Crucial Choices in a Global Health Crisis: Revealing the Demand and Willingness to Pay for a Hypothetical Monkeypox Vaccine - the PREVENT Study

"Besides empirical evidence on social and structural barriers to vaccination, frameworks for understanding vaccination motivation are needed to assess willingness to receive a monkeypox vaccine."

In July 2022, the World Health Organization declared monkeypox a global health emergency. The Preference for Vaccine Evaluation & Trail (the PREVENT Study) is a Vietnam nationwide assessment using a patient-centred design to inform health technology development and acceleration. This study was conducted to assess the acceptability and willingness to take and pay for a hypothetical monkeypox vaccine among the Vietnamese general public, as well as investigate preference for individual vaccine attributes.

An online cross-sectional study was conducted using snowball sampling among 842 respondents in Vietnam in 2022. A discrete choice experiment (DCE) on preference for six major attributes of vaccine - effectiveness, immunity duration, side effects, mortality rate, restriction, and cost - was applied.

Two-thirds of participants were willing to take the vaccine, while insufficient information on monkeypox and the vaccine were the main reasons for vaccine hesitancy. The study found that participants who had higher risks of infected diseases and service satisfaction scores had a higher level of willingness to inject the vaccine.

Although the monkeypox vaccine was widely accepted, just 20% of respondents were willing to pay for it, even when people had knowledge about the disease and the related risks. Results also demonstrated cost as the least influential factor when making vaccine decisions compared to other clinical attributes, where all factors were weighted at least twice as much cost. A higher score of knowledge of transmission routes and ways to prevent monkeypox and satisfaction with service were positive factors associated with willingness to pay for the monkeypox vaccine. By contrast, a higher score of fear of the vaccine and the burden of medical expenses were likely to be associated with a lower level of willingness to pay.

Overall, the findings indicate a high willingness to take monkeypox vaccines and a moderate willingness to pay, provided that sufficient information about the pandemic and vaccine characteristics are available; this preference was the same among the general population and health professionals/medical students. While most participants had a basic understanding of monkeypox, the researchers urge that more information should be given on monkeypox symptoms and transmission. As reported here, compared to COVID-19, monkeypox information was significantly less effectively communicated to the public.

Thus, the researchers recommend that "Transparent communication is needed about monkeypox presentation, risks, recommendations of clinicians, and the active role of the population in prevention and management. Given the increasing popularity of online platforms, information should be dispensed through social media as well. In the interest of early communication, public figures and influential individuals should be recruited or encouraged to raise awareness about the disease, especially in the domains where monkeypox substantially differs from COVID-19, such as transmission mode and symptoms."

Furthermore: "Social listening insights on public perception and misinformation should be more widely utilized to inform risk communication and identify areas that need addressing, such as the potential stigmatization of LGBTQ+ groups associated with the misconception that monkeypox is transmitted through homosexual contact....At the same time, conventional means such as television and public infographics should still maintain the role of an official and trusted standard-setting platform to avoid misinformation."

Future research directions could involve looking at the optimal price and discount level, cost distribution strategy across different socioeconomic and geographical groups, and social factors that influence the decision to vaccinate.

In conclusion: As lack of information and misinformation were the primary predictors of vaccine reluctance and unwillingness to pay, urgent and effective information dissemination should be implemented....Regarding vaccination, authorities should prioritize high-risk groups and consider the population's willingness to be vaccinated to determine the optimal vaccine price without compromising the country’s economic status and limited health resources."