Herpes zoster (HZ) causes substantial morbidity in adults, yet vaccine uptake remains suboptimal in jurisdictions where the vaccine is not covered universally. The study summarized here used Taiwan as an example of a self-payment setting: HZ vaccination is generally self-financed and local government subsidies are restricted to limited eligible groups. The analysis draws on a nationwide, web-based cross-sectional survey fielded in 2025 among adults aged 18 years and older to identify drivers of HZ vaccination behavior, vaccination intention among the unvaccinated, and willingness to pay (WTP).
The investigation used a cross-sectional, web-based survey design conducted in 2025. The report covers responses from 1,690 adult participants. The source abstract does not provide additional methodological details such as sampling frame, response rate, questionnaire items, timing within 2025, or weighting procedures; those details were not reported in the abstract.
Among the 1,690 respondents, 281 individuals (16.6%) reported having received HZ vaccination. Of the remaining 1,409 unvaccinated respondents, 1,140 (80.9%) indicated a willingness to receive the HZ vaccine. These figures show a notable gap between actual uptake and stated willingness to vaccinate in a population where the vaccine is typically paid for out-of-pocket.
The study identified several factors that were independently associated with having received HZ vaccination. After multivariable analysis (as reported in the abstract), the following associations were observed:
When prior vaccines were examined individually, the strength of association varied by vaccine type. Prior receipt of self-paid RSV vaccination (OR 5.35; 95% CI 3.44–8.31) and pneumococcal vaccination (OR 3.48; 95% CI 2.54–4.75) were more strongly associated with HZ vaccination than prior receipt of COVID-19 vaccination (OR 1.50; 95% CI 1.04–2.16) or influenza vaccination (OR 1.51; 95% CI 1.13–2.02). These findings suggest that prior engagement with self-paid adult vaccination services is a marker of subsequent HZ vaccine uptake.
Among respondents who remained unvaccinated, the variable most strongly associated with intention to vaccinate was a high level of concern about HZ (OR 3.62; 95% CI 2.67–4.90). This indicates that perceived risk or worry about disease outcomes is a primary motivator for stated intention in this population.
The study measured median willingness to pay (WTP) for the HZ vaccine and found a stepwise relationship across vaccination statuses. Median WTP values reported in the abstract were:
The differences across groups were statistically significant (p < .001). Despite higher medians among the vaccinated, all reported WTP medians remained below the market price of the vaccine, indicating that affordability is a major barrier even among those who are willing to be vaccinated.
In this self-payment setting, the authors interpret the findings to indicate that affordability, rather than lack of motivation, is the principal constraint on HZ vaccine uptake. High stated willingness among the unvaccinated (80.9%) contrasts with the low observed coverage (16.6%), and WTP medians below market price support the conclusion that cost restricts actual behavior.
Policy implications highlighted in the abstract include the need for cost-focused policy actions—such as expanded coverage or subsidies—to bridge the intention–behavior gap. The analysis also identifies prior receipt of self-paid adult vaccines as a clinically identifiable marker that could guide targeted counseling and interventions to improve HZ vaccination rates.
The abstract does not report several methodological and contextual details that may be relevant for assessing generalizability and bias. Specifically, the sampling methodology, response rate, questionnaire wording, definitions used for intention and willingness, temporal context within 2025, and study limitations were not provided in the abstract. These details would need to be reviewed in the full text to evaluate potential selection bias, measurement validity, and applicability to other settings.