Based on a Chilean sample (N = 531), Cerda and García  recently investigated the willingness to pay (WTP) for vaccination against COVID-19. While 91 participants indicated they would not pay for vaccination, the majority were willing to do so. As higher income increased payment intention, the authors argued that health systems could implement a mix of public and private financing, in which vaccination would be provided free of charge to low-income groups while wealthier individuals would be required to pay.
However, the article fails to fully acknowledge that overall vaccination uptake is likely to decrease if payments were introduced. As the article indicates, those unwilling to pay might choose not to be vaccinated for financial or moral reasons. Additionally, however, some of those who are willing to pay might also refrain if prices were to exceed individual limits related to income as well as the perceived costs and benefits of vaccination . For that reason, we reanalyzed the published data to investigate the potentially detrimental effects of monetary charges on vaccination uptake, especially among those who are willing to pay.
In the original study, one of ten vaccination prices (e.g., an initial charge of US$101) was randomly suggested to those participants who indicated their general willingness to pay for vaccination. If they indicated a willingness to pay the initial charge, they were asked whether they would be willing to pay a higher charge (e.g., US$151); alternatively, they were asked whether they would be willing to pay a lower charge (e.g., US$50). Based on these data, Cerda and García  estimated a mean WTP of US$232. On re-analyzing the data to investigate how many participants would be willing to pay a given price, two gradients were calculated. As shown in Fig. 1, the minimum (maximum) gradient refers to the lowest (highest) proportion of participants willing to pay for vaccination at a particular price. The results indicate that vaccination intention decreases with rising price. While a maximum of 83% of all participants were assumed willing to be vaccinated for US$0.01, vaccination willingness based on the original WTP estimate of US$232 fell to 24% (minimum) to 53% (maximum), and beyond as the price of vaccination increased.
It seems very unlikely that all of those who dropped out at a certain price did so because of limited resources. For that reason, vaccination intention can be expected to decline once a charge is introduced, even with financial support for low-income and vulnerable groups. It follows that vaccination charges would put public health at risk and make it difficult to reach herd immunity. As early research results indicate that vaccination also limits transmission of the coronavirus , it is important to achieve high uptake rates to protect those who cannot be vaccinated, and every affordable measure should therefore be implemented to promote vaccination . Consequently, vaccination against COVID-19 should be free of charge for everyone, and production/procurement, distribution, and administration of vaccines should be financed by government (e.g., by using income tax revenues). Where this is not possible, the COVAX initiative can provide international support .
As discussed by Cerda and García , there is a need for communication measures that emphasize the individual and social risks of COVID-19 and address concerns about the safety and efficacy of the vaccines. Information campaigns can help to foster vaccination intention , but vaccination should be free of charge to ensure maximum conversion of intention into action.
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Open Access funding enabled and organized by Projekt DEAL. This work was supported by the German Research Foundation (BE3970/12-1) and the Klaus Tschira Foundation (no award/grant number).
Conflicts of interest
Availability of data and material
Data are available at https://doi.org/10.17605/OSF.IO/XJHC2.
The data analysis script is available at https://doi.org/10.17605/OSF.IO/XJHC2.
PS and CB designed the research; PS planned and performed data analysis, and wrote the initial draft, which was revised and approved by CB.
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Sprengholz, P., Betsch, C. Comment on: “Willingness to Pay for a COVID-19 Vaccine”. Appl Health Econ Health Policy 19, 619–621 (2021). https://doi.org/10.1007/s40258-021-00656-2