---
title: "Herpes zoster vaccination uptake and willingness to pay in a self-payment setting: nationwide surv"
id: "pubmed-42842236"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42842236"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42842236/"
doi: "10.1080/21645515.2026.2741764"
published_at: "2026-10-07T12:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Herpes zoster vaccination uptake and willingness to pay in a self-payment setting: nationwide surv
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42842236
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42842236/)
- **DOI:** [10.1080/21645515.2026.2741764](https://doi.org/10.1080%2F21645515.2026.2741764)
- **Published At:** 2026-10-07T12:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This nationwide, web-based cross-sectional survey in 2025 examined adult herpes zoster (HZ) vaccination behavior, intention, and **willingness to pay (WTP)** in Taiwan, a setting where HZ vaccination is primarily **self-payment** and public subsidies are limited. - Of 1,690 respondents, 281 (16.6%) reported having received HZ vaccination; among 1,409 unvaccinated respondents, 1,140 (80.9%) expressed willingness to be vaccinated. - Factors positively associated with HZ vaccination included age ≥65 years, prior HZ infection, prior receipt of adult vaccines (influenza, pneumococcal, or RSV), and awareness of local subsidy programs. - When analyzed separately, prior self-paid RSV and pneumococcal vaccines had stronger associations with HZ vaccination than prior COVID-19 or influenza vaccination. - Among unvaccinated respondents, strong concern about HZ showed the largest association with vaccination intention. - Median WTP differed by vaccination status and rose stepwise: unvaccinated-unwilling USD 8.2; unvaccinated-willing USD 32.8; vaccinated USD 65.6; all medians remained below the market price (p < .001). - Authors conclude that in this self-payment environment HZ vaccination is limited primarily by **affordability** rather than lack of motivation; expanding coverage will require policy action on cost. - The study suggests prior receipt of self-paid adult vaccines can serve as a clinically identifiable marker for targeted counseling to improve HZ vaccine uptake. - Specific methodological details beyond what is summarized in the abstract (sampling frame, questionnaire items, response rate, and limitations) were not reported in the source abstract.
## Clinical Analysis & Structured Key Points
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Epub 2026 Oct 7. # Bridging the intention‒behavior gap in herpes zoster vaccination: A nationwide survey in a self-payment setting [Fang-Yu Liou](https://pubmed.ncbi.nlm.nih.gov/?term=Liou+FY&cauthor_id=42842236)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42842236/#full-view-affiliation-1 "Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan."), [Chang-Ying Chen](https://pubmed.ncbi.nlm.nih.gov/?term=Chen+CY&cauthor_id=42842236)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42842236/#full-view-affiliation-2 "Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan."), [Yin-Fan Chang](https://pubmed.ncbi.nlm.nih.gov/?term=Chang+YF&cauthor_id=42842236)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42842236/#full-view-affiliation-1 "Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42842236/#full-view-affiliation-3 "Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan."), [Ru-Hsueh Wang](https://pubmed.ncbi.nlm.nih.gov/?term=Wang+RH&cauthor_id=42842236)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42842236/#full-view-affiliation-1 "Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42842236/#full-view-affiliation-3 "Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan."), [Wei-Chen Shen](https://pubmed.ncbi.nlm.nih.gov/?term=Shen+WC&cauthor_id=42842236)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42842236/#full-view-affiliation-1 "Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan."), [Cheng-Kuo Huang](https://pubmed.ncbi.nlm.nih.gov/?term=Huang+CK&cauthor_id=42842236)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42842236/#full-view-affiliation-4 "Huang Cheng Kuo Clinic, Keelung, Taiwan."), [Chin-Sung Chang](https://pubmed.ncbi.nlm.nih.gov/?term=Chang+CS&cauthor_id=42842236)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42842236/#full-view-affiliation-1 "Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42842236/#full-view-affiliation-3 "Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan."), [Chih-Hsing Wu](https://pubmed.ncbi.nlm.nih.gov/?term=Wu+CH&cauthor_id=42842236)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42842236/#full-view-affiliation-1 "Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42842236/#full-view-affiliation-3 "Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.")[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42842236/#full-view-affiliation-5 "Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.") Affiliations Expand ### Affiliations * 1 Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan. * 2 Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan. * 3 Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan. * 4 Huang Cheng Kuo Clinic, Keelung, Taiwan. * 5 Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan. * PMID: **42842236** * DOI: [ 10.1080/21645515.2026.2741764 ](https://doi.org/10.1080/21645515.2026.2741764) Item in Clipboard # Bridging the intention‒behavior gap in herpes zoster vaccination: A nationwide survey in a self-payment setting Fang-Yu Liou et al. Hum Vaccin Immunother. 2026 Dec. Show details Display options Display options Format Abstract PubMed PMID Hum Vaccin Immunother Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Hum+Vaccin+Immunother%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Hum+Vaccin+Immunother%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42842236/) . 2026 Dec;22(1):2741764. doi: 10.1080/21645515.2026.2741764. Epub 2026 Oct 7. ### Authors [Fang-Yu Liou](https://pubmed.ncbi.nlm.nih.gov/?term=Liou+FY&cauthor_id=42842236)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42842236/#short-view-affiliation-1 "Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan."), [Chang-Ying Chen](https://pubmed.ncbi.nlm.nih.gov/?term=Chen+CY&cauthor_id=42842236)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42842236/#short-view-affiliation-2 "Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan."), [Yin-Fan Chang](https://pubmed.ncbi.nlm.nih.gov/?term=Chang+YF&cauthor_id=42842236)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42842236/#short-view-affiliation-1 "Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42842236/#short-view-affiliation-3 "Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan."), [Ru-Hsueh Wang](https://pubmed.ncbi.nlm.nih.gov/?term=Wang+RH&cauthor_id=42842236)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42842236/#short-view-affiliation-1 "Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42842236/#short-view-affiliation-3 "Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan."), [Wei-Chen Shen](https://pubmed.ncbi.nlm.nih.gov/?term=Shen+WC&cauthor_id=42842236)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42842236/#short-view-affiliation-1 "Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan."), [Cheng-Kuo Huang](https://pubmed.ncbi.nlm.nih.gov/?term=Huang+CK&cauthor_id=42842236)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42842236/#short-view-affiliation-4 "Huang Cheng Kuo Clinic, Keelung, Taiwan."), [Chin-Sung Chang](https://pubmed.ncbi.nlm.nih.gov/?term=Chang+CS&cauthor_id=42842236)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42842236/#short-view-affiliation-1 "Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42842236/#short-view-affiliation-3 "Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan."), [Chih-Hsing Wu](https://pubmed.ncbi.nlm.nih.gov/?term=Wu+CH&cauthor_id=42842236)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42842236/#short-view-affiliation-1 "Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42842236/#short-view-affiliation-3 "Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.")[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42842236/#short-view-affiliation-5 "Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.") ### Affiliations * 1 Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan. * 2 Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan. * 3 Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan. * 4 Huang Cheng Kuo Clinic, Keelung, Taiwan. * 5 Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan. * PMID: **42842236** * DOI: [ 10.1080/21645515.2026.2741764 ](https://doi.org/10.1080/21645515.2026.2741764) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract Herpes zoster (HZ) causes substantial morbidity, yet global uptake remains suboptimal where the vaccine is excluded from universal coverage. Taiwan exemplifies such a self-payment setting, with the HZ vaccine self-financed and local government subsidies restricted to limited eligible groups. This study analyzed data from a nationwide, web-based cross-sectional survey of adults aged ≥18y fielded in 2025, examining factors associated with HZ vaccination behavior, intention, and willingness to pay (WTP). Of 1690 respondents, 281 (16.6%) were vaccinated; among 1409 unvaccinated, 1140 (80.9%) were willing to vaccinate. Factors associated with HZ vaccination included age ≥65y (OR: 1.59; 95% CI: 1.12-2.25), prior HZ infection (OR: 1.62; 1.23-2.15), prior receipt of influenza, pneumococcal, or respiratory syncytial virus (RSV) vaccines (OR: 3.32; 2.26-4.89), and awareness of local subsidy programs (OR: 2.30; 1.70-3.12). Among unvaccinated respondents, intention was most strongly associated with high concern about HZ (OR: 3.62; 2.67-4.90). When each prior vaccine was examined separately, prior receipt of self-paid RSV (OR: 5.35; 3.44-8.31) and pneumococcal vaccines (OR: 3.48; 2.54-4.75) showed stronger associations with HZ vaccination than coronavirus disease 2019 (OR: 1.50; 1.04-2.16) or influenza vaccines (OR: 1.51; 1.13-2.02). The median WTP rose stepwise across vaccination statuses (unvaccinated-unwilling: USD 8.2, unvaccinated-willing: USD 32.8, vaccinated: USD 65.6; _p_ < .001), yet all values remained below the market price. In this self-payment setting, HZ vaccination was constrained by affordability rather than lack of motivation. Expanding coverage will require policy action on cost, while prior receipt of self-paid adult vaccines offers a clinically identifiable marker for targeted counseling. **Keywords:** Herpes zoster; adult immunization; intention-behavior gap; self-payment setting; vaccination behavior; vaccination intention; vaccine hesitancy; willingness to pay. 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