Quantifying the public's view on social value judgments in vaccine decision-making: A discrete choice experiment

Jeroen Luyten, Roselinde Kessels, Katherine E. Atkins, Mark Jit, Albert Jan Van Hoek*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

18 Citations (Scopus)


Vaccination programs generate direct protection, herd protection and, occasionally, side effects, distributed over different age groups. This study elicits the general public's view on how to balance these outcomes in funding decisions for vaccines. We performed an optimal design discrete choice experiment with partial profiles in a representative sample (N = 1499) of the population in the United Kingdom in November 2016. Using a panel mixed logit model, we quantified, for four different types of infectious disease, the importance of a person's age during disease, how disease was prevented—via direct vaccine protection or herd protection—and whether the vaccine induced side effects. Our study shows clear patterns in how the public values vaccination programs. These diverge from the assumptions made in public health and cost-effectiveness models that inform decision-making. We found that side effects and infections in newborns and children were of primary importance to the perceived value of a vaccination program. Averting side effects was, in any age group, weighted three times as important as preventing an identical natural infection in a child whereas the latter was weighted six times as important as preventing the same infection in elderly aged 65–75 years. These findings were independent of the length or severity of the disease, and were robust across respondents’ backgrounds. We summarize these patterns in a set of preference weights that can be incorporated into future models. Although the normative significance of these weights remains a matter open for debate, our study can, hopefully, contribute to the evaluation of vaccination programs beyond cost-effectiveness.

Original languageEnglish
Pages (from-to)181-193
Number of pages13
JournalSocial Science and Medicine
Publication statusPublished - May 2019

Bibliographical note

Funding Information:
We thank Shane Palmer and Jas Gidda of Vision One ( www.visionone.co.uk ) and the anonymous reviewers for their supportive comments. The data collection and the salary of KEA, MJ and AJVH were supported by the National Institute for Health Research Health Protection Research Unit ( NIHR HPRU ; HPRU-2012-10096 ) in Immunization at the London School of Hygiene & Tropical Medicine in partnership with Public Health England . RK acknowledges funding from The Research Foundation - Flanders . The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, the London School of Hygiene & Tropical Medicine, and the Department of Health or Public Health England . The funders have had no input to this study in terms of study design, analysis of the data or writing of the manuscript.


  • Age
  • Cost-effectiveness analysis
  • Decision making
  • Equity
  • Herd immunity
  • Priority-setting
  • Side effects
  • United Kingdom


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