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 investi-gate 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 impor-tance; 80.9% [95% confidence interval 76.3-85.0%] preference for parent and 74.8% [71.0-78.3%] for child incen-tive; 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 finan-cial benefits for parents of unvaccinated children; reference: 450 pound fine). Parents also preferred schemes that: offered a compensation scheme (18.1% relative importance; 66.4% [62.7-69.8%] preference; reference: not offered), man-dated vaccination in children aged 2 years (versus 5 years; 11.4% relative importance; 42.6% [39.4-45.9%] prefer-ence; 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 child-hood vaccination scheme in England.