Strategy for determining vaccination user fees and locations: A case study in rural China

Despite the enormous success of vaccinations in decreasing disease burden, there are still millions of deaths from vaccine-preventable diseases worldwide, especially in the developing world. The literature reports that people living in rural areas in China often fail to be immunized not only because of inability to pay user fee but also due to poor geographical accessibility to vaccination sites. However, the level of user fees and the locations of vaccination sites have not been systematically determined in vaccination planning practices, and little research effort has been dedicated to develop a scientific tool to design optimal vaccination strategies. This dissertation addresses important policy questions of how many vaccination sites are needed, where they should be located, and how much users should be charged, so as to maximize the outcomes of vaccination programs under budget constraints.;This research develops a decision-analytic tool to address these policy questions based on optimization models integrated with various quantitative techniques. The data were collected from a case study conducted in a rural area of southern China in 2004 with contingent valuation (CV) surveys to assess households' willingness to pay for typhoid vaccinations and using geographical information systems (GIS) to obtain location and road information. The data were used to estimate a household demand function for vaccinations which depends on user travel distance as well as the user fee. Using the demand information in location models and simulations, this research demonstrates how the outcomes of vaccination programs change based upon the outpost locations and user fees, along with evidence of substantial private benefits brought about by locating outposts closer to users. It also estimates a cost function to show how much of the costs of delivering vaccinations are associated with the number of outposts and the range of vaccination coverage. All these results are integrated into an optimization tool to seek out the user fee and locations of vaccination outposts that meets specific policy objectives. Upon successful adoption and implementation in actual planning processes, this tool could play a critical role in determining user fees and locations for market-based public health vaccination services in developing countries.