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Uptake and hesitancy of the second booster dose of COVID-19 vaccine among the general population in China after the surge period of the COVID-19 pandemic: a large-scale national study

樱花视频 volume听25, Article听number:听503 (2025) Cite this article

Abstract

Background

Although the second booster dose of COVID-19 vaccines is available, vaccine hesitancy among the public may have peaked due to the surge in infections caused by the Omicron variant. To improve coverage of the second booster dose, it is crucial to investigate the prevalence of vaccine hesitancy among the general population during this period and explore the reasons for this phenomenon.

Methods

A cross-sectional survey was conducted between January 5 to February 9, 2023. Variables including sociodemographics, mental health, COVID-19 infection status, COVID-19 vaccination status, and vaccine hesitancy were collected. Univariate and multivariate logistic regression analysis were performed to identify factors associated with the hesitancy of the second booster dose of COVID-19 vaccine among the general population.

Results

Among the 10,623 participants, the uptake rate of the second booster dose was 4.3%. Among those who did not receive the second booster dose, 43.6% expressed vaccine hesitancy. The highest hesitancy rate was observed among participants who had not completed primary immunization (71.4%), followed by those with chronic diseases (48.6%) and those aged 60 and above (33.2%). The COVID-19 vaccine听hesitancy was higher among females, participants with high incomes, those with a history of COVID-19 infection, those with depressive听symptoms and post-traumatic stress disorder, and those with adverse events after COVID-19 vaccination. Conversely, lower hesitancy was observed among students, participants aged 60 and above, those from southern China, and those with higher level of perceived听social support.

Conclusions

COVID-19 vaccine hesitancy remains prevalent among the general population in China after the surge period of the pandemic. Crucial steps, such as raising public awareness of the benefits and potential side effects of regular COVID-19 vaccination, ensuring timely monitoring and disclosure of pandemic information, and implementing targeted measures to improve social support and mental health, should be taken. These efforts will be instrumental in reducing vaccine hesitancy, advancing vaccination campaigns, and effectively preparing for the potential future outbreaks.

Peer Review reports

Introduction

Since it was first detected in 2021, Omicron has quickly become the dominant COVID-19 variant. Due to its high transmissibility and pathogenicity, the number of infections in China surged, peaking between December 2022 and January 2023 [1]. Although the overall pandemic in China entered a low-level period in January 2023 [2], the SARS-CoV-2 continues to spread, and the ongoing evolution of the virus remains a risk for the emergence听of new, more transmissible variants. Moreover, the lifting mandatory non-pharmaceutical interventions in public spaces poses another challenge to COVID-19 pandemic prevention and control [3]. Therefore, China needs to take necessary measures to prevent the health threat from a possible new wave of COVID-19 infection.

Vaccination has been widely recognized as the most efficient public health intervention for controlling infectious diseases, and compared to non-pharmaceutical interventions, it offers significant economic and health system advantages [4]. According to the World Health Organization (WHO), the COVID-19 vaccine is a critical tool in preventing infection and transmission, which is a crucial step toward ending the COVID-19 pandemic [5, 6]. In China, COVID-19 vaccines were officially rolled out on December 30, 2020, with all Chinese citizens eligible for free vaccination [7]. In February and December 2022, China launched the first and second booster dose vaccination campaign [8, 9]. In April 2023, the National Health Commission of China issued the vaccination program, emphasizing vaccination for uninfected individuals, those who had not completed the primary immunization series, and vulnerable populations. The program also recommended heterologous vaccines as the booster dose for individuals who have completed the first booster dose [10].

Currently, there are three types of COVID-19 vaccines authorized in China: inactivated vaccines (e.g., CoronaVac), viral vector vaccines (e.g., Ad5-nCoV), and recombinant protein vaccines (e.g., ZF2001). Studies have shown that, compared to homologous vaccination, heterologous vaccination effectively enhances the protective efficacy of vaccines, providing better protection against COVID-19 infection [11]. In addition, the second booster dose of the COVID-19 vaccine can rapidly increase the levels of neutralizing antibodies in vaccinated individuals, significantly reducing the risk of infection and alleviating the severity of symptoms [12, 13]. This is particularly important for mitigating the risks posed by new variants and in protecting vulnerable populations [14]. Apart from this, the widespread administration of the second booster dose does help听bolstering and sustaining population immunity, reducing severe cases and hospitalizations, and minimizing the societal impact of COVID-19 [15]. Therefore, further expanding the coverage of the second booster dose remains a key priority for the government.

However, vaccine hesitancy, defined as the delay in acceptance or refusal of vaccination despite the availability of vaccination services [16], remains a major challenge in promoting the COVID-19 vaccine. A repeated cross-sectional study found that the prevalence of COVID-19 vaccine hesitancy in China gradually increased from 8.39% in 2021 to 29.72% in 2023 [17]. This phenomenon significantly impedes the development of population immunity, undermining efforts to curb the further spread of virus among the public. Thus, investigating the state of vaccine hesitancy and its determinants is essential for supporting the control of the COVID-19 pandemic. In the early stages of the COVID-19 pandemic, vaccine hesitancy was primarily due to distrust in the newly developed COVID-19 vaccines, stemming from insufficient clinical evaluation, scientific data, and evidence regarding their efficacy and safety [18]. With the promotion of the COVID-19 vaccination campaign, more determinants for COVID-19 vaccine hesitancy have been identified. Besides demographic factors such as gender, education level, income, and age, perceived susceptibility, perceived benefits, mental health status, and trust in healthcare professionals have emerged as significant influences on vaccine hesitancy [19, 20]. Furthermore, a previous study found that the primary reason for vaccine hesitancy among patients who recovered from COVID-19 was the belief that they were protected by antibodies [21]. This perception, combined with concerns about the effectiveness of the vaccine after infection, influences their willingness to receive future vaccinations. Thus, following this wave of large-scale infections, the hesitancy of the second booster dose of the COVID-19 vaccine in China may have reached unprecedented levels.

Considering the challenges posed by the COVID-19 pandemic, it is crucial to investigate the vaccine hesitancy in China following the surge in the COVID-19 pandemic and provide potential suggestions to ensure sufficient coverage of the second booster dose and future COVID-19 variant-specific vaccines. However, research on this issue remains limited. This study aims to examine the COVID-19 vaccine hesitancy among the general population during this period, identify its underlying causes and influencing factors, and provide evidence for future policies and interventions that can enhance vaccination coverage and better respond to the evolving dynamics of the pandemic.

Methods

Study design and participants

An online cross-sectional survey was conducted from January 5 to February 9, 2023. A web-based, anonymous, and self-administered questionnaire was developed by a panel of epidemiologists, psychologists, and clinicians and distributed via an online questionnaire platform (WenJuanXing). The study protocol, quick response (QR) code and the questionnaire link were shared with team members from five geographical regions of China (east, west, south, north, and central), who were responsible for recruiting eligible participants. Survey invitations were sent via WeChat, the most popular social media platform in China. Interested participants accessed the questionnaire by scanning the QR code or clicking the shared link. Each WeChat account was allowed to access the online questionnaire only once to avoid duplicate responses.

The inclusion criteria were as follows: (1) citizens of China; (2) aged 18听years and above; (3) consented to participate in the survey; (4) primarily resided in Chinese mainland in the last month. Questionnaires with completion times of less than 120s or logically contradictory responses (e.g., selecting the same option consecutively in the COVID-19 Vaccine Hesitancy Scale) were excluded from the final analysis.

Sample size calculation

The sample size was estimated using the following equation: N鈥�=鈥塠Z(伪/2)2鈥壝椻赌�p鈥壝椻赌�(1-p)]/d2. Based on our prior research results [22], the expected prevalence of COVID-19 vaccine hesitancy in the general population was 21.2%. With a significance level of 伪鈥�=鈥�0.05 and a margin of error d鈥�=鈥�0.01, the required sample size was calculated. Considering an effective response rate of 80%, at least 4,094 participants were needed. The sample size was increased during the recruitment period to improve the representativeness of the study.

Measures

Sociodemographic and COVID-19 related information

Sociodemographic variables were collected, including age, gender, living area, educational level, student status, monthly income, cohabitation status, history of chronic diseases, and history of other vaccinations in the past five years. Participants were also asked about COVID-19 related information, including their status of COVID-19 infection and vaccination, and experience of adverse reactions after COVID-19 vaccinations.

Depressive symptoms

The nine-item Patient Health Questionnaire (PHQ-9) was used to screen, define, and quantify depressive symptoms of varying severity over the past 2听weeks [23]. This questionnaire has been validated in various Chinese populations [24,25,26]. The items of the PHQ-9 are scored on a 4-point Likert scale, with a range from 0-3. The total score of the scale ranges from 0 to 27, with 0-4 indicating minimal depressive symptoms, 5-9 indicating mild symptoms, 10-14 indicating moderate symptoms, and 15-27 indicating severe symptoms. The Cronbach鈥檚 alpha of the PHQ-9 in this study was 0.932.

Anxiety symptoms

The seven-item Generalized and Anxiety Disorder Scale (GAD-7) was used to measure the severity of generalized anxiety symptoms over the past 2听weeks [27]. This scale is rated on a 4-point Likert scale from 0 to 3. The total score of the scale ranges from 0 to 21, with 0-5 indicating minimal anxiety symptoms, 6-9 indicating mild symptoms, 10-14 indicating moderate symptoms, 15-21 indicating severe symptoms. This instrument has been shown to be reliable and valid among the Chinese population [28, 29]. The Cronbach鈥檚 alpha of the GAD-7 in this study was 0.965.

Post-traumatic stress disorder (PTSD)

The six-item Impact of Event Scale (IES-6) was employed to screen PTSD symptoms in adults in the past 2听weeks [30]. This scale is rated on a 5-point Likert scale from 0-4, with a score of 10 or higher considered as having PTSD symptoms. It has been validated in the Chinese population and has been proven valid and reliable among COVID-19 patients [31, 32]. The Cronbach鈥檚 alpha of the IES-6 in this study was 0.936.

Perceived social support

The Perceived Social Support Scale (PSSS) was employed to gauge the respondents鈥� perceived level of social support over the past 2听weeks. This scale was developed by Li et al. and has been used among the Chinese population [33]. It contains two items, each rated on a scale from 0-10 (0鈥�=鈥塻trongly disagree; 10鈥�=鈥塻trongly agree), with the overall score calculated by summing the scores of the two items. A higher score indicates a higher level of perceived social support. In this study, the Cronbach鈥檚 alpha of the scale was 0.838.

COVID-19 vaccine hesitancy

The COVID-19 Vaccine Hesitancy Scale was developed by Huang et al. and has been validated in the Chinese population [34]. This scale was applied to assess the degree of participants鈥� hesitancy toward the COVID-19 vaccine. The scale consists of 15 items, each scored 0, 1, or 2 based on responses, with items 5, 11, 13, and 14 being听reverse scored. A final score of 15 or higher indicates vaccine hesitancy [22]. The Cronbach鈥檚 alpha of the scale was 0.826.

Statistical analysis

The characteristics of the groups were reported as frequencies (percentage [%]) for categorical variables and means (standard deviation [SD]) for continuous variables. Univariate and multivariate logistic regression analyses were applied to identify factors associated with the hesitancy of the second booster dose of COVID-19 among the general population, and the Enter method was conducted to control confounders. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were estimated. According to the results of the Hosmer and Lemeshow Test (蠂2鈥�=鈥�14.55, df鈥�=鈥�8, P鈥�=鈥�0.068), the final model has a good fit. The variance inflation factor (VIF) was calculated using a linear regression model. The VIFs of the independent variables were all less than 10, and the average VIF of the final model was 1.34, which means there was no multicollinearity among the variables. Data analysis was performed with the SPSS version 26.0 (IBM Corp., United States) and the graphs were made by the GraphPad Prism 9.3.1 (GraphPad Software, Inc., United States). P鈥�<鈥�0.05 was considered to indicate statistical significance.

Results

Characteristics of participants

A total of 11,006 participants from 31 provinces of the Chinese mainland completed the questionnaire. After quality control, 10,623 questionnaires were considered valid with a valid response rate of 96.5% (383 questionnaires were excluded, and the reasons for exclusion are presented in Table S1. The geographic distribution is shown in Table S2.). In this study, 4.3% (n鈥�=鈥�459) of the participants received the second booster dose of the COVID-19 vaccine. Among the participants who did not receive the second booster dose (n鈥�=鈥�10,164), the mean age was 29.09鈥壜扁��12.59听years, 97.4% were aged 18鈥�59听years, 67.8% were female, 74.3% had received university or college education, 71.8% had a monthly income less than CNY 5,000, 92.9% were living with others, and 9.2% had chronic diseases. Additionally, 61.3% reported experiencing depressive symptoms, 40.9% reported experiencing anxiety symptoms, 34.7% reported experiencing PTSD symptoms, 69.6% had recovered from COVID-19, and 76.2% had received other vaccines in the past five years (Table听1).

Table听1 Characteristics of participants, stratified by COVID-19 vaccination status and vaccine hesitancy
Full size table

COVID-19 vaccination status and the reasons to initiate COVID-19 vaccination

Among the 10,623 participants, 98.8% (n鈥�=鈥�10,493) had received at least one听dose of COVID-19 vaccine, and 80.7% (n鈥�=鈥�8,571) had received three doses. Among participants who had received at least听one dose,听62.7% (n鈥�=鈥�6,583) of them had received the inactivated vaccine of Sinopharm (Beijing) while 25.8% (n鈥�=鈥�2,706)听of them听had experienced pain at the vaccination site after vaccination (Table S3). Figure听1 shows the reasons for initiating the COVID-19 vaccination听and over two-thirds (71.1%) of participants were vaccinated because of the requirement from school or workplace. Under half (46.7%) of participants have been vaccinated due to their personal needs such as concerns about getting infected. 18.5% of participants have been vaccinated following health authorities and community recommendations. In addition, a small number of people chose to get vaccinated on the recommendation of others (2.4%), online information (1.8%), and other reasons (0.7%).

Fig.听1
figure 1

Reasons to receive COVID-19 vaccine among the general population in China

Full size image

COVID-19 Vaccine hesitancy and the scale distribution

In the group of 130 participants who had not received COVID-19 vaccine, 98 (75.4%) exhibited vaccine hesitancy, and among 10,034 participants who had not receive the second booster dose of COVID-19 vaccine, 4,334 (43.2%) exhibited vaccine hesitancy. Figure听2 shows the reasons for COVID-19 vaccine hesitancy, and the three main reasons were the same for both unvaccinated and vaccinated individuals: 鈥�Have received negative reports about COVID-19 vaccine鈥� (31.63% vs. 43.91%), 鈥�Don't need the vaccination because of antibody protection鈥� (31.63% vs. 24.42%), and 鈥�Don't know how to obtain reliable information about COVID-19 vaccine鈥� (22.45% vs. 41.20%). The distribution of each item of the COVID-19 vaccine hesitancy scale is shown in Table听2. In this study, 43.6% (4,432/10,164) of the participants exhibited COVID-19 vaccine hesitancy. The highest prevalence of vaccine hesitancy was found among participants who had not completed primary immunization (71.4%), followed by those with chronic diseases (48.6%) and participants aged 60听years and above (33.2%).

Fig.听2
figure 2

Reasons for COVID-19 vaccine hesitancy among the general population in China

Full size image
Table听2 Distribution of the COVID-19 vaccine hesitancy scale across the different populations in China
Full size table

Predictors of COVID-19 vaccine hesitancy among the听general population

Table 3 shows the results of the logistic regression analysis, which revealed that the likelihood of hesitancy toward the second booster dose of the COVID-19 vaccine was higher among females (aOR鈥�=鈥�1.22, 95%CI: 1.10鈥�1.28), participants with higher income (aOR鈥�=鈥�1.29, 95%CI: 1.06鈥�1.56 for those with a monthly income of CNY 10,000鈥�29,999 and aOR鈥�=鈥�1.47, 95%CI: 1.04鈥�2.09 for those with a monthly income of CNY 30,000 and above, compared to those with a monthly income below CNY 5,000), those with a history of COVID-19 infection (aOR鈥�=鈥�1.47, 95%CI: 1.16鈥�1.85 for those during infection, aOR鈥�=鈥�1.17, 95%CI: 1.03鈥�1.33 for those who had recovered compared to uninfected participants), those with depressive symptoms (aOR鈥�=鈥�1.14, 95%CI:1.02鈥�1.27 for mild, aOR鈥�=鈥�1.34, 95%CI:1.14鈥�1.57 for moderate, aOR鈥�=鈥�1.38, 95%CI:1.11鈥�1.70 for severe compared to those with minimal depressive symptoms), those with PTSD symptoms (aOR鈥�=鈥�1.16, 95%CI: 1.05鈥�1.29) and those with a history of adverse reactions after COVID-19 vaccination (aOR鈥�=鈥�1.49, 95%CI: 1.36鈥�1.63). By contrast, the odds of COVID-19 vaccine hesitancy were lower among participants aged 60 and above (aOR鈥�=鈥�0.56, 95%CI: 0.41鈥�0.76), students (aOR鈥�=鈥�0.85, 95%CI: 0.75鈥�0.95), participants living in southern China (aOR鈥�=鈥�0.77, 95%CI: 0.66鈥�0.90), and those with higher social support (aOR鈥�=鈥�0.87, 95%CI: 0.86鈥�0.88) (Table听3).

Table听3 Predictors of hesitancy regarding听the听second booster dose of COVID-19 vaccine among the general population in China (n鈥�=鈥�10,164)
Full size table

Discussion

This study was the first large-scale, multi-center, and cross-sectional survey conducted after the surge period of the COVID-19 pandemic in China. It revealed the prevalence and explored the influencing factors of hesitancy of the second booster dose of COVID-19 vaccine among the general population in China. In this study, only 4.3% of the participants reported receiving the second booster dose at this stage. Among people who did not receive the second booster dose, the vaccine hesitancy rate reached 43.6%, which is much higher than that of the first booster dose (8.39%) [35] and the second booster dose before the surge period of the COVID-19 pandemic(18.9%) [36]. It also surpasses the global average prevalence of COVID-19 vaccine hesitancy for booster dose (30.72%) [37]. Therefore,the issue of vaccine hesitancy among the public in China remains a cause for concern.

COVID-19 infection was identified as a dominant reason for participants' hesitancy toward receiving the second booster dose. The underlying cause of this hesitancy is the belief that individuals who have been infected produce a great amount of antibodies, which can protect them from reinfection. This leads to the misconception that there is no longer a need to receive an additional dose of the vaccine after infection. However, the antibody levels induced by vaccination and infection gradually decrease after six months, which reduces the protective effect of individuals against reinfection [38,39,40]. In addition, the high transmissibility of the Omicron variant increases the risk of infection and reinfection among individuals [41, 42], and new variants may emerge during their transmission, which enables the SARS CoV-2 to evade immunity induced by previous vaccination and infection [43]. Thus, receiving the second booster dose remains important for the public. Furthermore, adverse reactions after COVID-19 vaccination are another significant factor contributing to vaccine hesitancy. Research shows that side effects, such as fever and pain, may lead to feelings of regret after vaccination, which negatively impacts individuals' willingness to receive vaccines in the future [44]. Moreover, individuals may develop a nocebo effect due to others' experiences, negative media coverage, or concerns about potential side effects mentioned in vaccine information. A study found that the incidence of the nocebo effect was higher among those unwilling to receive the COVID-19 vaccine [45]. These findings highlight the importance of providing clear and accurate information about both the benefits and potential side effects of booster doses to improve knowledge and reduce vaccine hesitancy among the public.

Psychological factors play a significant role in COVID-19 vaccine hesitancy. This study found that participants with depressive symptoms were more reluctant to vaccinate. This may be attributed to the fact that individuals with depressive symptoms are听often in a state of low mood, sadness, and negativity, which can diminish their motivation to get vaccinated [46]. Furthermore, a previous study showed that they are more likely to lack confidence in the safety and efficacy of the COVID-19 vaccine [47]. In addition, individuals who experience PTSD symptoms from the COVID-19 pandemic or adverse reactions to vaccination may develop a sense of distrust toward healthcare services and providers, which contributes to decreased utilization of healthcare services and leads to greater hesitancy toward the booster dose [48]. Another study found that anxiety and depression also increase the risk of individuals reporting adverse reactions to the COVID-19 vaccine [49]. The interaction of multiple psychological factors further hinders the progress of vaccination efforts, which highlights the importance of addressing mental health problems among the general population in vaccination campaigns. Thus, future research should develop and explore the potential of psychological interventions in alleviating mental health burdens among the public and evaluate their effectiveness in improving COVID-19 vaccine coverage.

This study found a positive correlation between social support and willingness to receive a second booster dose of the COVID-19 vaccine, which is consistent with the previous study [50]. Social support can alleviate the public's stress responses and emotional fluctuations associated with COVID-19 infection. It helps individuals cope with the uncertainty and anxiety brought by the pandemic, stabilizes their emotions, reduces feelings of isolation, and boosts confidence in vaccination [51, 52]. In addition, a mediation study demonstrated that enhancing perceived social support enables individuals to improve their risk perception and self-efficacy, thereby boosting their willingness to engage in COVID-19 prevention activities [53]. This finding underscores the importance for governments and communities to maintain and strengthen social support networks during the pandemic, particularly as isolation measures and social distancing restrictions may weaken these connections. Previous studies have found that promoting online social support effectively encourages COVID-19 vaccination [54]. It provides informational, experiential, and emotional support while offering broader coverage and more diverse intervention approaches. In the future, integrating novel technologies with traditional interpersonal approaches may offer a more effective strategy to reduce vaccine hesitancy among the public.

In this study, females and individuals with higher incomes were identified as risk groups for vaccine hesitancy, which has been thoroughly discussed in previous research [17, 55]. Students showed a low risk of vaccine hesitancy. This may be due to the convenience of vaccination on campus, as well as mutual support and companionship among students, which might help overcome the fear of vaccination [56, 57]. Contrary to previous research [58], this study found that people aged 60 and above tend to have less hesitancy toward the second booster dose than younger people. This may be because older adults are vulnerable to COVID-19 infection [59], and the infection and death of relatives and friends around them increase their risk perception [60, 61], prompting them to pay more attention to vaccination. Previous research indicates that young and middle-aged individuals without underlying diseases have a higher proportion of asymptomatic infections [62]. Compared to older adults, younger individuals tend to have better physical health, which often results in a better prognosis and milder symptoms [63]. This may lead to a lower perception of severity and susceptibility among younger people, causing vaccine hesitancy. However, due to their relatively active lifestyle and social interactions, they can still transmit the virus to others. This undermines efforts to achieve population immunity and may burden the healthcare system and medical services [64]. Therefore, public health campaigns should be promoted to address vaccine hesitancy among these groups, emphasizing the role of the second booster dose in protecting health and preventing virus transmission.

Our research has several limitations. Firstly, this study is an internet-based cross-sectional study, so that听we cannot explore the causal relationship between factors and outcomes. Secondly, as self-administered questionnaires were used, participants' responses may be subject to recall bias. Additionally, our sample included relatively few participants from eastern China and may not have covered individuals without internet access, which could affect the representativeness of the sample. We attempted to minimize this impact by expanding the sample size and excluding unqualified questionnaires. Moreover, our survey was conducted after the surge period of the COVID-19 pandemic, and due to the vulnerability of the elderly to COVID-19 infection, our findings may be influenced by survivor bias. Lastly, our research was conducted exclusively in Chinese mainland using online questionnaires, limiting the generalizability of results. Therefore, the findings of this study should be interpreted with caution when being extrapolated to other countries and regions.

Conclusions

The COVID-19 pandemic is not yet over, and after the surge period of infection, vaccine hesitancy remains a significant challenge in controlling the pandemic in China. The government should learn from past experiences to improve public awareness of the benefits of regular vaccination and the potential adverse effects, and continue to improve and promote its COVID-19 vaccination strategies. Efforts should also focus on advancing the development of vaccines that can protect people against emerging COVID-19 variants, maintaining robust monitoring of viral transmission and evolution, and ensuring the timely disclosure of reliable information about outbreaks and vaccines. Additionally, more attention should be given to mental health issues among the general population, with measures to enhance perceived social support. These efforts can increase the COVID-19 vaccine coverage and better prepare for potential future outbreaks.

Data availability

The datasets generated and/or analysed during the current study are not publicly available due to the privacy information of participants but are available from the corresponding author on reasonable request.

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Acknowledgements

The authors thank the technical support provided by WenJuanXing (https://www.wjx.cn).

Funding

This research was supported by The Innovative Engineering Program sponsored by the Chinese Academy of Medical Sciences (2020-I2M-2-015).

Author information

Author notes

  1. Xin Liu and You Xin joint first authors.

Authors and Affiliations

  1. School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China

    Xin Liu,听You Xin,听Ling Zhang,听Yijin Wu,听Shu Jing,听Tianrui Ren,听Xiaoyang Liu,听Jiaqi Fu,听Xu Chen,听Weijun Xiao,听Hao Wang,听Yiman Huang,听Yimin Qu,听Xiaoyou Su听&听Youlin Qiao

  2. Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China

    Zhenwei Dai

  3. School of Nursing, Jining Medical University, Jining, China

    Wenjun Wang

  4. Affiliated Tumor Hospital, Xinjiang Medical University, Urumqi, China

    Xiaofen Gu

  5. Public Health School, Dalian Medical University, Dalian, China

    Li Ma

  6. Henan Cancer Hospital, Affiliate Cancer Hospital of Zhengzhou University, Zhengzhou, China

    Shaokai Zhang

  7. The First Affiliated Hospital of Baotou Medical College, Baotou, China

    Yanqin Yu

  8. Department of Clinical Research, the First Affiliated Hospital of Jinan University, Guangzhou, China

    Li Li

  9. University of Rochester, Rochester, USA

    Tianzuo Gao

  10. Trinity College, Hartford, USA

    Tianyou Zhao

  11. Guang鈥檃nmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China

    Xinyan Liu

  12. Department of Epidemiology, Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China

    Youlin Qiao

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  1. Xin Liu

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  2. You Xin

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Contributions

XL and SJ conceived the research and designed the protocol, and all the authors participated in the field survey. XL and YX are responsible for data analysis and wrote the original draft; XS, XL, YQ reviewed and revised the papers. All authors contributed to writing and reviewing the article and approved the published version of the manuscript.

Corresponding authors

Correspondence to Xinyan Liu or Xiaoyou Su.

Ethics declarations

Ethics approval and consent to participate

The study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of Peking Union Medical College (Approval number: CAMS&PUMC-IEC-2022鈥�83). Informed consent was obtained from all participants.

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Not applicable.

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The authors declare no competing interests.

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Liu, X., Xin, Y., Zhang, L. et al. Uptake and hesitancy of the second booster dose of COVID-19 vaccine among the general population in China after the surge period of the COVID-19 pandemic: a large-scale national study. 樱花视频 25, 503 (2025). https://doi.org/10.1186/s12889-025-21691-x

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  • DOI: https://doi.org/10.1186/s12889-025-21691-x

Keywords

樱花视频

ISSN: 1471-2458

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