Allocation of COVID-19 vaccination: when public prioritisation preferences differ from official regulations

Abstract

As vaccines against COVID-19 are scarce, many countries have developed vaccination prioritisation strategies focusing on ethical and epidemiological considerations. However, public acceptance of such strategies should be monitored to ensure successful implementation. In an experiment with N=1379 German participants, we investigated whether the public’s vaccination allocation preferences matched the prioritisation strategy approved by the German government. Results revealed different allocations. While the government had top-prioritised vulnerable people (being of high age or accommodated in nursing homes for the elderly), participants preferred exclusive allocation of the first available vaccines to medical staff and personnel caring for the elderly. Interestingly, allocation preferences did not change when participants were told how many individuals were included in each group. As differences between allocation policies and public preferences can affect trust in the government and threaten the social contract between generations, we discuss possible strategies to align vaccination prioritisations.

Public attitudes about equitable COVID-19 vaccine allocation: a randomised experiment of race-based versus novel place-based frames

“…They also align well with related recent work demonstrating support by Americans for prioritising people of colour presented as being at higher health risk,31 as well as a study comparing public attitudes across 13 countries and finding that across these, ‘the public feel that a broader set of economic factors should be taken into account in prioritisation policies (including low income groups)’. Last, our findings are consistent with survey work emphasising the need to ensure alignment of allocation policy with public preferences to avoid threatening society’s social contract 26. We believe that the findings from this study can be used to develop equitable allocation policies that align with public preferences in the US regarding other healthcare resources (eg, masks, tests, COVID-19 boosters, non-Covid vaccines) in the future.…”

“…More subtle nuances were found when study respondents were provided with information about the fact that increased allocations were in response to NASEM’s recommendation and states’ practices, which led respondents to prefer marginally lower amounts of additional vaccine for at risk populations under all frames, compared with respondents’ preferences without the anchor. The experimental design does not permit us to point to a specific explanation for this difference, but it does align with research demonstrating tensions in the public acceptance of government-driven public health policy 8 19 26 35 36. The policy implication are somewhat paradoxical, in that they would imply that for public support to be strongest, endorsement by state, city or other governments should be as subtle as possible—yet, on grounds of accountability, and in terms of working towards a climate where addressing racism and other forms of inequity are not third rails but necessary components of public policy, it would be desirable not to shy away from being transparent.…”

“…By providing the context that NASEM had recommended a 10% set-aside, and states were implementing additional allocations between 5% and 40%, we provided respondents with real-world benchmarks—and by randomising half of the respondents to the same question without any anchoring, we were also able to gauge acceptable levels of additional allocations independent of actual policy recommendations and practice (as it was safe to assume that few, if any, of the respondents were aware of allocation policy at this level of detail). Second, from the earliest discussions around state-recommended policies such as social distancing, mask-wearing and related measures, it was clear that the public evaluation of public health policy was not merely focused on the scientific rationales, but also concerned with the justification of state authority, and trust in governments and policy-makers at different levels 8 19 26. By splitting respondents in two groups who considered the question of the magnitude of additional allocations with and without information on what state governments were doing, we opened an opportunity to analyse potential differences that could be due to respondents’ views on the authority of state governments in influencing equity through policy.…”

“…Two factors are likely particularly important influences on public perceptions: (1) how the proposals are framed, that is how the different rationales underlying allocation strategies are presented23 and (2) use of anchors, such as the inclusion of numerical information that is supported by experts 24. Both of these factors can influence the public’s understanding of complex decisions that are outside of one’s everyday direct experience and knowledge, such as understanding of vaccine allocation,25 26 and are particularly relevant to perceptions of policy affecting particular racial and ethnic groups, where the public’s underlying attitudes (and sometimes stereotypes) about these groups are so salient 27 28…”

How Should COVID-19 Vaccines be Distributed between the Global North and South? A Discrete Choice Experiment in Six European Countries

“…A majority of these studies examined public opinion on prioritisation within high-income countries and when COVID-19 vaccine availability was still heavily constrained in those countries. (Duch et al, 2021; Gollust et al, 2020; Knotz et al, 2021; Luyten et al, 2020; Persad et al, 2021; Reeskens et al, 2021; Sprengholz et al, 2021) Based on data from online surveys and survey experiments, the studies revealed substantial public support for prioritising frontline healthcare workers and clinically vulnerable groups. (Duch et al, 2021; Persad et al, 2021) To our knowledge, only four studies to date have examined individuals’ preferences on the distribution of COVID-19 vaccines across national borders.…”