What question did this study set out to answer?

The aim is to quantify the prevalence and determinants of delayed uptake of non-Expanded Program on Immunization childhood vaccines in urban China.

July 12, 2026Open Access

Timeliness gap in non‑EPI Childhood vaccination in urban China: a five-city study of socioeconomic determinants and caregiver preferences

LCLinchen ChuZhejiang Chinese Medical University KSKangning ShengZhejiang Chinese Medical University JLJiajun LiZhejiang Chinese Medical University

Key Points

The aim is to quantify the prevalence and determinants of delayed uptake of non-Expanded Program on Immunization childhood vaccines in urban China.
Conducted a multicenter clinic-based survey in May to July 2024 across five cities in China.
Caregivers of children aged 0-6 years provided vaccination information, socioeconomic data, and responses to a discrete-choice experiment.
Weighted logistic regression and mixed logit models analyzed the data.
In a sample of 1,292 caregiver-child pairs, the prevalence of delayed vaccination was 23.7% (95% CI: 21.3–26.1).
Increased delay risk was associated with monthly household income < ¥10,000 (adjusted OR: 1.24, 95% CI: 1.11–1.38) and negative prior vaccination experiences (adjusted OR: 1.11, 95% CI: 1.01–1.23).
Caregivers were willing to pay ¥106 for each 1% reduction in adverse event risk, indicating high sensitivity to perceived risk.

Abstract

Abstract Background Delays 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. Methods A 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). Results Among 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. Conclusions Delayed 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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