In the rapidly evolving landscape of global public health, vaccination programs stand at the forefront of disease prevention and population health optimization. A recent qualitative study conducted by Yuan, Long, Wang, and colleagues delves deep into the multifaceted factors that influence the intentions of urban residents in China regarding the herpes zoster vaccination. This research, published in Global Health Research and Policy, offers crucial insights into the complex interplay of social, cultural, informational, and systemic variables that act either as barriers or facilitators in vaccine uptake decisions. As the burden of herpes zoster—commonly known as shingles—continues to grow among aging populations worldwide, understanding these dynamics is imperative for devising effective public health strategies.
Herpes zoster is caused by the reactivation of the varicella-zoster virus, which remains dormant in nerve tissues following primary infection, usually in childhood as chickenpox. The reemergence of this virus in older adults results in painful, debilitating rashes and potentially severe complications such as postherpetic neuralgia. Vaccination against herpes zoster has proven highly effective in reducing both the incidence and severity of the disease. However, vaccine coverage rates remain suboptimal across many urban centers in China, prompting researchers to explore the underlying reasons through qualitative methodologies that capture lived experiences, perceptions, and decision-making processes.
The study employs semi-structured interviews and focus groups with urban residents across diverse demographic backgrounds to unpack their cognitive and emotional responses to the herpes zoster vaccine. This qualitative approach is invaluable because it transcends quantitative statistics to reveal nuanced factors like trust in healthcare providers, cultural beliefs regarding aging and illness, and the influence of peer networks. These subjective elements often dictate whether individuals feel motivated or hesitant to accept vaccination, shaping the trajectory of public health uptake beyond mere availability or policy mandates.
One prominent barrier identified is the widespread lack of awareness and knowledge about herpes zoster as a preventable condition and the existence of an effective vaccine. Many participants held misconceptions about the nature of shingles, conflating it with other dermatological conditions or perceiving it as an inevitable part of aging that cannot be mitigated. This gap in understanding fosters a sense of fatalism and diminishes perceived urgency, effectively dampening vaccination intentions. Public health campaigns must therefore prioritize clear, evidence-based education to dismantle misinformation and highlight the benefits of early vaccination.
Compounding the knowledge deficit are concerns about vaccine safety and efficacy, commonly fueled by skepticism toward new vaccine technologies and perceived governmental transparency. Urban residents expressed fears about potential side effects or unknown long-term consequences, which were sometimes amplified by circulating rumors on social media platforms or anecdotal accounts from acquaintances. This phenomenon aligns with global patterns of vaccine hesitancy where confidence in health authorities and vaccine science is critical for acceptance. Strengthening communication channels and transparency about vaccine development processes could mitigate these fears and enhance trust.
Healthcare system factors also play a pivotal role. The logistics surrounding vaccine access — including clinic availability, appointment scheduling, and direct costs — were frequently cited as inconvenient or burdensome. Urban lifestyles characterized by busy work schedules and crowded health facilities create a structural barrier that discourages timely vaccination. Moreover, the fragmentation between primary care and specialty services leads to inconsistent physician recommendations, which is a crucial determinant of patient compliance. Integrating vaccination services within routine healthcare visits could streamline uptake and align with patient behaviors.
Interestingly, cultural perceptions about illness and aging influenced responses to the herpes zoster vaccine. In some urban Chinese contexts, conditions associated with older age are normalized rather than medicalized, meaning that symptoms like pain or rash may be tolerated as part of natural decline rather than signs warranting prevention. This cultural framing reduces motivation for preemptive action and shifts attention toward treatment rather than prevention. Tailoring public health messaging to resonate with these cultural narratives, while gently reframing preventive health as a means to preserve vitality, could enhance receptivity.
Conversely, factors that facilitate vaccination intentions emerged as equally instructive. Trusted endorsements from healthcare providers significantly boosted confidence, illustrating the importance of clinician-patient relationships in shaping health behaviors. When physicians proactively discussed herpes zoster risks and vaccine benefits, patients reported feeling more empowered and reassured in their decision-making. Training healthcare professionals to initiate these conversations and address concerns comprehensively is essential in closing the intention-to-action gap.
Moreover, personal or vicarious experiences with herpes zoster markedly heightened perceived susceptibility, prompting stronger vaccination intentions. Witnessing the suffering of family members or friends due to shingles created emotionally salient reminders of the disease’s seriousness, motivating preventive action. This finding underscores the psychological mechanism of perceived risk as a driver of health behavior and suggests that testimonials and storytelling could serve as powerful public health tools.
Community-level social norms also influenced vaccine uptake. In urban environments where proactive health behaviors were socially valued and discussed openly, individuals felt a sense of collective responsibility and were more inclined to vaccinate. Conversely, social circles harboring skepticism or indifference toward vaccination perpetuated hesitancy. This social contagion effect highlights the role of peer influence and communal attitudes in public health interventions.
Digital media environment presented a double-edged sword. On one hand, official health information disseminated via online platforms expanded reach and accessibility of credible vaccine knowledge. On the other, misinformation proliferated rapidly, complicating efforts to establish consensus on vaccine safety and necessity. Technological literacy and critical appraisal skills become paramount in enabling individuals to navigate this informational landscape effectively. Public health authorities may need to collaborate with tech companies to monitor and counteract false narratives about herpes zoster vaccination.
Socioeconomic factors intercepted vaccine intentions as well. Cost considerations were a tangible impediment for some urban residents, despite the economic benefits of preventing herpes zoster-associated complications. Out-of-pocket expenses for the vaccine or related medical visits deterred lower-income individuals from prioritizing immunization. Policy interventions aimed at subsidizing or incorporating herpes zoster vaccination into public insurance schemes might stimulate equitable access and uptake.
The timing of vaccine introduction and public familiarity is another determinant. As the herpes zoster vaccine is relatively new in China compared to other routine vaccines, initial uncertainty and lack of historical precedent contribute to hesitancy. Over time, as vaccination becomes normalized and visibly endorsed by community leaders and influencers, uptake may improve. Early adopters and pilot programs could serve as catalysts to shift social norms toward acceptance.
This study reinforces the complexity of vaccine hesitancy as a dynamic and context-dependent phenomenon that demands tailored, multifocal strategies rather than one-size-fits-all solutions. The qualitative lens applied by Yuan and colleagues captures the lived realities of urban residents negotiating layers of information, trust, culture, and system constraints. Their findings invite policymakers, healthcare providers, and communicators to co-create interventions attuned to local identities and practical challenges.
In addressing herpes zoster vaccination in urban China, these insights come at a critical juncture when aging populations expand and the global health community intensifies focus on vaccine-preventable diseases beyond childhood immunization schedules. By integrating qualitative evidence into design and implementation, public health initiatives stand to improve their resonance, efficacy, and ultimately, the health trajectories of millions at risk for herpes zoster and its complications.
The research also serves as an exemplar for examining vaccination intentions amid other emerging adult immunizations, illustrating transferable lessons across contexts and diseases. From reinforcing provider-patient communication, enhancing educational outreach, ensuring equitable access, to counteracting misinformation, these multifaceted approaches could yield substantial public health dividends. The interplay of scientific knowledge, cultural sensitivity, and empathetic engagement featured in this study epitomizes the future of effective vaccination campaigns in complex urban settings.
As urban centers grapple with the dual challenges of infectious diseases and demographic shifts, advancing understanding of barriers and facilitators to vaccination moves from academic inquiry to urgent public health imperative. The comprehensive qualitative framework developed here offers a blueprint for researchers and practitioners aiming to close the gap between vaccine availability and acceptance, transforming preventive medicine from theoretical promise into everyday reality.
Subject of Research: Barriers and facilitators influencing herpes zoster vaccination intentions among urban residents in China.
Article Title: The barriers and facilitators of herpes zoster vaccination intentions of urban residents in China: a qualitative study.
Article References:
Yuan, B., Long, C., Wang, M. et al. The barriers and facilitators of herpes zoster vaccination intentions of urban residents in China: a qualitative study. Global Health Research and Policy 10, 19 (2025). https://doi.org/10.1186/s41256-025-00413-1
Image Credits: AI Generated
