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

In China, there are two categories of vaccines available from the Chinese Center for Disease Control and associated public health agencies. Extended Program Immunization (EPI) government-funded non-EPI voluntary paid out-of-pocket. The government plans to transition some EPI in coming years, which may burden system capacity, particularly terms budget, workforce, supply chains, information systems. Our study explored vaccinator caregiver perspectives on introducing into routine immunization perceived facilitators barriers affecting this transition. We conducted a qualitative realist perspective, analysing semi-structured interviews with 26 vaccination providers 160 caregivers three provinces, selected represent regional socioeconomic disparities across Eastern, Central, Western China. Data were analysed thematically, using deductive inductive coding. Most participants positive about adding national schedule. Candidate most frequently recommended by varicella, mumps vaccine, hand–foot–mouth disease. Providers generally considered existing workspaces, cold-chain equipment, funding sufficient, but described frontline staffing vaccine systems as requiring improvement. This is first explore interest, barriers, related China’s schedule provider perspectives. Findings can inform efforts introduce additional vaccines, including retain recruit programme staff implement whole-process data management that allow unified nationwide collection sharing.