ArticleInternational journal for equity in health2026
Timeliness gap in non‑EPI Childhood vaccination in urban China: a five-city study of socioeconomic determinants and caregiver preferences.
Article in International journal for equity in health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundDelays in receiving vaccinations lead to higher vaccine-preventable disease risk. We quantified the prevalence and drivers of delayed uptake of fee‑based, non-Expanded Program on Immunization (non-EPI) childhood vaccines in urban China.
methodsA multicentre clinic-based survey with an embedded discrete-choice experiment (DCE) was conducted from May to July 2024 in 15 immunisation clinics across five provincial capitals in China. Caregivers of children aged 0-6 years provided verified vaccination information, socio demographic data, scores on a 12 item Caregiver Timely Vaccination Scale, and responses to a DCEwith four attributes (price, waiting time, calendar delay, adverse event [AE] risk). Delayed vaccination was defined as receipt of at least one non-EPI dose 30 days or more after the recommended schedule.Weighted logistic regression identified correlates; mixed logit models generated marginal utilities and willingness to pay (WTP).
resultsAmong 1 292 valid caregiver-child pairs, the delay prevalence was 23.7% (95%CI: 21.3-26.1). Delay risk increased with monthly household income < ¥10 000 (adjusted OR: 1.24, 95% CI: 1.11-1.38), an unpleasant prior vaccination experience (1.11, 1.01-1.23) and a caregiver's delay history (1.22, 1.10-1.36), and less likely when knowledge was adequate (0.33, 0.25-0.43). The timely scale discriminated delayed from timely caregivers (+ 1.0 mean score). In the DCE, AE risk dominated all other attributes (66.3% relative importance): lowering the stated risk from 5% to 3% increased predicted uptake by 74% points. Reducing queue time from 30 min to 10 min added 24 points. Caregivers were willing to pay ¥106 (≈ US $14) per 1% AE‑risk reduction but only ¥4 for a 10‑day improvement in calendar timeliness.
conclusionsDelayed vaccination drives non-EPI under timeliness in urban China. Embedding delay metrics and the brief 3 C screen in routine dashboards, supported by sharper AE‑risk communication and fast‑track queues, could close the gap and advance Immunization Agenda 2030 targets.
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