Vaccine or policy attributes? Unpacking the drivers of vaccine acceptance in France

Abstract

Objectives: This study investigates how vaccine and policy attributes, along with individual characteristics, influence vaccination decisions in France. It focuses on respondents whose choices vary depending on vaccine or policy features, rather than those who always accept or refuse vaccination. Methods: We use data from the French subsample (N = 3,152) of the VaxPref database, which includes a discrete choice experiment (DCE) where respondents evaluated 12 hypothetical vaccination scenarios. A random effects logit model was estimated incorporating seven vaccine and policy attributes and individual-level covariates. We report average marginal effects and relative attribute importance. Heterogeneity is assessed by stratifying the sample based on general vaccine attitudes. Results: Vaccine effectiveness, protection duration, and side-effect risk substantially affect vaccine acceptance. The vaccine's origin has the strongest influence, with non-EU vaccines—especially those from China and Russia—markedly reducing acceptance. Social restrictions lower willingness to vaccinate, while work-related mandates show no significant impact. Vaccine and policy attributes together explain 11 % of decision variance, with vaccine attributes having greater weight. The remaining 89 % reflects individual characteristics, which are largely immutable but informative for targeted communication. Attribute rankings remain stable across general vaccine attitude subgroups, though their relative importance and explained variance differ. Conclusions: Vaccine acceptance is shaped by both vaccine-related and policy-related attributes, but vaccine characteristics—particularly country of origin—play a larger role in individual decision-making. In France, vaccination strategies aimed at preventing epidemic spread should therefore prioritize the production and promotion of vaccines manufactured in Europe. Communication strategies should also be tailored to audience attitudes: for individuals who already support vaccination, messages can emphasise vaccine efficacy and the risks of side effects, whereas for those with lower levels of support, message should be adapted to individual characteristics.