title: Acceptance of vaccinations in pandemic outbreaks: a discrete choice experiment.
abstract: BACKGROUND
  Preventive measures are essential to limit the spread of new viruses; their uptake is key to their success. However, the vaccination uptake in pandemic outbreaks is often low. We aim to elicit how disease and vaccination characteristics determine preferences of the general public for new pandemic vaccinations.
  
  
  METHODS
  In an internet-based discrete choice experiment (DCE) a representative sample of 536 participants (49% participation rate) from the Dutch population was asked for their preference for vaccination programs in hypothetical communicable disease outbreaks. We used scenarios based on two disease characteristics (susceptibility to and severity of the disease) and five vaccination program characteristics (effectiveness, safety, advice regarding vaccination, media attention, and out-of-pocket costs). The DCE design was based on a literature review, expert interviews and focus group discussions. A panel latent class logit model was used to estimate which trade-offs individuals were willing to make.
  
  
  RESULTS
  All above mentioned characteristics proved to influence respondents' preferences for vaccination. Preference heterogeneity was substantial. Females who stated that they were never in favor of vaccination made different trade-offs than males who stated that they were (possibly) willing to get vaccinated. As expected, respondents preferred and were willing to pay more for more effective vaccines, especially if the outbreak was more serious (€6-€39 for a 10% more effective vaccine). Changes in effectiveness, out-of-pocket costs and in the body that advises the vaccine all substantially influenced the predicted uptake.
  
  
  CONCLUSIONS
  We conclude that various disease and vaccination program characteristics influence respondents' preferences for pandemic vaccination programs. Agencies responsible for preventive measures during pandemics can use the knowledge that out-of-pocket costs and the way advice is given affect vaccination uptake to improve their plans for future pandemic outbreaks. The preference heterogeneity shows that information regarding vaccination needs to be targeted differently depending on gender and willingness to get vaccinated.
authors: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Center for Prevention and Health Services Research, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
authors: Domino
authors: D
authors: Determann
authors: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors: Ida J
authors: IJ
authors: Korfage
authors: Center for Prevention and Health Services Research, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
authors: Mattijs S
authors: MS
authors: Lambooij
authors: Institute of Transport and Logistics Studies, The University of Sydney Business School, Sydney, New South Wales, Australia.
authors: Michiel
authors: M
authors: Bliemer
authors: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Rotterdam-Rijnmond Public Health Service, Rotterdam, The Netherlands.
authors: Jan Hendrik
authors: JH
authors: Richardus
authors: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors: Ewout W
authors: EW
authors: Steyerberg
authors: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors: Esther W
authors: EW
authors: de Bekker-Grob
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002755:Choice Behavior; D003141:Communicable Diseases / Q000191:economics / Q000276:immunology / Q000523:psychology*; D004198:Disease Susceptibility; D005260:Female; D005102:Health Expenditures; D006801:Humans; D017589:Immunization Programs / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009426:Netherlands; D058873:Pandemics / Q000517:prevention & control*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014611:Vaccination