HPV vaccination scenario and parental willingness to pay among girls aged 9-14 y in the Yangtze River Delta, China.

HPV vaccination scenario and parental willingness to pay among girls aged 9–14 y in the Yangtze River Delta, China - PMC Skip to main content An official website of the United States government Here's how you know Here's how you know Search Log in Primary site navigation Search Log in Search PMC Full-Text Archive Search in PMC Journal List User Guide As a library, NLM provides access to scientific literature. Inclusion in an NLM database does not imply endorsement of, or agreement with, the contents by NLM or the National Institutes of Health. Learn more: PMC Disclaimer | PMC Copyright Notice Hum Vaccin Immunother . 2026 Jun 2;22(1):2681241. doi: 10.1080/21645515.2026.2681241 HPV vaccination scenario and parental willingness to pay among girls aged 9–14 y in the Yangtze River Delta, China Xiaoya Fu a, * , Qian Zhang b, * , Jia Lu c , Lianqin Shi d, ✉ , Yihan Lu a, ✉ Author information Article notes Copyright and License information a Department of Epidemiology, Ministry of Education Key Laboratory of Public Health Safety, School of Public Health, Fudan University, Shanghai, China b Department of Immunization Planning, Shanghai Jiading District Center for Disease Control and Prevention, Shanghai, China c Department of Immunization Planning, Shanghai Minhang District Center for Disease Control and Prevention, Shanghai, China d Department of Immunization Planning, Shanghai Chongming District Center for Disease Control and Prevention, Shanghai, China ✉ CONTACT Lianqin Shi cmcdcslq@163.com Department of Immunization Planning, Shanghai Chongming District Center for Disease Control and Prevention, No. 567 Yijiangshan Road, Shanghai 202150, China ✉ Yihan Lu luyihan@fudan.edu.cn Department of Epidemiology, Ministry of Education Key Laboratory of Public Health Safety, School of Public Health, Fudan University, 131 Dong’an Road, Shanghai 200032, China. * Xiaoya Fu and Qian Zhang contributed equally to the study. Roles Xiaoya Fu : Software, Writing – original draft Qian Zhang : Data curation, Formal analysis, Writing – original draft Jia Lu : Investigation Lianqin Shi : Conceptualization, Investigation Yihan Lu : Conceptualization, Data curation, Writing – review & editing Received 2026 Feb 19; Accepted 2026 May 23; Collection date 2026. © 2026 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License ( http://creativecommons.org/licenses/by-nc/4.0/ ), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent. PMC Copyright notice PMCID: PMC13232873  PMID: 42228981 ABSTRACT Human papillomavirus (HPV) vaccine uptake remains suboptimal among adolescent girls in China. In November 2025, bivalent HPV vaccine was included in China’s National Immunization Program for girls aged 13. This study examined girls’ vaccination scenario and parental willingness to pay (WTP) for HPV vaccine. A cross-sectional survey was conducted among parents of girls aged 9–14 in the Yangtze River Delta, one of the socioeconomically developed regions in China, between March and August 2025. The survey investigated HPV vaccination scenarios among mothers and their daughters. Contingent valuation method was used to estimate parental WTP. A total of 4,595 parents participated. Overall, 62.6% intended to vaccinate their daughters (39.9% for themselves or their wives), and 8.1% had completed/scheduled HPV vaccination in daughters (35.5% in mothers). It remained inconsistent between mothers and daughters (Kappa = 0.38). Daughters receiving influenza vaccine, parents being informed through schools or community health centers, and greater HPV knowledge were associated with both HPV vaccine intent and uptake (each P < .05). HPV vaccine uptake in daughters was associated with parents endorsing teacher engagement ( P = .004). The average WTP was CNY 2,373 for daughters; it was higher among higher-income parents and those with daughters who received influenza vaccine, but lower among parents expecting governmental funding or unwilling to vaccinate daughters (each P < .05). School-based settings are key drivers of HPV vaccine intent and uptake among girls in the Yangtze River Delta. Multi-channel communication and stakeholder engagement may enhance parental decision-making. Improving vaccine financing strategies may promote health equity as China expands HPV vaccination. KEYWORDS: Human papillomavirus, HPV; vaccine intent; vaccine uptake; willingness to pay, WTP; Yangtze River Delta; China Introduction Human papillomavirus (HPV) has been identified as one of the most common sexually transmitted infections worldwide. 1 Multiple HPV types can cause a variety of diseases, including genital warts, cervical cancer, vaginal cancer, oropharyngeal cancer, and laryngeal cancer. 1 Among these, cervical cancer is the most significant HPV-related disease in women. In 2022, China reported 151,000 new cases (incidence rate: 13.8 per 100,000) and 56,000 deaths (mortality rate: 4.5 per 100,000), with a growing trend of onset in younger women. 2 , 3 HPV vaccination is the most critical intervention for preventing cervical cancer and other HPV-related diseases. 4 In 2020, the World Health Organization (WHO) launched the Global Strategy to Accelerate the Elimination of Cervical Cancer as a Public Health Problem , setting a target for WHO member states to achieve over 90% HPV vaccination coverage among girls before the age of 15 by 2030. 5 Currently, seven HPV vaccines have been licensed for use in China, including three bivalent vaccines (Cervarix®, Cecolin®, Walrinvax®), two quadrivalent vaccines (Gardasil®, Cervivac®), and 2 nine-valent vaccines (Gardasil 9®, Cecolin 9®). Since 2021, multiple provinces and cities across China have successively implemented local HPV vaccination programs targeting adolescent girls in various forms. 6 However, the overall national vaccination coverage remains below the WHO target, with substantial regional disparities. 7 Following the COVID-19 pandemic, many regions in China have launched large-scale health advocacy and HPV vaccination campaigns, 8 , 9 especially in the Yangtze River Delta, where socioeconomics is highly developed and HPV vaccination coverage has continued to rise. 10 In October 2025, China’s National Health Commission officially announced the inclusion of domestic bivalent HPV vaccine for girls aged 13 y into the National Immunization Program (NIP), marking a new stage in the country’s HPV vaccination efforts. 11 The significance of this policy lies in shifting the financial burden from individual families to the government, ensuring equitable access to HPV vaccines and eliminating out-of-pocket costs for eligible girls. However, the NIP currently does not cover quadrivalent or nine-valent HPV vaccines, which remain self-paid. Some parents prefer these higher-valency vaccines, 12 making willingness to pay (WTP) for self-paid options a relevant consideration for pricing and subsidy policies. Parents are the primary decision-makers for vaccination among underage girls. Previous studies have shown that mothers’ educational level, household income, and perceptions of vaccine safety and efficacy are significantly associated with vaccination intent and uptake. 13–16 International evidence also indicates that physician recommendations and school-based education have a strong positive influence. 17–20 Furthermore, information sources and trust play a crucial role in shaping vaccination decisions. 21 During this policy transition period, identifying key determinants influencing parental decision-making is of great public health importance. Therefore, our study aims to assess HPV vaccination scenarios among mothers and their daughters and WTP HPV vaccination in the Yangtze River Delta region of China, providing evidence to inform the design of school- and community-based health advocacy, vaccination promotion, and payment policies in the future. Methods Study design We conducted a cross-sectional study between March and August 2025, recruiting parents (mothers or fathers) of daughters aged 9–14 y from six cities in the Yangtze River Delta region of China, including Shanghai Municipality; Wuxi, Suzhou, and Nanjing Cities in Jiangsu Province; and Hangzhou, Ningbo Cities in Zhejiang Province. An online questionnaire was used to collect information on HPV vaccination scenarios among mothers and daughters, as well as parental WTP HPV vaccine for themselves (or fathers reporting for their wives) and their daughters. The Yangtze River Delta region was purposively selected for this study because it represents one of the China’s most socioeconomically developed and healthcare-resourced areas, where HPV vaccine availability and parental awareness of HPV vaccination are generally higher than the national average. This region comprises a total of 41 prefecture-level cities. Of them, six cities were chosen as they are the core metropolitan centers in this region, with relatively mature HPV vaccination services and high population density. Therefore, findings from this sample may not be generalizable to less developed or rural regions of China. Recruitment of parents In each of the six cities, four districts or counties were purposively selected based on their socioeconomic development level and urban–rural classification to ensure the diversity. Within each district/county, two schools were purposively chosen based on school type and accessibility. Using a convenience sampling strategy, parents of girl students aged 9–14 y were invited to participate in a self-administered online survey powered by www.wjx.com . Eligibility criteria included: (1) respondents having at least one daughter aged 9–14 y; and (2) voluntary participation with completion of an online informed consent form. Questionnaires that were incomplete, contained illogical responses, or were completed in less than 180 s were excluded. Given the cross-sectional design, the sample size was estimated using the standard formula for prevalence studies: n = Z 1 − α / 2 2 p 1 − p deff / d 2 , where n is the required sample size, p is the expected prevalence, q = 1− p , d is the allowable error, and α is the significance level. Referring to a previous study that reported Chinese parental acceptance for HPV vaccination for daughters at 60.32%, 22 p was set to 0.60, d = 0.1 p , deff = 2 , and α = 0.05 Zi − α / 2 = 1.96 . After accounting for an anticipated 20% non-response rate, the required sample size was determined to be 640 participants per city, resulting in a total minimum sample size of 3,840. Data collection and measurement The questionnaire included items on sociodemographic characteristics, HPV vaccine intent and uptake, information sources, decision-making roles, payer, and WTP. In this study, information sources were categorized as traditional media (e.g., newspapers, magazines, television, and radio) and new media (e.g., social media platforms such as WeChat, TikTok/Douyin, and online health forums). The questionnaire was designed and developed by a multidisciplinary panel consisting of public health practitioners and researchers from municipal and district centers for disease control and prevention (CDCs) (n = 4), public health officers (n = 3), a statistician (n = 1), a behavioral psychologist (n = 1), a gynecologist (n = 1), a pediatrician (n = 1), and the principal investigator (n = 1). The expert panel carefully reviewed and refined the Chinese questionnaire in Mandarin to ensure consistency with theoretical constructs and suitability for quantitative analysis. Mandarin is the universal written language in China, and literacy rates among adults exceed 96.7% nationally. 23 By the end of 2025, 90.4% of the Chinese households had internet access. 24 A pilot test was conducted among 50 local parents of girls aged 9–14 y (80% of parents were mothers) recruited via convenience sampling to confirm clarity and feasibility. Sociodemographic variables included parental gender, age, educational attainment, monthly household income, number of children, and household influenza vaccination history during the most recent influenza season (September 2024 to March 2025). Respondents were also asked about their perceptions of information sources, decision-making roles, and payment related to their daughters’ HPV vaccination. HPV vaccine intent and uptake were assessed for both mothers and daughters, with four response options: “Had been vaccinated/had made an appointment,” “Intended to accept HPV vaccination, while had not made an appointment (defined as intent),” and “Did not intend to receive HPV vaccination.” HPV related knowledge was assessed using five items on HPV infection, covering HPV types, HPV-related diseases, infection risk, transmission routes, and typical symptoms, along with two items on HPV vaccination (virus clearance and HPV screening following vaccination). Each correct answer was scored 3 points, while incorrect or “do not know” responses were scored 0 points. Partially correct answers were scored 1 point. For multiple-response items, each correct choice was awarded 1 point. The total knowledge score was calculated as the sum of all item scores. The total knowledge score ranged from 0 to 26. Based on a median split (median = 16), knowledge scores were dichotomized into low knowledge (≤15 points) and high knowledge (>16 points) for analysis. The internal consistency of the knowledge scale was verified with a Cronbach’s α coefficient of 0.82, indicating good reliability. Furthermore, the Bartlett’s spherical test was performed and the KMO statistic was 0.84 ( P < .001), which could be considered a good construct validity. To assess parental normative perception of who should be involved in HPV vaccination decision-making, participants were asked: “Who do you think should be involved in making decisions about HPV vaccination for adolescent girls?” This question measured parental belief about the ideal decision-makers rather than who was actually involved in the decision. To assess parental normative perception of who should pay for HPV vaccination, participants were asked: “Who do you think should pay for HPV vaccination for adolescent girls?” This question measured parental belief about the ideal payment model rather than their current payment arrangement or awareness of the NIP policy. In the survey, most parents were likely unaware that HPV vaccine would soon be added to the NIP. Parental WTP HPV vaccine for themselves and their daughters was estimated using the contingent valuation method (CVM) with a double-bounded dichotomous choice format. Five randomly assigned starting bid groups were designed with initial WTP levels of CNY 800, 1,600, 2,400, 3,200, and 4,000 (equivalent to USD 111, 221, 332, 443, and 553, respectively), consistent with our previous study. 25 Each respondent received one bid set in the online questionnaire. For example, a parent was first asked, “If the HPV vaccine costs CNY 800 (USD 111), would you be willing to pay for your daughter?” If the response was “Yes,” the follow-up bid was raised to CNY 1,200 (USD 166). If the initial response was “No,” the bid was lowered to CNY 400 (USD 55). Finally, an open-ended question was provided for respondents to state their maximum WTP for themselves and for their daughters. Statistical analysis Descriptive methods were used to present the characteristics of parents in the study. Multivariable logistic regression was performed to compare HPV vaccination scenarios among daughters across parental characteristics. The Kappa test was used to assess the agreement between mothers’ and daughters’ HPV vaccination status across nine possible paired combinations. Multivariable linear regression was used to identify factors associated with the estimated parental WTP. All analyses were conducted using R Studio version 4.4.1 (R Foundation for Statistical Computing, Vienna, Austria) and SAS version 9.4 (SAS Institute Inc., Cary, NC, USA). A two-sided P < .05 was considered statistically significant. Results A total of 4,735 parents were recruited to participate in the questionnaire survey, of which 140 were completed by parents who had daughters outside 9–14, or were logically inconsistent or incorrectly completed (obviously inconsistent responses to logically related questions, or selection of all options for all questions, regardless of multiple or single choice questions), or were completed in less than 180 s. Thus, a total of 4,595 parents were included in this study to assess HPV vaccination scenarios among their daughters. Among the parents, 22.4% were aged ≤35 y, 42.2% were aged 36–40 y, and 35.4% were aged >40 y ( Table 1 ). Females accounted for 78.6% of the participants. Most participants had undergraduate or junior college education (43.0%) and reported a monthly household income ≤CNY 10,000 (54.9%). Single-daughter families accounted for 47.3%, while families with two or more children accounted for 52.7%. Additionally, during the most recent influenza season (September 2024 to March 2025), influenza vaccination coverage among respondents, their spouses, elderly family members, and daughters was 23.6%, 18.9%, 15.7%, and 24.6%, respectively. Table 1. HPV vaccination scenario of daughters by parental characteristics. Variable Category HPV vaccination scenario of daughters (%) Had been vaccinated/had made an appointment Intended to accept HPV vaccination, while had not made an appointment Did not intend to receive HPV vaccination Total Parental age (y) ≤35 42 (4.07) 708 (68.67) 281 (27.26) 1,031 36–40 128 (6.60) 1,261 (65.07) 549 (28.33) 1,938 >40 202 (12.42) 908 (55.84) 516 (31.73) 1,626 Parental gender Male 106 (10.78) 533 (54.22) 344 (34.99) 983 Female 266 (7.36) 2,344 (64.89) 1,002 (27.74) 3,612 Educational level Junior high school or below 137 (11.08) 708 (57.24) 392 (31.69) 1,237 High school / Technical school 95 (7.36) 811 (62.87) 384 (29.77) 1,290 College or above 140 (6.77) 1,358 (65.67) 570 (27.56) 2,068 Monthly household income (CNY) ≤10,000 202 (8.01) 1,465 (58.11) 854 (33.88) 2,521 >10,000 161 (8.21) 1,329 (67.77) 471 (24.02) 1,961 Prefer not to disclose 9 (7.96) 83 (73.45) 21 (18.58) 113 Number of children 1 127 (5.85) 1,404 (64.67) 640 (29.48) 2,171 ≥2 245 (10.11) 1,473 (60.77) 706 (29.13) 2,424 Knowledge score ≤15 201 (8.56) 1,321 (56.28) 825 (35.15) 2,347 >16 171 (7.61) 1,556 (69.22) 521 (23.18) 2,248 Influenza vaccination of respondent (Sep 2024-Mar 2025) Yes 176 (16.21) 659 (60.68) 251 (23.11) 1,086 No 196 (5.59) 2,218 (63.21) 1,095 (31.21) 3,509 Influenza vaccination of spouse (Sep 2024-Mar 2025) Yes 171 (19.70) 515 (59.33) 182 (20.97) 868 No 198 (5.58) 2,256 (63.55) 1,096 (30.87) 3,550 No spouse 3 (1.69) 106 (59.89) 68 (38.42) 177 Influenza vaccination of elderly family members (Sep 2024-Mar 2025) Yes 132 (18.33) 426 (59.17) 162 (22.50) 720 No 222 (6.00) 2,364 (63.89) 1,114 (30.11) 3,700 No elderly members 18 (10.29) 87 (49.71) 70 (40.00) 175 Influenza vaccination of daughter (Sep 2024-Mar 2025) Yes 220 (19.50) 672 (59.57) 236 (20.92) 1,128 No 152 (4.38) 2,205 (63.60) 1,110 (32.02) 3,467 Open in a new tab HPV vaccination scenario of mothers and daughters Among parents, 35.5% of mothers (or the wives of male respondents) had received HPV vaccine or had made an appointment, 39.9% were willing to accept HPV vaccine for themselves or their wives, and 24.8% did not intend to be vaccinated ( Table 2 ). In contrast, only a small proportion of daughters (8.1%) had received HPV vaccine or made an appointment, while the majority (62.6%) had not yet been vaccinated but their parents intended to do so. The concordance between mothers’ and daughters’ vaccination scenario was low (Kappa = 0.38). Table 2. Concordance between mothers’ and daughters’ HPV vaccination scenario. Daughter’s HPV vaccination scenario Mother’s HPV vaccination scenario Had been vaccinated/had made an appointment Intended to accept HPV vaccination, while had not made an appointment Did not intend to receive HPV vaccination Had been vaccinated/had made an appointment 279 1,077 266 Intended to accept HPV vaccination, while had not made an appointment 68 1,583 184 Did not intend to receive HPV vaccination 25 217 896 Open in a new tab Information sources and decision-making roles Parents primarily obtained information about HPV vaccination from community health centers (CHCs) (70.5%), schools (74.0%), and local CDCs (61.7%) ( Figure 1 ). In contrast, the information provided by routine health examinations (36.6%), traditional media (28.3%), and new media (30.3%) remained limited. Regarding decision-making, parents continued to play the dominant role in decisions about their daughters’ HPV vaccination (89.4%), followed by public health practitioners in CDCs (41.6%) and the daughters themselves (31.2%). Logistic regression analysis showed that obtaining information from schools, CHCs, or CDCs was positively associated with parental involvement in decision-making (all P < .05). Furthermore, school-based information was positively associated with school teachers’ involvement (OR = 3.51, P < .001), and information from CDCs was positively associated with the involvement of CDC professionals (OR = 2.68, P < .001). Figure 1. Open in a new tab Associations between information sources and decision-making roles. Blue columns represents the channels through which parents obtain information about HPV vaccination, and green columns represents the stakeholders whom parents consider should engage in their daughters’ vaccination decision-making. CDC, center for disease control and prevention; CHC, community health center. Factors associated with parental intent and actual HPV vaccination among daughters Daughters were more likely to have been vaccinated or to have an appointment when they had received influenza vaccine during the most recent influenza season (OR = 5.12, 95% CI: 3.69–7.10) and had siblings (OR = 1.57, 95% CI: 1.28–1.92), or parents received HPV vaccine related information from schools (OR = 1.51, 95% CI: 1.13–2.00) or CHCs (OR = 1.38, 95% CI: 1.02–1.86), considered school teachers should engage in HPV vaccination decisions (OR = 1.69, 95% CI: 1.18–2.43), and had greater knowledge scores (≥16 points) (OR = 1.02, 95% CI: 1.01–1.05). By contrast, respondents who were mothers (OR = 1.46, 95% CI: 1.23–1.74), those whose daughters had received influenza vaccine during the most recent influenza season (OR = 1.28, 95% CI: 1.03–1.58), those who obtained HPV vaccine related information from schools (OR = 2.10, 95% CI: 1.79–2.45) or CHCs (OR = 1.26, 95% CI: 1.07–1.47), those who perceived that parents (OR = 1.27, 95% CI: 1.01–1.60), children (OR = 1.21, 95% CI: 1.03–1.42), healthcare workers in CDCs (OR = 1.55, 95% CI: 1.31–1.83), or pediatricians in secondary and tertiary hospitals (OR = 1.26, 95% CI: 1.02–1.54) should engage in HPV vaccination decision-making, and those with greater knowledge scores (OR = 1.04, 95% CI: 1.02–1.05) were more likely to express intent for their daughters to receive HPV vaccine. Overall, the determinants of parental intent and actual vaccination among daughters moderately differed, suggesting that behavioral implementation may be more strongly associated with teacher engagement in decision-making ( Figure 2 ). Figure 2. Open in a new tab Factors associated with parental intent and actual HPV vaccination among their daughters. Multivariable logistic regression was utilized, with parents with no intent to vaccinate presented as reference group. CDC, center for disease control and prevention; CHCs, community health centers. Parental WTP HPV vaccine for themselves and for their daughters The average WTP for mothers’ HPV vaccination was CNY 2,433 (IQR: 1,400–3,600) for those already vaccinated or had an appointment, CNY 2,349 (IQR: 1,200–3,200) for those with intent but no appointment, and CNY 1,922 (IQR: 1,000–2,200) for those with no intent. The average WTP for daughters’ HPV vaccination was CNY 2,472 (IQR: 1,400–3,600) for those already vaccinated or had an appointment, CNY 2,419 (IQR: 1,200–3,600) for those with intent but no appointment, and CNY 2,109 (IQR: 1,200–2,800) for those with no intent. Parents with a monthly household income above CNY 10,000 (P = .03) and those whose daughters received the influenza vaccine during the most recent influenza season (P = .02) reported significantly higher WTP. In contrast, parents who considered that HPV vaccination costs should be covered by the government ( P = .04) and those unwilling for their daughters or themselves/wives to receive HPV vaccination ( P < .001) reported significantly lower WTP ( Table 3 ). Table 3. Factors associated with parental willingness to pay (WTP) for daughters’ HPV vaccination by using multivariable linear regression. Variable Estimate Std. error P value Age (y) (≤35 = 0) 36–40 −16.79 43.27 .69 >40 −11.66 45.08 .79 Parent gender (male = 0; female = 1) 9.04 41.24 .82 Educational level (≤junior high = 0) High school/technical school 10.54 44.87 .81 College or above 47.19 43.84 .28 Household income (CNY) (>10,000 = 1; ≤10,000 = 0) 64.96 34.81 .03 Not disclosed −32.94 107.5 .75 Number of children (≥2 = 1; 1 = 0) −45.64 33.79 .17 Knowledge score (>16 = 1; ≤15 = 0) 2.37 2.78 .39 Perceived payer: government (yes = 1; no = 0) −78.72 39.69 .04 Perceived payer: parents (yes = 1; no = 0) 59.77 41.16 .14 Perceived payer: parent’s medical insurance (yes = 1; no = 0) −17.75 38.74 .64 Perceived payer: child’s medical insurance (yes = 1; no = 0) −23.33 36.49 .52 Perceived payer: commercial insurance (yes = 1; no = 0) 46.26 48.12 .33 Daughter received influenza vaccine (yes = 0; no = 1) −91.25 39.21 .02 Daughter’s HPV vaccination scenario (vaccinated/appointed = 0) Intend to vaccinate but not yet scheduled −37.43 63.20 .55 Unwilling to vaccinate −326.71 67.14 <.001 Mother’s HPV vaccination scenario (vaccinated/appointed = 0) Intend to vaccinate but not yet scheduled −59.39 42.10 .15 Unwilling to vaccinate −222.79 56.01 <.001 Open in a new tab Discussion This study found that parents in the Yangtze River Delta region of China showed limited HPV vaccine intent and uptake among their daughters. Following the COVID-19 pandemic, many regions in China have launched large-scale health advocacy and HPV vaccination campaigns, 8 , 9 especially in the Yangtze River Delta, where socioeconomics is highly developed and HPV vaccination coverage has continued to rise. 10 However, the current coverage still falls short of the WHO target in the Global Strategy to Accelerate the Elimination of Cervical Cancer as a Public Health Problem . 5 In addition, we found that parental information sources regarding HPV vaccination remained limited, mainly obtained from public health practitioners and school settings. On October 30, 2025, the China’s National Health Commission announced that the domestic bivalent HPV vaccine would be included in the NIP for girls aged 13 y. 11 This policy change represents a major step forward in improving HPV vaccine access. However, it also necessitates more targeted health education and promotion strategies to enhance parental acceptance of the new policy and address potential concerns about vaccine quality or safety associated with publicly funded programs. In this study, the determinants of parental HPV vaccine intent and uptake among their daughters were largely similar, although some factors differed. Notably, fewer factors were associated with actual vaccination behavior, which appeared to be more concentrated in teachers’ engagement in decision-making, suggesting that teachers may be key drivers to transforming vaccine intent into action. Previous studies have documented that school teachers receiving flu vaccinations could promote vaccination among students (and their parents). 26 , 27 When teachers actively vaccinated against HPV experienced no side effects, it increased acceptance among students and parents. Additionally, prioritizing teachers helped create a positive health environment in schools. 28 Given that China has included the HPV vaccine in the NIP, teachers could play an even greater role through routine health education, student mobilization, and vaccination reminders. Additionally, our study incorporated influenza vaccination as a covariate and found that influenza vaccination was associated with both parental HPV vaccine intent and actual uptake among daughters. This indicates that different non-NIP vaccines may share common psychological or behavioral drivers, as noted in other studies. 29 Therefore, strategies that enhance vaccine confidence could simultaneously benefit the uptake of multiple vaccines. Furthermore, we observed that parents obtained relatively limited HPV vaccine information from specialists, and media sources. Previous studies have shown that parents are more likely to accept HPV vaccination when recommendations come from healthcare professionals. 30 Social media also exerts a strong influence on vaccination behaviors. A study conducted in the United States found that the volume and sentiment of HPV vaccine – related information on Twitter explained a larger proportion of state-level variation in vaccine coverage than several traditional sociodemographic factors, such as poverty, educational background, and insurance coverage, highlighting the potential influence of online narratives on vaccine acceptance and hesitancy. 31 In recent years, Chinese studies have reported that social media platforms such as Weibo, Douyin, and Bilibili contribute to improved vaccine awareness. 32–34 Even when parents do not actively seek vaccine information on social media, passive exposure through algorithmic content or peer sharing can still shape their attitudes and decisions. 35 Nevertheless, our findings indicated that parents’ reported information sources remain limited. Thus, we recommend strengthening health advocacy and vaccination strategies led by public health practitioners and schools, while considering traditional and new media as supplementary channels to collectively build vaccine confidence and facilitate informed parental decision-making. In general, this study found that parental WTP HPV vaccine was associated with perceived payers. Higher family economic status and government subsidies had positive and negative effects, respectively. The Yangtze River Delta is one of The China’s most socioeconomically developed regions, where HPV vaccine coverage and WTP tend to be relatively high. 36 However, socioeconomic disparities in HPV vaccination exist even within developed Chinese cities. A study in Tianjin, a major metropolis in northern China, analyzed vaccination data from 2018 to 2023 and found that nonavalent vaccines were preferred by urban professionals (OR = 1.577) and those with higher incomes (OR = 1.958). 37 Although the bivalent HPV vaccine of domestic manufacturers has been included in the NIP, many parents still prefer the quadrivalent or nine-valent vaccines, which remain self-paid. 12 The quadrivalent vaccine (Gardasil®) was licensed in China in 2017, and the nine-valent vaccine (Gardasil 9®) in 2018. 38 One quadrivalent vaccine (Cervivac®) and 1 nine-valent vaccine (Cecolin 9®) of domestic manufacturers were licensed in August and September 2025, respectively. 39 , 40 However, as our data collection concluded prior to these licensures, parental preferences observed in this study specifically reflect the established availability and accumulated market familiarity of the internationally manufactured vaccines. The introduction of domestically produced multivalent vaccines may help improve health equity. 12 Therefore, reasonable pricing and multiple payment options, including commercial insurance and health insurance accounts, 41 could further enhance vaccine coverage and promote health equity. We also found inconsistencies in HPV intent and uptake between mothers and daughters, which was consistent with our previous studies. In a study in Shanghai, eastern China, we compared HPV vaccine acceptance and intent between mothers and daughters, stratified by age groups 9–12 and 13–14 y, and reported Kappa coefficients of 0.371 and 0.412, respectively. 42 Similarly, our findings show partial alignment. Currently, the China’s NIP meets the HPV vaccination needs of girls aged 13 y, consistent with WHO position paper recommendations. 11 However, catch-up vaccination for older girls and HPV vaccination for adult women remain valuable public health priorities. Several studies in China have shown that mother-daughter or female teacher-girl student co-vaccination programs effectively increased uptake among both girls and adult women. 43 Designing tailored strategies that simultaneously promote vaccination among girls and their mothers could accelerate progress toward cervical cancer elimination. This study has several limitations. First, the sample size was limited to the Yangtze River Delta, especially those socioeconomically developed regions, which restricts the generalizability to more regions and larger Chinese population. Furthermore, the purposive selection of regions, cities, districts, and schools may limit the generalizability of our findings to other settings. Second, as China’s NIP implementation changes the vaccination context, the determinants of HPV vaccine intent and uptake may also shift over time; thus, our findings provide only partial evidence. Third, we used a convenience sampling strategy for an online survey, which prevented us from estimating the response rate or describing non-respondent characteristics, and further introduced potential bias. Our online, Mandarin-only survey may have introduced selection bias. Adults with limited Mandarin proficiency, low literacy, or lack of internet access or digital literacy were unable to participate. Although the Yangtze River Delta region has high literacy and internet penetration rates, these figures might not be 100%, which might exclude individuals likely differ systematically from participants. Fourth, our WTP assessment used a simplified double-bounded format with only one follow-up bid before the open-ended question, rather than a full iterative bidding process. This may have introduced a starting point bias, where the initial bid influenced subsequent responses. However, the inclusion of an open-ended question and random assignment to five different starting bids partially mitigates this concern. Finally, it should be noted that a small proportion of respondents were fathers, who might have inaccurately reported their wives’ intent to vaccinate their daughters. Conclusions This study found that school settings play a crucial role in influencing both parental HPV vaccine intent and actual uptake among girls in the Yangtze River Delta region of China. In addition, multi-channel information dissemination and engagement of multiple stakeholders in decision-making may further enhance parental intent and decision-making regarding HPV vaccination for their daughters. Our finding that higher-income parents had higher WTP while those expecting government funding had lower WTP suggests that a one-size-fits-all payment model may exacerbate disparities. Moreover, improving vaccine financing strategies may promote health equity. This includes potential future subsidies or diversified payment mechanisms such as commercial insurance and health insurance accounts, which could reduce out-of-pocket burdens and improve access for underserved families. Acknowledgments We appreciate all parents and healthcare workers at CDCs and CHCs participated in the survey. YL and XF conceived of this study. QZ, JL, and LS collected the data. XF conducted the analysis and drafted the initial manuscript. YL, QZ, JL, and LS critically revised the manuscript and helped interpret data. All authors reviewed the final manuscript. Biography Yihan Lu , Associate Professor of Epidemiology at Fudan University School of Public Health and Fudan Global Health Institute. He graduated with a PhD in Epidemiology and Health Statistics from Fudan University in China (2009) and completed a postdoctoral program at Vanderbilt University School of Medicine in the USA (2012). During 2016–2017, he was a fellow of Afya Bora Fellowship in Global Health Leadership with the Department of Global Health at the University of Washington and Kenyatta National Hospital at the University of Nairobi. His research interests cover molecular epidemiology and bioinformatics of viral diseases, and vaccination strategy of these viruses. Dr. Lu is a member of the Chinese Preventive Medicine Association, Chinese Geriatrics Society, China Association for Vaccines, Shanghai Medical Association, and International Society for Infectious Diseases. Funding Statement This work was partially supported by Shanghai Jiading District Health Commission [grant no. GWGZLXK-2023-01] and Shanghai Municipal Science and Technology Major Project [ZD2021CY001]. Disclosure statement YL received a grant from MSD China (quadrivalent and nine-valent HPV vaccines licensed in China’s mainland) for research in modeling and health economics of HPV vaccination in adolescent girls; and consultation fee from Walwax Biotechnology Co., Ltd. (bivalent HPV vaccine licensed in China’s mainland and a nine-valent HPV vaccine candidate in the clinical trial) and Xiamen Innovax Biotech Co., Ltd (bivalent and nine-valent HPV vaccines licensed in China’s mainland). Availability of data and materials The dataset analyzed during the current study is available from the corresponding author on reasonable request. Consent for publication Not applicable. Ethics approval and consent to participate This study was approved by the Institutional Review Board of the Fudan University School of Public Health (IRB 00002408 and FWA 00002399) under IRB #2024–10–1164. The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. All participants were informed about the purpose of the study, assured of confidentiality, and informed that participation was voluntary and that they could withdraw at any time without consequence. When entering the online questionnaire, parents were required to read an electronic informed consent form; only those who clicked “agree” were able to proceed with the survey, which was considered as provision of informed consent. No personal identifying information was collected during the survey. References 1. Meites E, Szilagyi PG, Chesson HW, Unger ER, Romero JR, Markowitz LE.. Human papillomavirus vaccination for adults: updated recommendations of the Advisory Committee on Immunization Practices. Morb Mortal Wkly Rep. 2019;68(32):698–12. doi: 10.15585/mmwr.mm6832a3. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 2. Bray F, Colombet M, Aitken JF, Bardot A, Eser S, Galceran J, Hagenimana M, Matsuda T, Mery L, Piñeros M, et al. Cancer incidence in five continents, Vol. XII. Lyon, France: International Agency for Research on Cancer; 2024. https://publications.iarc.who.int/641 . [ Google Scholar ] 3. Bonjour M, Charvat H, Franco EL, Piñeros M, Clifford GM, Bray F, Baussano I.. Global estimates of expected and preventable cervical cancers among girls born between 2005 and 2014: a birth cohort analysis. Lancet Public Health. 2021;6(7):e510–e521. doi: 10.1016/S2468-2667(21)00046-3. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 4. Rahangdale L, Mungo C, O’Connor S, Chibwesha CJ, Brewer NT. Human papillomavirus vaccination and cervical cancer risk. BMJ. 2023;383:2901. doi: 10.1136/bmj.p2901. [ DOI ] [ PubMed ] [ Google Scholar ] 5. World Health Organization . Global strategy to accelerate the elimination of cervical cancer as a public health problem 2020. [accessed 2025 Feb 17]. https://iris.who.int/bitstream/handle/10665/336583/9789240014107-eng.pdf?sequence=1 . 6. China Youth Daily . HPV vaccines will be included in the National Immunization Program. Many places have already launched free vaccination services. [accessed 2025 Sep 22]. https://finance.sina.com.cn/jjxw/2025-09-19/doc-infqzuwc2885159.shtml . 7. World Health Organization . Human papillomavirus vaccines: WHO position paper. 2022. [accessed 2026 Feb 17]. https://www.who.int/zh/news/item/20-12-2022-WHO-updates-recommendations-on-HPV-vaccination-schedule . 8. Wu D, Liu P, Song D, Wang H, Chen S, Tang W, Zhao X, Zhao F, Wang Y. Implementing the free HPV vaccination for adolescent girls aged below 14 in Shenzhen, Guangdong Province of China: experience, challenges, and lessons. Infect Dis Poverty. 2023;12(1):98. doi: 10.1186/s40249-023-01149-1. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 9. Zhao F, Lang J, Qiao Y, Zhu L. How can China achieve WHO’s 2030 targets for eliminating cervical cancer? BMJ. 2024;386:e078641. doi: 10.1136/bmj-2023-078641. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 10. Lu X, Zhao D, Tian J, Wang N, Ma ZH, Yang SF, Li Z, Wang WB, Sun XD, Huang ZY. Analysis on human papillomavirus vaccination coverage in women aged 9–45 years in Shanghai, 2017–2024. Chin J Epidemiol. 2025;46(10):1808–1814. doi: 10.3760/cma.j.cn112338-20250319-00176. [ DOI ] [ PubMed ] [ Google Scholar ] 11. The Central People’s Government of the People’s Republic of China . Notice on matters concerning the inclusion of human papillomavirus vaccine in the National Immunization Program. [accesssed 2025 Nov 7]. https://www.gov.cn/zhengce/zhengceku/202510/content_7046467.htm . 12. Wang Q, Zhang W, Cai H, Cao Y. Understanding the perceptions of Chinese women of the commercially available domestic and imported HPV vaccine: a semantic network analysis. Vaccine. 2020;38(52):8334–8342. doi: 10.1016/j.vaccine.2020.11.016. [ DOI ] [ PubMed ] [ Google Scholar ] 13. Xie Y, Su LY, Wang F, Tang H-Y, Yang Q-G, Liu YJ. Awareness regarding and vaccines acceptability of human papillomavirus among parents of middle school students in Zunyi, Southwest China. Hum Vaccin Immunother. 2021;17(11):4406–4411. doi: 10.1080/21645515.2021.1951931. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 14. Zhao Y, Sun Y, Li Z, Ma J, Wang F, Jia B. Hpv vaccination willingness among 3,081 secondary school parents in China’s capital. Hum Vaccin Immunother. 2025;21(1):2477383. doi: 10.1080/21645515.2025.2477383. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 15. Otto AK, Ketcher D, McCormick R, Davis JL, McIntyre MR, Liao Y, Reblin M, Vadaparampil ST. Using the health belief model to assess racial/ethnic disparities in cancer-related behaviors in an NCI-designated comprehensive cancer center catchment area. Cancer Causes Control. 2021;32(10):1085–1094. doi: 10.1007/s10552-021-01457-7. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 16. Zheng S, Deng X, Li L, Luo F, He H, Wang Y, Xu X, Wang S, Chen Y. Awareness, preference, and acceptance of HPV vaccine and related influencing factors among guardians of adolescent girls in China: a health belief model-based cross-sectional study. Vaccines (Basel). 2025;13(8):840. doi: 10.3390/vaccines13080840. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 17. Abdelhadi LM, Aryan FS, Alsabi R, Samhan GA, Al-Qaaneh AM. Knowledge, attitudes, and practices associated with human papillomavirus vaccine recommendation among healthcare professionals: a cross-sectional study. Infect Dis Rep. 2025;17(5):126. doi: 10.3390/idr17050126. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 18. Rodriguez AM, Do TQN, Chen L, Schmeler KM, Montealegre JR, Kuo Y-F. Human papillomavirus vaccinations at recommended ages: how a middle school-based educational and vaccination program increased uptake in the Rio Grande Valley. Hum Vaccin Immunother. 2022;18(6):2133315. doi: 10.1080/21645515.2022.2133315. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 19. Rosso A, Riccio M, Renzi E, Patania F, Baccolini V, Kaisy AM, Marzuillo C, De Vito C, Villari P, Massimi A. The role of school-based health education in promoting childhood and adolescent vaccination: a systematic review and meta-analysis. Vaccine. 2026;79:128479. doi: 10.1016/j.vaccine.2026.128479. [ DOI ] [ PubMed ] [ Google Scholar ] 20. Gould J, Litchfield E, Jenkins M, Nathoo A, Pudwell J, Velez MP. Social determinants of health and human papillomavirus vaccination uptake: a systematic review. J Obstet Gynaecol Can. 2026;48(4):103246. doi: 10.1016/j.jogc.2026.103246. [ DOI ] [ PubMed ] [ Google Scholar ] 21. Harrington N, Chen Y, O’Reilly AM, Fang, C. Y.. The role of trust in HPV vaccine uptake among racial and ethnic minorities in the United States: a narrative review. AIMS Public Health. 2021;8(2):352–368. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 22. Zhang Y, Wang Y, Liu L, Fan Y, Liu Z, Wang Y, Nie S. Awareness and knowledge about human papillomavirus vaccination and its acceptance in China: a meta-analysis of 58 observational studies. BMC Public Health. 2016;16(1):216. doi: 10.1186/s12889-016-2873-8. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 23. World Bank . China - Literacy rate, adult total (% of people ages 15 and above). [accesssed 2026 Apr 25]. https://tradingeconomics.com/china/literacy-rate-adult-total-percent-of-people-ages-15-and-above-wb-data.html . 24. China Internet Network Information Center . The 57th statistical report on internet development in China. [accessed 2026 Apr 25]. https://www.cnnic.net.cn/ . 25. Zhou W, Lu X, Lu J, Zhang Q, Fu X, Sun X, Guo X, Lu Y. Parental willingness to pay and preference for human papillomavirus vaccine for girls aged 9-14 in subsidy scenarios in Shanghai, China. Hum Vaccin Immunother. 2024;20(1):2372883. doi: 10.1080/21645515.2024.2372883. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 26. Pavlasová L, Vojíř K. Influenza and influenza vaccination from the perspective of Czech pre-service teachers: knowledge and attitudes. Cent Eur J Public Health. 2021;29(3):177–182. doi: 10.21101/cejph.a6670. [ DOI ] [ PubMed ] [ Google Scholar ] 27. Ganczak M, Kalinowski P, Drozd-Dąbrowska M, Biesiada D, Dubiel P, Topczewska K, Molas-Biesiada A, Oszutowska-Mazurek D, Korzeń M. School life and influenza immunization: a cross-sectional study on vaccination coverage and influencing determinants among Polish teachers. Vaccine. 2020;38(34):5548–5555. doi: 10.1016/j.vaccine.2019.10.067. [ DOI ] [ PubMed ] [ Google Scholar ] 28. Huiberts A, van Cleef B, Tjon ATA, Dijkstra F, Schreuder I, Fanoy E, van Gageldonk A, van der Hoek W, van Asten L. Influenza vaccination of school teachers: a scoping review and an impact estimation. PLOS ONE. 2022;17(8):e0272332. doi: 10.1371/journal.pone.0272332. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 29. Kaufmann J, DeVoe JE, Angier H, Moreno L, Cahen V, Marino M. Association of parent influenza vaccination and early childhood vaccinations using linked electronic health record data. Vaccine. 2022;40(49):7097–7107. doi: 10.1016/j.vaccine.2022.09.040. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 30. Newman PA, Logie CH, Lacombe-Duncan A, Baiden P, Tepjan S, Rubincam C, Doukas N, Asey F. Parents’ uptake of human papillomavirus vaccines for their children: a systematic review and meta-analysis of observational studies. BMJ Open. 2018;8(4):e019206. doi: 10.1136/bmjopen-2017-019206. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 31. Dunn AG, Surian D, Leask J, Dey A, Mandl KD, Coiera E. Mapping information exposure on social media to explain differences in HPV vaccine coverage in the United States. Vaccine. 2017;35(23):3033–3040. doi: 10.1016/j.vaccine.2017.04.060. [ DOI ] [ PubMed ] [ Google Scholar ] 32. Zhou F, Zhang W, Cai H, Cao Y. Portrayals of 2v, 4v and 9vHPV vaccines on Chinese social media: a content analysis of hot posts on Sina Weibo. Hum Vaccin Immunother. 2021;17(11):4433–4441. doi: 10.1080/21645515.2021.1971016. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 33. Gao H, Yin H, Peng L, Wang H. Effectiveness of social video platforms in promoting COVID-19 vaccination among youth: a content-specific analysis of COVID-19 vaccination topic videos on Bilibili. Risk Manag Healthc Policy. 2022;15:1621–1639. doi: 10.2147/RMHP.S374420. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 34. Sun S, Liu Z, Zhai Y, Wang F. COVID-19 vaccines on TikTok: a big-data analysis of entangled discourses. Int J Environ Res Public Health. 2022;19(20):13287. doi: 10.3390/ijerph192013287. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 35. Lin Z, Chen S, Su L, Liao Y, Chen H, Hu Z, Chen Z, Fang Y, Liang X, Chen J, et al. Influences of HPV disease perceptions, vaccine accessibility, and information exposure on social media on HPV vaccination uptake among 11,678 mothers with daughters aged 9-17 years in China: a cross-sectional study. BMC Med. 2024;22(1):328. doi: 10.1186/s12916-024-03538-1. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 36. Chen J, Zhang Z, Pan W, Song Y, Zheng L, Li L, Ye J, Cao L, Yu W. Estimated human papillomavirus vaccine coverage among females 9-45 years of age - China, 2017-2022. China CDC Wkly. 2024;6(19):413–417. doi: 10.46234/ccdcw2024.080. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 37. Xiang J, Sun X. Socioeconomic disparities in HPV vaccine uptake: multivariable analysis of vaccination data from Tianjin (2018–2023). Front Public Health. 2025;13:1428267. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 38. Guoliang T, Yuxin H, Jiwei W. Research status and vaccination policy of human papillomavirus vaccine. Shanghai J Preventative Med. 2024;36(3):297–302. [ Google Scholar ] 39. 百度百科 . Cecolin 9®. 2025. Jun 04 [accessed 2026 Jan 17]. https://baike.baidu.com/item/%E9%A6%A8%E5%8F%AF%E5%AE%81%C2%AE%209/65745254 . 40. Cervivac®. [accessed 2025 Sep 21]. https://news.qq.com/rain/a/20250928A07JQZ00 . 41. Duke Kunshan VaxLab . HPV vaccine price thresholds for China’s NIP expansion. [accessed 2025 Nov 7]. https://vaxlab.dukekunshan.edu.cn/en/weekly-update/issue-49 . 42. Guo Q, Zhou W, Wen X, Lu J, Lu X, Lu Y. Discrepancy of human papillomavirus vaccine uptake and intent between girls 9-14 and their mothers in a pilot region of Shanghai, China. Hum Vaccin Immunother. 2022;18(6):2132801. doi: 10.1080/21645515.2022.2132801. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 43. Innovation Lab for Vaccine Delivery Research . Local pilots of HPV vaccination in China. [accessed 2025 Nov 7]. https://vaxlab.dukekunshan.edu.cn/en/evidence-db-expert/hpv-vaccine-policy-advocacy-evidence-repository/local-pilots-of-hpv-vaccination-in-china/ . Associated Data This section collects any data citations, data availability statements, or supplementary materials included in this article. Data Availability Statement The dataset analyzed during the current study is available from the corresponding author on reasonable request. Articles from Human Vaccines & Immunotherapeutics are provided here courtesy of Taylor & Francis ACTIONS View on publisher site PDF (2.4 MB) Cite Collections Permalink RESOURCES Similar articles Cited by other articles Links to NCBI Databases Follow NCBI NCBI on X (formerly known as Twitter) NCBI on Facebook NCBI on LinkedIn NCBI on GitHub NCBI RSS feed Connect with NLM NLM on X (formerly known as Twitter) NLM on Facebook NLM on YouTube National Library of Medicine 8600 Rockville Pike Bethesda, MD 20894 Web Policies FOIA HHS Vulnerability Disclosure Help Accessibility Careers NLM NIH HHS USA.gov Back to Top

Related documents

• HPV vaccination scenario and parental willingness to pay among girls aged 9-14 y in the Yangtze River Delta, China.#255603
• Covid-19 Vaccination in Adolescents and Children#387208
• Parental knowledge, socioeconomic factors and barriers to HPV vaccination uptake among children in Lebanon: a cross-sec#5147
• Changes in HPV vaccine hesitancy and influencing factors among female university students in China: A national repeated study.#427846
• Impact of the two-dose varicella vaccination recommendation program and surveillance optimization on epidemiological trends in a megacity in China.#9914