Adult and maternal pertussis vaccination in China: intention, preferences, and pricing implications from a discrete choice experiment.

OBJECTIVES

To assess pertussis vaccination intentions and identify key vaccine attribute preferences among Chinese adolescents, adults and pregnant women to inform future pertussis immunisation strategies.

METHODS

We conducted a cross-sectional survey using multistage stratified cluster random sampling across five provinces selected to capture geographic and socioeconomic diversity in China. Participants included adolescents aged 15-17 years, adults, and pregnant women. Prior to the DCE component, all respondents received a brief, standardised description of pertussis and pertussis vaccination to ensure a minimum level of understanding. Correlates of intention were examined using multivariable logistic regression and causal mediation analysis. A discrete choice experiment (DCE) varied efficacy, adverse events following immunisation (AEFI), duration, origin and cost, with willingness-to-pay (WTP) estimated via mixed logit models. Subgroup heterogeneity was assessed by demographic and cognitive characteristics.

RESULTS

Respondents expressed generally high vaccination intention. Among adolescents and adults, larger household size was associated with higher intention; among pregnant women, primiparity was associated with lower intention. Pertussis knowledge partially mediated the education-intention association. In the DCE, all attributes except duration influenced choices, with efficacy the dominant driver; lower AEFI risk, domestically produced vaccines, and lower cost increased preference. Pregnant women showed higher WTP than adults. Preferences varied across demographic and cognitive subgroups.

CONCLUSIONS

Respondents showed sizeable intention and consistent preferences for efficacy, safety and affordability, especially for domestically produced vaccines, informing programme design through targeted risk communication, willingness-to-pay-aligned pricing and integration within antenatal services to support real-world uptake.