TY - JOUR
T1 - Would COVID-19 vaccination willingness increase if mobile technologies prohibit unvaccinated individuals from public spaces? A nationwide discrete choice experiment from China
AU - Wang, Jing
AU - Wagner, Abram L.
AU - Chen, Ying
AU - Jaime, Etienne
AU - Hu, Xinwen
AU - Wu, Shiqiang
AU - Lu, Yihan
AU - Ruan, Yuhua
AU - Pan, Stephen W.
N1 - Publisher Copyright:
© 2021 Elsevier Ltd
PY - 2022/12/5
Y1 - 2022/12/5
N2 - Background: Achieving COVID-19 community protection (aka, herd immunity) in China may be challenging because many individuals remain unsure or are unwilling to be vaccinated. One potential means to increase COVID-19 vaccine uptake is to essentially mandate vaccination by using existing mobile technologies that can prohibit unvaccinated individuals from certain public spaces. The “Health Code” is a ubiquitous mobile phone app in China that regulates freedom of travel based on individuals’ predicted risk of exposure to SARS-CoV-2. Green-colored codes indicate ability to travel unrestricted in low-risk regions; yellow-colored codes indicate prohibition from major public spaces and modes of public transportation. We examined the effects of a “Health Code”-based vaccine mandate on willingness to vaccinate for COVID-19 in China. Methods: In August 2020, an online discrete choice experiment (DCE) was conducted among adults living in China. Participants completed up to six DCE choice sets, each containing two hypothetical COVID-19 vaccination scenario choices and a “do not vaccinate” choice. Half of the choice sets had a “Health Code” attribute that associated the “do not vaccinate” choice with a yellow Health Code implying restricted travel. Weighted, mixed effects multinomial logit regression was used to estimate preference utilities and predicted choice probabilities. Results: Overall, 873 participants completed 4317 choice sets. Most participants attained at least college-level education (90.9%). 29.8% of participants were identified as vaccine hesitators (defined as being unsure or unwilling to receive a COVID-19 vaccination). With and without the “Health Code”-based vaccine mandate, there was an 8.6% (85% CI: 6.4% − 10.92%) and 17.3% (85% CI:13.1% − 21.6%) respective predicted probability that vaccine hesitators would choose “do not vaccinate” over a common vaccination scenario currently in China (i.e., free, domestic vaccine, 80% effectiveness, 10% probability of fever side-effects, administered in a large hospital, two doses). Corresponding predicted probabilities for people who did not express vaccine hesitancy was 0.3% (93% CI: 0.0% − 14.3%) and 3.5% (93% CI:2.3% − 4.8%). The “Health Code”-based mandate significantly increased willingness to vaccinate when vaccine efficacy was greater than 60%. Conclusion: Among vaccine hesitators with higher educational attainment, willingness to vaccinate for COVID-19 appears to increase if mobile technology-based vaccine mandates prohibit unvaccinated individuals from public spaces and public transportation. However, such mandates may not increase willingness if perceived vaccine efficacy is low.
AB - Background: Achieving COVID-19 community protection (aka, herd immunity) in China may be challenging because many individuals remain unsure or are unwilling to be vaccinated. One potential means to increase COVID-19 vaccine uptake is to essentially mandate vaccination by using existing mobile technologies that can prohibit unvaccinated individuals from certain public spaces. The “Health Code” is a ubiquitous mobile phone app in China that regulates freedom of travel based on individuals’ predicted risk of exposure to SARS-CoV-2. Green-colored codes indicate ability to travel unrestricted in low-risk regions; yellow-colored codes indicate prohibition from major public spaces and modes of public transportation. We examined the effects of a “Health Code”-based vaccine mandate on willingness to vaccinate for COVID-19 in China. Methods: In August 2020, an online discrete choice experiment (DCE) was conducted among adults living in China. Participants completed up to six DCE choice sets, each containing two hypothetical COVID-19 vaccination scenario choices and a “do not vaccinate” choice. Half of the choice sets had a “Health Code” attribute that associated the “do not vaccinate” choice with a yellow Health Code implying restricted travel. Weighted, mixed effects multinomial logit regression was used to estimate preference utilities and predicted choice probabilities. Results: Overall, 873 participants completed 4317 choice sets. Most participants attained at least college-level education (90.9%). 29.8% of participants were identified as vaccine hesitators (defined as being unsure or unwilling to receive a COVID-19 vaccination). With and without the “Health Code”-based vaccine mandate, there was an 8.6% (85% CI: 6.4% − 10.92%) and 17.3% (85% CI:13.1% − 21.6%) respective predicted probability that vaccine hesitators would choose “do not vaccinate” over a common vaccination scenario currently in China (i.e., free, domestic vaccine, 80% effectiveness, 10% probability of fever side-effects, administered in a large hospital, two doses). Corresponding predicted probabilities for people who did not express vaccine hesitancy was 0.3% (93% CI: 0.0% − 14.3%) and 3.5% (93% CI:2.3% − 4.8%). The “Health Code”-based mandate significantly increased willingness to vaccinate when vaccine efficacy was greater than 60%. Conclusion: Among vaccine hesitators with higher educational attainment, willingness to vaccinate for COVID-19 appears to increase if mobile technology-based vaccine mandates prohibit unvaccinated individuals from public spaces and public transportation. However, such mandates may not increase willingness if perceived vaccine efficacy is low.
KW - Antivaccine
KW - Antivaxx
KW - Digital technology
KW - Public health
KW - Stated choice
KW - Vaccine hesitancy
UR - http://www.scopus.com/inward/record.url?scp=85118552023&partnerID=8YFLogxK
U2 - 10.1016/j.vaccine.2021.10.020
DO - 10.1016/j.vaccine.2021.10.020
M3 - Article
C2 - 34742594
AN - SCOPUS:85118552023
SN - 0264-410X
VL - 40
SP - 7466
EP - 7475
JO - Vaccine
JF - Vaccine
IS - 51
ER -