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• W4229444893 abstract "We wish to thank the commentators for their time and effort in providing valuable feedback to our study. The main purpose of our study was to evaluate the willingness to pay (WTP) for a coronavirus vaccine and its associated determinants in Lebanon. WTP for a vaccine is important to understand public acceptance of such a novel vaccine. Given that the refusal of vaccination or delay in acceptance is recognized as a serious public threat,1MacDonald N.E. SAGE Working Group on Vaccine HesitancyVaccine hesitancy: definition, scope and determinants.Vaccine. 2015; 33: 4161-4164Crossref PubMed Scopus (1594) Google Scholar the reasons for hesitation about vaccination and the determinants of WTP are essential for the global vaccination campaign to be effective. As mentioned by Mungmunpuntipantip and Wiwanitkit,2Mungmunpuntipantip R. Wiwanitkit V. Willingness to pay for a coronavirus vaccine: correspondence.Value Health Reg Issues. 2022; 30: 119Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar previous studies support our point of view regarding most of the determinant factors, such as the conception of the severity of the disease.3Tsutsui Y. Shahrabani S. Yamamura E. Hayashi R. Kohsaka Y. Ohtake F. The willingness to pay for a hypothetical vaccine for the coronavirus disease 2019 (COVID-19).Int J Environ Res Public Health. 2021; 18: 12450Crossref PubMed Scopus (3) Google Scholar Moreover, a study conducted in Nigeria showed that religion and age were related to WTP.4Okafor U.G. Isah A. Onuh J.C. Mgbemena C.B. Ubaka C.M. Community acceptance and willingness to pay for hypothetical COVID-19 vaccines in a developing country: a web-based nationwide study in Nigeria.Pan Afr Med J. 2021; 40: 112Crossref PubMed Scopus (3) Google Scholar In the present study by Karam et al,5Karam M.M. Baki J.A. Al-Hajje A. et al.Willingness to pay for a coronavirus vaccine and its associated determinants in Lebanon.Value Health Reg Issues. 2022; 30: 18-25Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar age was not significantly associated with WTP, whereas religion was not considered as a confounding variable. To assess the respondent’s WTP, the contingent valuation method was used. This method is a standard and accepted technique of stated preferences for capturing maximum WTP. Both payment card and open questions were used to reveal WTP. Given that Lebanon is dealing with unstable currency, the WTP presented in our article was assessed based on the maximum value in US dollars. To identify factors associated with this WTP, a bivariate analysis was done. Student’s t test, analysis of variance, or Pearson’s tests were used to test these associations in the case of variables with adequate normal distributions. We agree with the commentators that WTP might be different according to the setting. In Lebanon, although some vaccines can be available for free at primary healthcare centers, not all the vaccines are free of charge. To note, out-of-pocket payments accounted approximately for 33.1% of total health spending in 2017.6Statistical bulletins 2019. Ministry of Public Health. https://www.moph.gov.lb/en/Pages/8/327/statistical-bulletins. Accessed March 17, 2022.Google Scholar As mentioned in our article, this study was conducted at a very early phase between June and July 2020, in which there was not yet a Food and Drug Administration–approved vaccine. It was not clear whether the vaccine will be covered or not. Thus, we estimated a hypothetical range of prices based on the grid of vaccination fees found on the official site of the Ministry of Public Health (MOPH). We noted that the prices of vaccines ranged between 10$ and 200$, according to the disease.7Lebanon national drugs database. Ministry of Public Health. https://www.moph.gov.lb/en/Drugs/index/3/4848/lebanon-national-drugs-database. Accessed November 15, 2020.Google Scholar The prices are fixed by the local currency, the Lebanese pound. Considering the official rate of 1$ = 1507 Lebanese pound, WTP for the hypothetical vaccine was proposed taking as a starting point the lowest price of vaccine available on the website of MOPH and a rounded value of the highest price of vaccine available in Lebanon. As mentioned earlier, an alternative method was considering the inflation scenario. Till January 2021, the coverage of the vaccine was not defined for all the residents in Lebanon. The MOPH has reserved vaccines for 20% of the population residing in Lebanon through the COVID-19 Vaccines Global access (COVAX) facility and for approximately 15% of the population through an official bilateral agreement with Pfizer.8Lebanon national deployment and vaccination plan for COVID-19 vaccines. Ministry of Public Health. https://moph.gov.lb/userfiles/files/Prevention/COVID-19%20Vaccine/Lebanon%20NDVP-%20Feb%2016%202021.pdf. Accessed March 17, 2022.Google Scholar Concerning the pricing system, it is fixed by MOPH. It is done by the general procedure of fixing the price for a vaccine taking into consideration the cost of importation, the custom standardized fees, and the effectiveness and the quality of the vaccine according to the scientific commissions and financial committee.9Karam R. Survey report—prices of medicines in Lebanon. World Health Organization – Health Action International Project on Medicine Prices. https://haiweb.org/wp-content/uploads/2015/07/Lebanon-Report-Pricing-Surveys.pdf. Accessed March 17, 2022.Google Scholar Finally, because the main aim of our study was to evaluate the WTP of the vaccine and its determinants, the pricing process has not been discussed. The application of value-based pricing would be a good perspective in Lebanon because of the increase of out-of-pocket payments. Author Contributions: Concept and design: Karam, Baki, Hajje, Sraj, Ajrouche Acquisition of data: Karam, Baki Analysis and interpretation of data: Karam, Baki, Awada, Salameh, Ajrouche Drafting of the manuscript: Karam, Hajje, Awada, Ajrouche Critical revision of the paper for important intellectual content: Karam, Hajje, Sraj, Awada, Salameh, Ajrouche Statistical analysis: Karam, Baki, Sraj Provision of study materials or patients: Karam Supervision: Salameh, Ajrouche Conflict of Interest Disclosures: The authors reported no conflicts of interest. Funding/Support: The authors received no financial support for this research. Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication." @default.
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