Willingness to pay for hand, foot, and mouth disease vaccination in Ho Chi Minh City, Vietnam: A cross-sectional analysis

Abstract

Objective: To estimate the willingness to pay (WTP) of Ho Chi Minh City residents for the hand, foot, and mouth disease (HFMD) vaccine and its associated factors using the contingent valuation method.

Methods: This cross-sectional study was conducted in 2024, involved face-to-face interviews with 423 participants in Ho Chi Minh City. The participants were divided into two groups: parents of children under six and individuals without young children. WTP for the HFMD vaccine was assessed using the Krinsky and Robb procedure and the double-bound dichotomous choice technique. A probit regression model was used to analyze factors influencing WTP.

Results: The participants had a mean age of (34.0±10.3) years, and the majority of them were female, resided in urban areas, and held a university degree. 54.6% had children under six years of age, and 63.8% had never heard of the EV71 vaccine. The mean WTP for two doses of the HFMD vaccine was VND 1 240 000 (USD 51.66). Parents of children under six years old had a mean WTP of USD 49.16, while individuals without young children had a mean WTP of USD 56.25. Significant factors that were positively associated with WTP included vaccine price, younger age, higher income, and greater knowledge about vaccines.

Conclusions: The study indicates a relatively high willingness to pay for HFMD vaccination in Ho Chi Minh City, suggesting strong potential for vaccine implementation. It is recommended that the government disseminate vaccine-related information to enhance public awareness and understanding.

Keywords

Contingent valuation method / Hand, foot, and mouth disease / Vaccination / Vietnam / Willingness to pay

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Funding

The authors received no extramural funding for the study.

Authors’ contributions

Vo TQ, Marzo RR and Vo BV conceived and designed the study. La TB, Vo TQ and Tran QV collected the data. La TB and Tran QV analyzed the data and contributed to the interpretation of the results. Marzo RR, Rajamoorthy Y, Chen HWJ provided methodological support, assisted in statistical analysis, and reviewed the manuscript. All authors contribute to the final version of the manuscript. Vo BV supervised the project and critically revised the manuscript.

Publisher’s note

The Publisher of the Journal remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Edited by Pan Y, Lei Y, Zhang Q

References

[1] Chen Z, Ren X, Yang J, Dong J, Xue Y, Sun LL, et al. An elaborate landscape of the human antibody repertoire against enterovirus 71 infection is revealed by phage display screening and deep sequencing. MAbs 2017; 9(2): 342-349.

[2] Gu W, Zeng G, Hu YM, Hu YS, Zhang Y, Hu YL, et al. A comparative analysis of immunogenicity and safety of an enterovirus 71 vaccine between children aged 3-5 years and infants aged 6-35 months . Expert Rev Vaccines 2018; 17(3): 257-262.

[3] Zhuang ZC, Kou ZQ, Bai YJ, Cong X, Wang LH, Li C, et al. Epidemiological research on hand, foot, and mouth disease in mainland China. Viruses 2015; 7(12): 6400-6411.

[4] Liu Z, Meng Y, Xiang H, Lu Y, Liu S. Association of short-term exposure to meteorological factors and risk of hand, foot, and mouth disease: A systematic review and meta-analysis. Intern J Environm Res Public Health 2020; 17(21): 8017.

[5] Van Pham H, Phan UTN, Pham ANQ. Meteorological factors associated with hand, foot and mouth disease in a Central Highlands province in Viet Nam: An ecological study. West Pac Surveill Response J 2019; 10(4): 18.

[6] World Health Organization. Hand, foot and mouth disease in Viet Nam. [Online]. Available from:https://www.who.int/vietnam/health-topics/hand-foot-and-mouth-disease-(hfmd).Accessed on 27 January 2025].

[7] General Statistics Office of Vietnam. Infographic social-economic situation 4th quarter and 2023 December 29, 2023. [Online]. Available from: https://www.gso.gov.vn/en/data-and-statistics/2023/12/infographic-social-economic-situation-4th-quarter-and-2023/. Accessed on 27 January 2025].

[8] Ho Chi Minh City Center for Disease Control.Epidemic situation of dengue fever and hand, foot and mouth disease in the city. Ho Chi Minh as of week 19/2024. May 18, 2024. [Online]. Available from: https://hcdc.vn/tinh-hinh-dich-benh-sot-xuat-huyet-va-tay-chan-mieng-tai-tp-ho-chi-minh-tinh-den-tuan-192024-DxQ10n.html. Accessed on 27 January 2025].

[9] Nhan LNT, Turner HC, Khanh TH, Hung NT, Lien LB, Hong NTT, et al. Economic burden attributed to children presenting to hospitals with hand, foot, and mouth disease in Vietnam. Open Forum Infect Dis 2019; 6(7): ofz284. doi: 10.1093/ofid/ofz284.

[10] World Health Organization Regional Office for the Western Pacific and the Regional Emerging Diseases Intervention (REDI) Centre. A guide to clinical management and public health response for hand, foot and mouth disease (HFMD). 20U.December 12, 2023. [Online]. Available from: https://iris.who.int/bitstream/handle/10665/207490/9789290615255_eng.pdf. Accessed on 27 January 2025].

[11] Nayak G, Bhuyan SK, Bhuyan R, Sahu A, Kar D, Kuanar A. Global emergence of Enterovirus 71: A systematic review. Beni Suef Univ J Basic Appl Sci 2022; 11(1): 1-11. doi: 10.1186/s43088-022-00258-4.

[12] National center for health communication and education (Vietnam Ministry of Health). How effective is the soon-to-be-licensed hand, foot and mouth vaccine in Vietnam?October 18, 2023 . [Online]. Available from:http://t5g.org.vn/diem-bao-ngay-372023. Accessed on 27 January 2025].

[13] Mao QY, Wang Y, Bian L, Xu M, Liang Z. EV71 vaccine, a new tool to control outbreaks of hand, foot and mouth disease (HFMD). Expert Rev Vaccines 2016; 15(5): 599-606.

[14] Wu JT, Jit M, Zheng Y, Leung K, Xing WJ, Yang J, et al. Routine pediatric enterovirus 71 vaccination in China: A cost-effectiveness analysis. PLoS Med 2016; 13(3): e1001975. doi: 10.1371/journal. pmed.1001975.

[15] Harapan H, Bustamam A, Radiansyah A, Angraini P, Fasli R, Salwiyadi S, et al. Dengue prevention: Confirmatory factor analysis of relationships between economic status, knowledge, attitudes and practice, vaccine acceptance and willingness to participate in a study. Southeast Asian J Trop Med Public Health 2017; 48(2): 297-305.

[16] Harapan H, Fajar JK, Sasmono RT, Kuch U. Dengue vaccine acceptance and willingness to pay. Hum Vaccin Immunother 2017; 13(4): 786-790.

[17] Marzo RR, Chakraborty R, Soh SY, Thew HZ, Chong C, Siau CS, et al. Factors influencing parents’ hesitancy to vaccinate their children aged 5-11 years old against COVID-19: Results from a cross-sectional study in Malaysia. Front Public Health 2023; 11: 1091015. doi: 10.3389/fpubh.2023.1091015.

[18] Tung TH, Lin XQ, Chen Y, Wu H, Zhang MX, Zhu JS. Why do parents willingness-to-pay to vaccinate their children against COVID-19? A real-world evidence in Taizhou, China. Hum Vaccin Immunother 2022; 18(1): 1-9. doi: 10.1080/21645515.2021.2014731.

[19] Etikan I, Musa SA, Alkassim RS. Comparison of convenience sampling and purposive sampling. Am J Theoret Appl Statist 2016; 5(1): 1-4. doi: 10.11648/j.ajtas.20160501.11.

[20] Bornstein MH, Jager J, Putnick DL. Sampling in developmental science: Situations, shortcomings, solutions, and standards. Developm Rev 2013; 33(4): 357-370. doi: 10.1016/j.dr.2013.08.003.

[21] Cochran WG. Sampling techniques. John Wiley & Sons; 1977. [Online]. Available from: https://books.google.com.vn/books?hl=en&lr=&id=byh1AwAAQBAJ&oi=fnd&pg=PP1&dq=The+Sage+encyclopedia+of+qualitative+research+methods. Accessed on 12 December 2023].

[22] Liu JL, Chang PI, Den SJ. Consumer willingness to pay for energy conservation: A comparison between revealed and stated preference method. Proced Environm Sci 2013; 7: 620-629.

[23] Hanemann M, Loomis J, Kanninen B. Statistical efficiency of double-bounded dichotomous choice contingent valuation. Am J Agricul Econom 1991; 3(4): 255-1263.

[24] Lopez-Feldman A. Introduction to contingent valuation using Stata.2012;[Online]. Available from: https://mpra.ub.uni-muenchen.de/41018/2/MPRA_paper_41018.pdf.Accessed on 27 January 2025].

[25] Opić S. Specifics of logit and probit regression in education sciences- Why wouldn’t we use it? Kıbrıslı Eğitim Bilimleri Dergisi 2020; 15(6): 1557-1568.

[26] Jeanty PW. Constructing Krinsky and Robb confidence intervals for mean and median willingness to pay (WTP) using Stata. Presented at Sixth North American Stata Users Group Meeting, 13th-14th August 2007, Boston. December 30, 2023. [Online]. Available from: http://repec.org/nasug2007/pwj_nasug07.pdf.Accessed on 27 January 2025].

[27] General Statistics Office of Vietnam. Statistical yearbook of 2022. [Online]. Available from: https://www.gso.gov.vn/en/data-and-statistics/2023/06/statistical-yearbook-of-2022/. Accessed on 7 September 2023].

[28] Geleto AK. Contingent valuation technique: A review of literature. ISABB J Health Environm Sci 2011; 1(1): 8-16. doi: 10.5897/ISAAB- JHE11.017.

[29] Heinzen RR, Bridges JF. Comparison of four contingent valuation methods to estimate the economic value of a pneumococcal vaccine in Bangladesh. Int J Technol Assess Health Care Fall 2008; 24(4): 481-487. doi: 10.1017/s026646230808063x.

[30] Rajamoorthy Y, Taib NM, Harapan H, Wagner AL, Munusamy S. Application of the double bounded dichotomous choice model to the estimation of parent’s willingness to pay for the hand foot mouth disease vaccination: A survey in Selangor, Malaysia. PLoS One 2023; 18(6):e0286924. doi: 10.1371/journal.pone.0286924.

[31] Cheng L, Zhong S, Lin Y. Chinese parents’ intention to vaccinate their 0-5 years children with EV-71 vaccine against hand, foot and mouth disease and willingness-topay. Front Public Health 2024; 12: 1336687. doi: 10.3389/fpubh.2024.1336687.

[32] Le XTT, Nguyen NTT, Le HT, Do TTT, Nguyen TH, Nguyen HLT, et al. Income inequalities in hepatitis B vaccination and willingness to pay among women of reproductive age in Hanoi, Vietnam . Global Health Sci Prac 2021; 9(3): 523-531. doi: 10.9745/ghsp-d-20-00480.

[33] Nguyen TH, Le XTT, Nguyen LH, Le HT, Do TTT, Nguyen HLT, et al. Resource mobilization for tetanus vaccination in Vietnam: Uptake, demand and willingness to pay among women of reproductive age. Front Public Health 2022; 10: 980850. doi: 10.3389/fpubh.2022.980850.

[34] Nguyen LH, Le TBT, Le NQN, Tran NTT. Acceptance and willingness to pay for vaccine against human papilloma virus (HPV) among parents of boys in central Vietnam. Front Public Health 2022; 10: 801984. doi: 10.3389/fpubh.2022.801984.

[35] Vo NX, Huyen Nguyen TT, Van Nguyen P, Tran QV, Vo TQ. Using contingent valuation method to estimate adults’ willingness to pay for a future coronavirus 2019 vaccination. Value Health Region Issues 2021; 24: 240-246. doi: 10.1016/j.vhri.2021.01.002.

[36] Vo TQ, Tran QV, Vo NX. Customers’ preferences and willingness to pay for a future dengue vaccination: A study of the empirical evidence in Vietnam. Patient Prefer Adher 2018; 12: 2507-2515. doi: 10.2147/ppa. S188581.

[37] Wang Y, Meng F, Li J, Li GF, Hu JL, Cao JQ, et al. Willingness of parents to vaccinate their 6-60-month-old children with EV71 vaccines: A cross-sectional study in rural areas of northern Jiangsu Province. Human Vaccines Immunother 2020; 16(7): 1579-1585. doi: 10.1080/21645515.2020.1737465.

[38] Lane S, MacDonald NE, Marti M, Dumolard L. Vaccine hesitancy around the globe: Analysis of three years of WHO/UNICEF Joint Reporting Form data-2015-2017. Vaccine 2018; 36(26): 3861-3867. doi: 10.1016/j.vaccine.2018.03.063.

[39] Dubé È, Ward JK, Verger P, MacDonald NE. Vaccine hesitancy, acceptance, and anti-vaccination: Trends and future prospects for public health. Annu Rev Public Health 2021; 42(1): 175-191. doi: 10.1146/annurev-publhealth-090419-102240.

[40] Qi L, Su K, Xia Y, Tang W, Shen T, Li Q. Enterovirus 71 vaccine acceptance among parents of children <5 years old and their knowledge of hand, foot and mouth disease,Chongqing, China, 2017. PLoS One 2019; 14(11): e0225569. doi: 10.1371/journal.pone.0225569.

[41] Li T, Wang H, Lu Y, Li Q, Chen C, Wang DH, et al. Willingness and influential factors of parents to vaccinate their children with novel inactivated enterovirus 71 vaccines in Guangzhou, China. Vaccine 2018; 36(26): 3772-3778. doi: 10.1016/j.vaccine.2018.05.054.

[42] Given LM. The Sage encyclopedia of qualitative research methods. Sage publications; 2008. December 12, 2023.[Online]. Available from:https://edge.sagepub.com/system/files/Ch10CodesandCoding.pdf. Accessed on 27 January 2025].

[43] Bayoumi AM. The measurement of contingent valuation for health economics. Pharmacoeconomics 2004; 22: 691-700. doi: 10.2165/00019053-200422110-00001.