Public Acceptance and Willingness-to-Pay for a Future Dengue Vaccine: A Community-Based Survey in Bandung, Indonesia.

Background: All four serotypes of dengue virus are endemic in Indonesia, where the population at risk for infection exceeds 200 million people. Despite continuous control efforts that were initiated more than four decades ago, Indonesia still suffers from multi-annual cycles of dengue outbreak and dengue remains as a major public health problem. Dengue vaccines have been viewed as a promising solution for controlling dengue in Indonesia, but thus far its potential acceptability has not been assessed. Methodology/Principal Findings: We conducted a household survey in the city of Bandung, Indonesia by administering a questionnaire to examine (i) acceptance of a hypothetical pediatric dengue vaccine; (ii) participant's willingness-to-pay (WTP) for the vaccine, had it not been provided for free; and (iii) whether people think vector control would be unnecessary if the vaccine was available. A proportional odds model and an interval regression model were employed to identify determinants of acceptance and WTP, respectively. We demonstrated that out of 500 heads of household being interviewed, 94.2% would agree to vaccinate their children with the vaccine. Of all participants, 94.6% were willing to pay for the vaccine with a median WTP of US$1.94. In addition, 7.2% stated that vector control would not be necessary had there been a dengue vaccination program. Conclusions/Significance: Our results suggest that future dengue vaccines can have a very high uptake even when delivered through the private market. This, however, can be influenced by vaccine characteristics and price. In addition, reduction in community vector control efforts may be observed following vaccine introduction but its potential impact in the transmission of dengue and other vector-borne diseases requires further study. Author Summary: While methods for vector control such as mosquito breeding source reduction and focal insecticide spraying that have been practiced to reduce dengue transmission in Indonesia have had limited success, dengue vaccines are expected to be an effective control method. However, even if an efficacious vaccine is developed, public acceptance and viable financing mechanisms are crucial for a successful introduction and sustainability of a new vaccination program. In this paper, we report public acceptance and willingness-to-pay for a hypothetical dengue vaccine for children that would be made available in the future. We found a very high proportion of surveyed participants, more than ninety-four percent, were willing to accept and pay for the vaccine. These findings provide a strong support for a dengue vaccination program. On the other hand, we also found a small possibility of reduction in vector control efforts if a dengue vaccination program is put in place. This could have a potential to increase the transmission of other vector-borne diseases and should be taken into account when introducing a dengue vaccination program. [ABSTRACT FROM AUTHOR]