No Such Thing as a Free-Rider? Understanding Drivers of Childhood and Adult Vaccination through a Multicountry Discrete Choice Experiment

Frederik Verelst · Roselinde Kessels · Lander Willem · Philippe Beutels

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Vaccine Coverage and Hesitancy Decision-Making and Behavioral Economics Economic and Environmental Valuation

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.

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References

2010Discrete choice experiments in health economics: a review of the literature 2016The State of Vaccine Confidence 2016: Global Insights Through a 67-Country Survey 2009A postmodern Pandora's box: Anti-vaccination misinformation on the Internet 2011Addressing the vaccine confidence gap 2011Wakefield's article linking MMR vaccine and autism was fraudulent 2012Communicating with parents about vaccination: a framework for health professionals 2011Perceived risk, anxiety, and behavioural responses of the general public during the early phase of the Influenza A (H1N1) pandemic in the Netherlands: results of three consecutive online surveys 2011The Age-Old Struggle against the Antivaccinationists

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2022Parental refusal and hesitancy of vaccinating children against COVID-19: Findings from a nationally representative sample of parents in the U.S.

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