Abstract
The increasing incidence of tick-borne encephalitis (TBE) in Sweden and several other European countries has sparked a discussion about the need for a public vaccination strategy. However, TBE vaccination coverage is incomplete and there is little knowledge about the factors influencing vaccination behavior. Based on a survey of 1,500 randomly selected respondents in Sweden, we estimate vaccination coverage in areas with different TBE risk levels and analyze the role of vaccine price and other factors influencing the demand for vaccination. First, we find that the average rate of TBE vaccination in Sweden is 33% in TBE risk areas and 18% elsewhere. Income, age and risk-related factors such as incidence of TBE in the area of residence, frequency of visits to areas with TBE risk, and experience with tick bites are positively associated with demand for TBE vaccine. Next, using contingent valuation methodology, we estimate the willingness to pay for TBE vaccination among the unvaccinated respondents and the effect of a possible subsidy. Among the unvaccinated respondents in TBE risk areas, we estimate the mean willingness to pay for the recommended three doses of TBE vaccine to be 465 SEK (approximately 46 euros or 40% of the current market price). We project that a subsidy making TBE vaccines free of charge could increase the vaccination rate in TBE risk areas to around 78%, with a larger effect on low-income households, whose current vaccination rate is only 15% in risk areas. However, price is not the only factor affecting demand. We find significant effects on vaccination behavior associated with trust in vaccine recommendations, perceptions about tick bite-related health risks and knowledge about ticks and tick-borne diseases. Hence, increasing knowledge and trust, as well as ease of access to vaccinations, can also be important measures for public health agencies that want to increase the vaccination rate.
Highlights
An increasing number of tick-borne encephalitis (TBE) cases have initiated a discussion about the need for a public vaccination strategy, potentially including a vaccine subsidy, in Sweden and other European countries [1,2,3,4]
To quantify the effect of a possible vaccine subsidy, the unvaccinated respondents were asked about their (WTP) for TBE vaccination using the following question: “Would you vaccinate yourself or someone in your household against TBE if it cost a total of [100, 250, 500, 750, 1000] SEK for the three doses of the vaccine that protect ONE person for at least three years?” Each respondent was presented with one of the five different prices shown in the brackets
We find no significant differences in results between those stating they were certain about their answer and those stating they were uncertain about their answer to the question about willingness to pay (WTP) for TBE vaccination (See Table C in S1 Text)
Summary
An increasing number of tick-borne encephalitis (TBE) cases have initiated a discussion about the need for a public vaccination strategy, potentially including a vaccine subsidy, in Sweden and other European countries [1,2,3,4]. This study estimates the willingness to pay (WTP) for TBE vaccination and the effect of a possible TBE vaccine subsidy on vaccination rates in Sweden. We estimate the current vaccination coverage in areas differing in TBE incidence and analyze the role of income, risk behavior and other factors influencing vaccine demand. Around 40% of those infected by the European subtype of the virus suffer from serious long-term or permanent sequelae [5]. In Sweden and several other European countries, risk areas are expanding and incidence is increasing [7, 8]. There is no treatment, but effective vaccines are available [9]
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