high risk of contracting the COVID-19,

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and 77.3% (778/1006) believed that the COVID-19 epidemic was serious. Of these,
41.6% (418/1006) believed that the COVID-19 epidemic continues to spread, but 41.3%
disagreed or strongly disagreed that the COVID-19 epidemic would rebound. Most
residents (678/1006 (67.4%)) took the initiative to focus on the updated data about the
COVID-19 epidemic at home and abroad. In addition, 67.4% (678/1006) agreed or

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strongly agreed that the quality of life was severely affected by the COVID-19
epidemic in the past year. About 35.3% (355/1006) indicated that the quality of life
would be severely affected by the COVID-19 epidemic in the next year, however,

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47.3% (476/1006) remained neutral (Table 2).
We used four questions to assess the residents' attitudes towards the COVID-19

vaccine and the results were listed in the Table 3. A total of 893 residents (893/1006
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(88.8%)) agreed or strongly agreed that the COVID-19 vaccine was safe and effective,
89% (895/1006) also agree or strongly agreed that the COVID-19 epidemic can be
effectively prevented by vaccination. Among them, 84% (845/1006) believed that

there were differences between domestic and imported vaccines, and 84.9%
(854/1006) strong agreed that they can accept self-paid vaccine.

Among the residents surveyed, 942 (93.6%) received the two-dose COVID-19
vaccination, and 64 (6.4%) did not received it. In the meanwhile, the results indicated

were unwilling (Figure 1).

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that 865 (86%) were willing to receive COVID-19 vaccine booster shot, only 14%

According to our survey, the concerns about vaccine safety was the main reason for
the two-dose COVID-19 vaccination schedule, accounting for 45%, followed by
pregnancy, lactation and work trip, accounting for 42% and 13%, respectively (Figure
2a). Besides, concerns about vaccine safety were also the major reason accounting for
residents’ unwillingness to receive the COVID-19 vaccine booster shot, accounting
for 67%, followed by pregnancy and lactation and contraindications for vaccination,
accounting for 21% and 12% respectively (Figure 2b).

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The results showed that gender and age were significantly associated with the
willingness to receive the COVID-19 vaccine booster shot (both P < 0.05). Moreover,

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most residents were willing to receive the two-dose COVID-19 vaccination (P =
0.021). However, they hadn't received the COVID-19 vaccine booster shot yet
because of fear of infection (P = 0.001). The residents who obtained information
about COVID-19 vaccine booster shot through various ways were more willing to be
vaccinated (P = 0.026) (Table 4).
A multivariate logistic regression model was used to analyze the relevant factors of

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the willingness to take the COVID-19 vaccine booster shot and the statistically
significant variables in the one-way analysis of variance were included. The results

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showed that male, age, and the residents who had received the two-dose COVID-19
vaccination or were afraid of being infected were statistically significantly associated
with willingness to receive COVID-19 vaccine booster shot. Specifically, male was
less willingness to take COVID-19 vaccine booster shot (OR = 0.630, 95%CI: 0.436 7

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0.910, P = 0.014). But the residents of the 18 - 29 years of age group (OR = 2.708,
95%CI: 1.243 - 5.896, P = 0.012), the residents who had received the two-dose

COVID-19 vaccination (OR = 2.066, 95%CI: 1.120 - 3.811, P = 0.020) and who
were afraid of being infected (OR =1.801, 95%CI: 1.230 - 2.638, P = 0.002) were
more willingness to take COVID-19 vaccine booster shot (Table 5).

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Discussion

The COVID-19 pandemic has posed unprecedented burdens to healthcare systems
worldwide, and COVID-19 vaccination is considered to be the most effective
intervention to control the pandemic. The success of the vaccination schedule depends

on the vaccination coverage rate,23 but vaccine hesitancy is the major factor affecting
the coverage rate of COVID-19 vaccination.18 As a result, understanding the
willingness and influencing factors of COVID-19 vaccination is uniquely important
and can guide effective measures to fight the COVID-19 pandemic.24,25 To date, few
study explored Chinese residents’ willingness to receive the COVID-19 vaccine
booster shot. As far as we know, it is the first cross-sectional study for willingness to

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receive the COVID-19 vaccine booster shot based on Chinese population. In our study,
77.3% of residents believed that the COVID-19 epidemic was serious, 88.8% agreed

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or strongly agreed that the COVID-19 vaccine was safe and effective and 89%
thought that the COVID-19 epidemic can be effectively prevented by vaccination.
Next, we found that 93.6% received the two-dose COVID-19 vaccination and 86%
were willing to receive COVID-19 vaccine booster shot. The results of one-way
ANOVA showed that gender and age were significantly associated with the

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willingness to receive the COVID-19 vaccine booster shot, most residents were
willing to receive the two-dose COVID-19 vaccination. However, they haven't
received the COVID-19 vaccine booster shot yet because of fear of infection. The

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residents who obtained information about COVID-19 vaccine booster shot through

various ways were more willing to be vaccinated. Multivariate logistic regression
analyses revealed that male was less willingness to take COVID-19 vaccine booster
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shot. But the residents of the 18 - 29 years of age group, the residents who had
received the two-dose COVID-19 vaccination or were afraid of being infected were
more willingness to take COVID-19 vaccine booster shot.

We found that the participants had a positive attitude towards the COVID-19
vaccine. Although the COVID-19 epidemic is considered a serious health concern
worldwide, they believed COVID-19 vaccine was safe and effective and can

effectively prevent the COVID-19 epidemic. We found that the majority of Chinese

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residents had received the two dose of COVID-19 vaccine and were willing to receive

COVID-19 vaccine booster shot, which was within the similar range as the studies by
Lazarus et al.26 and Dodd et al..27 Lazarus et al found that 86.6% (631/712)
respondents from China were willing to take the COVID-19 vaccine. Dodd et al.
reported that 85.8% (3741/4362) participants would accept the vaccine if the

COVID-19 vaccine was available. These results suggested that the willingness to get
vaccinated against COVID-19 was strong for general public. Currently, public
concerns about vaccine safety increases the risk of vaccination hesitancy and affect
the high vaccine coverage.28 In our survey, the concerns about vaccine safety were the

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main reason accounting for residents’ unwillingness to receive the COVID-19
vaccination schedule. Hence, in practical work, the government should increase

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advocacy to let the general public know about the hazards of COVID-19, the
therapeutic and preventive interventions of the COVID-19 and the protective effect of
the COVID-19 vaccine. Additionally, the channels and forms of publicity should be
diverse, the coverage should be wide and the false and negative publicity should be
verified and corrected.29,30 These will strengthen residents’ awareness of the necessity
of the COVID-19 vaccination and enhance confidence in vaccination against

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COVID-19.

Furthermore, we investigated the factors influencing the Chinese residents'

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willingness to receive the COVID-19 vaccine booster shot. We found that female was
more likely to receive COVID-19 vaccine booster shot than male. This is consistent

with the previous studies.31,32 Then, we reported that younger people tended to be
willingness to receive COVID-19 vaccine booster shot. This is contradicted with other
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studies31,33 and we considered the possible reasons as follows. First, there are gender
differences between countries in terms of vaccination willingness. Second, with the
COVID-19 vaccine knowledge promotion, vaccination promotion, the protective

efficacy and less side effects of vaccine being confirmed, younger people had a better

understanding of the COVID-19 vaccine and therefore might be more willing to

receive the COVID-19 vaccine booster shot. Further study reported that the residents
had

received

the

were afraid of being infected

two

dose

of

were

statistically

COVID-19

significantly

vaccine

or

who

associated

with

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who

willingness to receive COVID-19 vaccine booster shot. The protective efficacy and
less side effects of vaccine were validated and thus it was more acceptable to be
vaccinated against COVID-19. The widespread anxiety and psychological problems

caused by the pandemic affect poor health perceptions.34,35,36 As the promotion of the
COVID-19 vaccine, they were more intent to be vaccinated against COVID-19 and
anxiety was considered to relieved.

This study still has some shortcomings. First of all, the sample size was relatively
small and our study was conducted at a single location; hence, a larger sample size

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and multi-sites are needed for further study. Next, due to the nature of the
cross-sectional design, the conclusions were regarded as associations rather than

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causal relationships. However, the results and suggestions of this study have potential
application value for policy makers.
In summary, most residents were willing to receive the COVID-19 vaccine booster
shot. Being female, younger age and the residents who had received the two-dose
COVID-19 vaccination and who were afraid of being infected were statistically
significantly associated with willingness to receive COVID-19 vaccine booster shot.

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This study will provide reliable and important information to help policy makers

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make an effective vaccination strategy.

Ethics approval and consent to participate
All patients agreed to participate in this study and signed written informed consent. The guidelines
outlined in the Declaration of Helsinki were followed. All survey were performed with approval
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from the Ethics Committee of the Peoples Hospital of Guangxi Zhuang Autonomous Region.
Contributions

All authors contributed to data analysis, drafting or revising the manuscript. All authors read and

approved the final manuscript and agree to be accountable for all aspects of the work. Wensheng
Lu is the guarantor of this work and, as such, had full access to all the data in the study and takes
responsibility for the integrity of the data and the accuracy of the data analysis.
Declaration of interests

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The authors declare that they have no known competing financial interests or personal
relationships that could have appeared to influence the work reported in this paper.
Data and resource availability

The corresponding author has full access to all data in the study and is ultimately responsible for

the decision to submit this manuscript for publication.
Acknowledgements

The authors would like to thank the participants for their contributions to the survey. Thanks to
Baohui Xie, Yuanlin Huang, Qiufeng Yan, Jining Wei, Qiuhua Lu, Binbin Chen, Jinxu Liang,

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Qiuyun Nong, Chaozan Yang, Yongguang Su for collecting data.

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27 Dodd RH, Cvejic E, Bonner C, Pickles K, McCaffery KJ, Sydney Health Literacy Lab C-g.
Willingness to vaccinate against COVID-19 in Australia. Lancet Infect Dis 2021; 21(3): 318-319.

28 Baxter R, Klein NP. Kaiser Permanente Vaccine Study Center: Highlights of 2009-2012. Vaccines
(Basel) 2013; 1(2): 139-53.

29 Basch CH, Zybert P, Reeves R, Basch CE. What do popular YouTube(TM) videos say about

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vaccines? Child Care Health Dev 2017; 43(4): 499-503.

30 Chan C, Sounderajah V, Daniels E, Acharya A, Clarke J, Yalamanchili S, Normahani P, Markar S,
Ashrafian H, Darzi A. The Reliability and Quality of YouTube Videos as a Source of Public Health
Information Regarding COVID-19 Vaccination: Cross-sectional Study. JMIR Public Health Surveill
2021; 7(7): e29942.

31 Diesel J, Sterrett N, Dasgupta S, et al. COVID-19 Vaccination Coverage Among Adults - United
States, December 14, 2020-May 22, 2021. MMWR Morb Mortal Wkly Rep 2021; 70(25): 922-927.
32 Murthy BP, Sterrett N, Weller D, Zell E, Reynolds L, Toblin RL, Murthy N, Kriss J, Rose C,

Cadwell B, Wang A, Ritchey MD, et al. Disparities in COVID-19 Vaccination Coverage Between
Urban and Rural Counties - United States, December 14, 2020-April 10, 2021.

33 Neumann-Bohme S, Varghese NE, Sabat I, et al. Once we have it, will we use it? A European survey
on willingness to be vaccinated against COVID-19. Eur J Health Econ 2020; 21(7): 977-982.
34 Chou WS, Budenz A. Considering Emotion in COVID-19 Vaccine Communication: Addressing
Vaccine Hesitancy and Fostering Vaccine Confidence. Health Commun 2020; 35(14): 1718-1722.
35 Mosby I, Swidrovich J. Medical experimentation and the roots of COVID-19 vaccine hesitancy

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among Indigenous Peoples in Canada. CMAJ 2021; 193(11): E381-E383.
36 Cooper S, van Rooyen H, Wiysonge CS. COVID-19 vaccine hesitancy in South Africa: how can we

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maximize uptake of COVID-19 vaccines? Expert Rev Vaccines 2021; 20(8): 921-933.

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This preprint research paper has not been peer reviewed. Electronic copy available at: />

Table 1 Demographic characteristics of survey respondents (N = 1006)
Number of individuals (n)

Gender
Male

459

Female

547

Age group (years)
159

30 - 39

366

40 - 49

243

50 - 59

149

≥60

89

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18 - 29

Weighted (%)

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Variable

Place of residence
Urban
Rural
Marital status
Married
Unmarried
Other
Education level
Elementary school and below

45.6
54.4

15.8
36.4
24.2
14.8
8.8

413

41.1

593

58.9

838

83.3

129

12.8

39

3.9

94

9.3

491

48.8

227

22.6

194

19.3

633

62.9

355

35.3

18

1.8

0 - 3000

478

47.5

3001 - 6000

374

37.2

6001 - 9000

109

10.8

≥9001

45

4.5

98

9.7

Migrant workers

621

61.7

Teacher

34

3.4

Medical staff

23

2.3

Freelance

230

22.9

Junior high school
High school
University and above
Medical insurance type

Urban insurance
Self-paid

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Monthly income (RMB)

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Rural insurance

Occupation

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Personnel of enterprises and institutions

Suffer from chronic diseases
60

6

No

946

94

Yes

9

0.9

No

997

99.1

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Yes

Have received other vaccines in the past year

14

This preprint research paper has not been peer reviewed. Electronic copy available at: />

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Table 2 Residents' awareness of the COVID-19 epidemic
Strongly
Question

Strongly

Disagree, n

Neutral, n

Agree, n

(%)

(%)

(%)

Disagree, n

Agree, n

(%)

contracting the COVID-19?
Do you agree that the COVID-19 epidemic is
serious?
Do you agree that the COVID-19 epidemic
continues to spread?
Do you agree that the COVID-19 epidemic will
rebound?
Do you agree that you often focus on the updated
data about the COVID-19 epidemic at home and
abroad?
Do you agree that your quality of life has been
severely affected by the COVID-19 epidemic in
the past year?
Do you agree that your quality of life will be
severely affected by the COVID-19 epidemic in

116

267

513

106

(0.4%)

(11.6%)

(26.5%)

(51.0%)

(10.5%)

4

45

179

518

260

(0.4%)

(4.5%)

(17.8%)

(51.5%)

(25.8%)

22

243

323

366

52

(2.2%)

(24.1%)

(32.1%)

(36.4%)

(5.2%)

60

355

311

253

27

(6.0%)

(35.3%)

(30.9%)

(25.1%)

(2.7%)

8

70

250

583

95

(0.8%)

(6.9%)

(24.9%)

(58.0%)

(9.4%)

1

92

362

442

109

(0.1%)

(9.2%)

(36.0%)

(43.9%)

(10.8%)

12

163

476

301

54

(1.2%)

(16.2%)

(47.3%)

(29.9%)

(5.4%)

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the next year?

4

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Do you agree that you are at high risk of

(%)

15

This preprint research paper has not been peer reviewed. Electronic copy available at: />

Table 3 Residents' attitudes towards the COVID-19 vaccine
Question

Strongly

Disagree,

Neutral, n

Agree, n

n (%)

(%)

(%)

Disagree,

Agree, n

n (%)

(%)

0

10

103

748

145

(0%)

(1.0%)

(10.2%)

(74.4%)

(14.4%)

1

9

101

744

151

(0.1%)

(0.9%)

(10.0%)

(74.0%)

(15.0%)

2

118

21

845

20

(0.2%)

(11.7%)

(2.1%)

(84.0%)

(2.0%)

2

7

25

118

854

Do you believe that the COVID-19 vaccine is safe and effective?
Do you agree that the COVID-19 epidemic can be effectively
prevented by vaccination?
Do you agree that there are differences between domestic and

Do you think that you can accept self-paid vaccine?

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imported vaccines?

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Strongly

(0.7%)

(2.5%)

(11.7%)

(84.9%)

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(0.2%)

16

This preprint research paper has not been peer reviewed. Electronic copy available at: />

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Table 4 Results of one-way ANOVA for willingness to take COVID-19 vaccine booster shot
Unwilling or

Category

Willing, n (%)

P value

undecided, n (%)
Gender

0.014*

Male

381 (83.0%)

Female

484 (88.5%)

Age group (years)

78 (17.0%)
63 (11.5%)

0.038*

146 (91.8%)

30 - 39

312 (85.2%)

40 - 49

213 (87.7%)

50 - 59

124 (83.2%)

13 (8.2%)

54 (14.8%)
30 (12.3%)
25 (16.8%)

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18 - 29

≥60

70 (78.7%)

Place of residence
City
Rural area
Marital status
Married
Unmarried

Other
Education level
Elementary school and below
Junior high school
High school
University and above

19 (21.3%)

359 (86.9%)

54 (13.1%)

506 (85.3%)

87 (14.7%)

716 (85.4%)

122 (143.6%)

115 (89.1%)

14 (10.9%)

34 (87.2%)

5 (12.8%)

77 (81.9%)

17 (18.1%)

416 (84.7%)

75 (15.3%)

195 (85.9%)

32 (14.1%)

177 (91.2%)

17 (8.8%)

Rural medical insurance
City Medical Insurance

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Own expense

0.517

0.095

0.840

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Medical insurance

0.474

542 (85.6%)

91 (14.4%)

308 (86.6%)

47 (13.2%)

15 (83.3%)

3 (16.7%)

Monthly income (RMB)

0.144

0 - 3000

403 (84.3%)

75 (15.7%)

3001 - 6000

327 (87.4%)

47 (12.6%)

6001 - 9000

92 (84.4%)

17 (15.6%)

≥9001

43 (95.6%)

2 (4.4%)

Profession

0.361
80 (81.6%)

18 (18.4%)

Migrant workers

533 (85.8%)

88 (14.2%)

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Personnel of government agencies and Institutions

Teacher

28 (82.4%)

6 (17.6%)

Medical staff

22 (95.7%)

1 (4.3%)

Freelance

202 (87.8%)

28 (12.2%)
0.142

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Suffer from chronic diseases
Yes

47 (78.3%)

13 (21.7%)

No

818 (86.5%)

128 (13.5%)

Have you received other vaccines in the past year?

0.801

17

This preprint research paper has not been peer reviewed. Electronic copy available at: />

8 (88.9%)

1 (11.1%)

No

857 (86.0%)

140 (14.0%)

Have you received the two-dose COVID-19 vaccination?

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Yes

0.021*

Yes

818 (86.8%)

No

47 (73.4%)

Fear of infection

124 (13.2%)
17 (26.6%)

0.001*

Yes

638 (88.5%)

No

227 (79.6%)

Ways to obtain information about COVID-19 vaccine booster shot

58 (20.4%)

0.026*

28 (87.5%)

4 (12.5%)

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Television

83 (11.5%)

Internet
Cell phone
Community promotion
Other

94 (81.7%)

21 (18.3%)

272 (90.7%)

28 (9.3%)

339 (82.9%)

70 (17.1%)

132 (88.0%)

18 (12.0%)

The vaccination form of COVID-19 vaccine booster shot
Unit organization
Community organization
Online appointment
On-site hospital appointment
Other

2 (8.3%)

108 (85.7%)

18 (14.3%)

215 (88.1%)

29 (11.9%)

367 (84.2%)

69 (15.8%)

153 86.9%)

23 (13.1%)

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*P < 0.05

22 (91.7%)

0.578

18

This preprint research paper has not been peer reviewed. Electronic copy available at: />

Table 5 Results of the multivariate logistic regression analysis for willingness to take COVID-19 vaccine booster shot
OR

95% CI

P value

Male

0.63

(0.436 - 0.910)

0.014*

Female

1.00

-

-

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Influencing factors
Gender

Age group (years)

0.076

2.708

(1.243 - 5.896)

0.012*

30 - 39

1.326

(0.726 - 2.424)

0.358

40 - 49

1.631

(0.847 - 3.140)

0.143

50 - 59

1.101

(0.554 - 2.187)

0.783

≥60

1.00

-

-

2.066

(1.120 - 3.811)

0.020*

1.00

-

-

1.801

(1.230 - 2.638)

0.002*

1.00

-

-

Have you received the two-dose COVID-19 vaccination?
Yes
No
Fear of infection
Yes

No
Ways to obtain information about COVID-19 vaccine booster shot
Television
Internet
Cell phone
Community promotion
Other

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18 - 29

0.063

0.997

(0.307 - 3.233)

0.996

0.653

(0.325 - 1.310)

0.230

1.327

(0.701 - 2.511)

0.384

0.688

(0.391 - 1.212)

0.195

1.00

-

-

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Figure legends

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OR: odds ratio; 95% CI: 95% confidence interval; *P < 0.05.

Figure 1: The completion of the two-dose COVID-19 vaccination and the willingness to take
COVID-19 vaccine booster shot

Figure 2a: Reasons for not completing the two-dose COVID-19 vaccination

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Figure 2b: Reasons for reluctance to receive COVID-19 vaccine booster shot

19

This preprint research paper has not been peer reviewed. Electronic copy available at: />