Public acceptance and willingness-to-pay for a future dengue vaccine: a community-based survey in Bandung, Indonesia

Date: Sep-20-2013Vaccinating children would be an acceptable strategy, from the community perspective, to control dengue in Indonesia, and delivering the vaccine through the private market could reach a significant proportion of the targeted population, according to a study by researchers from Harvard School of Public Health.

Indonesia is among the countries that have been hardest hit by dengue. With more than 200 million people at risk for acquiring dengue, efforts to control the disease have not yielded significant results. About 30 million dengue infections occur annually in the country, and the circulation of all four dengue serotypes increases the potential for occurrence of severe dengue from a heterologous secondary infection. In 2010, when a severe outbreak occurred, more than 150,000 cases of potentially fatal dengue hemorrhagic fever were reported in Indonesia.

The study, to be published September 19 in PLOS Neglected Tropical Diseases, interviewed 500 household heads in the city of Bandung, a dengue-endemic urban area in Indonesia inhabited by more than 2 million people, and showed that vaccinating children against dengue would be accepted by 94.2 percent of the households. Further, a large majority of the households would be willing to pay for the vaccine if the public sector did not offer it free of charge. The median willingness-to-pay for the vaccine was $1.94; a small proportion of participants were also willing to pay more than $10, suggesting that a price tier strategy can improve coverage in the private sector.

"The findings strongly support the introduction of a pediatric dengue vaccine in Indonesia as a public health strategy to control dengue, even when the vaccine could not be obtained free of charge through the national immunization program" says Panji Hadisoemarto, doctoral candidate at the Department of Global Health and Population, Harvard School of Public Health, who conducted the study. Previously, other researchers have demonstrated that similar support was expressed by Indonesian policy makers, but adoption of a new vaccine into Indonesia's immunization program is usually slow. Indonesia, for instance, was among the last two countries to include vaccination against Haemophilus influenzae B in its expanded program of immunization, launched just two weeks ago; the other country being South Sudan. "Of course, the question on whether and when an efficacious and safe dengue vaccine will be available still need to be answered" added Marcia Castro, Associate Professor at the Harvard School of Public Health, who co-authored the study.

The study hypothesized that the vaccine would be fully efficacious to protect against dengue disease. Recent results from a Phase IIb dengue vaccine trial in Thailand, however, have fallen short of that assumption. In the interim, dengue control efforts will likely depend heavily on promoting community participation in controlling Aedes mosquitoes, the vector responsible for transmitting dengue viruses in Indonesia.

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