AUTHOR=Wu Jian , Guo Xinghong , Zhou Xue , Wang Meiyun , Gu Jianqin , Miao Yudong , Tarimo Clifford Silver , He Yilin , Xing Yuhan , Ye Beizhu 

TITLE=The pattern from the first three rounds of vaccination: declining vaccination rates

JOURNAL=Frontiers in Public Health

VOLUME=Volume 11 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2023.1124548

DOI=10.3389/fpubh.2023.1124548

ISSN=2296-2565

ABSTRACT=Introduction: Global COVID-19 vaccination rates have stagnated. And we aim to analyze the potential patterns of vaccination development from the first three doses to demonstrate the possible trends of the next round of vaccination and further explore the factors that influence vaccination in the selected populations.
	Methods: In the survey conducted in July 2022, a stratified multistage random sampling method was used to select 6781 individuals over the age of 18 from four provinces in China. Participants were divided into two groups on the basis of whether they had a chronic disease. And the data were run through the Cochran-Armitage trend test and multivariable regression analyses.
	Results: This survey included a total of 957 participants with chronic disease and 5454 participants without chronic disease. Vaccination rates for the first, second, and booster doses in the chronic disease population were93.70% (95% CI:  92.19%-95.27%), 91.12% (95%CI: 94.43%-95.59%), and 83.18% (95%CI: 80.80%-85.55%), correspondingly. By contrast, the first, second, and booster vaccination rates for the general population were 98.02% (95% CI: 97.65%-98.39%), 95.01% (95% CI: 94.43%-95.59%), and 85.06%(95% CI: 84.11%-86.00%), respectively. Moreover, the widening gap in vaccination rates was observed as the number of vaccinations increased. Higher self-efficacy was a considerable factor in promoting vaccination, which has been observed in all doses of vaccines. Higher education levels, middle-level physical activity, and higher public prevention measures serve a positive function in vaccination among the general population, whereas alcohol consumption acts as an essential positive factor in the chronic disease population (P<0.05). 
	Conclusion: As the number of vaccinations increases, the trend toward a declining vaccination rate becomes more evident. In future regular vaccinations, we may face low vaccination rates as the increasing number of infections and fatigue in association with the prolonged outbreak hamper vaccination. Consequently, measures need to be found to counter this downward trend including enhancing the self-efficacy of the population.