Hypothetical assessment of efficiency, willingness-to-accept and willingness-to-pay for dengue vaccine and treatment: a contingent valuation survey in Bangladesh

Figures & data

Figure 1. (A) Combined bar and line graph to show the number of reported dengue cases from 2000–2019 (blue color bar chart presents dengue cases and red color line graph shows death cases). The dengue cases (blue) with death (red) for 2019 (January1^st–September 9^th) is represented by an inset diagram. (B) Map of Bangladesh indicating dengue-affected people in 64 districts from January 1^st–September 9^th, 2019 (health emergency operation center and control room, DGHS, Bangladesh) and survey locations (black-filled circle)

Figure 2. Double-bounded dichotomous choice and bidding game approach presented for elicitation of WTP amount. Since there was no previous data about the cost of the dengue vaccine available in Bangladesh, the starting bid (A-US$ 35, B-US$ 60, C-US$ 70, and T-US$ 95) was established by referring to some previous studies and tests online. Here, No indicates an unwillingness to pay and Yes indicates WTP

Table 1. Respondents’ socio-demographic profile of dengue vaccine acceptance (n=3251)

Characteristics Number of respondents [n (%)]
Area
Village	749 (23.0)
City	1110 (34.2)
Capital	1392 (42.8)
Gender
Male	2006 (61.7)
Female	1245 (38.3)
Age (Mean 32.07)
<20	411(12.6)
21-30	1459 (44.9)
31-40	716 (22.0)
41-50	383 (11.8)
51<	282 (8.7)
Marital Status
Single	1400 (43.1)
Married	1770 (54.4)
Divorced	22 (0.7)
Widow/Widower	59 (1.8)
Education
>Primary	523 (16.1)
Secondary	445 (13.7)
College	815 (25.1)
University<	1468 (45.2)
Occupation
Student	1095 (33.7)
Unempl./Housewife	811 (25.0)
Service (G/P)	732 (22.5)
Self-empl./Business	561 (17.3)
Retired/Pensioner	52 (1.6)
Income (Household)
< US$180	886 (27.3)
US$181-355	1374 (42.3)
US$356-590	662 (20.4)
US$591-890	197 (6.1)
US$891 <	132 (4.1)
Previous Dengue experience
Yes	1220 (37.5)
No	2031 (62.5)

Table 2. Respondents’ socio-demographic profile of dengue vaccine acceptance (n=3251)

Dengue disease knowledge (correct answer; either Yes or No)	Yes [n(%)]	No [n(%)]	Don’t know [n(%)]
1. Dengue disease is transmitted by Aedes mosquitoes (Y)	2911 (89.5)	64 (2.0)	276 (8.5)
2. Aedes mosquitos bite during early morning and late evening only (Y)	1803 (55.5)	524 (16.1)	924 (28.4)
3. Aedes mosquitos breed and lay eggs in stagnant clear water only (Y)	1549 (47.7)	713 (21.9)	989 (30.4)
4. One person can contract dengue disease more than once in a life time (Y)	437 (13.4)	1524 (46.9)	1290 (39.7)
5. Children are more prone to contracting dengue fever (N)	2007 (61.7)	433 (13.3)	811 (25.0)
6. Dengue fever can be fatal (Y)	2884 (88.7)	165 (5.1)	202 (6.2)
7. Every person with dengue fever requires a blood transfusion (N)	709 (21.8)	744 (22.9)	1798 (55.3)
8.There are specific medicines that can cure dengue disease (N)	1087 (33.4)	839 (25.8)	1325 (40.8)
9. There is an available vaccination that can protect against dengue disease (N)	976 (30.0)	811 (25.0)	1464 (45.0)
10. Is the dengue vaccine available in your area? (N)	299 (9.2)	1140 (35.1)	1812 (55.7)
Dengue prevention practice	Never [n(%)]	Occasionally [n(%)]	Sometimes [n(%)]	Often [n(%)]	Always [n(%)]
1.We clean and scrub water containers in our house.	53 (1.6)	191 (5.9)	1081 (33.3)	859 (26.4)	1067 (32.8)
2.We remove water from items such as unused tires and empty cans or bottles.	370 (11.4)	343 (10.6)	715 (22.0)	787 (24.2)	798 (24.6)
3. We buy insect repellent for our family members.	697 (21.4)	343 (10.6)	715 (22.0)	757 (23.3)	739 (22.7)
4.We use mosquito bed nets and window screens in our house.	169 (5.2)	151 (4.6)	609 (18.7)	724 (22.3)	1598 (49.2)
5.We limit our outdoor activities during early morning and late evening.	2346 (72.2)	303 (9.3)	354 (10.9)	124 (3.8)	124 (3.8)
Vaccination attitudes and acceptance	Strongly disagree [n(%)]	Disagree [n(%)]	Neutral [n(%)]	Agree [n(%)]	Strongly agree [n(%)]
1.I think vaccination is important for disease prevention.	29(0.9)	76(2.3)	333(10.2)	615(18.9)	2198(67.6)
2.All vaccines registered with the Bangladesh Ministry of Health (MOH) are safe.	43(1.32)	118(3.63)	429(13.20)	737(22.7)	1924(59.2)
	Very unlikely [n(%)]	Somewhat unlikely [n(%)]	Undecided [n(%)]	Somewhat likely [n(%)]	Very likely [n(%)]
3. If a 100% safe and fully protective dengue vaccine were provided free by the government, how likely is it that you would vaccinate yourself?	38(1.2)	72(2.2)	202(6.2)	236(7.3)	2703(83.1)
4. How would you best describe the dengue treatment in your area?	248(7.6)	1310(40.3)	657(20.2)	114(3.4)	922(28.4)
	Social media [n(%)]	Newspaper/Television [n(%)]	friends/family [n(%)]	I don’t know [n(%)]
How did you obtain information about dengue disease?	607(18.7)	1814(55.8)	724(22.3)	106(3.3)

Figure 3. The percentage share of (A) dengue knowledge and (B) dengue prevention practices categorized by the respondents’ socio-demographic characteristics

Figure 4. Statistics of WTP of respondents, classified by socio-demographic characteristics: (A) Gender, (B) age, (C) area, (D) marital status, (E) education, (F) occupation, (G) income, and (H) dengue experience. Values with *, **, and *** refer to statistical significance with a level 5%, 1%, and 0.1%, respectively

Figure 5. Bar chart of mean WTP for respondents’ groups categorized according to two attributes; (A) vaccine A for occupation vs. area, (B) vaccine A for income vs. area, (C) vaccine B for occupation vs. area, (D) vaccine B for age vs. experience, (E) vaccine C for occupation vs. area and (F) vaccine C for

Table 3. ANOVA analysis (p-value) of multiple factors of respondents’ socio-demographic conditions on willingness to pay for vaccines A, B, and C. Values with *, **, and *** refer to statistical significance with a level 5%, 1%, and 0.1%, respectively. Green, blue, and white colors mean that both factors were significant, only one factor was significant, and none were significant, respectively

Area	Income	Education	Occupation	Experience	Age
	0.00866** 0.0065**	0.24331 0.00871**	0.02586* 0.00014***	0.42916 0.01001*	0.53418 0.00101**	Area
		0.17648 0.05545	0.2838 0.0204*	0.27056 0.00278*	0.5429 <0.0001**	Income
			0.43309 0.41968	0.4595 0.05497	0.27225 0.26498	Education
				0.92069 0.245	0.99013 0.2427	Occupation
					0.5287 0.40597	Experience
	0.1631 0.00883**	0.36044 0.02362*	0.01246* <0.0001***	0.29512 0.01467*	0.4386 <0.0001	Area
		0.48451 0.01272*	0.10171 0.01654*	0.37887 0.00653**	0.15389	Income
			0.0979 0.07847	0.06688 0.04379*	0.17952 0.03451*	Education
				0.05642 0.06396	0.87193 0.3465	Occupation
					0.00287** 0.00035***	Experience
	0.04446* 0.00243**	0.14408 0.00049***	0.02088* <0.0001***	0.2789 0.00243**	0.12943 <0.0001***	Area
		0.17355 0.00982**	0.12852 <0.0001***	0.40722 0.00064***	0.36318 <0.0001***	Income
			0.82087 0.00556**	0.16816 0.05942	0.16364 0.00035***	Education
				0.2619681 0.24009	0.84254 0.0323*	Occupation
					0.46538 0.0727	Experience

Figure 6. (A) Statistical summaries of respondents’ mean WTP, WTA for vaccines A, B, and C, and treatment T. (B) Histogram of respondents’ WTP for hypothetical vaccinations indicating willingness to accept the vaccine

Figure 7. 2D phase diagram of vaccination coverage/willingness to accept (WTP); (A) survey results (B) epidemic vaccination game model with repeated seasons⁴³ and (C) single-season epidemic model.⁴⁵

Kuga K, Tanimoto J. Impact of imperfect vaccination and defense against contagion on vaccination behavior in complex networks. Jstate. 2018;113402(11).

 Google Scholar

Kabir KMA, Tanimoto J. Dynamical behaviors for vaccination can suppress infectious disease - a game theoretical approach, Cha. Sol Frac. 2019;123:229–39. doi:10.1016/j.chaos.2019.04.010.

 Web of Science ®Google Scholar