Parental preferences for a mandatory vaccination scheme in England: A discrete choice experiment

Background: Mandatory vaccination has been mooted to combat falling childhood vaccine uptake rates in England. This study investigated parental preferences for a mandatory vaccination scheme.Methods: Discrete choice experiment. Six attributes were investigated: vaccine, child age group, incentive, penalty, ability to opt out, and compensation scheme. Mixed effects conditional logit regression models were used to investigate parental preferences and relative importance of attributes.Findings: Participants were 1,001 parents of children aged 5 years and under in England (53% female; mean age=33·6 years, SD=7·1; 84% white). Parental preferences were mostly based on incentives (30·7% relative importance; 80·9% [95% confidence interval 76·3–85·0%] preference for parent and 74·8% [71·0–78·3%] for child incentive; reference: no incentive) and penalties (25·4% relative importance; 69·5% [65·7–73·1%] preference for schemes where unvaccinated children cannot attend school or day care and 67·6% [63·6–71·4%] for those withholding financial benefits for parents of unvaccinated children; reference: £450 fine). Parents also preferred schemes that: offered a compensation scheme (18·1% relative importance; 66·4% [62·7–69·8%] preference; reference: not offered), mandated vaccination in children aged 2 years (versus 5 years; 11·4% relative importance; 42·6% [39·4–45·9%] preference; reference: 2 years), mandated the 6-in-1 vaccine (10·5% relative importance; 58·2% [54·6–61·7%] preference; reference: MMR), and that offered only medical exemptions (versus medical and religious belief exemptions; 4·0% relative importance; 45·5% [41·1–50·0%] preference; reference: medical exemptions).Interpretation: These findings can inform policymakers’ decisions about how best to implement a mandatory childhood vaccination scheme in England.Funding: Data collection was funded by a British Academy/Leverhulme Small Research Grants (SRG1920\101118).<br>Data will be made available ending 5 years following article publication, until 01/05/2027.

研究背景：为应对英格兰地区儿童疫苗接种率持续下滑的现状，强制疫苗接种政策已被提议讨论。本研究旨在探究家长对于强制疫苗接种方案的偏好。
研究方法：采用离散选择实验法，共设置6项研究属性：疫苗种类、儿童年龄组别、奖励激励、处罚措施、退出选择权以及补偿方案。本研究使用混合效应条件logit回归模型，分析家长的疫苗接种偏好及各属性的相对重要性。
研究结果：本研究共纳入1001名英格兰地区5岁及以下儿童的家长作为研究对象，其中53%为女性，家长平均年龄为33.6岁（标准差SD=7.1），84%为白人。家长的疫苗接种偏好主要受奖励激励（相对重要性占比30.7%）影响：相较于无奖励的参照方案，80.9%（95%置信区间76.3%~85.0%）的家长偏好针对自身的奖励措施，74.8%（95%置信区间71.0%~78.3%）的家长偏好针对儿童的奖励措施。其次为处罚措施（相对重要性占比25.4%）：相较于450英镑罚款的参照方案，69.5%（95%置信区间65.7%~73.1%）的家长偏好未接种疫苗儿童不得就读学校或日托机构的方案，67.6%（95%置信区间63.6%~71.4%）的家长偏好取消未接种儿童家长经济福利的方案。此外，家长还偏好具备以下特征的方案：设置补偿方案（相对重要性占比18.1%，相较于无补偿的参照方案，66.4%[95%置信区间62.7%~69.8%]的家长表示偏好该类方案）；要求2岁儿童接种疫苗（相较于5岁儿童接种的参照方案，相对重要性占比11.4%，42.6%[95%置信区间39.4%~45.9%]的家长表示偏好该方案）；强制接种六联疫苗（6-in-1 vaccine，相较于麻腮风三联疫苗（MMR）的参照方案，相对重要性占比10.5%，58.2%[95%置信区间54.6%~61.7%]的家长表示偏好该方案）；仅允许医学豁免（相较于同时允许医学豁免与宗教信仰豁免的参照方案，相对重要性占比4.0%，45.5%[95%置信区间41.1%~50.0%]的家长表示偏好该方案）。
研究解读：本研究结果可为政策制定者优化英格兰地区儿童强制疫苗接种方案的落地实施提供决策参考。
资助说明：本研究的数据收集工作由英国学术院/勒弗休姆小型研究基金（SRG1920101118）资助。研究数据将在论文发表后5年内（至2027年5月1日）公开。