The origins and consequences of administrative burdens in mass immunization programs: Experimental evidence based on the monkeypox outbreak

Studies in medicine, bioscience, psychology, sociology, and public health have provided various contextual, individual, and vaccine-specific explanations for vaccine uptake. However, one significant yet often ignored fact is that vaccination could be viewed as a site of citizen-state interaction in implementing public vaccination policy. This begs the questions: What barriers create administrative burdens in vaccination? How do the experiences of administrative burdens (i.e., the learning, psychological, and compliance costs in citizen-state interactions) shape the public's willingness to vaccinate? According to theoretical insights drawn from the extant literature on administrative burden and vaccine uptake, this study uses a conjoint experiment design based on a representative sample of China to reveal the role of administrative burdens in shaping the public's willingness to vaccinate against the monkeypox outbreak, a ‘Public Health Emergency of International Concern’ from July 2022 to May 2023. The experimental results suggest that multiple salient barriers have distinct effects on the respondents' learning, psychological, and compliance costs, thus significantly influencing their vaccine uptake. These findings have important implications for both future research and efforts to promote mass immunization programs.