How should COVID-19 vaccines be distributed between the Global North and South: a discrete choice experiment in six European countries

  1. Janina I Steinert
  2. Henrike Sternberg
  3. Giuseppe A Veltri
  4. Tim Büthe

  • Curated by eLife

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    Evaluation Summary:

    This paper provides evidence on public opinion from six European countries on key attributes according to which they believe COVID-19 vaccines should be prioritized. The paper presents significant and valuable findings supported by solid evidence.

    (This preprint has been reviewed by eLife. We include the public reviews from the reviewers here; the authors also receive private feedback with suggested changes to the manuscript. The reviewer remained anonymous to the authors)

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Abstract

The global distribution of COVID-19 vaccinations remains highly unequal. We examine public preferences in six European countries regarding the allocation of COVID-19 vaccines between the Global South and Global North.

Methods:

We conducted online discrete choice experiments with adult participants in France (n=766), Germany (n=1964), Italy (n=767), Poland (n=670), Spain (n=925), and Sweden (n=938). Respondents were asked to decide which one of two candidates should receive the vaccine first. The candidates varied on four attributes: age, mortality risk, employment, and living in a low- or high-income country. We analysed the relevance of each attribute in allocation decisions using conditional logit regressions.

Results:

In all six countries, respondents prioritised candidates with a high mortality and infection risk, irrespective of whether the candidate lived in the respondent’s own country. All else equal, respondents in Italy, France, Spain, and Sweden gave priority to a candidate from a low-income country, whereas German respondents were significantly more likely to choose the candidate from their own country. Female, younger, and more educated respondents were more favourable to an equitable vaccine distribution.

Conclusions:

Given these preferences for global solidarity, European governments should promote vaccine transfers to poorer world regions.

Funding:

Funding was provided by the European Union’s Horizon H2020 research and innovation programme under grant agreement 101016233 (PERISCOPE).

Article activity feed

  1. Version published to 10.7554/elife.79819 on eLife
  2. eLife

    Evaluation Summary:

    This paper provides evidence on public opinion from six European countries on key attributes according to which they believe COVID-19 vaccines should be prioritized. The paper presents significant and valuable findings supported by solid evidence.

    (This preprint has been reviewed by eLife. We include the public reviews from the reviewers here; the authors also receive private feedback with suggested changes to the manuscript. The reviewer remained anonymous to the authors)

  3. eLife

    Public Review:

    Using a Discrete Choice Experiment (DCE) the study asks respondents in six EU countries to choose between two persons A and B and select the one that they believe s/he should receive the COVID-19 vaccine first. Across eight different scenarios, each person is given different attributes in terms of age, COVID-19 mortality risk, employment status, and country of residence (own vs. other with low healthcare system capacity). The study found the risk of mortality and also working for essential services to be perceived as particularly important across all the countries. Moreover, living in a low-income country with poor healthcare system capacity was found to be favored when it came to allocating the vaccine first. This is particularly interesting given that the respondents were selected from those who were not vaccinated at the time of the survey but were willing to receive one.

    Strengths:

    • The study evidence is based on large samples from 6 EU countries.
    • It captures the opinion of those who had not been vaccinated at the time of the survey, hence, allocation to those in low-income countries indicated further altruism.
    • The method, a conditional logit estimate, and also the robustness checks are appropriate and suitable.
    • The study distinguishes between two key attributes of mortality risk and country of residence allowing for evaluating the importance of each factor separately. The implication of these factors can be helpful in making decisions in the future. This is in particular critical given that the initial aim of COVAX was to prioritize those who are vulnerable and the healthcare workforce across the world before launching national programs did not materialize and we are still facing large global disparities between the global north and south.

    Weaknesses:

    • The sample from Germany is noticeably different from the rest of the countries (particularly in terms of having a higher ratio of those who are in the high-risk category). This might have impacted the results and needs to be reflected in the study discussion. Also, there is heterogeneity between studies in terms of the time of the fieldwork and each country's conditions in regards to the vaccination roll-out and the number of infections at that time.
    • The manuscript narrative needs to be updated to reflect the present conditions in terms of inoculation campaigns, their success rate, and their disparities across the world.
    • There is space for more discussions on an interesting finding of the study that is prioritizing the vaccines according to employment status and in particular income loss.
    • The temporal nature of the public views at various stages of the pandemic and vaccination campaigns should also be noted.

  4. ScreenIT

    SciScore for 10.1101/2022.05.19.22275055: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    NIH rigor criteria are not applicable to paper type.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: Thank you for sharing your data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    A number of limitations are worth noting. First, participants’ preferences may partly be driven by cross-country variation in (1) COVID-19 infection and mortality rates, (2) COVID-19 vaccination rates, and (3) the pandemic trajectory over time. Our analyses did not allow for any in-depth investigation of these factors. Second, on an individual level, there may be additional characteristics that explain approval or rejection of COVID-19 vaccine donations but were not captured in the survey, including (1) nationalistic attitudes, (2) altruistic preferences or (3) migration background. Third, our analysis points to a number of predictors of variation. However, they are not susceptible to experimental manipulation and should therefore not be interpreted as causal. Fourth, at the country level (except in Germany), we were not able to achieve our initial target sample sizes due to budget constraints. Thus, we likely only have adequate statistical power in the pooled analysis. Lastly and relatedly, sample sizes varied across countries and statistical power was higher in the German survey than in the other five surveys. However, since we find statistically significant effects of the main attributes in all countries except from Poland, lack of statistical power might have been less of a concern. Policymakers and global health scholars have condemned the unequitable distribution of COVID-19 vaccines between high- and low-income countries as “vaccine apartheid”.(Gonsalves and Yamey, 202...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  5. Version published to 10.1101/2022.05.19.22275055v1 on medRxiv