Bridging the intention‒behavior gap in herpes zoster vaccination: A nationwide survey in a self-payment setting.

Authors

Fang-Yu Liou, Chang-Ying Chen, Yin-Fan Chang, Ru-Hsueh Wang, Wei-Chen Shen, Cheng-Kuo Huang, Chin-Sung Chang, Chih-Hsing Wu

Published in

Human vaccines & immunotherapeutics. Volume 22. Issue 1. Pages 2741764. Epub Oct 07, 2026.

Abstract

Herpes zoster (HZ) causes substantial morbidity, yet global uptake remains suboptimal where the vaccine is excluded from universal coverage. Taiwan exemplifies such a self-payment setting, with the HZ vaccine self-financed and local government subsidies restricted to limited eligible groups. This study analyzed data from a nationwide, web-based cross-sectional survey of adults aged ≥18y fielded in 2025, examining factors associated with HZ vaccination behavior, intention, and willingness to pay (WTP). Of 1690 respondents, 281 (16.6%) were vaccinated; among 1409 unvaccinated, 1140 (80.9%) were willing to vaccinate. Factors associated with HZ vaccination included age ≥65y (OR: 1.59; 95% CI: 1.12-2.25), prior HZ infection (OR: 1.62; 1.23-2.15), prior receipt of influenza, pneumococcal, or respiratory syncytial virus (RSV) vaccines (OR: 3.32; 2.26-4.89), and awareness of local subsidy programs (OR: 2.30; 1.70-3.12). Among unvaccinated respondents, intention was most strongly associated with high concern about HZ (OR: 3.62; 2.67-4.90). When each prior vaccine was examined separately, prior receipt of self-paid RSV (OR: 5.35; 3.44-8.31) and pneumococcal vaccines (OR: 3.48; 2.54-4.75) showed stronger associations with HZ vaccination than coronavirus disease 2019 (OR: 1.50; 1.04-2.16) or influenza vaccines (OR: 1.51; 1.13-2.02). The median WTP rose stepwise across vaccination statuses (unvaccinated-unwilling: USD 8.2, unvaccinated-willing: USD 32.8, vaccinated: USD 65.6; p < .001), yet all values remained below the market price. In this self-payment setting, HZ vaccination was constrained by affordability rather than lack of motivation. Expanding coverage will require policy action on cost, while prior receipt of self-paid adult vaccines offers a clinically identifiable marker for targeted counseling.

PMID:
42842236
Bibliographic data and abstract were imported from PubMed on 08 Oct 2026.

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