Click here to access/download;Figure;Figure 1.jpg Figure pr no int ev ed iew ee rr This preprint research paper has not been peer reviewed Electronic copy available at: https://ssrn.com/abstract=3980906 Pr e Click here to access/download;Figure;Figure 2a.jpg Figure 2a pr no int ev ed iew ee rr This preprint research paper has not been peer reviewed Electronic copy available at: https://ssrn.com/abstract=3980906 Pr e Click here to access/download;Figure;Figure 2b.jpg Figure 2b pr no int ev ed iew ee rr This preprint research paper has not been peer reviewed Electronic copy available at: https://ssrn.com/abstract=3980906 Pr e Manuscript Click here to view linked References iew ed Willingness to receive the COVID-19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* rin tn ot pe er re v 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 The Nursing Department, Guangxi Academy of Medical Sciences and the People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, P.R.China Department of Hematology, Guangxi Academy of Medical Sciences and the People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, P.R.China The Office of Guangxi Academy of Medical Sciences and the People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, P.R.China 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 Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, 530021, P.R.China 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 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 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 Pr ep # They contributed equally to this work; ∗ Corresponding author: Prof Wensheng Lu, E-mail: Lws2613676@sohu.com; ORCID ID: 0000-0003-4179-1171 This preprint research paper has not been peer reviewed Electronic copy available at: https://ssrn.com/abstract=3980906 iew ed 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 pe er re v 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 ot 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 rin tn 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, ep 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 Pr 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 This preprint research paper has not been peer reviewed Electronic copy available at: https://ssrn.com/abstract=3980906 iew ed 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 pe er re v Corona Virus Disease 2019 (COVID-19) is an emerging infectious disease caused by a novel corona virus, Severe Acute Respiratory Coronavirus (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 ot 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 rin tn 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 ep 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 Pr 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 This preprint research paper has not been peer reviewed Electronic copy available at: https://ssrn.com/abstract=3980906 iew ed 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 pe er re v 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 communities ot including the Forestry Academy, Beihu, Lianchou, Xijin, and Yongning, Guangxi Province, China We excluded those who had difficulties in listening, speaking, rin tn 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 ep 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)], Pr 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 This preprint research paper has not been peer reviewed Electronic copy available at: https://ssrn.com/abstract=3980906 iew ed 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, pe er re v 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 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 ot reluctance to receive COVID-19 vaccine booster shot rin tn 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 ep were excluded to ensure the reliability of the data Statistical analysis Pr 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 This preprint research paper has not been peer reviewed Electronic copy available at: https://ssrn.com/abstract=3980906 iew ed 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 pe er re v 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 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 ot 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, rin tn 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 ep 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, Pr 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 A total of 893 residents (893/1006 This preprint research paper has not been peer reviewed Electronic copy available at: https://ssrn.com/abstract=3980906 iew ed (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) pe er re v 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) ot 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, rin tn 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 ep 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 Pr 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 This preprint research paper has not been peer reviewed Electronic copy available at: https://ssrn.com/abstract=3980906 iew ed 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) pe er re v 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 ot 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 rin tn 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 ep 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 Pr 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 This preprint research paper has not been peer reviewed Electronic copy available at: https://ssrn.com/abstract=3980906 iew ed 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 pe er re v 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 ot main reason accounting for residents’ unwillingness to receive the COVID-19 vaccination schedule Hence, in practical work, the government should increase rin tn 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 ep COVID-19 Furthermore, we investigated the factors influencing the Chinese residents' Pr 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 This preprint research paper has not been peer reviewed Electronic copy available at: https://ssrn.com/abstract=3980906 iew ed 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 pe er re v 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 ot 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 rin tn 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 ep This study will provide reliable and important information to help policy makers Pr 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 10 This preprint research paper has not been peer reviewed Electronic copy available at: https://ssrn.com/abstract=3980906 iew ed 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 pe er re v 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, ot Qiuyun Nong, Chaozan Yang, Yongguang Su for collecting data References Liu X, Shaw RH, Stuart ASV, et al Safety and immunogenicity of heterologous versus homologous rin tn prime-boost schedules with an adenoviral vectored and mRNA COVID-19 vaccine (Com-COV): a single-blind, randomised, non-inferiority trial Lancet 2021; 398(10303): 856-869 Ramasamy MN, Minassian AM, Ewer KJ, et al Safety and immunogenicity of ChAdOx1 nCoV-19 vaccine administered in a prime-boost regimen in young and old adults (COV002): a single-blind, randomised, controlled, phase 2/3 trial Lancet 2021; 396(10267): 1979-1993 World Health Organization WHO Coronavirus Disease (COVID-19) Dashboard (2021) Available at: https://covid19.who.int/ Milken Institute’s COVID-19 Treatment and Vaccine Tracker Available online: ep https://covid-19tracker.milkeninstitute.org/#vaccines_intro Krause PR, Fleming TR, Peto R, et al Considerations in boosting COVID-19 vaccine immune responses Lancet Oct 2021;398(10308):1377-1380 Shaw RH, Stuart A, Greenland M, Liu X, Nguyen Van-Tam JS, Snape MD; Com-COV Study Group Pr Heterologous prime-boost COVID-19 vaccination: initial reactogenicity data Lancet 2021; 397(10289): 2043-2046 Mahase E Covid-19: Booster dose reduces infections and severe illness in over 60s, Israeli study reports BMJ 2021; 374: n2297 11 This preprint research paper has not been peer reviewed Electronic copy available at: https://ssrn.com/abstract=3980906 Kozlov M COVID-vaccine booster shot shows promise in Israeli study Nature 2021; 16 iew ed Li G, Yi B, Liu J, et al Effect of CYP3A4 Inhibitors and Inducers on Pharmacokinetics and Pharmacodynamics of Saxagliptin and Active Metabolite M2 in Humans Using Physiological-Based Pharmacokinetic Combined DPP-4 Occupancy Front Pharmacol 2021; 12: 746594 10 Wang C, Han B, Zhao T, et al Vaccination willingness, vaccine hesitancy, and estimated coverage at the first round of COVID-19 vaccination in China: A national cross-sectional study Vaccine 2021; 39(21): 2833-2842 11 Kukreti S, Lu MY, Lin YH, et al Willingness of Taiwan's Healthcare Workers and Outpatients to Vaccinate against COVID-19 during a Period without Community Outbreaks Vaccines (Basel) 2021; 9(3) pe er re v 12 Chen M, Li Y, Chen J, Wen Z, Feng F, Zou H, Fu C, Chen L, Shu Y, Sun C An online survey of the attitude and willingness of Chinese adults to receive COVID-19 vaccination Hum Vaccin Immunother 2021 Jul 3; 17(7): 2279-2288 13 Gan L, Chen Y, Hu P, Wu D, Zhu Y, Tan J, Li Y, Zhang D Willingness to Receive SARS-CoV-2 Vaccination and Associated Factors among Chinese Adults: A Cross Sectional Survey Int J Environ Res Public Health 2021; 18(4): 1993 14 Szilagyi PG, Thomas K, Shah MD, et al National Trends in the US Public's Likelihood of Getting a COVID-19 Vaccine-April to December 8, 2020 JAMA 2020 15 Danabal KGM, Magesh SS, Saravanan S, Gopichandran V Attitude towards COVID 19 vaccines and vaccine hesitancy in urban and rural communities in Tamil Nadu, India - a community based survey BMC Health Serv Res 2021; 21(1): 994 16 Haas EJ, Angulo FJ, McLaughlin JM, et al Impact and effectiveness of mRNA BNT162b2 vaccine against SARS-CoV-2 infections and COVID-19 cases, hospitalisations, and deaths following a nationwide vaccination campaign in Israel: an observational study using national surveillance data Lancet 2021; 397(10287): 1819-1829 ot 17 Haas EJ, McLaughlin JM, Khan F, et al Infections, hospitalisations, and deaths averted via a nationwide vaccination campaign using the Pfizer-BioNTech BNT162b2 mRNA COVID-19 vaccine in Israel: a retrospective surveillance study Lancet Infect Dis 2021; 22: S1473-3099(21)00566-1 rin tn 18 Graffigna G, Palamenghi L, Boccia S, Barello S Relationship between Citizens' Health Engagement and Intention to Take the COVID-19 Vaccine in Italy: A Mediation Analysis Vaccines (Basel) 2020; 8(4) 19 Barello S, Nania T, Dellafiore F, Graffigna G, Caruso R 'Vaccine hesitancy' among university students in Italy during the COVID-19 pandemic Eur J Epidemiol 2020; 35(8): 781-783 20 Dell RB, Holleran S, Ramakrishnan R Sample size determination ILAR J 2002; 43(4): 207-13 21 Zewude B, Belachew A Intention to Receive the Second Round of COVID-19 Vaccine Among Healthcare Workers in Eastern Ethiopia Infect Drug Resist 2021; 14: 3071-3082 ep 22 Schwarzinger M, Watson V, Arwidson P, Alla F, Luchini S COVID-19 vaccine hesitancy in a representative working-age population in France: a survey experiment based on vaccine characteristics Lancet Public Health 2021; 6(4): e210-e221 23 Nuno M, Chowell G, Gumel AB Assessing the role of basic control measures, antivirals and Pr vaccine in curtailing pandemic influenza: scenarios for the US, UK and the Netherlands J R Soc Interface 2007; 4(14): 505-21 24 Han K, Francis MR, Zhang R, et al Confidence, Acceptance and Willingness to Pay for the COVID-19 Vaccine among Migrants in Shanghai, China: A Cross-Sectional Study Vaccines (Basel) 12 This preprint research paper has not been peer reviewed Electronic copy available at: https://ssrn.com/abstract=3980906 2021; 9(5) self-paid vaccines in China Vaccine 2014; 32(35): 4471-4477 iew ed 25 Hou Z, Jie Chang, Yue D, Fang H, Meng Q, Zhang Y Determinants of willingness to pay for 26 Lazarus JV, Ratzan SC, Palayew A, et al A global survey of potential acceptance of a COVID-19 vaccine Nat Med 2021; 27(2): 225-228 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 popular YouTube(TM) videos say about pe er re v 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 ot 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 Pr ep rin tn maximize uptake of COVID-19 vaccines? Expert Rev Vaccines 2021; 20(8): 921-933 13 This preprint research paper has not been peer reviewed Electronic copy available at: https://ssrn.com/abstract=3980906 Table 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 pe er re v 18 - 29 Weighted (%) iew ed 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 - 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 rin tn Monthly income (RMB) ot Rural insurance Occupation ep Personnel of enterprises and institutions Suffer from chronic diseases 60 No 946 94 Yes 0.9 No 997 99.1 Pr Yes Have received other vaccines in the past year 14 This preprint research paper has not been peer reviewed Electronic copy available at: https://ssrn.com/abstract=3980906 iew ed Table 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%) 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%) 70 250 583 95 (0.8%) (6.9%) (24.9%) (58.0%) (9.4%) 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%) Pr ep rin tn ot the next year? pe er re v Do you agree that you are at high risk of (%) 15 This preprint research paper has not been peer reviewed Electronic copy available at: https://ssrn.com/abstract=3980906 Table Residents' attitudes towards the COVID-19 vaccine Question Strongly Disagree, Neutral, n Agree, n n (%) (%) (%) Disagree, Agree, n n (%) (%) 10 103 748 145 (0%) (1.0%) (10.2%) (74.4%) (14.4%) 101 744 151 (0.1%) (0.9%) (10.0%) (74.0%) (15.0%) 118 21 845 20 (0.2%) (11.7%) (2.1%) (84.0%) (2.0%) 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? pe er re v imported vaccines? iew ed Strongly (0.7%) (2.5%) (11.7%) (84.9%) Pr ep rin tn ot (0.2%) 16 This preprint research paper has not been peer reviewed Electronic copy available at: https://ssrn.com/abstract=3980906 iew ed Table 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%) pe er re v 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%) (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 rin tn Own expense 0.517 0.095 0.840 ot Medical insurance 0.474 542 (85.6%) 91 (14.4%) 308 (86.6%) 47 (13.2%) 15 (83.3%) (16.7%) Monthly income (RMB) 0.144 - 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%) (4.4%) Profession 0.361 80 (81.6%) 18 (18.4%) Migrant workers 533 (85.8%) 88 (14.2%) ep Personnel of government agencies and Institutions Teacher 28 (82.4%) (17.6%) Medical staff 22 (95.7%) (4.3%) Freelance 202 (87.8%) 28 (12.2%) 0.142 Pr 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: https://ssrn.com/abstract=3980906 (88.9%) (11.1%) No 857 (86.0%) 140 (14.0%) Have you received the two-dose COVID-19 vaccination? iew ed 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%) (12.5%) pe er re v 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 (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%) Pr ep rin tn ot *P < 0.05 22 (91.7%) 0.578 18 This preprint research paper has not been peer reviewed Electronic copy available at: https://ssrn.com/abstract=3980906 Table 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 - - iew ed 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 pe er re v 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 - - rin tn Figure legends ot 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 Pr ep 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: https://ssrn.com/abstract=3980906 ... 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... mRNA BNT162b2 vaccine against SARS-CoV-2 infections and COVID- 19 cases, hospitalisations, and deaths following a nationwide vaccination campaign in Israel: an observational study using national... vaccination against ep COVID- 19 Furthermore, we investigated the factors influencing the Chinese residents' Pr willingness to receive the COVID- 19 vaccine booster shot We found that female was