Parental preferences for a mandatory vaccination scheme in England; a discrete choice experiment
Authors: Smith Louise E , Carter Ben 
Published: December 2021

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 (MMR, 6-in-1), child age group (2 years and older, 5 years and older), incentive (£130 cash incentive for parent, £130 voucher incentive for child, no incentive), penalty (£450 fine, parent not able to claim Child Benefits for an unvaccinated child, unvaccinated child not able to attend school or day care), ability to opt out (medical exemption only, medical and religious belief exemption), and compensation scheme (not offered, offered). 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 (53% female, mean age=33·6 years, SD=7·1, 84% white British). Parental preferences were mostly based on incentives (slight preference for cash pay-out for the parent versus a voucher for the child) and penalties (preference for schemes that did not allow unvaccinated children to attend school or day care and those that withheld financial benefits for parents of unvaccinated children). Parents also preferred schemes that: offered a compensation scheme, mandated the 6-in-1 vaccine, mandated vaccination in children aged 2 years and older, and that offered only medical exemptions.

Interpretation

Results 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).

Research in context

Evidence before this study

Uptake of childhood vaccines in high-income countries has decreased in recent years. Making vaccination mandatory has the potential to increase uptake. There is no standard approach to mandatory vaccination schemes. Research suggests that the cultural context will affect perceived acceptability of vaccine laws. Mandatory vaccination has been mooted in England as a way to increase vaccine uptake. However, there is no recent research investigating parental preferences for how a mandatory vaccine scheme could be implemented.

Added value of this study

We used a discrete choice experiment to investigate English parents’ preferences for a mandatory vaccination scheme. Variables included were parameters that are likely to be considered by policymakers if a mandatory vaccination scheme were to be proposed.

Implications of all the available evidence

Study results indicate that parents prefer mandatory vaccination schemes that offer financial incentives for vaccination. The penalty imposed for missing a vaccine dose, and the inclusion of a compensation scheme for severe adverse effects also influenced preferences. These results can be used to inform policy should a mandatory vaccination scheme be proposed in England.