# Understanding determinants of parental HPV vaccine hesitancy under a municipal free vaccination program in Guangzhou, China

## TL;DR

A study in Guangzhou, China, found that factors like occupation and vaccine preference influence parental hesitancy toward HPV vaccination, despite a free program.

## Contribution

The study identifies novel determinants of HPV vaccine hesitancy using supply–demand alignment theory in a free vaccination context.

## Key findings

- Farmers and preference for imported vaccines were linked to higher hesitancy.
- Better family health scores and CHC satisfaction were associated with lower hesitancy.
- Longer CHC wait times and information access issues paradoxically correlated with lower hesitancy.

## Abstract

Despite efforts to promote HPV vaccination, coverage remains suboptimal in China. Following Guangzhou's 2022 free HPV vaccination program for girls aged 9–15, a cross-sectional survey was conducted from May to August 2024 among 411 parents of eligible girls in Guangzhou. The questionnaire was developed based on the supply–demand alignment theory. Vaccine Hesitancy Scale and Family Health Scale-Short Form were administered. Generalized linear regression identified factors associated with hesitancy. Overall, 10.7% of parents exhibited high hesitancy. Key determinants included occupation [farmers: β = −3.61, 95% CI = (−6.88, −0.34)], preference for imported over domestic vaccines [β = −1.65, 95% CI = (−3.10, −0.12)]. Higher family health scores [β = 0.25, 95% CI = (0.16, 0.33)], moderate child health status [β = 1.24, 95% CI = (0.10, 2.38)], and satisfaction with community healthcare centers (CHCs) [β = 0.05, 95% CI = (0.02, 0.07)] were less hesitant. Paradoxically, longer CHC wait times (>1 hour) [β = 2.29, 95% CI = (0.27, 4.31)] and difficulty accessing information [β = 2.80, 95% CI = (0.33, 5.27)] correlated with lower hesitancy. The results suggest potential policy-driven tolerance. Besides, this emphasizes the critical need for enhanced service quality in CHCs, targeted health education, and confidence building in national vaccines. These insights offer potential guidance for implementing complementary strategies to achieve equitable HPV vaccine coverage.