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).Data will be made available ending 5 years following article publication, until 01/05/2027.

背景：为应对英格兰儿童疫苗接种率下降的问题，强制接种疫苗的方案已被提出。本研究旨在探讨家长对强制疫苗接种计划的偏好。方法：采用离散选择实验法。研究考察了六个属性：疫苗、儿童年龄段、激励措施、处罚、自愿选择退出能力和赔偿方案。通过混合效应条件对数似然回归模型，分析了家长的偏好以及属性的相对重要性。研究发现：参与者为1011名英格兰5岁及以下儿童的父母（其中53%为女性；平均年龄为33.6岁，标准差为7.1；84%为白人）。家长偏好主要基于激励措施（相对重要性为30.7%；80.9%（95%置信区间为76.3–85.0%）偏好家长激励措施，74.8%（71.0–78.3%）偏好儿童激励措施；参考：无激励措施）和处罚（相对重要性为25.4%；69.5%（65.7–73.1%）偏好禁止未接种疫苗的儿童上学或日托，67.6%（63.6–71.4%）偏好拒绝向未接种疫苗儿童的家长提供经济利益；参考：450英镑罚款）。家长还偏好以下方案：提供赔偿方案（相对重要性为18.1%；66.4%（62.7–69.8%）偏好；参考：未提供）、强制2岁儿童接种疫苗（而非5岁；相对重要性为11.4%；42.6%（39.4–45.9%）偏好；参考：2岁）、强制接种六联疫苗（相对重要性为10.5%；58.2%（54.6–61.7%）偏好；参考：MMR疫苗），以及仅提供医疗豁免（而非医疗和宗教信仰豁免；相对重要性为4.0%；45.5%（41.1–50.0%）偏好；参考：医疗豁免）。解读：这些发现可为政策制定者提供有关如何在英格兰最佳实施强制儿童疫苗接种计划的决策依据。资助：数据收集由英国学术院/莱弗休姆小型研究补助金（SRG1920101118）资助。数据将在文章发表后5年内提供，直至2027年1月1日。