Gap between willingness and behavior in the vaccination against influenza, pneumonia, and herpes zoster among Chinese aged 50–69 years

Vaccination uptake of influenza vaccine, 23-valent pneumococcal polysaccharide vaccine (PPV23) and herpes zoster vaccine (HZV) remains low among Chinese aged 50-69 years, posing a significant public health concern. This study's aim is to determine the gap between the vaccination willingness and uptake.We conducted a face-to-face questionnaire survey among the persons aged 50-69 years in 13 communities in Shanghai in November-December 2020 to measure vaccination willingness, vaccine price sensitivity, vaccination service accessibility, and vaccine hesitancy. Then, we explored the factors influencing the vaccination uptake using a structural equation model.Vaccination willingness was 70.5% (self-paid influenza vaccine), 79.4% (free PPV23 for local persons), 54.7% (self-paid PPV23 for non-local persons), and 16.6% (self-paid HZV); however, actual uptake was 10.8% (influenza vaccine), 11.0% (free PPV23), and 2.5% (self-paid PPV23). Moreover, vaccination uptake was strongly influenced by service accessibility (β = 0.941), followed by willingness (β = 0.201), price sensitivity (β = -0.188), and medical history of vaccine-preventable diseases and underlying diseases (β = 0.176). Related knowledge (β = 0.017) and vaccine hesitancy (β = -0.003) affected the uptake indirectly.There is a gap between the vaccination willingness and uptake in Chinese elderly. It warrants specific measures, including increasing service accessibility and reforming payment mechanism, to bridge the gap.