Understanding co-payment for COVID-19 vaccines during period vaccine scarcity: evidence from urban Ghana

Purpose This study investigates citizens' willingness to pay (WTP) as a complementary financing mechanism for COVID-19 vaccines in Ghana, analyzing behavior during a period of peak prevalence and severe vaccine scarcity. Design/methodology/approach A cross-sectional survey of 2,010 respondents was conducted in the Greater Accra Metropolitan Area. A two-stage regression approach was employed, using a logit model to analyze the decision to pay and ordinary least squares to determine the factors influencing the amount willing to be paid. The analysis integrated Protection Motivation Theory (PMT) and included heterogeneity assessments by gender and age. The two-stage Heckman, double-hurdle and quantile regression models were employed to test the robustness of the WTP results. Findings The study reveals that a significant segment (23%) of the urban population was willing to pay for COVID-19 vaccines during a period of scarcity, with an average amount of GH₵122 (US$24). The decision to pay was primarily driven by attitudinal factors aligned with PMT. However, heterogeneity analysis reveals critical nuances: the drivers of WTP differed markedly by gender and age. A key finding is the role of altruism, where married males with larger families were willing to pay significantly higher amounts, demonstrating that familial protection motives can override individual cost barriers. Research limitations/implications The cross-sectional design captures WTP at a specific, high-stakes moment, which may not reflect preferences in a non-crisis context. The focus on an urban epicenter population, while methodologically sound for the research questions, limits the generalizability of findings to rural areas. Furthermore, the reliance on stated, rather than revealed, preferences for WTP may be subject to social desirability or hypothetical bias. Practical implications Policymakers should consider demographically sensitive co-payment schemes and tailored public health communication. For long-term resilience, investing in domestic pharmaceutical production is necessary. Originality/value This study provides unique insights by analyzing WTP during an acute vaccine shortage. It moves beyond sociodemographics by integrating behavioral theory and a crucial heterogeneity analysis, offering a nuanced theoretical and practical contribution to sustainable vaccine financing.