National Center for Emerging and Zoonotic Infectious Diseases

Value of a vaccine to prevent travel-related 

chikungunya for US persons

Nicole Lindsey, MS

CDC Deputy Lead, Chikungunya Vaccines Work Group

Arboviral Diseases Branch

Centers for Disease Control and Prevention

June 22, 2023
Potential value of a chikungunya vaccine among 

international travelers (Valneva survey)
 2021 online survey of 2,002 US residents aged ≥ 18 years who either 

travelled internationally in last 3 years or planned to do so in next 3 years

– Excluded anyone who self-identified as ‘anti-vaccination’

 Limited information provided about the surveyed population

 Participants provided basic information about chikungunya disease

– Disease distribution, symptoms of disease, rarely joint pain/fatigue that lasts 

for months or years, and lack of treatment

– No information on risk of infection, potential adverse events, costs of vaccine

Awareness of chikungunya and value of a chikungunya 

vaccine among travelers

9
 Only 18% had heard of chikungunya prior to survey

 After participants provided information about chikungunya, asked two 

questions:

– How likely would you be to ask a healthcare professional about a vaccine to 

protect yourself against chikungunya? 72% Likely 

– If a doctor or health care provider recommended the chikungunya vaccine for 

you, how likely would you be to get vaccinated? 81% Likely

Awareness of chikungunya and value of a chikungunya 

vaccine among travelers

10
 Low awareness of chikungunya virus disease among traveler population

 Most would likely ask healthcare provider about a chikungunya vaccine 

and be vaccinated if their provider recommended vaccination

 Limitations

– No information provided to participants about risk of disease or 

risks/benefits of vaccination

– No information about costs

– Although traveler population, unknown if representative of traveler 

population to areas at risk for chikungunya

Awareness of chikungunya and value of a chikungunya 

vaccine among travelers: Summary

11
Potential value of a chikungunya vaccine among U.S. 

persons (CDC survey) 
Method: Porter Novelli Consumer Styles surveys

 Online panel representative of non-institutionalized U.S. population 

– Members randomly recruited using probability-based sampling by address 

– Provided with a laptop or tablet and access to internet if needed

– Receive small monetary rewards for participation

 2022 Summer Styles respondents included 4,156 invited adults (69% 

response rate)

 Core questions capture demographic information in addition to consumer 

attitudes, values, and behaviors

 Data weighted to U.S. Population Survey proportions for sex, age, 

household income, race/ethnicity, household size, education, census region

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Questions on value of a chikungunya vaccine

1. Imagine you are going on a trip to another country. You have a 1 in 150 

chance of getting a disease. About 1 in 4 people who get the disease 

suffer from long-term joint pain. A vaccine is available that costs $350 

and is not covered by insurance. How likely would you be to get the 

vaccine? 

2. Now imagine you are going on the same trip, but your chances are 1 in 

15,000 of getting the disease. About 1 in 4 people who get the disease 

suffer from long-term joint pain. The vaccine costs $350 and is not 

covered by insurance. How likely would you be to get the vaccine? 

3. Which factors are most important to you in deciding whether or not to 

get the vaccine? 

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 50% female; median age 54 years (range: 18-94 years)

 72% identified as white, non-Hispanic

 Education

– 5% with less than high school education

– 25% with high school education

– 70% with at least some college or higher education

 Household income

– <$25K: 10%

– $25-<$75K: 30%

– ≥$75K: 60% 

Demographics of survey participants (N=4,156)

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Imagine you are going on a trip 

to another country. You have a 

1 in 150 chance of getting a 

disease. About 1 in 4 people 

who get the disease suffer from 

long-term joint pain. A vaccine 

is available that costs $350 and 

is not covered by insurance. 

How likely would you be to get 

the vaccine? (n=4,146)

*Includes very and somewhat likely responses

**Includes very and somewhat unlikely responses

42%

26%

32%

Likely* Unsure Unlikely**

16
Likelihood of chikungunya vaccination by age group 

where disease risk is 1 in 150 

45%

43%

43%

35%

26%

26%

24%

28%

30%

31%

33%

37%

70+

50-69

30-49

18-29

Likely Not Sure Unlikely

17
Likelihood of chikungunya vaccination by sex where 

disease risk is 1 in 150 

39%

44%

29%

22%

32%

33%

Female

Male

Likely Not Sure Unlikely

18
Likelihood of chikungunya vaccination by 

race/ethnicity where disease risk is 1 in 150 

51%

42%

36%

42%

26%

21%

35%

25%

24%

37%

29%

33%

Other

Hispanic

Black

White

Likely Not Sure Unlikely

19
Likelihood of chikungunya vaccination by education 

where disease risk is 1 in 150 

54%

41%

31%

19%

26%

32%

27%

33%

38%

College and higher

Some college

High school or less

Likely Not Sure Unlikely

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Likelihood of chikungunya vaccination by household 

income where disease risk is 1 in 150 

51%

38%

31%

22%

22%

29%

27%

36%

27%

33%

42%

42%

75K+

50-74K

25-49K

<25K

Likely Not Sure Unlikely

21
Likelihood of chikungunya vaccination where disease 

risk is 1 in 150: Summary

 42% respondents likely to be vaccinated when disease risk is high

– About a third unlikely to be vaccinated even in high-risk scenario

– About a quarter unsure

 Main differences by group

– Lower likelihood of vaccination among youngest age groups, those with lower 

education and household income levels

– Blacks less likely to be vaccinated and more likely to report ‘unsure’

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Now imagine you are going on 

the same trip, but your 

chances are 1 in 15,000 of 

getting the disease. About 1 in 

4 people who get the disease 

suffer from long-term joint 

pain. A vaccine is available that 

costs $350 and is not covered 

by insurance. How likely would 

you be to get the vaccine? 

(n=4,138)

27%

24%

49%

Likely* Unsure Unlikely**

*Includes very and somewhat likely responses

**Includes very and somewhat unlikely responses 23
Likelihood of chikungunya vaccination where disease 

risk is 1 in 15,000: Summary

 Level of risk is important factor in determining likelihood of vaccination 

with 27% being likely to vaccinate in low-risk scenario compared to 42% in 

higher risk scenario

 About a quarter of respondents unsure for both risk level scenarios

 Similar trends for different demographic factors between high and low risk 

scenarios, with responses more towards ‘unlikely’ end of scale

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Which factors are most important to you in deciding 

whether or not to get the vaccine? (n=4,130)

6%

11%

36%

41%

43%

57%

I do not get any vaccinations

Other factors not listed

Chance of getting long-term joint pain

Cost of the vaccine

Chance of side effects from the vaccine

Chance of getting the disease

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 Not many differences by age 

– Youngest age group more concerned about costs and less about long-term 

joint pain

– Middle aged (45-59 years) most concerned about vaccine side effects

 No meaningful differences by sex or race/ethnicity

 Importance of risk of disease and risk of long-term joint pain following 

infection increased with both education level and household income

 Conversely, proportion of respondents that do not receive vaccination 

decreased by increasing education and income

Differences in factors influencing vaccination by 

demographics

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Factors influencing vaccination in high-risk scenario 

by likelihood of vaccination

71%

51%

40%

33%

1%

44%

21%

42%

51%

14%

Chance of getting

disease

Chance of long-term

joint pain

Chance of side

effects from vaccine

Cost of the vaccine I do not get any

vaccinations

Likely

Unlikely

27
Factors influencing vaccination in lower risk scenario 

by vaccine acceptance

68%

53%

40%

27%

1%

55%

28%

43%

51%

9%

Chance of getting

disease

Chance of long-term

joint pain

Chance of side

effects from vaccine

Cost of the vaccine I do not get any

vaccinations

Likely

Unlikely

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Factors influencing likelihood of vaccination: 

Summary

 Most commonly reported factor was risk of getting disease, which is 

consistent with findings for high and low risk scenario questions

 Also important are risk of side effects, vaccine cost, and risk of long-term 

join pain following infection 

 Significant differences between those likely and unlikely to be vaccinated 

in importance of factors, with exception of concern about side effects

– For “likely to be vaccinated” key factors were chance of disease and chance of 

long-term joint pain

– For “unlikely to be vaccinated”, key factors were vaccine cost and chance of 

disease 

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Survey limitations

 Not a traveler population

– Unknown how well these responses reflect attitudes of a traveler population

 Only very basic disease information provided

 No information on likelihood or type of side effects from vaccination

 Vaccine cost was estimate based on typical travel vaccine not actual cost

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Potential value of a chikungunya vaccine among U.S. 

persons: Summary

 42% of respondents likely to be vaccinated when disease risk is high; 27% 

when disease risk is low

– About a quarter of participants were unsure in both scenarios

 Lower likelihoods of vaccination than reported in Valenva survey (81%), 

but were important differences in methods 

– Traveler vs general population

– Different background information provided – more general information on 

chikungunya vs. information focusing on disease risks, sequela, and costs

– Response to question on “likelihood of getting vaccine if recommended by 

healthcare provider” vs “likelihood of getting vaccine” 31
Awareness of chikungunya and value of a 

chikungunya vaccine to U.S. travel healthcare 

providers (Valenva survey)
 Online survey conducted in 2021 of 158 US travel healthcare providers

– All participants routinely preform pre-travel health counseling and prescribe 

and/or administer relevant travel vaccines

– Mix of provider types and practice settings relevant to travel health

 How familiar, if at all, are you with chikungunya disease? 

– Familiar with disease and have clinical knowledge of it (30%)

– Have heard of it but don’t know what it is (20%) 

– Majority not familiar (51%)

Awareness of chikungunya and value of a vaccine to 

U.S. travel healthcare providers

33
Value of chikungunya vaccine to U.S. travel 

healthcare providers

 Participants provided information:

– Disease epidemiology, clinical presentation, types and duration of sequelae

– Chikungunya vaccines likely available within few years

 Asked to indicate likelihood to recommend/prescribe a vaccine for 

chikungunya if recommended by ACIP

– 15% Very likely

– 73% Somewhat likely

– 11% Neither likely nor unlikely

– 1% Unlikely

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 Low awareness of and familiarity with chikungunya among U.S. healthcare 

providers, even among those who work in travel medicine

 Following minimal education, 88% of providers surveyed would be likely to 

recommend/administer vaccine to travelers if recommended by ACIP

– Explicit in question that vaccination would be recommended by ACIP

– No estimates of risk of disease or possible risks of vaccination 

Awareness of chikungunya and value of a vaccine to 

U.S. travel healthcare providers: Summary

35
Value of chikungunya vaccine to U.S. travelers and 

healthcare providers: Summary 

 Awareness of chikungunya low among travelers and healthcare providers

 Healthcare providers likely to prescribe vaccination as recommended by 

ACIP and travelers interested in vaccination if recommended by provider

 Independent of healthcare provider recommendation, about 30–40% of 

U.S. persons interested in vaccination and remainder unsure or unlikely to 

be vaccinated

– Variability in population perception of whether potential desirable effects 

outweigh undesirable effects

– Risk of disease, vaccine cost, vaccine side effects, and risk of chronic arthralgia 

are influential factors in deciding on chikungunya vaccination 

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