We read the comments from Dr. Floriano Amimo with interest. We sincerely appreciate Dr. Amimo’s interest in and comments on our study in terms of the many factors that are relevant to a family’s willingness to pay (WTP) for a vaccine and ability to get their child vaccinated.
The author highlighted the lack of any significant association between monthly income and WTP, pointing out that high out-of-pocket vaccine costs may compromise basic needs such as food and housing, potentially leading to medical impoverishment. However, we do not believe that this the case in China, as there is little evidence that vaccination causes medical poverty in China. The writer’s point is well taken, though, because the results of our study may not apply to other countries or other areas due to different socioeconomic situations of families.
In China, vaccines are categorized as Expanded Programme on Immunization (EPI) vaccines, which are provided free of charge by government, and non-EPI vaccines, which are considered optional and may be selected and paid for by parents or guardians.Citation1 The average WTP of the full-course hexavalent vaccination in our study was 2267 CNY, which is approximately 11% of the per capita disposable income of Chinese residents.Citation2 However, our study was conducted in seven provincial capitals with better economic conditions, and the per capita disposable income of residents in these cities is much higher than in some parts of China. Given their income level, parents in our study did not consider cost when choosing hexavalent vaccine for their child, hence the lack of significant association between monthly income and WTP.
We agree with Dr. Amimo that the indirect costs associate with vaccination affect the policy relevance of WTP determinations. Indirect costs such as distance from place of residence to a health care facility and time spent obtaining vaccination services were not captured in our survey. Dr. Amimo’s good suggestions of additional analyses can be considered in future research, although quantifying these indirect costs can be difficult for parents. To reduce the burden of completing the questionnaire, we used only three questions in the fourth part of the questionnaire to measure the indirect costs of vaccination for parents: accessibility of vaccination services, convenience of transportation, and time spent on vaccination. These factors were included in our Tobit model, but other factors suggested by Dr. Amimo were not part of the current study.
We highly appreciate the comments on our research. As suggested, future studies could focus more on the impact of the financial burden of vaccination on families and include more indirect cost factors in the analysis to enhance the public health value of WTP research.
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References
- Zheng YM, Rodewald L, Yang J, Qin Y, Pang MF, Feng LZ, Yu H. The landscape of vaccines in China: history, classification, supply, and price. BMC Infect Dis. 2018;18(1):18. doi:10.1186/s12879-018-3422-0.
- National Bureau of Statistics of China. Per capita disposable income in China. [accessed 2023 Jul 18]. http://www.stats.gov.cn/sj/sjjd/202307/t20230718_1941321.html.