Abstract
Background: Corona Virus Disease 2019 (COVID-19) caused by the novel severe acute respiratory syndrome corona virus 2 (SARS-CoV-2), had its origin in Wuhan, China in December 2019 before it spread globally affecting millions casing death and severe morbidity. The World Health Organization declared it a pandemic on 11 March 2020. Vaccines were considered as one of the chief prevention strategies to check the spread of the contagion and end the pandemic. However, vaccine uptake was not as brisk as expected right from the roll out. One commonly encountered reason was vaccine hesitancy where concerns regarding attributes of the vaccines such as its effectiveness, risk of adverse events, and cost among other factors affected decision making.
One of the ways to identify these factors is to conduct a discrete choice experiment (DCE). DCE is a quantitative technique that elicits individual preferences regarding goods or services, (in this case, a COVID-19 vaccine), wherein the idea of preferences can be broken down into separate characteristics – called “attributes” (such as safety, effectiveness, cost etc.,) which are assumed to vary across diverse levels (e.g., the levels for the vaccine’s effectiveness could be 50%, 70% or 90%).
Objectives: To identify the key attributes of COVID-19 vaccine for its acceptability and their willingness to pay (WTP) for a COVID-19 vaccine in the face of an ongoing pandemic by the general population of India
Methods: After IEC approval, digital informed consent was obtained from all respondents. A pan-India digital cross-sectional survey with a target sample size of 10,000 was conducted among those over 18 years, any gender, and residing in India for at least six months. The questionnaire given out digitally comprised of two sections namely (a) demography including socio-economic class (assessed by BG Prasad scale), and (b) DCE. The DCE section had six pairs of hypothetical vaccines wherein the 6th pair was used as a trap question with one of the vaccine pair being unambiguously better than the other. Those who failed the trap question were excluded
Results: Of 10,000 respondents, 1241 failed the trap question and 8759 responses were finally analyzed. The mean (SD) age was 36.32 (12.61) and 61.03% were men. The most important attribute was effectiveness followed by the duration of protection and Indian origin vaccine. Cost of the vaccine was a significant but least important attribute. The participants were willing to spend approximately INR 1549 (20.12 USD) and INR 587 (7.62 USD) per dose to take vaccines that provided 90% protection and a protective duration of 5 years when compared to those vaccines with an effectiveness of 50% protection and a protective duration of 6 months respectively. The significant predictors of vaccine hesitancy were male sex, upper and middle socio-economic class, and presence of comorbidities such as diabetes, heart problems or asthma.
Conclusions: Most important attributes that influence decisions were effectiveness, duration of protection & indigenous vaccines. When in a pandemic, and while seeking to achieve close to 100% vaccination, understanding these individual health economic issues becomes imperative.