Parental and Societal Values for the Risks and Benefits of Childhood Combination Vaccines

Published In: Vaccine, v. 30, no. 23, May 2012, p. 3445-3452

Posted on on May 01, 2012

by Courtney A. Gidengil, Tracy A. Lieu, Katherine Payne, Donna Rusinak, Mark L. Messonnier, Lisa A. Prosser

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Research Questions

  1. Do parents and other adults think combination vaccines are safe?
  2. Would they willing to pay more to avoid minor adverse side effects of the vaccines?
  3. Would they be willing to pay more to increase community-level immunization coverage?

BACKGROUND: New combination vaccines reduce the number of injections needed for immunization. However, possible drawbacks include higher prices, extra doses of vaccine antigens and increased minor adverse events. Our objective was to measure parental and societal values for attributes of childhood combination vaccines. METHODS: We conducted a discrete choice experiment using an online survey of adults administered by Knowledge Networks. Values were measured for attributes of combination vaccines for a hypothetical child aged 6 months: (1) number of injections, (2) extra dose of hepatitis B vaccine, (3) 20% higher chance of fever, (4) community-level immunization coverage of 2-year-olds of 90% or 80%, and (5) cost per visit. Logistic regression with generalized estimating equations was used to analyze the value of different attributes and generate a marginal willingness-to-pay for a change in attribute level. RESULTS: The response rate was 64% (N = 558). Most respondents were parents (63%) and most respondents agreed that combination vaccines were safe (77%). Respondents were willing to pay $7.68 to avoid an injection (compared to $9.94 when looking at parents only). However, respondents were willing to pay $41.57 to avoid higher risk of fever after one set of immunizations (10% versus 30%) and $65.42 for higher immunization coverage rates. These results were very similar for parents only. There was no significant preference to avoid an extra dose of hepatitis B vaccine. CONCLUSIONS: Respondents were willing to pay larger amounts to avoid increased risk of minor adverse events and to increase community-level immunization coverage than to avoid injections. These values should be taken into account when determining the risks and benefits of combination vaccines.

Key Findings

  • Respondents thought that combination vaccines were safe.
  • They were willing to pay $41.57 to avoid higher risk of fever after one set of immunizations (10 percent versus 30 percent) and $65.42 for higher immunization coverage rates in the community.
  • Respondents in this survey placed more value on avoiding fever than avoiding injections.
  • Results were very similar for parents and non-parents.


  • This information can help guide decisions for groups such as Advisory Committee on Immunization Practices, and allows for a better understanding of the public's valuation of side effects such as fever.

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