Preferences for vaccination program attributes among parents of young infants in Shanghai, China

ABSTRACT

Compared to many other countries, China offers fewer pediatric vaccines. Future attempts to add mandatory vaccines may run counter to parents’ preferences for shot-limiting. The aim of this study was to assess Chinese parents’ preferences and willingness-to-pay (WTP) for programmatic attributes of vaccination services. Parents of young infants ≤3 months of age presenting at immunization clinics in Shanghai, China, in 2017 completed a discrete choice experiment (DCE) on vaccination program attributes: waiting time at the clinic, number of shots before 7 months, number of injections per visit, cost per visit, and location of the shot. We estimated preference utilities and WTP using logistic regression. In total, 590 completed the DCE. Caregivers expressed greater utility for less waiting time, fewer office visits, lower cost of vaccines, and fewer injections co-administered. Over the course of their child’s first 6 months, parents were willing to pay 113 RMB ($17) to avoid an additional 10 minutes of waiting at each appointment (95% confidence interval [CI]: 213, 929), 474 RMB ($70) to avoid an additional office visit (95% CI: 241, 707), and 703 RMB ($104) to avoid an additional injection at each appointment (95% CI: 337, 1068). As China expands its list of publicly funded vaccines, public health officials will have to counter Chinese parents’ strong preferences for limiting the total number of office visits and the number of injections administered at each visit, potentially through the use of combination vaccines.

KEYWORDS:

• Stated preference
• conjoint analysis
• discrete choice experiment
• China
• vaccination

Acknowledgments

We are grateful to the vaccine providers who gave us access to their clinics to conduct these interviews.

Author contributions

ZH, ALW, and ML analyzed the data and wrote the first draft of the paper. XS, BJZ, MLB, and LAP conceived the study idea and revised the manuscript for important intellectual content. JR supervised data collection and revised the manuscript for important intellectual content. All authors agree to the paper as submitted for publication.

Disclosure of potential conflicts of interests

No potential conflicts of interest were disclosed.

Ethical considerations

The research protocol was approved by the Health Sciences and Behavioral Sciences Institutional Review Board at the University of Michigan (#HUM00125379) and the ethical review committee at the Shanghai Centers for Disease Control and Prevention (#2017–2). All participants provided oral informed consent. After completing the interview, participants were given a small gift (such as an umbrella or blanket) to compensate for the time spent on completing the survey.

Additional information

Funding

This work was supported by The Fourth Round of Three-Year Public Health Action Plan of Shanghai, China (No. 15GWZK0101). This study was funded by grants from the Office of Global Public Health, University of Michigan, Ann Arbor, the Susan B. Meister Child Health Evaluation and Research Center, and from the MCubed program, University of Michigan, Ann Arbor. ALW has received funding as a Health Outcomes Post Doctoral Fellow from the PhRMA Foundation.