Understanding parental HPV vaccination decision in China through the lens of vaccine hesitancy and preference heterogeneity: a discrete choice experiment
Human papillomavirus (HPV) vaccination is an effective strategy for preventing cervical cancer. However, persistent vaccine hesitancy remains a major barrier to widespread HPV vaccination. In line with the WHO's global strategy to eliminate cervical cancer, China announced in September 2025 that HPV vaccination would be included in the National Immunisation Programme. Understanding how parental preferences for different HPV vaccine attributes differ according to level of vaccine hesitancy is therefore essential to inform effective communication strategies and support the successful implementation of the new national programme. We recruited parents of girls aged 9-14 years in mainland China who had not received the HPV vaccine. A total of 1062 participants completed a discrete choice experiment to examine parental preferences for vaccinating their children. Five vaccine attributes were evaluated: protection efficacy, duration of protection, possibility of minor side effects, vaccine's country of manufacture, and price. The HPV Vaccine Hesitancy Scale was used to measure participants' degree of vaccine hesitancy. A mixed logit model was employed to explore preference heterogeneity according to level of vaccine hesitancy among participants. All vaccine attributes significantly influenced parental preferences. Protective efficacy and duration of protection were the most important attributes for both high-hesitancy and low-hesitancy parents. Preferences differed by hesitancy level: parents with higher hesitancy assigned greater weight to efficacy and duration, and showed greater preference for imported vaccines. Under the baseline scenario, the predicted uptake was 35.9%, whereas the optimal scenario, characterised by high efficacy, forever protection, low cost, minimal side effects, and domestic production, was projected to increase uptake to 99.2%. Parental preference of HPV vaccine attributes varied across vaccine hesitancy groups. Optimisation of vaccine attributes, particularly protection efficacy and duration of protection, may substantially enhance acceptance, supported by effective public communication and strengthened trust in domestically produced vaccines. These findings provide evidence to inform targeted strategies for increasing HPV vaccination coverage in China.