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Background  China’s achievements in immunization are being threatened by a vaccine crisis. This paper aims to investigate vaccine confidence in China after the Changsheng vaccine incident and attempts to identify the factors contributing to it.    Methods  An online cross-sectional investigation was conducted from 1 to 25 September 2018. Descriptive analysis and logistic regression were performed to examine the associations between socio-demographic factors, cognition and attitudes towards the Changsheng vaccine incident and vaccine confidence.    Results  We included 1115 respondents in the final analysis, and found that approximately 70% (783) of the respondents did not have vaccine confidence. More than half of the respondents (54.53%) were dissatisfied with the government’s response measures to the Changsheng vaccine incident. The logistic regression model indicated that vaccine confidence was positively associated with the degree of satisfaction with the government’s response measures (OR = 1.621, 95% CI = 1.215–2.163), attitudes towards the risks and benefits of vaccination (OR = 1.501, 95% CI = 1.119–2.013), concerns about vaccine safety (OR = 0.480, 95% CI = 0.317–0.726), and vaccine efficacy (OR = 0.594, 95% CI = 0.394–0.895).    Conclusions  A majority of the respondents held negative attitudes towards vaccines after the Changsheng vaccine incident. A coordinated effort is required to restore public confidence in vaccines, especially in China, where a nationwide mandatory immunization policy is implemented. To end dissent towards inoculation, a series of actions is crucial and multiple parties should work together to advance efforts and explore the possibility of establishing an open and transparent regulatory system.

Vaccine confidence in China after the Changsheng vaccine incident: a cross-sectional study