Willingness to Pay for a COVID-19 Vaccine

The present value of human life losses associated with COVID-19 and likely productivity losses averted through COVID-19 vaccination in Madagascar

BACKGROUND

As of 3 March 2023, Madagascar had reported 1,422 deaths from COVID-19. Up to now, there hasn't been a study to estimate the Total Present Value of Human Life lostTPVHL MADAGASCAR , productivity losses, and potential productivity losses averted through COVID-19 vaccination for use in advocacy. The study reported in this paper aimed to fill these information gaps.

METHODS

The Human Capital Model (HCM) was used to estimate theTPVHL MADAGASCAR , which is the sum of the discounted value of human life losses among individuals in seven different age groups. The Present Value of Human Life for each age groupPVHL i was calculated by multiplying the discount factor, the undiscounted years of life, the non-health gross domestic product (GDP) per capita, and the number of COVID-19 deaths in that age group. To test the robustness of the results, the HCM was rerun five times, assuming (i) a 5% discount rate, (ii) a 10% discount rate, (iii) Africa's highest average life expectancy at birth of 78.76 years, (iv) the world's highest life expectancy of 88.17 years, (v) projected excess COVID-19 mortality of 11,418.66 deaths as of 3 March 2023 in Madagascar, and assuming different levels of vaccine coverage: 100%, 70%, 60.93%, and 8.266%.

RESULTS

The 1,422 human lives lost due to COVID-19 had aTPVHL MADAGASCAR of Int$ 46,331,412; and an average of Int$ 32,582 per human life. Re-estimation of the HCM, using (i) discount rates of 5% and 10% reducedTPVHL MADAGASCAR by 23% and 53%, respectively; (ii) average life expectancies of 78.76 years and 88.17 years increasedTPVHL MADAGASCAR by 23.7% and 39.5%, respectively; (iii) projected excess COVID-19 mortality of 11,418.66 augmentedTPVHL MADAGASCAR by 703%. Furthermore, it is estimated that vaccinating 70% of the target population could potentially save the country Int$ 1.1 billion, equivalent to 1.94% of the GDP.

CONCLUSIONS

The COVID-19 pandemic has resulted in significant health and productivity losses for Madagascar. Optimizing COVID-19 vaccination coverage for the target population could substantially reduce these losses.

Prevalence of caregiver hesitancy for vaccinations in children and its associated factors: A systematic review and meta-analysis

This review aimed to systematically compare and pool the prevalence of all the known evidence on caregiver hesitancy and to describe the factors influencing vaccine hesitancy among caregiver worldwide such as COVID-19, MMR, Influenza, HPV and others. We searched article from few electronic databases (PubMed, CENTRAL, ProQuest, and Web of Science) from inception to August 2023 using specific keywords for example caregiver, parents, prevalence, factor, hesitancy, and others. We included population-based studies that reported the prevalence of caregiver hesitancy. We used random-effects meta-analyses for pool prevalence estimates of caregiver hesitancy. A total of 765 studies met our inclusion criteria, containing data on 38,210,589 caregivers from seven regions across the globe. Overall or pool prevalence of vaccine hesitancy among caregiver is 25.0% (95% CI: 0.22-0.27, I2 = 99.91%, p = 0.001). Based on the evidence gathered, vaccine hesitancy was found to be religious sentiments, personal beliefs, perceived safety concerns, and a desire for more information from healthcare providers, along with factors related to availability, accessibility, affordability, and acceptability of vaccinations. Vaccine safety and efficiency have been identified as the main factor for caregiver vaccine hesitancy globally with a prevalence of 91.4%. Trial registration PROSPERO registration number: CRD42022331629. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022331629.

The acceptability of the risk of death in the treatment of respiratory diseases in France

BACKGROUND

The costs associated with respiratory illnesses in the French healthcare budget continue to rise. However, pharmaceutical companies and research centres are continuously developing new treatments. Consequently, accepting these treatments, which necessitates the acceptance of the mortality risk associated with their use, represents a significant economic and public health issue. Our study aims to assess this acceptance.

METHODS

The data were obtained from an online questionnaire completed by 315 respondents located in France during June and July 2019. The standard gamble method was employed to ascertain the acceptability of risk. This method quantifies the 'disutility' of a health state by evaluating the extent to which an individual is willing to accept a specific mortality risk in exchange for avoiding the state.

RESULTS

The study demonstrated that individuals, irrespective of their personal characteristics, were willing to accept a treatment with an average mortality risk of less than 19%. The findings revealed discrepancies between individuals' perceptions of mortality and actual risks.

CONCLUSIONS

In France, it is incumbent upon public decision-makers and research centres to ensure that treatment-related mortality rates remain below 19% so that patients readily accept treatment, irrespective of their personal characteristics. In addition, they should provide further information on the risks associated with treating respiratory diseases to avoid a discrepancy between the mortality risks perceived by individuals and the actual risks.

Individuals' willingness to pay for HIV vaccines in Iran: Contingent valuation method

Background and Aims

This study aims to assess individuals' willingness to pay (WTP) for a human immunodeficiency virus (HIV) vaccine in Iran, focusing on key determinants influencing vaccine acceptance. Utilizing the contingent valuation method (CVM), we aim to provide insights into the economic and socio-cultural factors shaping WTP in Iran.

Methods

We conducted face-to-face surveys with 468 participants in Tehran province using purposive sampling. We analyzed demographic characteristics, perspectives on HIV/AIDS, and financial considerations alongside participants' WTP. Statistical analyses, including maximum likelihood estimation, identified factors influencing WTP. Mean WTP values were calculated to quantify the economic valuation of an HIV vaccine.

Results

Higher education and monthly income significantly correlated with increased WTP, while gender, age, marital status, and health insurance showed no substantial impact. The mean WTP was 12,590.83 to 12,599.63 thousand Rials in different models, both showing statistically significant WTP values.

Conclusion

Higher education and income levels are key determinants of WTP for an HIV vaccine in Iran. These findings provide valuable insights for policymakers to enhance vaccine accessibility and acceptance in Iran.

You can't nudge into vaccination: Comparing the effects of nudge types and Covid-19 vaccination attitudes on vaccine willingness

Nudges can be an effective strategy to promote vaccination. However, it is necessary to better identify the characteristics of nudges that produce the strongest effects and how they interact with individuals' attitudes. Here we sequentially test the effectiveness of three nudge characteristics (framing, nudge type, and presentation modality) and the role of participants' attitudes toward Covid-19 vaccination, social solidarity and authoritarianism in vaccination decisions. In studies 1-4, participants were presented with a nudge manipulating a target characteristic (e.g. positive/negative framing, nudge type) and measuring willingness to vaccinate and related variables compared a control nudge. Study 5 used a single combined nudge reflecting the combination of successful nudges in previous studies. Results over all studies show that nudging has unreliable effects while vaccine attitudes are more reliably linked to all measures of vaccines willingness. These results suggest that attitudes play a more reliable role on effective adoption of vaccinations.

The Value of Flexible Vaccine Manufacturing Capacity: Value Drivers, Estimation Methods, and Approaches to Value Recognition in Health Technology Assessment

Expanding flexible vaccine manufacturing capacity (FVMC) for routine vaccines could facilitate more timely access to novel vaccines during future pandemics. Vaccine manufacturing capacity is 'flexible' if it is built on a technology platform that allows rapid adaption to new infectious agents. The added value of routine vaccines produced using a flexible platform for pandemic preparedness is not currently recognised in conventional health technology assessment (HTA) methods. We start by examining the current state of play of incentives for FVMC and exploring the relation between flexible and spare capacity. We then establish the key factors for estimating FVMC and draw from established frameworks to identify relevant value drivers. The role of FVMC as a countermeasure against pandemic risks is deemed an additional value attribute that should be recognised. Next, we address the gap in the vaccine-valuation literature between the conceptual understanding of the value of additional FVMC and the availability of accurate and reliable tools for its estimation to facilitate integration into HTA. Three practical approaches for estimating the value of additional FVMC are discussed: stated and revealed preference studies, macroeconomic modelling, and benefit-cost analysis. Lastly, we review how value recognition of additional FVMC can be realised within the HTA process for routine vaccines manufactured on flexible platforms. We argue that, while the value of additional FVMC is uncertain and further research is needed to help to better estimate it, the value of increased pandemic preparedness is likely to be too large to be ignored.

Public Preference for Financing Preventive Vaccines in Health Shocks: The Case of COVID-19 Vaccines in a Middle-Income Country

BACKGROUND

To effectively manage health crises such as disease pandemics, health authorities require reliable information regarding people's preferences. This helps to ensure timely and targeted interventions and avoids increasing societal costs through developing evidence-based policies. This study investigates the Iranian people's preference for financing coronavirus disease 2019 (COVID-19) vaccines and the factors affecting this.

METHODS

A cross-sectional survey was performed during the third-wave peak of COVID-19 in Iran from 1 to 20 February 2021 utilizing various data collection methods. The public preference regarding imported and domestically produced vaccines, their willingness to fully or partially contribute to the financing of these vaccines, and their willingness to pay (WTP) for domestically produced vaccines using the contingent valuation method was assessed in different scenarios. The determinants of the probability of positive financing preferences were evaluated using an ordered probit regression model.

RESULTS

Among the 2071 survey respondents, approximately 60% stated willingness to contribute to vaccine financing in the form of partial or full user fee payments. Forty percent of respondents are willing to be vaccinated if it is provided for free by the government. Interestingly, people's preference for financing the vaccine was not related to the type of vaccine. The regression analysis showed that income, having supplementary insurance, being male, perceived COVID-19 risk, education, and working in the health sector are significantly related to a higher probability of contribution to vaccine financing.

CONCLUSIONS

Regardless of country of origin of COVID-19 vaccines, vaccination is very important for the Iranian people, and the majority of respondents in our study showed an inclination to contribute to vaccine funding, from partial to full user fees, to achieve higher protection against COVID-19 disease. Hence, ensuring timely access to vaccines during health crises such as pandemics is imperative, as it saves lives and reduces the economic burden of disease. This commitment from the health system can be supported by financial contributions from the general public. In this regard, considering public preferences is strongly advised to policymakers.

Sociodemographic determinants of vaccination and willingness to pay for COVID-19 vaccines in Hungary, results of a cross-sectional online questionnaire

BACKGROUND

Several different coronavirus disease (COVID-19) vaccines were authorized and distributed all over the world, including Hungary, but vaccination rates and acceptance of the different vaccines varied through 2021 and subsequent years. In Hungary Western vaccines and the Chinese and Russian vaccines were available in early 2021. Understanding preference and willingness to pay (WTP) for the COVID-19 vaccine could provide information for policy decision making to control the COVID-19 pandemic. We aimed to assess the socio-demographic factors influencing the COVID-19 vaccination and to analyse individual preferences for the available COVID-19 vaccines in Hungary.

METHODS

A cross-sectional online questionnaire survey was conducted between 25-05-2021 and 08-06-2021 exploring the vaccine acceptance and WTP for vaccination in the Hungarian general population. To assess the preferences towards the different vaccines available in Hungary at the time of the study, we used a multi-step WTP task.

RESULTS

Altogether 2,000 respondents filled out our survey, with the average age of 49.1 (SD = 15.3), out of whom 370 respondents (18.5%) stated that they already had a COVID-19 infection. Age above 65 years, male gender, higher level of education, higher income and residence in the capital or county seats were associated with a higher probability of vaccination. The average WTP ranged from 14.2 to 30.3 EUR for the different vaccine types.

CONCLUSIONS

Males, respondents with higher education and income stated a higher WTP value for all vaccines. Better socioeconomic status increased both vaccination coverage and willingness to pay for vaccines.

Investigating COVID-19 Vaccine Uptake Intention Using an Integrated Model of Protection Motivation Theory and an Extended Version of the Theory of Planned Behavior

As global governments continue to inoculate populations in the aftermath of the SARS-CoV-19 epidemic, health protection and related problems such as vaccination reluctance have sparked conflicting emotions and discourses. Stakeholder concerns about vaccination promotion have arisen in this context. Consequently, this research investigates vaccination uptake behavior using an integrated framework that includes protective motivation theory and an extended version of the theory of planned behavior. Except for perceived severity, empirical study results based on the structural equation modeling technique demonstrated a positive relationship between PMT factors (i.e. perceived vulnerability, reaction efficacy, self-efficacy, and cost response) and intention to vaccinate. TPB factors (attitude, perceived behavior control, subjective norm, personal moral norm, and descriptive norm) were also found to have a positive connection with intention. The model's utility and suitability are indicated by the predictive and explanatory potency score (R2 = .415). Study implications for COVID-19 vaccine uptake promotion and ideas for future investigations are explored in light of our findings.

Determinants of vaccination decisions and lived experiences of Ghanaians with the COVID-19 pandemic; a qualitative study

Background

Two years after the WHO declared a state of emergency as a result of the rapid spread of the COVID-19 virus from Wuhan, China, the rate of new infections experienced intermittent flare-ups globally, with vaccinations still ongoing in countries such as Ghana. One year after the implementation of Ghana's COVID-19 vaccine deployment program, Ghanaians have had the opportunity to reflect on their vaccination decisions, albeit the initial vaccine hesitancy.

Objectives

The current paper examined the knowledge and lived experiences of Ghanaians during the COVID-19 pandemic, and the factors influencing their vaccination decisions, one year after COVID-19 vaccinations commenced in Ghana, with special focus on the social and geographical histories which influenced their vaccination decisions.

Methodology

A qualitative approach using a case study design was used to conduct in-depth interviews among 25 respondents who were 18 years and above, not pregnant, and willing to participate in the study, between 5th and 23rd September 2022. Data was collected in 5 hotspot areas in Ghana with the highest cumulative case counts. A semi-structured interview guide was used to collect data which was analyzed using a thematic approach.

Findings

Respondents demonstrated a good level of knowledge on COVID-19 and related vaccines. Fear, panic, and anxiety were some of the experiences lived by respondents during the pandemic. The factors influencing vaccination decisions included conspiracy theories about COVID-19 and related vaccines, subjective notions about the COVID-19 disease, and subjective notions about the vaccine. The type of community one lived in, taboos, and previous successful vaccination programs in the community were geographic factors that informed respondents' decision to vaccinate or not. Social circles, religion, opinion leaders, and media-based campaigns were the social factors that influenced respondents' decision to vaccinate or not.

Surname order and revaccination intentions during the COVID-19 pandemic

Teachers in Japanese schools employ alphabetical surname lists that call students sooner, with surnames appearing early on these lists. We conducted Internet surveys nearly every month from March 2020 to September 2022 with the same participants, wherein we asked participants where the alphabetical columns of their childhood and adult surnames were located. We aimed to identify how surname order is important for the formation of noncognitive skills. During the data collection period, the COVID-19 vaccines became available; Japanese people could receive their third dose starting in December 2021. The 19th wave of the survey was conducted in January 2022. Therefore, to examine how a surname's alphabetical order could influence intention to revaccinate, we used a subsample of data from December 2021 to September 2022. The major findings were as follows. Women with early surnames had an approximately 4% stronger likelihood of having such intentions than men with early surnames. Early name order was more strongly correlated with revaccination intention among women than among men. The surname effect for women was larger when a mixed-gender list was used compared with when it was not used. This effect was only observed for childhood surnames and not for adult surnames.

Parents' willingness to pay for their children's COVID-19 vaccine in Taiwan, China: A cross-sectional study

Most COVID-19 studies aim to assess factors influencing willingness to pay for vaccines between the public and medical staff. However, few studies focus on parents' willingness to pay for their children's COVID-19 vaccine. The current study aimed to assess parents' willingness to pay for their children's vaccination against COVID-19 and its influencing factors. This population-based cross-sectional study used a self-administered questionnaire. The inclusion criterion was parents with at least one child younger than 18 years. The final analysis included 384 valid data points. A total of 89.1% of the parents indicated that they are willing to pay for their children's vaccination against COVID-19. Among them, both fathers' and mothers' willingness to pay for their children's COVID-19 vaccine was 89.6%. The mean and median willingness to pay were% would pay for their children. Excluding other confounding factors, willingness to pay for the COVID-19 vaccine for themselves and hesitation to vaccinate their children were significantly associated with parents' willingness to pay for their children's COVID-19 vaccine. We found that 89.1% of the parents in Taiwan would pay for their children's COVID-19 vaccine. Parents' willingness to pay for themselves and hesitation to vaccinate their children were associated with willingness to pay. Reducing hesitation about vaccines and developing policies for vaccine payment may have a positive impact on willingness to pay for vaccines and promoting COVID-19 vaccination.

An examination of willingness to participate and willingness to pay for a universal school food program in the Canadian context

OBJECTIVE

To examine parents'/caregivers' willingness to participate and willingness to pay (WTP) for a cost-shared school food program (SFP) and its associated factors.

DESIGN

A quantitative survey design was used where WTP for a hypothetical SFP was elicited using a double-bounded dichotomous choice elicitation method. We used a double hurdle (logistic and truncated regression) model to examine WTP and positively or negatively associated factors.

SETTING

Saskatoon Public School Division elementary schools situated in high-, mid- or low-median-income neighbourhoods.

PARTICIPANTS

Parents or caregivers of children attending grades 1 to grade 8 in the Saskatoon Public School Division elementary schools.

RESULTS

94 % respondents were willing to participate in a SFP while less than two-thirds of participants were willing to pay for such a program. Over 90 % respondents from all the socio-economic groups were willing to participate. Multiple household income earners, higher household income, higher number of children, household food security status and higher academic attainment of parents'/caregivers predicted greater willingness to pay. Mean willingness to pay was $4·68 (CAN), and households reporting moderate or severe food insecurity were likely to be willing to pay significantly less for a SFP.

CONCLUSION

A cost-shared program might be financially sustainable in Canada if community characteristics such as household food insecurity status, economic participation of women and average household size are kept in mind while determining the price of the program.

Comparison of SARS-CoV-2 Vaccination Skepticism, Reasons, and Concerns Between Mass Vaccination Centers and General Practices in Germany 2021

Introduction

The reluctance to be vaccinated against COVID-19 has significantly curbed vaccine uptake. Unlike mass vaccination centers, general practitioners (GPs) might be able to address some of the patients' concerns through their long-term doctor-patient relationship. This study compared vaccination reasons, concerns and skepticism about vaccination, and perceived importance of the vaccine and its hypothetical value between vaccination centers and GP practices.

Methods

A survey was distributed (07/2021-10/2021) among newly vaccinated individuals in ten GP practices (n = 364) and two vaccine centers (n = 474).

Results

Participants in vaccine centers stated more prosocial and benefit-oriented reasons for vaccination, whereas participants in GP practices more often stated the GP's recommendation as the reason. Perceived importance of the vaccine in combating the pandemic was rated higher among individuals at vaccine centers and with higher health awareness and self-efficacy. Participants at both types of sites who preferred a GP for vaccination expressed more vaccination skepticism, which was also related to older age, more health risk concerns related to COVID-19 vaccines, and lower perceived importance of the vaccine.

Conclusion

Our results indicate opportunities for framing future vaccination campaigns that include vaccination centers. Additionally, a rapid GP involvement in future mass vaccinations might be crucial for overcoming attitudinal barriers and achieving higher vaccine uptake.

Jumping the Queue:Willingness to Pay for Faster Access to COVID-19 Vaccines in Seven European Countries

INTRODUCTION

Given the initial shortage of vaccines to protect against coronavirus disease 2019 (COVID-19), many countries set up priority lists, implying that large parts of the population had to wait. We therefore elicited the willingness to pay (WTP) for access to two hypothetical COVID-19 vaccines.

METHODS

Respondents were asked how much they would be willing to pay to get an immediate COVID-19 vaccination rather than waiting for one through the public system. We report data collected in January/February 2021 from the European COVID Survey (ECOS) comprising representative samples of the population in Denmark, France, Germany, Italy, Portugal, the Netherlands, and the UK (N = 7068).

RESULTS

In total, 73% (68.5%) of respondents were willing to pay for immediate access to a 100% (60%) effective vaccine, ranging from 66.4% (59.4%) in the Netherlands to 83.3% (81.1%) in Portugal. We found a mean WTP of 54.36 euros (median 37 euros) for immediate access to the 100% effective COVID-19 vaccine and 43.83 euros (median 31 euros) for the 60% effective vaccine. The vaccines' effectiveness, respondents' age, country of residence, income, health state and well-being were significant determinants of WTP. Willingness to be vaccinated (WTV) was also strongly associated with WTP, with lower WTV being associated with lower WTP. A higher perceived risk of infection, higher health risk, more trust in the safety of vaccines, and higher expected waiting time for the free vaccination were all associated with a higher WTP.

CONCLUSION

We find that most respondents would have been willing to pay for faster access to COVID vaccines (jumping the queue), suggesting welfare gains from quicker access to these vaccines. This is an important result in light of potential future outbreaks and vaccines.

Choice preference and willingness to pay for COVID-19 vaccination in Namibia

Background

Namibia has not been spared from the coronavirus (COVID-19) pandemic, and as intervention the Namibian government has rolled out vaccination programmes. This study was conducted before the roll out of these vaccines to assess the preference for COVID-19 vaccinations. Stated preference studies provide information about social demand, access, willingness-to-pay and financing for future COVID-19 vaccination.

Methods

A stated choice experiment (SCE) survey was administered to a sample of 506 participants from Namibia's general population between October 2020 and December 2020. Participants were asked to make a series of hypothetical choices and estimate their preference for different attributes of a vaccine. A latent class model was used to analyse the SCE data. The study also assessed anti-vaccination behaviour, past vaccination behaviour, impacts of COVID-19 on mental and physical health and Willingness-To-Pay (WTP) measures. The WTP measures were captured as out-of-pocket and further calculated using the marginal rate of substitution method in SCE.

Results

Data from 269 participants was included in the analysis. Vaccine side effects (40.065), population coverage (4.688), payment fee to receive vaccine immediately (3.733) were the top three influential attributes for vaccine preferences. Accordingly, increases in mild and severe side effects of vaccine options had negative impacts on utility; with an average WTP of N$728.26 to reduce serious side effects. The average WTP to receive a high-quality vaccine with 90% efficient was found to be N$233.11 (US$15.14). Across classes, there was a strong preference for vaccines with high effectiveness over longer durations of time.

Conclusions

The results provide useful information for the Namibian government to improve the current strategies for vaccine rollout interventions.

Factors associated with COVID-19 vaccine uptake among foreign migrants in China

BACKGROUND/PURPOSE

The COVID-19 outbreak created unique policy challenges for vaccinating special groups like migrants. As part of sustainable development goals, the equitable distribution of the COVID-19 vaccine can contribute to ensuring health for all. This study examined COVID-19 vaccine uptake among foreign migrants in China based on sociodemographics, cultural beliefs, past vaccine behaviors, and psychosocial factors.

DESIGN

An online cross-sectional survey was conducted among foreign migrants in mainland China via social media platforms from 21 November through 20 December 2021. Bivariate (unadjusted odd-ratio) and multivariate logistic regression analyses were performed to establish the correlates of COVID-19 vaccine uptake.

RESULT

Surveyed foreign migrants that are culture neutral (AOR: 2.5, CI: 95%, 1.02-5.90, p = 0.044), willing to pay for vaccination (AOR: 2.27, CI: 95%, 1.18-3.98, p = 0.012), believe in vaccine efficacy (AOR: 3.00, CI: 95%, 1.75-5.16, p < 0.000), have poor psychological health (AOR: 1.96, CI: 95%, 1.14-3.38, p = 0 0.014), and have higher perceived seriousness of COVID-19 (AOR: 2.12, CI: 95%, 1.26-3.57, p = 0.005) are more likely to receive COVID-19 vaccine. Those migrants with a history of declining vaccination (AOR: 0.34, CI: 95%, 0.18-0.65, p = 0.000) and middle-income earners $1701-3500 (AOR: 0.43, CI: 95%, 0.23-0.82, p = 0.010) are less likely to receive the COVID-19 vaccine.

CONCLUSION

This study brings a unique perspective to understanding vaccine behavior among international migrants in China. There is an urgent call from the World Health Organization and countries for complete vaccination and efforts to improve vaccine coverage. However, fewer studies have been conducted globally on the vaccination of migrant populations. The current study provides empirical information to increase the knowledge of the correlates of vaccine behavior among immigrants in countries around the globe. Future studies should conduct cross-country comparisons to understand the factors associated with increasing vaccination rates among immigrant populations to formulate a strong policy to increase vaccine coverage among immigrant populations across countries.

Understanding the role of personal experiences and contextual variables in shaping risk reduction preferences

This article explores how preferences for risk reduction during the COVID-19 pandemic are influenced by personal experiences and contextual variables such as having a close friend or relative who has been infected by the virus (closeness), the severity of the illness (severity), people's own perceptions of being in a risky group (risk group), change in employment status due to the pandemic (employment situation), and vaccination status (vaccination status and altruistic vaccination). We conducted a choice experiment (CE) in Chile, Colombia, and Costa Rica. The attributes of the experiment were risk reduction, latency, and cost. Then, we estimated a mixed logit model to capture preference heterogeneity across the countries. The attributes presented in the CE were statistically significant, with the expected sign in each country. The variables closeness and employment situation presented homogeneous behavior in each country; however, severity, risk group, and vaccination status showed mixed results. We found that preferences were more heterogeneous for the attributes of the CE than for the personal experiences and contextual variables. Understanding the impact of these variables is essential for generating more effective risk reduction policies. For instance, methodologies such as the value of statistical life base their calculations on society's valuation of risk reduction. We provide evidence that the preferences for risk reduction vary due to the everyday situations that individuals face in the context of the pandemic. The latter may cause distortions in the values used to evaluate policies aimed at mitigating the outbreak.

Willingness to COVID-19 vaccination: Empirical evidence from EU

The unforgettable COVID-19 shock is most likely to be reversed by a viable vaccination strategy. In this paper, we investigate willingness to be vaccinated (WTV) against the COVID-19. Current trends suggest that only around 73% of EU inhabitants (15 and +) were immunized, with more than 104 million people still warranted to be immunized. Vaccine reluctance is a key impediment to conducting immunization programs in the setting of a pandemic. We provide first of its kind empirical evidence on the citizens (N = 11,932) of the EU-27 by employing the recent data from the European Commission. Based on the survey responses, controlling for the correlations in the error terms, we utilize a simulated multivariate probit regression model. Our results show that amongst all the statistically significant drivers of the WTV, the positive perception (vaccination works and has no side effects); R&D information (clarity on how vaccination is developed, tested, authorized) has the largest impact on the WTV. We find that the group of variables on social feedback (Positive perception; social adoption and pressure), and on trustworthy sources of information (R&D info; medical advice) are to be considered for WTV policy. The counteracting policy gaps that act against WTV include vaccination governance dissatisfaction, perception of long-term side effects, growing mistrust in information sources, uncertainty between safety and efficacy, education level, and risky age group. Strategies based on the outcomes of this study are needed to address public acceptance and willingness to vaccinate during a pandemic. This research is novel and offers authorities in-depth insights into the challenges and solutions regarding the COVID-19 pandemic and thus to its end via stimulation of the WTV.

Evaluation of Coronavirus Disease 2019 Burnout Syndrome Among Healthcare Workers in Taizhou, China

Objectives: To evaluate COVID-19 burnout syndrome among healthcare workers in Taizhou, China. Methods: A total of 1,103 qualified healthcare workers in Taizhou were included in the study. The Maslach Burnout Inventory-General Survey (MBI-GS) was used to assess burnout syndrome. Results: Among the healthcare workers surveyed, 25.9% experienced COVID-19 burnout syndrome, including 22.3% and 3.6% with mild and moderate burnout, respectively. Multivariate linear regression models revealed associations with emotional exhaustion among healthcare workers, as follows: occupation, education level and professional qualifications. Professional efficacy was impacted by the pandemic, as follows: sex and occupation. The following factors were associated with cynicism among healthcare workers: occupation and underlying disease. Occupation (medical technician vs. physician, β = -7.40, 95% confidence interval: -12.09 to -2.71, p = 0.002) was significantly related to MBI-GS scores after adjusting for confounding factors. Conclusion: COVID-19 burnout syndrome was common among healthcare workers in Taizhou, China, and its impact was more burdensome to physicians.

Implications for COVID-19 vaccine uptake: A systematic review

BACKGROUND

Globally, increasing coronavirus disease (COVID-19) vaccination coverage remains a major public health concern in the face of high rates of COVID-19 hesitancy among the general population. We must understand the impact of the determinants of COVID-19 vaccine uptake when designing national vaccination programmes. We aimed to synthesise nationwide evidence regarding COVID-19 infodemics and the demographic, psychological, and social predictors of COVID-19 vaccination uptake.

METHODS

We systematically searched seven databases between July 2021 and March 2022 to retrieve relevant articles published since COVID-19 was first reported on 31 December 2019 in Wuhan, China. Of the 12,502 peer-reviewed articles retrieved from the databases, 57 met the selection criteria and were included in this systematic review. We explored COVID-19 vaccine uptake determinants before and after the first COVID-19 vaccine roll-out by the Food and Drug Authority (FDA).

RESULTS

Increased COVID-19 vaccine uptake rates were associated with decreased hesitancy. Concerns about COVID-19 vaccine safety, negative side effects, rapid development of the COVID-19 vaccine, and uncertainty about vaccine effectiveness were associated with reluctance to be vaccinated. After the US FDA approval of COVID-19 vaccines, phobia of medical procedures such as vaccine injection and inadequate information about vaccines were the main determinants of COVID-19 vaccine hesitancy.

CONCLUSION

Addressing effectiveness and safety concerns regarding COVID-19 vaccines, as well as providing adequate information about vaccines and the impacts of pandemics, should be considered before implementation of any vaccination programme. Reassuring people about the safety of medical vaccination and using alternative procedures such as needle-free vaccination may help further increase vaccination uptake.

Willingness to pay for a COVID-19 vaccine and its associated determinants in Iran

Introduction

Understanding the individuals' willingness to pay (WTP) for the COVID-19 vaccine could help design policy interventions to control the COVID-19 pandemic. This study aimed to estimate the individuals' willingness to pay (WTP) for a COVID-19 vaccine and to identify its associated determinants.

Methods

A cross-sectional survey was conducted on 526 Iranian adults using a web-based questionnaire. A double-bounded contingent valuation approach was used to estimate WTP for the COVID-19 vaccine. The parameters of the model were estimated based on the maximum likelihood method.

Results

A considerable proportion of participants (90.87%) were willing to pay for a COVID-19 vaccine. Based on our discrete choice model, the estimated mean WTP for a COVID-19 vaccine was US$ 60.13 (CI: 56.80-63.46; p < 0.01). Having a higher perceived risk of being contaminated with COVID-19, higher average monthly income, higher education level, pre-existence of chronic diseases, previous experience of vaccination, and belonging to higher age groups were significant determinants associated with WTP for COVID-19 vaccination.

Conclusion

The present study indicates a relatively high WTP and acceptance of a COVID-19 vaccine among the Iranian population. Average monthly income, risk perception, education level, the preexistence of chronic disease, and previous vaccination experience increased the likelihood of WTP for a vaccine. Subsidizing the COVID-19 vaccine for the low-income population and raising risk perception among the population should be considered in formulating vaccine-related interventions.

Preference and Willingness to Pay for the Regular COVID-19 Booster Shot in the Vietnamese Population: Theory-Driven Discrete Choice Experiment

BACKGROUND

The COVID-19 booster vaccination rate has declined despite the wide availability of vaccines. As COVID-19 is becoming endemic and charges for regular booster vaccination are being introduced, measuring public acceptance and the willingness to pay for regular COVID-19 boosters is ever more crucial.

OBJECTIVE

This study aims to (1) investigate public acceptance for regular COVID-19 boosters, (2) assess the willingness to pay for a COVID-19 booster shot, and (3) identify factors associated with vaccine hesitancy. Our results will provide crucial insights into and implications for policy response as well as the development of a feasible and effective vaccination campaign during Vietnam's waning vaccine immunity period.

METHODS

A cross-sectional study was conducted among 871 Vietnamese online participants from April to August 2022. An online questionnaire based on the discrete choice experiment (DCE) design was developed, distributed using the snowball sampling method, and subsequently conjointly analyzed on the Qualtrics platform. A history of COVID-19 infection and vaccination, health status, willingness to vaccinate, willingness to pay, and other factors were examined.

RESULTS

Among the participants, 761 (87.4%) had received or were waiting for a COVID-19 booster shot. However, the willingness to pay was low at US $8.02, and most participants indicated an unwillingness to pay (n=225, 25.8%) or a willingness to pay for only half of the vaccine costs (n=222, 25.4%). Although information insufficiency and a wariness toward vaccines were factors most associated with the unwillingness to pay, long-term side effects, immunity duration, and mortality rate were the attributes the participants were most concerned with during the vaccine decision-making period. Participants who had children less than 18 years old in their homes infected with COVID-19 had a lower willingness to pay (odds ratio [OR] 0.54, 95% CI 0.39-0.74). Respondents who had children under 12 years old in their family who received at least 1 vaccine dose had a higher willingness to pay (OR 2.03, 95% CI 1.12-3.66). The burden of medical expenses (OR 0.33, 95% CI 0.25-0.45) and fear of the vaccine (OR 0.93, 95% CI 0.86-1.00) were negative factors associated with the level of willingness to pay.

CONCLUSIONS

A significant inconsistency between high acceptance and a low willingness to pay underscores the role of vaccine information and public trust. In addition to raising awareness about the most concerning characteristics of the COVID-19 booster, social media and social listening should be used in collaboration with health professionals to establish a 2-way information exchange. Work incentives and suitable mandates should continue to encourage workforce participation. Most importantly, all interventions should be conducted with informational transparency to strengthen trust between the public and authorities.

The willingness of Chinese healthcare workers to receive monkeypox vaccine and its independent predictors: A cross-sectional survey

The global monkeypox outbreak in 2022 has severely affected the life and health of people. Currently, partial smallpox vaccines have been approved for monkeypox prevention. Considering the potential occupational health risks of monkeypox infection among healthcare workers (HCWs), this study explored the willingness of Chinese HCWs to receive the monkeypox vaccine and analyzed the factors influencing their decision. We conducted an online cross-sectional survey among HCWs of 10 Chinese hospitals from May 30th, 2022 to August 1st, 2022. Specifically, a self-report questionnaire was administered to evaluate the attitude and acceptance of HCWs toward the monkeypox vaccine, followed by a multivariate logistic regression analysis to determine the independent predictors of vaccination. The survey included 1032 participants, of whom 90.12% expressed their willingness for vaccination (vaccine hesitancy rate = 9.88%). Univariate analysis showed that 11 variables differed significantly between the vaccine acceptance and vaccine hesitancy groups. Multivariate logistic regression analysis demonstrated that the age of 30-40 years (odds ratio [OR] = 0.504, 95% confidence interval [CI]: 0.284-0.893, p = 0.019 vs. age of <30 years old), working in a secondary hospital (OR = 0.449, 95% CI: 0.249-0.808, p = 0.019 vs. working in a tertiary hospital), considering vaccination necessary for controlling monkeypox infection (OR = 4.135, 95% CI: 2.109-8.106, p < 0.001 vs. not considering it necessary), willingness to pay for the monkeypox vaccine (OR = 2.125, 95% CI: 1.206-3.745, p = 0.009 vs. no willingness to pay), considering implementation of mandatory vaccination necessary (OR = 1.990, 95% CI: 1.023-3.869, p = 0.043 vs. not considering it necessary), and recommending family members and friends to take the vaccine (OR = 13.847, 95% CI: 7.487-25.609, p < 0.001 vs. not recommending) were crucial independent predictors of the willingness to receive monkeypox-related vaccination. This study evaluated the acceptance and hesitancy rates of Chinese HCWs toward the monkeypox vaccine and found that the willingness to receive vaccination was mainly correlated to age, hospital level, and attitude toward vaccination. Therefore, to promote vaccine absorption, we recommend expanding publicity, formulating reasonable policies, and improving the recognition of vaccines.

Willingness to Pay (WTP) for COVID-19 Vaccine Booster Dose and Its Determinants in Indonesia

Willingness to pay (WTP) for booster doses of coronavirus disease 2019 (COVID-19) vaccines is an under studied research topic. Therefore, the current study aimed to investigate the WTP for the booster doses of COVID-19 vaccines and its predictors in Indonesia using an online survey distributed all over the provinces of this low-middle-income country. The WTP was evaluated using a basic dichotomous contingent valuation approach, and its associated determinants were evaluated using a linear regression model. Out of 2935 responders, 66.2% (1942/2935) were willing to pay for a booster dose of the COVID-19 vaccine. The majority of respondents (63.5%) were willing to pay within a price range of 100,000-500,000 Indonesian rupiah (IDR), i.e., USD 6.71-33.57. Being older than 40 years, having a higher educational level, having a higher income, knowing and understanding that booster doses were important, and having a vaccine status that is certified halal (permissible in Islamic law), were all associated with a higher WTP for the booster dose of COVID-19 vaccines. The study findings imply that the WTP for a booster dose of COVID-19 vaccination in Indonesia is lower compared to acceptance of vaccines provided free of charge. This WTP data can be utilized to develop a pricing scheme for the booster doses of COVID-19 vaccination in the country with potential benefits in other low-income countries. The government may be required to provide subsidies for the herd immunity vaccination process to proceed as anticipated. Furthermore, the public community must be educated on the importance of vaccination as well as the fact that the COVID-19 epidemic is far from being over.

Cueing quality: Unpacking country-of-origin effects on intentions to vaccinate against COVID-19 in Taiwan

While existing studies have reported and recognized country-of-origin effects on the intentions to vaccinate against COVID-19 among individual citizens in some countries, the causal mechanism behind such effects to inform public health policymakers remain unexplored. Adding up a quality cue explanation for such effects to the existing literature, the authors argue that individual consumers are less willing to get a vaccine designed and manufactured by a country with a significantly lower quality perception than other countries. A survey experiment that recruited a nationally representative sample of Taiwanese adults (n = 1951) between December 13, 2020 and January 11, 2021 was designed and conducted to test the argument. We find that all else equal, Taiwanese respondents were on average less likely to express stronger willingness to take a vaccine from China than from the US, Germany, and Taiwan. Furthermore, even when the intrinsic quality of the vaccine was held constant by the experimental design, respondents still had a significantly lower quality perception of the vaccine from China, both in terms of perceived protection and severe side effects. Further evidence from casual mediation analyses shows that about 33% and 11% of the total average causal effects of the "China" country-of-origin label on vaccine uptake intention were respectively mediated through the perceived efficacy of protection and perceived risk of experiencing severe side effects. We conclude that quality cue constitutes one of many casual mechanisms behind widely reported country-of-origin effects on intention to vaccinate against COVID-19.

COVID-19 vaccine acceptance and its determinants in the Bono Region of Ghana

Objective

The study assessed willingness to accept the COVID-19 vaccine among out-patient department (OPD) attendants in the Bono Region in Ghana.

Design

This was an analytical cross-sectional study.

Setting

The study was conducted at the Wenchi Methodist Hospital (WMH) OPD, Bono Region, Ghana. The region had not yet been earmarked for vaccination at the time of the study.

Participants

Three hundred and twenty-five (325) participants aged ≥18 years, accessing care at the OPD of WMH and willing to give informed consent, were interviewed.

Main outcome measures

The proportion of participants willing to accept the COVID-19 vaccine and its determinants.

Results

Of 325 participants interviewed, 32 (9.8%) had been vaccinated already. 82.6% (242/293) indicated COVID-19 vaccine acceptance among the unvaccinated. The major reason for vaccine acceptance was "it could protect against COVID-19" (96.7%, 234/242). "Fear of vaccine side effects and "perception of not being susceptible to COVID-19" were among the reasons for vaccine refusal. Perceived susceptibility to COVID-19 (AOR 4.09, 95% CI 1.79, 9.34), knowledge of COVID-19 and COVID-19 vaccine (AOR 3.62, 95% CI 1.14, 11.46) and willingness to pay for the vaccine (AOR 5.20, 95% CI 2.49, 10.43) were associated with vaccine acceptance.

Conclusions

Adequate knowledge of COVID-19 and the vaccine may drive vaccine acceptance in the study area and possibly other areas in Ghana. Campaign messages aimed at increasing COVID-19 vaccine coverage must emphasise its safety, likely side effects and management in order to help rid the population of misconceptions.

Funding

None indicated.

The main decision-making competence for willingness-to-pay towards COVID-19 vaccination: a family-based study in Taizhou, China

PURPOSE

This research aimed to explore individuals' willingness to pay (WTP) and studied the role of family decision makers in WTP for COVID-19 vaccines.

METHODS

A self-administered online questionnaire evaluating the willingness of community residents to pay for booster vaccination of COVID-19 vaccine was conducted among families in a community in Taizhou, China. The logistic regression model was performed to identify the factors associated with WTP for the COVID-19 vaccines, and all data were analysed by R software, version 4.1.0.

RESULTS

44.2% and 43.7% of 824 community residents were willing to pay for the first two doses and the booster dose of the COVID-19 vaccine, respectively. Decision-makers were more willing to pay for both the first two doses and the boost dose of the COVID-19 vaccines, with OR (95%CI) being 1.75 (1.25-2.47) and 1.89 (1.34-2.67), respectively. Besides, participants' WTP for COVID-19 vaccines were also associated with their occupation and monthly household income.

CONCLUSION

This study found that family decision-makers were more willing to pay for both the first two doses and the booster dose of COVID-19 vaccines in Taizhou, China. To improve the WTP for COVID-19 vaccines, public policy programs need to conduct a comprehensive cost-benefit analysis and focus on the role of family decision makers in vaccination.Key MessagesA study evaluating the willingness of community residents to pay for booster vaccination of COVID-19 vaccine was conducted among families in a community in Taizhou, China.Family decision-makers were more willing to pay for both the first two doses and the booster dose of COVID-19 vaccines.To improve the WTP for COVID-19 vaccines, public policy programs need to conduct a comprehensive cost-benefit analysis and focus on the role of family decision-makers in vaccination.

Determinants of willingness to pay for health services: a systematic review of contingent valuation studies

INTRODUCTION

Stated preference studies are a valuable tool to elicit respondents' willingness to pay (WTP) for goods or services, especially in situations where no market valuation exists. Contingent valuation (CV) is a widely used approach among stated-preference techniques for eliciting WTP if prices do not exist or do not reflect actual costs, for example, when services are covered by insurance. This review aimed to provide an overview of relevant factors determining WTP for health services to support variable selection.

METHODS

A comprehensive systematic literature search and review of CV studies assessing determinants of WTP for health services was conducted, including 11 electronic databases. Two of the authors made independent decisions on the eligibility of studies. We extracted all determinants used and related p values for the effect sizes (e.g. reported in regression models with WTP for a health service as outcome variable). Determinants were summarised in systematic evidence tables and structured by thematic domains.

RESULTS

We identified 2082 publications, of which 202 full texts were checked for eligibility. We included 62 publications on 61 studies in the review. Across all studies, we identified 22 WTP determinants and other factors from 5 thematic domains: sociodemographic characteristics, perceived threat, perceived benefit, perceived barriers, and other information.

CONCLUSION

Our review provides evidence on 22 relevant determinants of WTP for health services, which may be used for variable selection and as guidance for planning CV surveys. Endogeneity should be carefully considered before interpreting these determinants as causal factors and potential intervention targets.

Impacts of Vaccination on International Trade During the Pandemic Era

This paper examines how COVID-19 vaccinations change international trade. We analyze monthly level trade data from January 2020 to March 2022 that cover the bilateral exports from 40 reporting countries to 220 partner countries. Our findings can be summarized as follows. On average, the effects of vaccination rates in importing and exporting countries on exports were found to be insignificant. When considering the income level, we also did not find significant effects of vaccination rates in high- and low-income importing countries on exports. In contrast, the rise of vaccination rates in low-income exporting countries significantly increased their exports though no significant increase in exports was detected when vaccination rates rose in high-income exporting countries. These results imply that since low-income countries are mainly engaged in labor-intensive industries, the relaxation of lockdown orders (i.e., movement and gathering restrictions) driven by the rise of vaccination rates plays a crucial role in production activities in low-income countries.

Willingness to pay for booster dose of COVID-19 vaccine among healthcare workers in Taizhou,China

PURPOSE

We explored the willingness to pay for booster dose of COVID-19 vaccine among health-care workers in Taizhou, China.

METHODS

A population-based self-administered online questionnaire evaluating the willingness of health-care workers to pay for booster vaccination of COVID-19 vaccine was conducted in Taizhou, China. Of the 1102 health-care workers received the invitation, 1072 (97.3%) had received twice vaccination of COVID-19 vaccine.

RESULTS

There were 1569 (53.1%) out of 1072 health-care workers not willing to pay for thebooster dose of COVID-19 vaccines, 348 (32.5%) were willing to pay less than 100CHY for the booster dose of COVID-19 vaccines, only 155 (14.5%) were willing to pay more than 100 CHY. The factors related to willingness to pay for booster dose of COVID-19 vaccines were education level (c2 = 9.42, P = .01) or whether they had adverse effect to COVID-19 vaccines (c2 = 11.87, P < .01) .

CONCLUSION

This study found that about half of health-care workers were willing to pay for booster dose of inactivated SARS-CoV-2 vaccines in Taizhou, China, most of them are willing to pay less than 100 CHY. Health-care workers' willingness to pay for booster dose of COVID-19 vaccines were related to sex, education level, whether they had adverse effect to COVID-19 vaccines.

COVID-19 Vaccination: Sociopolitical and Economic Impact in the United States

Since the outbreak of COVID-19, vaccination against the virus has been implemented and has progressed among various groups across all ethnicities, genders, and almost all ages in the United States. This study examines the impacts of socioeconomic status and political preference on COVID-19 vaccination in over 443 counties in the southwestern United States. Regression analysis was used to examine the association between a county’s vaccination rate and one’s personal income, employment status, education, race and ethnicity, age, occupation, residential area, and political preference. The results were as follows: First, counties with higher average personal income tend to have a higher vaccination rate (p < 0.001). Second, county-level vaccination is significantly associated with the percentage of Democrat votes (β = 0.242, p < 0.001). Third, race and ethnicity are vaccine-influencing factors. Counties with more Black residents have lower vaccine acceptance (β = −0.419, p < 0.001), while those where more Hispanics or Native Americans reside are more likely to accept vaccines for health protection (β = 0.202, p < 0.001; β = 0.057, p = 0.008, respectively). Lastly, pertaining to the age difference, seniors aged 65 and older show substantial support for vaccination, followed by the median age group (all p < 0.001).

Willingness to pay for a COVID-19 vaccine for oneself and one's child among individuals attending a tertiary care centre in West Bengal, India

BACKGROUND

The free-of-cost supply could not meet the demand for coronavirus disease-2019 (COVID-19) vaccines in India, so the government approved an injection option with a price. We aimed to determine how much money an individual would be willing to pay for a COVID-19 vaccine for themselves and their children and assess the factors determining it.

METHODS

We conducted a study among all adults visiting the outpatient department of a government tertiary care hospital in West Bengal, India, in August 2021. Trained nursing officers combined bidding game and open-ended question methods during personal interviews to estimate the willingness-to-pay (WTP) values.

RESULTS

The mean (standard deviation) age of 1565 participants was 40.8 (12.2) years with 46.5% (n = 727) males, 70.4% (n = 1102) parents, 50.0% (n = 783) educated upto class 12 and 30.9% (n = 483) belonging to upper-middle socio-economic scale (SES). The median (inter-quartile range [IQR]) WTP amount for the first dose and the subsequent/booster dose among the unvaccinated (50.2%, n = 785) and vaccinated (49.8%, n = 780) participants were ₹0 (0-100) and ₹0 (0-200), respectively. The median (IQR) WTP for inoculating children with any COVID-19 vaccine was ₹50 (0-300) in both groups. Significant differences were found in the WTP prices for adult vaccines in both groups concerning age category (P = 0.02), education (P < 0.01) and SES (P < 0.01).

CONCLUSION

Although more than half of the respondents were unwilling to pay for themselves, WTP for COVID-19 vaccination was higher for their children. Policy-makers should consider income, education and age to cap the private sector vaccination price.

Willingness to pay for and willingness to vaccinate with the COVID-19 vaccine booster dose in China

Objective: The present study aims to assess the willingness to pay (WTP) for and willingness to vaccinate (WTV) with the Coronavirus (COVID-19) vaccine booster dose in China when the pandemic is under adequate control and the majority of the population is vaccinated. This study is also to identify significant factors associated with the WTP. Methods: This was a cross-sectional study on adults with no past or present COVID-19 infection. An online questionnaire was distributed to collect data on vaccination status, quarantine experience, and factors related to health beliefs on vaccination. The WTV was assessed through the vaccination preference. The WTP was examined by payment scale (PS) and iterative bidding game (IBG) administered in random order. Three IBG algorithms with different starting-price were presented randomly. The average WTP of PS and IBG were analyzed as primary outcomes using univariate and multivariate analyses. Multivariate ordered logistic regression was performed to identify significant factors for the WTP. Results: The survey recruited 543 participants with a mean age of 32 years and 57.80% being female. The WTV rate was 86.74%, while 94.66% of participants completed full-schedule or enhanced vaccination. The mean WTP was CNY 149 (±CNY 197) and the median WTP was CNY 80. Regarding significant factors for the WTP, urban residents were 57% more likely (95% CI: 1.11-2.22) to pay for a high-priced vaccine than rural residents. Respondents who completed full-schedule vaccination were 46% more likely (95% CI: 1.03-2.07) to pay for a high-priced vaccine than those who completed enhanced vaccination. Respondents with a low household income of CNY 40k or lower were 62% less likely (95% CI: 0.21-0.66) to pay for a high-priced vaccine than those with a middle household income of CNY 110k-210k. Other significant factors associated with the WTP included the perceived benefit of vaccination and peer environmental pressure in the health belief model. Conclusion: The WTV with the COVID-19 vaccine booster dose was high in China. The WTP was influenced by the place of residence, vaccination status, household income, perceived benefit of vaccination, and environmental peer pressure. Study findings can inform policymakers to better design vaccination programs and financial schemes involving out-of-pocket payments.

Willingness to pay for COVID-19 vaccines in Jordan: Applying the health belief model

BACKGROUND

To date, there is no effective treatment for COVID-19. Vaccines are effective and safe strategies to control the pandemic.

OBJECTIVE

To measure consumers' maximum willingness to pay (WTP) for COVID-19 vaccines in Jordan and to identify the predictors of WTP.

METHOD

An online survey was used to collect data related to sociodemographic factors and constructs from the Health Belief Model (HBM). The contingent valuation method using the payment card approach was used, whereby the respondents were asked to choose their maximum WTP value from a range of 5-200 Jordanian Dinar (JOD). The maximum WTP values were then categorized into several groups, and an ordered logistic model was used to generate adjusted odds ratios and estimate the significant predictors of maximum WTP.

RESULTS

A total of 3116 respondents completed the survey. More than half of the sample were not willing to pay out of pocket for the vaccine (57%). Among the respondents who were willing to pay any amount above zero, the mean maximum WTP was 28.1 JOD (39.63 USD), and the median WTP was 20 JOD (28.21 USD). The significant predictors of higher WTP values were being of younger age, higher income, being a healthcare provider, having one or more chronic diseases, previous history of receiving the seasonal influenza vaccine, having a family member/friend who has died from the COVID-19, lower perceived risk of the vaccine, higher perceived benefits of the vaccine, and having been recommended to get the vaccine.

CONCLUSION

It is recommended to continue providing the vaccine free of charge to increase its uptake. Educational campaigns should focus on refuting myths related to the vaccine and promoting the benefits of receiving the vaccine in slowing the spread of the pandemic, and improving the economy. Healthcare providers' recommendations have the potential to increase WTP for the vaccine.

Factors influencing the acceptability of COVID-19 vaccination: A cross-sectional study from Malaysia

Background

With the surge of COVID-19 cases worldwide, vaccines against COVID-19 are also developing across the countries. However, the acceptability of COVID-19 vaccination among general people is questionable. The availability of several vaccines’ options against COVID-19 has perplexed people regarding individual vaccines’ efficacy and safety. Therefore, we aim to determine the acceptance, preferences, impact factors of future COVID-19 vaccines in Malaysia and the factors influencing the COVID-19 vaccination acceptance among vaccine demand and vaccine delay groups.

Material and methods

An online-based cross-sectional survey was conducted among Malaysian residents 18 years and above of either gender using the snowball sampling technique. A self-administered questionnaire was made available to participants through various social media networks, email, and telegram. The data obtained from the survey were analyzed using SPSS version 25.0. Association between background characteristics and respondents were analyzed using the Chi-square test in the vaccine delay group and vaccine acceptance group.

Results

Total of 1282 responses were considered for the study, mainly from male respondents (71%). Among the respondents, 95.9% thought that vaccination would be an effective way to prevent and control COVID-19, and 96% would accept vaccination if the COVID-19 vaccine were successfully developed and approved for listing in the future. Essential factors influencing vaccination decisions were vaccine convenience (95.7%) and doctor's recommendation (97.3%). Bivariate analysis revealed that age less than 24 years, Malay race, living in urban areas, tertiary education, students, single marital status, family income (Malaysian ringgits) RM 4,850 to RM 10,959 and >RM 10,960 were significantly associated with vaccine acceptance of COVID19 vaccination.

Conclusion

All the factors influencing COVID-19 vaccine acceptance rates throughout the country should be studied on a larger scale, and appropriate steps to ensure vaccine acceptance among the public should be meticulously devised by the government and related authorities.

The demand for a COVID-19 vaccine

Taking willingness to pay as primitive, this paper establishes an analytical framework for demand estimation, where the estimator is robust to endogeneity of price. Applying the framework, this paper then estimates demand functions for a COVID-19 vaccine and compute the consumer surplus in both China and the UAE. We find that the price elasticities of demand are mostly greater than one in both countries. An elastic demand suggests subsidy is likely to be successful in promoting vaccination. The consumer surplus is sizeable, around 58 billion US$ in China and 646 million US$ in the UAE. The figures can inform policymakers in assessing their vaccine programs.

Financing COVID-19 vaccination in sub-Saharan Africa: lessons from a nation-wide willingness to pay (WTP) survey in Ghana

BACKGROUND

Over 13 million doses of the corona virus disease, 2019 (COVID-19) vaccines have been administered in Ghana as at March, 2022; 28.5% of the population have received one dose while 16.3% have been fully vaccinated. Cost associated with COVID-19 vaccinations in low- and middle-income countries (LMICs) requires rethinking on sustainable funding arrangements to consolidate gains made towards containing the COVID-19 pandemic.

OBJECTIVE

Ascertain the determinants of willingness to pay (WTP) for COVID-19 vaccination among adult eligible population in Ghana, and prefer evidence-based policy recommendations on sustainable financing regime for COVID-19 vaccination in the global south.

METHODS

Setting/design: A cross-sectional web-based survey was conducted among adult population aged 18 years and above across the sixteen (16) administrative regions of Ghana.

PARTICIPANTS

A sub-sample of 697 participants willing to receive the COVID-19 vaccine was used as the unit of analysis.

OUTCOME MEASURES

main outcome measures of interests were willingness to pay for COVID-19 vaccination and the specific amount respondents were willing to pay. The odds of WTP and specific amount were predicted using the step-wise backward logistic regression and backward step-wise OLS, respectively.

RESULTS

A total of 2,107 adult respondents aged 18 years and above were reached out to answer the questionnaire; 1,556 successfully completed the questionnaire, representing 74% response rate. Out of the 1,556 valid responses, 697 said they will receive the COVID-19 vaccine. Out of the 697 sub-sample willing to accept the vaccine, 386 (55%) were willing to pay an average of US$6.00 for the vaccine. Positive predictors of WTP were: being an educated male (OR = 0.55, 95% [CI = 0.366, 0.826], p = 0.004), married and educated (OR = 2.19, 95% [CI = 1.077, 4.445], p = 0.030), being a married health worker (OR = 0.43, 95% [CI = 0.217, 0.845], p = 0.015), and having positive perception of the vaccine (OR = 2.40, 95% [CI = 1.144, 5.054], p = 0.021). High WTP amounts correlated positively with adherence to COVID-19 prevention protocols (Coef. = 10.30, 95% [CI = 0.463, 20.137], p = 0.040) and being a health worker with tertiary education (Coef. = 56.339, 95% [CI = 8.524, 104.154], p = 0.021). Christians who are also health workers by occupation were less likely to pay higher amounts for the vaccine (Coef. = -71.431, 95% [CI = 118.821, -24.040], p = 0.003).

CONCLUSIONS

WTP for COVID-19 vaccination in Ghana is low relative to comparative studies in the sub-region. There is the need for accelerated, advocacy and public education on the benefits of vaccination. Likewise, there should be broader stakeholder engagement and national dialogue on sustainable financing options for COVID-19 vaccination as donor support continues to dwindle for LIMCs like Ghana.

Perspectives on COVID-19 Vaccines and Its Hesitancy Among Jordanian Population

Background

Since the spread of the COVID-19 virus, governments are putting significant resources into ending the pandemic. Vaccination arises as the best solution to get back to our everyday lives. However, we are now facing vaccine hesitancy, which is a critical problem.

Methods

This cross-sectional study was conducted between December 15, 2020, and March 1, 2021, using a validated online-based questionnaire; participants were compared using the Statistical Package for the Social Sciences (SPSS) program based on multiple factors.

Results

A total of 1607 participants throughout Jordan have responded to the questionnaire, among which 880 (54.8%) have bachelor's degrees, 236 (14.7%) have a high educational level (master and doctoral), and 491 (30.5%) have a diploma or less. Although this is a non-probable sample, it is not a representative sample as, according to United Nations Educational, Scientific and Cultural Organization (UNESCO), only 33.6% of the Jordan population have a tertiary education.

Overall, 892 (55.5%) of the studied subjects had the intention to take the vaccine, distributed as follows: 156 (66.1%) of the high educational participants wanted to take the vaccine, compared to 512 (58.2%) of those who have bachelor’s degree and 224 (45.6%) of those who have diploma or less (p < 0.001). Reading scientific articles talking about the vaccines and their effects (55.6%, p < 0.001), knowing the mechanism of action (45.2%, p = 0.007), getting proper medical advice (27.2%, p < 0.001), encouraged by the increasing number of infections and deaths (39.7%, p < 0.001), and the number of people who received the vaccine (16.1%, p < 0.001) were the most critical factors that played a role in taking the vaccine by all of the studied groups.

Male gender (OR = 2.02; 95% CI = 1.54-2.64; p < 0.001), high income of more than 1000 JDs (1400 USD) (OR = 3.23; 95% CI = 2.21-4.71; p < 0.001), having an educational level of either high education (OR = 3.39; 95% CI = 2.07-5.55; p < 0.001) or bachelor degree (OR = 1.67; 95% CI = 1.25-2.24; p = 0.001), and being encouraged by the increasing number of infections and deaths caused by COVID-19 (OR = 1.97; 95% CI = 1.46-2.66; p < 0.001) were all significantly associated with the willingness to take the vaccine.

Conclusion

As the world rushes toward vaccination to end the pandemic, efforts are needed to end this phenomenon of vaccine hesitancy by enlightening people with the precise knowledge regarding the vaccine's mechanism of action, side effects, and efficacy focusing mainly on people with lower educational levels.

Design and Cross-Cultural Invariance of the COVID-19 Vaccine Conspiracy Beliefs Scale (COVID-VCBS) in 13 Latin American Countries

Aims

Over the past 2 years, the vaccine conspiracy beliefs construct has been used in a number of different studies. These publications have assessed the determinants and outcomes of vaccine conspiracy beliefs using, in some cases, pooled data from different countries, and compared the results across these contexts. However, studies often do not consider measurement invariance as a necessary requirement for comparative analyses. Therefore, the aim of this study was to develop and evaluate the cross-cultural MI of the COVID-19 Vaccine Conspiracy Beliefs Scale (COVID-VCBS) in 12 Latin American countries.

Methods

Confirmatory factor analysis, item response theory analysis and alignment method were applied to test measurement invariance in a large number of groups.

Results

The COVID-VCBS showed robust psychometric properties and measurement invariance for both factor loadings and crosstabs. Also, a higher level of acceptance of conspiracy beliefs about vaccines is necessary to respond to higher response categories. Similarly, greater acceptance of conspiracy beliefs about COVID-19 vaccines was related to a lower intention to be vaccinated.

Conclusion

The results allow for improved understanding of conspiracy beliefs about COVID-19 vaccines in the countries assessed; furthermore, they provide researchers and practitioners with an invariant measure that they can use in cross-cultural studies in Latin America. However, further studies are needed to test invariance in other countries, with the goal of developing a truly international measure of conspiracy beliefs about COVID-19 vaccines.

COVID-19 Vaccine Acceptance in Padang City, West Sumatra, Indonesia

Background: Indonesia started the COVID-19 vaccination program in January 2021. West Sumatra, Indonesia, as one of the epicentres of the spread of COVID-19, has also begun the vaccination program. However, the Government has conducted no vaccine acceptance survey in this area as done in several other Indonesia regions. Aim: This study aims to see an overview of the acceptance of COVID-19 vaccination in West Sumatra, Indonesia. Methods: A descriptive research with a survey method using a questionnaire instrument given directly to the people of Padang, West Sumatra, Indonesia. The total respondents in this study amounted to 390 people based on inclusion criteria, with the method of taking accidental sampling. Results: This study showed that 38.2% of respondents were willing to be vaccinated, 27.9% refused to be vaccinated, and 33.8% had not decided to accept or reject the vaccine. Most respondents refused the vaccine with fear of side effects 42.9% and were concerned about vaccine safety 33.9%. More than half of the respondents (51.0%) wanted to vaccinate at public health centre. As many as 85.4% of respondents wanted to get more information about the COVID-19 vaccine being developed. Online platforms, print and electronic media are sources of information with about 40.5%, followed by face-to-face communication with 36.0% and social media with 23.5%. Conclusion: The people of Padang who stated that they were willing to undergo the COVID-19 vaccine program had not yet reached half of the number of respondents studied. However, this number has the opportunity to increase based on the enthusiastic trend of people who want to get more information about the COVID-19 vaccine. Providing correct and precise information should encourage the general public to participate in vaccination.

Sociodemographic Determinants of Willingness and Extent to Pay for COVID-19 Vaccine in India

Background

Responding to the fast transmission rates and increasing fatality rates, countries across the world expedited the development and deployment of the vaccine for coronavirus disease 2019 (COVID-19). Evaluation of individuals' willingness to pay (WTP) would provide pertinent information regarding future demand and financing preferences, which shall help to devise the effective payment strategy for COVID-19 vaccination.

Methods

A nationwide, cross-sectional, and self-administered online survey using a structured questionnaire was conducted to identify the sociodemographic determinants of willingness and extent to pay for COVID-19 vaccine in India. A non-probability convenience sampling followed by snowball sampling was employed to recruit participants (n = 3,341). The likelihood of sociodemographic determinants to predict willingness and extent to pay was modeled using the multivariate binary logistic regression analysis.

Results

Out of 3,341 participants, 68% (n = 2,271) were willingness to pay for COVID-19 vaccine. Results showed significantly higher odds for willingness to pay among participants who were single [adjusted odds ratio (aOR) = 1.394, p < 0.01] and having a family size of 4 members (aOR = 1.346, p < 0.01). The adjusted odds ratio sizably increased from 1.396 for participants whose monthly income was between INR 10,000 and 20,000/month to 2.240 for participants whose monthly income was above INR 50,000/month. Further, out of 2,271 of those participants who were willingness to pay for COVID-19 vaccine, majority (n = 1,246, 54.9%) of participants were willingness to pay below 50% of COVID-19 vaccine cost. This study found that those who are single (aOR = 0.688, p < 0.01), having an income between INR 20,000 and 50,000/month (aOR = 0.686, p < 0.05), and those who belonged to socially disadvantaged category (aOR = 0.450, p < 0.01) were estimated to have significantly lower odds of willingness to pay more than 50% of COVID-19 vaccine cost.

Conclusion

This study observed that majority of those participants who willingness to pay for COVID-19 vaccine were willingness to pay only up to 50% of COVID-19 vaccine and income was observed as a precursor predictor of the willingness and extent to pay for COVID-19 vaccine. The understanding on the willingness and extent to pay for COVID-19 vaccine and its sociodemographic determinants will be helpful for making the strategic decisions related to the financing of COVID vaccine in India.

Acceptance and willingness to pay under the different COVID-19 vaccines: A contingent valuation method

Background

The COVID-19 vaccine is recognized as a novel tool in the battle against COVID-19. Recently, there were several types of vaccines that have a different effectiveness and safety profile. Understanding the vaccine acceptance and willingness to pay (WTP) are essential to develop a strategic plan to increase the rate of COVID-19 vaccination uptake.

Objectives

To assess the acceptance and WTP for a COVID-19 Vaccine in Thailand using the contingent valuation method (CVM). Additionally, to identify the factors that affect the acceptance and the amount of WTP for a COVID-19 Vaccine.

Methods

We conducted a cross-sectional survey using a payment card approach with open-ended questions during September 2021. Three hypothetical COVID-19 vaccines (Vaccines A, B, and C) in two scenarios were employed. Data were collected from 752 people. Multivariate logistic regression was performed to assess the predictors of vaccine acceptance. Multiple linear regression was used to analyze factors associated with the maximum amount WTP for a vaccine.

Results

Of 742 respondents, the highest acceptance was vaccine C (70.71%), followed by B (17.72%) and A (11.57%). Similarly, 53.87%, 41.44%, and 36.21% of the respondents expressed WTP for vaccine C, B and A, respectively. The maximum amount WTP for vaccine C was US$46, followed by B (US$35) and A (US$32). Factors affecting acceptance included monthly salary, region of residence, education, perceived risk of COVID-19 infection, knowledge and attitude about the COVID-19 vaccine. In addition, monthly salary, region of residence, education and knowledge on COVID-19 vaccine were related to maximum amount WTP.

Conclusion

Acceptance and WTP depends on vaccine characteristics. Educational campaigns should be implemented to improve people's awareness, knowledge, and attitude towards COVID-19 vaccines to increase the vaccines' acceptance. To increase the rate of vaccination, the Thai government needs to allow freedom of choice on vaccines, while considering effectiveness and safety issues.

Factors Associated With the Vaccination Behavior Among COVID-19 Vaccine Hesitant College Students in Wuhan, China: A Survey Based on Social Psychological Dimension

Background

During the COVID-19 pandemic, vaccine hesitancy (VH) on COVID-19 vaccination still exists in different populations, which has a negative impact on epidemic prevention and control. The objectives were to explore college students' willingness to vaccinate, determine the factors influencing the vaccination behavior of students with COVID-19 vaccine hesitancy, and provide a basis for improving the compliance of college students with COVID-19 vaccination.

Methods

The universities in Wuhan are categorized into three levels according to their comprehensive strength and randomly sampled at each level, of which ten universities were selected. A self-designed anonymous electronic questionnaire was distributed online from May 12 to 31, 2021 to investigate the hesitancy, vaccination status, and influencing factors of COVID-19 vaccination among college students in Wuhan.

Results

Of the 1,617 participants (1,825 students received the electronic questionnaire) surveyed, 19.0% reported COVID-19 vaccine hesitancy. Among the vaccine-hesitant students, 40.1% were vaccinated against COVID-19. The binary logistic regression analysis shows that families' attitudes "Uncertain" (odds ratio (OR) = 0.258 [0.132-0.503]), vaccination risk psychology (OR = 0.242 [0.079-0.747]) and wait-and-see mentality (OR = 0.171 [0.068-0.468]) are negative factors for the vaccination behavior of hesitant students, while herd mentality (OR = 7.512 [2.718-20.767]) and uncertainty of free policy's impact on vaccine trust (OR = 3.412 [1.547-7.527]) are positive factors.

Conclusion

The vaccine hesitancy among college students in Wuhan was relatively high. Family support, herd mentality and free vaccination strategies can help improve vaccination among hesitant students, while vaccination risk psychology and "wait-and-see" psychology reduce the possibility of vaccination. The vaccination strategy of college students should be strengthened from the perspective of social psychological construction.

What Is the Support for Conspiracy Beliefs About COVID-19 Vaccines in Latin America? A Prospective Exploratory Study in 13 Countries

Conspiracy theories about COVID-19 began to emerge immediately after the first news about the disease and threaten to prolong the negative impact of the COVID-19 pandemic by limiting people's willingness of receiving a life-saving vaccine. In this context, this study aimed to explore the variation of conspiracy beliefs regarding COVID-19 and the vaccine against it in 5779 people living in 13 Latin American countries (Argentina, Bolivia, Chile, Colombia, Cuba, Ecuador, El Salvador, Guatemala, Mexico, Paraguay, Peru, Uruguay and Venezuela) according to sociodemographic variables such as gender, age, educational level and source of information about COVID-19. The study was conducted during the COVID-19 pandemic between September 15 and October 25, 2021. The Spanish-language COVID-19 Vaccine Conspiracy Beliefs Scale (ECCV-COVID) and a sociodemographic survey were used. The results indicate that, in most countries, women, people with a lower educational level and those who receive information about the vaccine and COVID-19 from family/friends are more supportive of conspiracy ideas regarding the COVID-19 vaccine. In the case of age, the results vary by country. The analysis of the responses to each of the questions of the ECCV-COVID reveals that, in general, the countries evaluated are mostly in some degree of disagreement or indecision regarding conspiratorial beliefs about COVID-19 vaccines. The findings could help open further study which could support prevention and treatment efforts during the COVID-19 pandemic.

Health-care Workers’ Willingness to Pay for COVID-19 Vaccines in Eastern Ethiopia: Using Contingent Valuation Method

Background

Health-care workers (HCWs) are among the highest risk groups for COVID-19 infection. The vaccine is found to be vital for HCWs, their household contacts, and their patients to protect against COVID-19 infection and maintain the safety of health systems. The actual willingness to pay for COVID-19 vaccination and associated factors remain uncertain among health-care workers in Ethiopia. Therefore, studying health-care workers’ willingness to pay (WTP) for COVID-19 vaccination helps to have an insight on valuation of the vaccine.

Methods

Institution-based cross-sectional study was conducted among 403 randomly selected health-care workers working in health facilities in eastern Ethiopia from February 3 to March 20, 2021. Pretested structured questionnaire was used to collect data. Binary logistic regression analysis was fitted to test the associations between outcome and explanatory variables. A p-value of <0.05 with 95% confidence interval was used to declare statistical significance.

Results

The magnitude of willingness to pay for a COVID-19 vaccine was 42.8%. The median amounts of money respondents willing to pay was 400 ETB (US$ 10.04). Sex (male, AOR = 2.33; 95% CI: 1.39, 3.93), monthly income (>7000 ETB, AOR = 1.22; 95% CI: 1.11, 2.51), affordability (AOR = 1.99; 95% CI: 1.18, 3.35), fear of side effects (AOR = 3.75; 95% CI: 2.13, 6.60), support vaccinations (AOR = 2.97; 95% CI: 1.65, 5.35), the likelihood of getting COVID-19 infection (AOR = 2.11; 95% CI: 1.26, 3.52) were independent determinants of WTP for a COVID-19 vaccine.

Conclusion

Health-care workers’ willingness to pay for COVID-19 vaccination was found to be low. Detailed health education and training about COVID-19 vaccines are required regarding their side effects, and efficacy to make an informed decision to enhance the willingness to pay for the vaccine. Moreover, the government should consider providing COVID vaccines free of charge for low-income groups and at an affordable price for those who could pay.

Scope Issue in Contingent Valuation Studies of the COVID-19 Vaccine: The Case of China

BACKGROUND

Assessing the public's willingness to pay (WTP) for the coronavirus disease 2019 (COVID-19) vaccine by the contingent valuation (CV) method can provide a relevant basis for government pricing. However, the scope issue of the CV method can seriously affect the validity and reliability of the estimation results.

AIM

To examine whether there are scope issues in respondents' WTP for the COVID-19 vaccine and to further verify the validity and reliability of the CV estimate results.

METHOD

In this study, nine different CV double-bounded dichotomous choices (DBDC) hypothetical COVID-19 vaccine scenarios were designed using an orthogonal experimental design based on the vaccine's attributes. A total of 2450 samples from 31 provinces in Mainland China were collected to independently estimate the public's WTP in these nine scenarios with logistic, normal, log-logistic and log-normal parameter models. Based on this estimation, several external scope tests were designed to verify the validity and reliability of the CV estimate results.

RESULTS

In the 20 pairs of COVID-19 vaccine scenarios, 6 pairs of scenarios were classified as negative scope issues, therefore not passing the external scope test. Of the remaining 14 pairs of scenarios, only four pairs of scenarios completely passed the external scope test, and one pair of scenarios partially passed the external scope test. Significant negative scope and scope insensitivity issues were revealed.

CONCLUSION

In the context of a dynamic pandemic environment, the findings of this study reveal that the CV method may face difficulty in effectively estimating respondents' WTP for the COVID-19 vaccine. We suggest that future studies be cautious in applying the CV method to estimate the public's WTP for the COVID-19 vaccine.

Self-Reported COVID-19 Vaccine Hesitancy and Willingness to Pay: A Cross-Sectional Survey in Thailand

This study aimed to estimate the prevalence and influencing factors of COVID-19 vaccine hesitancy and willingness to pay in Thailand. A descriptive cross-sectional study was conducted from 13 September 2021 to 14 January 2022. Data were collected using an online questionnaire consisting of demographic characteristics, COVID-19 vaccine hesitancy (delay in acceptance and denying vaccination), determinants of vaccine hesitancy (complacency, convenience, and confidence), and willingness to pay. The general Thai population aged ≥18 years were surveyed. Among 705 respondents, 10.4% reported hesitancy, with significant determinants being low complacency and confidence in the vaccine; low convenience was not a significant determinant. Multivariate analysis revealed vaccine hesitancy among women, those with higher education, non-healthcare workers, and those who lived in rural areas. Furthermore, 77.2% of respondents were willing to pay, with the majority willing to pay in the range of THB 501-1000 ( USD 1 = THB 33) per dose. Increased monthly income, no impact of COVID-19 on income, and time period (before mRNA vaccine availability) significantly affected willingness to pay.

COVID-19 and Pro-environmental Behaviour at Destinations Amongst International Travellers

This paper investigates the COVID-19 pandemic, and its impact on pro-environmental behaviour of individuals travelling internationally for leisure and recreational purposes. The aim of this manuscript is to investigate a conceptual framework created through the examination of current existing literature in the field of tourism science. The conceptual framework, consisting of certain constructs of the health belief model (HBM), and the theory of planned behaviour (TPB), is applied and tested using a partial least-squares-structural equation modelling (PLS-SEM). Data were collected from participants who have travelled internationally before and during the outbreak of the COVID-19 pandemic, and those who plan to travel post-COVID-19 pandemic. Results revealed that the conceptual framework tested positively against existing theory, highlighting the key influencing factors in which COVID-19 is likely to have on future pro-environmental behaviour of individuals travelling internationally for leisure and recreational purposes. Moreover, perceived safety threat and outcome expectations have a positive impact on attitude; attitude has a positive impact on behavioural intentions; subjective norm has a positive impact on behavioural intentions, and perceived behavioural control has a positive impact on behavioural intentions. The study results identify practical and theoretical implications for global and travel companies and organisations, presenting opportunities to adjust environmental policies and procedures accordingly, whilst identifying the most effective marketing and management strategies to rebuild a collapsed global travel industry.