To Pay or Not to Pay? Using the Health Belief Model to Explore Willingness to Pay for COVID-19 Vaccine Among High-Risk Ugandans

OBJECTIVES: Since its emergence in late 2019, coronavirus disease (COVID-19) has dramatically impacted global public health. With overstretched public health resources, Uganda's health ministry authorized private health facilities to administer COVID-19 vaccines for a fee. This study assessed the willingness to pay (WTP) for the COVID-19 vaccine among individuals at high risk of severe disease at a national referral hospital in Uganda.

METHODS: We conducted a secondary analysis of data from 273 participants in a cross-sectional study on COVID-19 vaccine acceptance among high-risk patients at a Ugandan national referral hospital. Descriptive statistics were employed to summarize frequencies, percentages, means, or medians. A multivariable logistic regression model was used to assess the association of demographic factors and the health belief model with WTP.

RESULTS: The mean age was 52.6±13.4 years, 62.6% were ≥ 50 years and 59.1% were female. About 83.9% had at least one comorbidity, mostly cardiovascular diseases (61.5%) and diabetes mellitus (33.7%). Only 2.2% (n=6) had previously been diagnosed with COVID-19. Overall, 44.7% (n=122) were willing to pay for the COVID-19 vaccine, with a median amount of 10,000 UGX (2.4 Euros). WTP was significantly associated with being male (aOR: 2.77, 95%CI: 1.32–5.82, p=0.007), employed (aOR: 2.51, 95%CI: 1.20–5.26, p=0.014), urban residency (aOR: 2.83, 95%CI: 1.29–6.22, p=0.009), perceived belief in the COVID-19 vaccine efficacy (aOR:3.06, 95%CI: 1.48–6.35, p=0.003) and perceived risk of contracting COVID-19 (aOR: 0.14, 95%CI: 0.02–0.90, p=0.038).

CONCLUSIONS: Nearly half Ugandans at high-risk of COVID-19 were willing to pay for a COVID-19 vaccine, with willingness influenced by gender, employment status, urban residency, and belief in vaccine efficacy. These findings suggest the need for targeted health education and vaccine accessibility strategies, particularly in rural areas and among populations with lower perceived risk and vaccine efficacy beliefs.