A cluster randomized controlled trial across seven Chinese cities is set to evaluate the impact of a “pay-it-forward” (PIF) strategy on influenza vaccine uptake among adults aged 60 and over. In this three-arm study involving 1,113 participants from 21 community health centres, one group receives free vaccination and is invited to donate to support others (PIF), another receives free vaccination without donation, and a third continues with standard user-paid vaccination. The primary aim is to compare verified vaccination rates across groups, while secondary outcomes will track participants’ willingness to donate, actual donation amounts, and a full incremental cost-effectiveness analysis.
With older populations in China facing low influenza vaccine coverage and high disease burden, this trial addresses a critical gap in understanding how to mobilize community-driven funding mechanisms. By comparing the effectiveness and cost-effectiveness of PIF versus free and paid models, the study promises practical insights for policymakers aiming to boost vaccine uptake in resource-constrained settings. If the PIF approach proves as effective and cost-efficient as free vaccination, it could offer a scalable, sustainable alternative to traditional subsidy programs and pave the way for community-engaged public health financing.
Thumbnail image credit: WHO
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