{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T07:17:53Z","timestamp":1784013473622,"version":"3.55.0"},"reference-count":38,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2021,5,8]],"date-time":"2021-05-08T00:00:00Z","timestamp":1620432000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the National Institute for Health Research","award":["EPIDZL9012"],"award-info":[{"award-number":["EPIDZL9012"]}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["71974035"],"award-info":[{"award-number":["71974035"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["71774031"],"award-info":[{"award-number":["71774031"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["72074048"],"award-info":[{"award-number":["72074048"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"name":"the Ministry of Education of Humanities and Social Science project","award":["19YJCZH143"],"award-info":[{"award-number":["19YJCZH143"]}]},{"name":"the Three-Year Initiative Plan for Strengthening Public Health System Construction in Shanghai (2020-2022)","award":["GWV-10.1-XK23"],"award-info":[{"award-number":["GWV-10.1-XK23"]}]},{"name":"Shanghai Foundation for Talents Development","award":["grant number 2020128"],"award-info":[{"award-number":["grant number 2020128"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>In China, there are two categories of vaccines available from the Chinese Center for Disease Control and associated public health agencies. Extended Program of Immunization (EPI) vaccines are government-funded and non-EPI vaccines are voluntary and paid for out-of-pocket. The government plans to transition some non-EPI vaccines to EPI in the coming years, which may burden public health system capacity, particularly in terms of budget, workforce, supply chains, and information systems. Our study explored vaccinator and caregiver perspectives on introducing non-EPI vaccines into routine immunization and perceived facilitators and barriers affecting this transition. We conducted a qualitative study from a realist perspective, analysing semi-structured interviews with 26 vaccination providers and 160 caregivers in three provinces, selected to represent regional socioeconomic disparities across Eastern, Central, and Western China. Data were analysed thematically, using deductive and inductive coding. Most participants were positive about adding vaccines to the national schedule. Candidate EPI vaccines most frequently recommended by participants were varicella, mumps vaccine, and hand\u2013foot\u2013mouth disease. Providers generally considered existing workspaces, cold-chain equipment, and funding sufficient, but described frontline staffing and vaccine information systems as requiring improvement. This is the first qualitative study to explore interest, barriers, and facilitators related to adding vaccines to China\u2019s national schedule from provider and caregiver perspectives. Findings can inform government efforts to introduce additional vaccines, by including efforts to retain and recruit vaccine programme staff and implement whole-process data management and health information systems that allow unified nationwide data collection and sharing.<\/jats:p>","DOI":"10.3390\/vaccines9050476","type":"journal-article","created":{"date-parts":[[2021,5,10]],"date-time":"2021-05-10T02:54:58Z","timestamp":1620615298000},"page":"476","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Health System Barriers and Facilitators to Delivering Additional Vaccines through the National Immunisation Programme in China: A Qualitative Study of Provider and Service-User Perspectives"],"prefix":"10.3390","volume":"9","author":[{"given":"Dan","family":"Gong","sequence":"first","affiliation":[{"name":"Department of Health Policy and Management, School of Public Health, Fudan University, 130 Dong\u2019an Road, Shanghai 200032, China"},{"name":"Research Institute of Health Development Strategies, Fudan University, 130 Dong\u2019an Road, Shanghai 200032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiyun","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, School of Public Health, Fudan University, 130 Dong\u2019an Road, Shanghai 200032, China"},{"name":"Research Institute of Health Development Strategies, Fudan University, 130 Dong\u2019an Road, Shanghai 200032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7776-7339","authenticated-orcid":false,"given":"Tracey","family":"Chantler","sequence":"additional","affiliation":[{"name":"Department of Global Health and Development, London School of Hygiene &amp; Tropical Medicine, 15\u201317 Tavistock Place, London WC1H 9SH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fiona Yueqian","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Epidemiology, London School of Hygiene &amp; Tropical Medicine, University of London, Keppel Street, London WC1E 7HT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiatong","family":"Zou","sequence":"additional","affiliation":[{"name":"Department of Organization and Personnel, Shanghai Municipal Center for Disease Control and Prevention, 1380 West Zhongshan Road, Shanghai 200336, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiejie","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, School of Public Health, Fudan University, 130 Dong\u2019an Road, Shanghai 200032, China"},{"name":"Research Institute of Health Development Strategies, Fudan University, 130 Dong\u2019an Road, Shanghai 200032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuqian","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, School of Public Health, Fudan University, 130 Dong\u2019an Road, Shanghai 200032, China"},{"name":"Research Institute of Health Development Strategies, Fudan University, 130 Dong\u2019an Road, Shanghai 200032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chengyue","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, School of Public Health, Fudan University, 130 Dong\u2019an Road, Shanghai 200032, China"},{"name":"Research Institute of Health Development Strategies, Fudan University, 130 Dong\u2019an Road, Shanghai 200032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5987-5977","authenticated-orcid":false,"given":"Mei","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, School of Public Health, Fudan University, 130 Dong\u2019an Road, Shanghai 200032, China"},{"name":"Research Institute of Health Development Strategies, Fudan University, 130 Dong\u2019an Road, Shanghai 200032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4174-7349","authenticated-orcid":false,"given":"Natasha","family":"Howard","sequence":"additional","affiliation":[{"name":"Department of Global Health and Development, London School of Hygiene &amp; Tropical Medicine, 15\u201317 Tavistock Place, London WC1H 9SH, UK"},{"name":"Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, Singapore 117549, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,5,8]]},"reference":[{"key":"ref_1","first-page":"359","article-title":"Achievements in prevention and control of seven infectious diseases targeted by the National Immunization Program in China across 70 years","volume":"25","author":"Wang","year":"2019","journal-title":"Chin. 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Pract."}],"container-title":["Vaccines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-393X\/9\/5\/476\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:58:20Z","timestamp":1760162300000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-393X\/9\/5\/476"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,8]]},"references-count":38,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021,5]]}},"alternative-id":["vaccines9050476"],"URL":"https:\/\/doi.org\/10.3390\/vaccines9050476","relation":{},"ISSN":["2076-393X"],"issn-type":[{"value":"2076-393X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,8]]}}}