No such thing as a free-rider? Understanding multicountry drivers of childhood and adult vaccination

Background
Increased vaccine hesitancy and refusal negatively affects vaccine uptake leading to vaccine preventable disease reemergence. We aimed to quantify the relative importance of characteristics people consider when making vaccine decisions for themselves, or for their child, with specific attention for underlying motives arising from context, such as required effort (accessibility) and opportunism (free riding on herd immunity).
Methods
We documented attitudes towards vaccination and performed a discrete choice experiment in 4802 respondents in The United Kingdom, France and Belgium eliciting preferences for six attributes: (1) vaccine effectiveness, (2) vaccine preventable disease burden, (3) vaccine accessibility in terms of co-payment, vaccinator and administrative requirements, (4) frequency of mild vaccine-related side-effects, (5) vaccination coverage in the country’s population and (6) local vaccination coverage in personal networks. We distinguished adults deciding on vaccination for themselves (‘oneself’ group) from parents deciding for their youngest child (‘child’ group).
Results
While all six attributes were found to be significant, vaccine effectiveness and accessibility stand out in all (sub)samples, followed by vaccine preventable disease burden. We confirmed that people attach more value to severity of disease compared to its frequency and discovered that peer influence dominates free-rider motives, especially for the vaccination of children.
Conclusions
These behavioral data are insightful for policy and are essential to parameterize dynamic vaccination behavior in simulation models. In contrast to what most game theoretical models assume, social norms dominate free-rider incentives. Therefore policy-makers and healthcare workers should actively communicate on high vaccination coverage, and draw attention to the effectiveness of vaccines, while optimizing their practical accessibility.