Willingness to pay for herpes zoster vaccination in urban China

Herpes zoster imposes a substantial disease burden in China. Despite vaccination being critical for burden mitigation, willingness-to-pay (WTP) for herpes zoster vaccines among urban residents remains understudied, with a lack of national-level evidence on its determinants. A national-wide survey was conducted among 2,864 urban residents aged ≥25 years across nine provinces and nine cities in China. Using the contingent valuation method (CVM), three elicitation approaches - payment scales, bidding, and open-ended questions - were employed to assess respondents' willingness-to-pay (WTP) for herpes zoster vaccination. Univariate statistical analyses were then performed to explore the associations between socioeconomic characteristics and WTP. Median WTP varied by methods (payment cards: CNY 300, bidding: CNY 500, open-ended: CNY 300). Across these methods, 36.09%, 29.06%, and 23.64% of participants, respectively, were unwilling to pay (including those rejecting free vaccination). For higher thresholds, 2.36% and 9.96% reported WTP ≥ 2,000 CNY via the payment scale and bidding methods, while 2.09% indicated WTP ≥ 2,000 CNY through the open-ended method. Age was negatively associated with WTP, and respondents from moderately developed regions had the highest WTP. Education and annual household income showed positive associations with WTP. Additionally, unemployment, chronic disease, divorced or widowed residents, and below-average self-reported health correlated with lower WTP. While respondents with public or commercial insurance had highest WTP. In conclusion, individual WTP for herpes zoster vaccine is substantially influenced by socioeconomic characteristics, which are inherently linked to income. This highlights the need for income-sensitive policies, including affordable pricing and targeted health education for vulnerable groups.