How do the public think we should prioritise

vaccination programmes?

Results from qualitative interviews and a

discrete choice experiment

Hannah Christensen

Gemma Lasseter, Hareth Al-Janabi, Caroline L Trotter, Fran E Carroll

Health Protection Research Unit (HPRU) in Evaluation of Intervention

27 November 2017

1MRF conference 2017

Is the current approach ok?

2

Are all QALYs equal?

3

=?

The plan

• Identify factors which the population may consider relevant in prioritising different vaccination programmes

• Use a discrete choice experiment to determine population preferences >> ‘weights’ that could be used to prioritise vaccination programmes against childhood diseases

4

Identifying factors the population think are

relevant when considering vaccine decisions

• Qualitative study

• 320 postal invites to adults in Bristol & S Gloucestershire (200 March, +120 June 2016)

• 4 rounds of semi-structured interviews – thematic analysis

• 21 interviews; 17♀ 4♂ age range 35-75+

5

6

Age

Disease

severity

How

common

Social

group

Carer

impact

Side

effects

Herd

effects

Peace

of mind

infection

Factors

7

“I think 1 year old or less is a vulnerable age group from health wise and you know within considering possible death, causes of death. Once they get a bit older, say two year olds,

they’re a bit more robust…”

Age

8

“If it’s something that you can get over without any long-term consequences then I’m not sure there’s a real need to be

vaccinated against it, but if it could result in death or long-term health consequences then I think it’s a different case.”

Disease

severity

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[J]ust considering the impact on families or, children with diseases that they could’ve been immunised against…it’s a

way of making policymakers think about the effects, because they tend to think in financial terms, not necessarily in

effects on the family, on parents, on siblings and psychological effects...depression, anxiety, self-harming, any, any of those kind of things that can be triggered by extreme

circumstances.

Carer

impact

Using a DCE to determine population

preferences

• Developed DCE using 5 attributes from qualitative study

• 32 questions split into 2 blocks – each person answers 16 questions

• Respondents given a scenario and asked to choose between 2 vaccine options

• Representative sample of 2002 UK adults 10

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27 November 2017

“Imagine that you are a policy maker and that you have been given a limited

amount of money to fund a new vaccination programme in the UK. You have

been asked to choose between two different vaccination programmes, but

there is only enough money to fund one. Each vaccination programme costs

the same amount of money and will be given to same number of people (to

be exact 650,000 people). The vaccination programme is publically funded,

so there will be no charge for those people receiving the vaccine and it will

not be possible to buy the vaccine privately. The different vaccination

programmes have different benefits for the people vaccinated.”

Question 1

Vaccination Programme A Vaccination Programme B

Age group 12 to 17 years ≤1 year old

Disease severity Severe Moderate

How common Rare (65 people) Uncommon (650 people)

Carer impact Moderate Severe

Social group Socially advantaged Socially disadvantaged

I would choose Vaccination Programme A

I would choose Vaccination Programme B

DCE results

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-0.800

-0.600

-0.400

-0.200

0.000

0.200

0.400

0.600

0.800

Vaccine A (left handside)

Vaccine B (right handside)

-0.800

-0.600

-0.400

-0.200

0.000

0.200

0.400

0.600

0.800

Verycommon

Common Uncommon Rare

-0.800

-0.600

-0.400

-0.200

0.000

0.200

0.400

0.600

0.800

Mild Moderate Severe Very severe

-0.800

-0.600

-0.400

-0.200

0.000

0.200

0.400

0.600

0.800

Mild Moderate Severe Very severe

-0.800

-0.600

-0.400

-0.200

0.000

0.200

0.400

0.600

0.800

Advantaged Disadvantaged

Age group How common

Carer impact

Disease severity

Social (dis)ad Alternative

-0.800

-0.600

-0.400

-0.200

0.000

0.200

0.400

0.600

0.800

≤1 year old 2 to 11years

12 to 17years

18 years+

Vaccine A(left hand side)

Co

effi

cien

tC

oef

fici

ent

Vaccine B(right hand side)

Conclusions

• The UK general public do have preferences for characteristics relevant to vaccine decision making

• Early evidence to suggest these preferences differ from ‘weight’ currently used

• Future CE analysis should consider these population preference ‘weights’

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Acknowledgements

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With thanks to the individuals who took part in the qualitative interviews and DCE survey.

This study was funded by the Meningitis Research Foundation.

HC is supported by the NIHR Health Protection Research Unit in Evaluation of Interventions at University of Bristol. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, the Department of Health or Public Health England.

Research teamDr Gemma LasseterUniversity of Bristol

Dr Hareth Al-JanabiUniversity of Birmingham

Dr Caroline L TrotterUniversity of Cambridge

Dr Fran E CarrollRoyal College of Obstetricians and Gynaecologists