What are public preferences for COVID-19 vaccine prioritization strategies across the globe?

By Dr. Liji Thomas, MDFeb 4 2021

An interesting new study by an international team of researchers describes the results of a novel survey that asked members of the public in a range of countries for their thoughts on prioritization measures for vaccination programs against coronavirus disease 2019 (COVID-19).

Though highly diverse, the sample population provided surprisingly similar answers, which indicates the need to take the public into account when determining how to roll out these vaccines.

Image Credit: Who should be first in line for the COVID-19 vaccine? Surveys in 13 countries of the public’s preferences for prioritisation. Image Credit: Rido / Shutterstock

This news article was a review of a preliminary scientific report that had not undergone peer-review at the time of publication. Since its initial publication, the scientific report has now been peer reviewed and accepted for publication in a Scientific Journal. Links to the preliminary and peer-reviewed reports are available in the Sources section at the bottom of this article. View Sources

The research team’s findings were recently released on the medRxiv* preprint server.

Public prioritization

The researchers surveyed over 15,500 people online in 13 countries to ask about how they would want the vaccines to be distributed. They asked the survey participants to assess provided descriptions of potential vaccine recipients, containing randomly assigned attributes.

The model used in this study – namely, conjoint modeling – has already been used successfully to reflect public views on healthcare, such as on influenza vaccination. The results are largely in line with decision making in the real-world setting. In the current survey, the responses dealt with how vaccines should be made available to people other than the respondents, which is an important departure from earlier uses of this method.

The responses showed that the public used a wide spectrum of characteristics to assign vaccine priorities. These included features such as the risk of being infected or of severe disease, as well as of spreading the disease widely. As such, age, the presence of comorbidities and occupation played a major role in the participants’ preferences in vaccine allocation.

However, the public priorities also included other less predictable factors, such as low-income groups, teaching and other key occupations even though not directly related to health, and non-essential workers who could not work from home.

Consistent preferences across national boundaries

Interestingly, public health vaccine priorities showed quite a marked difference from country to country, but the surveyed members of the public showed a consistent preference pattern across both countries and regions. These are also correlated with the age and income of the respondents, irrespective of their country.

Political preferences also did not appear to interfere with these priorities, which is encouraging, since it indicates that governmental policies tuned to these views would not divide countries.

Putting others first

The researchers observed that many of the participants put the perceived need of other, often dissimilar, vaccine recipients over their own interests. One striking example is how elderly people over 65 years, who are known to be at higher risk of severe disease and death following SARS-CoV-2 infection, often indicated that essential workers in many occupations should receive the vaccine first.

The motives in such allocations may be mixed, mingling a feeling of unselfish generosity, with a desire to decrease the numbers of potentially exposed individuals who could infect others, including the participants, or simply a desire for the world to return to normalcy as quickly as possible through optimal use of the vaccine.

However, these results unmistakably demonstrate that people, in general, can choose to have the most useful type of vaccination schedule without reference to their own personal need for protection from the pandemic.

Comparison with other research

Similar studies are few, but a recent Belgian survey showed that essential workers, those likely to spread the virus, and high-risk groups, were prioritized by the public. This study failed to show any evidence that the public wanted those over 60 years to receive the vaccine earlier.

Such comparisons across countries help us understand to what extent public opinions converge despite different geographical, economic and cultural settings.

Mismatch between vaccine policy and public opinion

The researchers point out that government policies on vaccine priorities show a much larger range of divergence across countries than do public opinions. The two do coincide in some areas, such as prioritizing those at high risk of death from SARS-CoV-2 infection.

However, most countries do not place similar stress on vaccinating those in key occupations such as teaching, though this was evidently a public priority.

The same mismatch was observed with respect to poorer sections of society and those workers in non-essential occupations who nonetheless have to go out of their homes for work. Such a firm emphasis on economically deprived segments of the population, or otherwise disadvantaged groups, has not been a feature of vaccine prioritization by any government anywhere in the world.

Public versus private distribution

Most of the respondents said they would prefer for the vaccine to be allocated only by the government. However, a significant minority said they would pay for the vaccine if it was privately distributed. Many also indicated they would be willing to pay for faster access, most of these being in low- and middle-income countries (India, Uganda, Brazil, Chile).

This trend should be taken into account when framing policies for private allocation, as this should not limit the availability of the vaccine for public vaccination programs. Instead, complementary public and private access should be planned to optimize the reach of the vaccines.

Simultaneously, such combined-access vaccination programs will allow the public to defray the cost as far as is feasible, while preventing injustice and corruption as far as possible.

Allocation Mechanism.

Mandatory or voluntary vaccination?

The survey also reveals broad support for mandatory vaccination but at the same time considerable opposition by a significant proportion of the population, especially in the USA and the UK, and by most of the public in France. These countries should therefore take considerable care to communicate, persuade and execute vaccination programs and policies, in a way that convinces without alienating a large part of their people.

What are the implications?

The important role of the public as stockholders in any public vaccination program should not be disregarded, since public opinion is mostly based on values that should be reflected, or at least seriously considered, by policymakers.

The findings of this study “identify opportunities for policymakers, who have often struggled during the COVID-19 pandemic to meet their obligations to protect public health and the economy while simultaneously respecting the public will.”

Where there are major differences, and the government chooses unpopular policies for the sake of the broader good of the public, a recognition of such differences will help them communicate to the public with greater moral and persuasive force, enhancing the acceptance of vaccination programs against COVID-19.

This news article was a review of a preliminary scientific report that had not undergone peer-review at the time of publication. Since its initial publication, the scientific report has now been peer reviewed and accepted for publication in a Scientific Journal. Links to the preliminary and peer-reviewed reports are available in the Sources section at the bottom of this article. View Sources