Abstract
Increased vaccine hesitancy and refusal negatively affects vaccine uptake, leading to the reemergence of vaccine preventable diseases. We aim to quantify the relative importance of factors people consider when making vaccine decisions for themselves, or for their child, with specific attention for underlying motives arising from context, such as required effort (accessibility) and opportunism (free riding on herd immunity). We documented attitudes towards vaccination and performed a discrete choice experiment in 4802 respondents in The United Kingdom, France and Belgium, eliciting preferences for six attributes: (1) vaccine effectiveness, (2) vaccine preventable disease burden, (3) vaccine accessibility in terms of copayment, vaccinator and administrative requirements, (4) frequency of mild vaccine-related side-effects, (5) vaccination coverage in the country’s population and (6) local vaccination coverage in personal networks. We distinguished adults deciding on vaccination for themselves from parents deciding for their youngest child. While all attributes were found to be significant, vaccine effectiveness and accessibility stood out in all (sub)samples, followed by vaccine preventable disease burden. We confirmed that people attach more value to severity of disease compared to its frequency, and discovered that peer influence dominates free-rider motives, especially for the vaccination of children. These behavioral data are insightful for policy and are essential to parameterize dynamic vaccination behavior in simulation models. In contrast to what most game theoretical models assume, social norms dominate free-rider incentives. Policy-makers and healthcare workers should actively communicate on high vaccination coverage, and draw attention to the effectiveness of vaccines while optimizing their practical accessibility.
Highlights
We report on the findings of a Discrete choice experiments (DCEs) quantifying individual preferences for vaccination attributes in Belgium, the United Kingdom (UK) and France
Women are slightly overrepresented in the samples from the UK and France
Our multicountry series of DCEs generated highly valuable data for parameterization and validation of epidemiological models. This is because data-driven host behavior derived from DCEs can be added to models mimicking the spread of infectious diseases
Summary
Its success is currently undermined by growing vaccine hesitancy and refusal. Sentiments underpinning this have multifaceted origins, most notably distorted perceptions of severe vaccine side-effects, much of which can be traced back to fraudulent research linking measles-mumps-rubella (MMR) vaccination with autism [2,3], and misconceptions about the use of adjuvants in vaccines [4]. Others include doubts about vaccine effectiveness [3,5] and about the ability of our immune system to cope with the increasing number of recommended vaccine antigens [3,6]. More extreme attitudes are based on government and vaccine industry conspiracy theories [3], religious beliefs (e.g., Protestantism in the Dutch Bible Belt [7]) and “back to nature” motives (i.e., preferring immunity acquired by natural infection to vaccine-induced immunity, under the belief that “divine or natural” risks are smaller and/or more “just” than those imposed by human interventions) [3]
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