Understanding determinants of parental HPV vaccine hesitancy under a municipal free vaccination program in Guangzhou, China

Despite efforts to promote HPV vaccination, coverage remains suboptimal in China. Following Guangzhou's 2022 free HPV vaccination program for girls aged 9-15, a cross-sectional survey was conducted from May to August 2024 among 411 parents of eligible girls in Guangzhou. The questionnaire was developed based on the supply-demand alignment theory. Vaccine Hesitancy Scale and Family Health Scale-Short Form were administered. Generalized linear regression identified factors associated with hesitancy. Overall, 10.7% of parents exhibited high hesitancy. Key determinants included occupation [farmers: β = -3.61, 95% CI = (-6.88, -0.34)], preference for imported over domestic vaccines [β = -1.65, 95% CI = (-3.10, -0.12)]. Higher family health scores [β = 0.25, 95% CI = (0.16, 0.33)], moderate child health status [β = 1.24, 95% CI = (0.10, 2.38)], and satisfaction with community healthcare centers (CHCs) [β = 0.05, 95% CI = (0.02, 0.07)] were less hesitant. Paradoxically, longer CHC wait times (>1 hour) [β = 2.29, 95% CI = (0.27, 4.31)] and difficulty accessing information [β = 2.80, 95% CI = (0.33, 5.27)] correlated with lower hesitancy. The results suggest potential policy-driven tolerance. Besides, this emphasizes the critical need for enhanced service quality in CHCs, targeted health education, and confidence building in national vaccines. These insights offer potential guidance for implementing complementary strategies to achieve equitable HPV vaccine coverage.