Parental preferences for a mandatory vaccination scheme in England: A discrete choice experiment.

Background: Mandatory vaccination has been mooted to combat falling childhood vaccine uptake rates in England. This study investigated parental preferences for a mandatory vaccination scheme. Methods: Discrete choice experiment. Six attributes were investigated: vaccine, child age group, incentive, penalty, ability to opt out, and compensation scheme. Mixed effects conditional logit regression models were used to investigate parental preferences and relative importance of attributes. Findings: Participants were 1,001 parents of children aged 5 years and under in England (53% female; mean age=33·6 years, SD=7·1; 84% white). Parental preferences were mostly based on incentives (30·7% relative importance; 80·9% [95% confidence interval 76·3-85·0%] preference for parent and 74·8% [71·0-78·3%] for child incentive; reference: no incentive) and penalties (25·4% relative importance; 69·5% [65·7-73·1%] preference for schemes where unvaccinated children cannot attend school or day care and 67·6% [63·6-71·4%] for those withholding financial benefits for parents of unvaccinated children; reference: £450 fine). Parents also preferred schemes that: offered a compensation scheme (18·1% relative importance; 66·4% [62·7-69·8%] preference; reference: not offered), mandated vaccination in children aged 2 years (versus 5 years; 11·4% relative importance; 42·6% [39·4-45·9%] preference; reference: 2 years), mandated the 6-in-1 vaccine (10·5% relative importance; 58·2% [54·6-61·7%] preference; reference: MMR), and that offered only medical exemptions (versus medical and religious belief exemptions; 4·0% relative importance; 45·5% [41·1-50·0%] preference; reference: medical exemptions). Interpretation: These findings can inform policymakers' decisions about how best to implement a mandatory childhood vaccination scheme in England. Funding: Data collection was funded by a British Academy/Leverhulme Small Research Grants (SRG1920\101118).