1
|
Kawamitsu S, Win TZ, Han SM, Nakamura T, Jogie M, Smith C. Public perspectives on COVID-19 public health and social measures in Japan and the United Kingdom: a qualitative study. BMC Public Health 2024; 24:1393. [PMID: 38783233 PMCID: PMC11118899 DOI: 10.1186/s12889-024-18866-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 05/16/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic, caused by SARS-CoV-2, was one of the greatest modern public health crises that the world has faced. Countries undertook sweeping public health and social measures (PHSM); including environmental actions such as disinfection and ventilation; surveillance and response, such as contact tracing and quarantine; physical, such as crowd control; and restrictions on travel. This study focuses on the public perceptions of PHSM in two countries, Japan and the United Kingdom (UK) as examples of high-income countries that adopted different measures over the course of the pandemic. METHODS This study was conducted between November 2021 and February 2022, a period in which the Omicron variant of SARS-CoV-2 was predominant. Fourteen online focus group discussions were conducted in each country. Overall, 106 total participants (50 from the UK and 56 from Japan) participated in 23 focus groups (11 in the UK and 12 in Japan) with an average of three to six participants per group. Both countries were compared using a thematic analysis method. RESULTS Both countries' participants agreed that vaccination was an effective measure. However, they did not favor mandatory vaccination policies. Working from home was well accepted by both sides, but they reported that schools should have continued to be opened as before COVID-19. Both sides of participants expressed that temperature testing alone in indoor facilities was ineffective as a COVID-19 control measure. There were contrasting views on face covering rules in public spaces, international and domestic movement restrictions. High acceptance of mask-wearing was reflective of Japanese customs, while it was accepted as a strong recommendation for participants in the UK. Japanese participants favored quarantine for international travel, while the UK participants supported banning non-essential travel. CONCLUSION Similar and contrasting views on PHSM against COVID-19 between Japan and the UK demonstrated how policies in controlling an epidemic should be tailored by country with respect to its norms, cultures, economic and disease burden. Our findings may guide how policy makers can engage with the public through effective health communication and consider regulations that are aligned with the public's views and capacities in changing their behavior for future pandemic preparedness.
Collapse
Affiliation(s)
- Saki Kawamitsu
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- School of Health Sciences, Faculty of Medicine and Graduate School of Health Sciences, University of the Ryukyus, Okinawa, Japan
| | - Tin Zar Win
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Su Myat Han
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- National Centre for Infectious Disease, Novena, Singapore
| | - Tomoka Nakamura
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Chris Smith
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.
| |
Collapse
|
2
|
Candio P, Violato M, Clarke PM, Duch R, Roope LS. Prevalence, predictors and reasons for COVID-19 vaccine hesitancy: Results of a global online survey. Health Policy 2023; 137:104895. [PMID: 37666080 DOI: 10.1016/j.healthpol.2023.104895] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/10/2023] [Accepted: 08/17/2023] [Indexed: 09/06/2023]
Abstract
Vaccine hesitancy has the potential to cripple efforts to end the COVID-19 pandemic. Policy makers need to be informed about the scale, nature and drivers of this problem, both domestically and globally, so that effective interventions can be designed. To this end, we conducted a statistical analysis of data from the CANDOUR survey (n = 15,536), which was carried out in 13 countries representing approximately half of the global population. Both pooled and country-level ordered regression models were estimated to identify predictors of vaccine hesitancy and reasons for not getting vaccinated. We found high levels of hesitancy, particularly in high-income countries. Factors driving moderate hesitancy differed from those driving extreme hesitancy. A lack of trust in health care providers was consistently the underlying driver of more extreme hesitancy. Predictors of moderate hesitancy varied across countries, though being younger and female was typically associated with greater hesitancy. While political ideology played a role in vaccine hesitancy in some countries, this effect was often moderated by income level, particularly in the US. Overall, the results suggest that different interventions such as mass-media campaigns and monetary incentives may be needed to target the moderately versus extremely hesitant. The lack of trust in health care professionals that drives extreme hesitancy may reflect deep societal mistrust in science and institutions and be challenging to overcome.
Collapse
Affiliation(s)
- Paolo Candio
- Department of Economics and Management, University of Trento, Trento, Italy; Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; National Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, United Kingdom.
| | - Mara Violato
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; National Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, United Kingdom
| | - Philip M Clarke
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; National Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, United Kingdom; Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Raymond Duch
- Nuffield College, University of Oxford, Oxford, United Kingdom of Great Britain and Northern Ireland, UK
| | - Laurence Sj Roope
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; National Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, United Kingdom
| |
Collapse
|
3
|
Kemper S, Bongers M, Kupper F, De Vries M, Timen A. Preferences for public engagement in decision-making regarding four COVID-19 non-pharmaceutical interventions in the Netherlands: A survey study. PLoS One 2023; 18:e0292119. [PMID: 37796885 PMCID: PMC10553365 DOI: 10.1371/journal.pone.0292119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 09/12/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Worldwide, non-pharmaceutical interventions (NPIs) were implemented during the COVID-19 crisis, which heavily impacted the daily lives of citizens. This study considers public perspectives on whether and how public engagement (PE) can contribute to future decision-making about NPIs. METHODS An online survey was conducted among a representative sample of the public in the Netherlands from 27 October to 9 November 2021. Perceptions and preferences about PE in decision-making on NPIs to control COVID-19 were collected. Preferences regarding four NPIs were studied: Nightly curfew (NC); Digital Covid Certificate (DCC); Closure of elementary schools and daycares (CED); and physical distancing (1.5M). Engagement was surveyed based on the five participation modes of the IAP2 Spectrum of Public Participation, namely inform, consult, advice, collaborate and empower. RESULTS Of the 4981 respondents, 25% expressed a desire to engage in decision-making, as they thought engagement could improve their understanding and the quality of NPIs, as well as increase their trust in the government. Especially for the NPIs DCC and NC, respondents found it valuable to engage and provide their perspective on trade-offs in values (e.g. opening up society versus division in society by vaccination status). Respondents agreed that the main responsibility in decision-making should stay with experts and policy-makers. 50% of respondents did not want to engage, as they felt no need to engage or considered themselves insufficiently knowledgeable. Inform was deemed the most preferred mode of engagement, and empower the least preferred mode of engagement. CONCLUSION We reveal large variations in public preferences regarding engagement in NPI decision-making. With 25% of respondents expressing an explicit desire to engage, and considering the benefit of PE in other areas of (public) health, opportunities for PE in NPI decision-making might have been overlooked during the COVID-19 pandemic. Our results provide guidance into when and how to execute PE in future outbreaks.
Collapse
Affiliation(s)
- Sophie Kemper
- National Coordination Centre for Communicable Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Athena Institute, Faculty of Science, VU University Amsterdam, Amsterdam, The Netherlands
| | - Marloes Bongers
- National Coordination Centre for Communicable Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Frank Kupper
- Athena Institute, Faculty of Science, VU University Amsterdam, Amsterdam, The Netherlands
| | - Marion De Vries
- National Coordination Centre for Communicable Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Aura Timen
- National Coordination Centre for Communicable Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Athena Institute, Faculty of Science, VU University Amsterdam, Amsterdam, The Netherlands
- Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
4
|
Carol S, Amro A. COVID-19 booster prioritization in the West Bank: a survey experiment among Bedouins, refugees, and the majority group. Front Public Health 2023; 11:1227559. [PMID: 37860806 PMCID: PMC10582936 DOI: 10.3389/fpubh.2023.1227559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/22/2023] [Indexed: 10/21/2023] Open
Abstract
Introduction Our main aim is to understand to what extent Bedouins, internally displaced Palestinians (refugees) and majority-group members (non-refugees, non-Bedouins, settled) in the West Bank prioritize COVID-19 booster shots for their own group over other groups. Methods We conducted a survey experiment (face-to-face) among 678 Palestinians living in the West Bank. Participants randomly received a description of an older man (Bedouin, refugee, settled) and were asked to indicate to what extent this person should be prioritized for the booster shot. Respondents belonging to a minority saw the profile of an in-group member or a majority-group member, whereas majority-group members would see the profile of an in-group or one out-group member (Bedouin, Palestinian refugee). Results We found slightly higher in-group preferences for Palestinian refugees when it came to vaccination, whereas majority-group members were less inclined to support a prioritization of Palestinian refugees but equally prioritized their group and Bedouins. For Bedouins, we did not find strong in-group preferences. Discussion Our study reveals the salience of group boundaries during the COVID-19 pandemic with potentially adverse effects on the health care of minorities.
Collapse
Affiliation(s)
- Sarah Carol
- School of Sociology, University College Dublin, Dublin, Ireland
- Social Science Research Center Berlin, Berlin, Germany
| | - Ahmad Amro
- Faculty of Pharmacy, Al-Quds University, Jerusalem, Palestine
| |
Collapse
|
5
|
Tradigo G, Das JK, Vizza P, Roy S, Guzzi PH, Veltri P. Strategies and Trends in COVID-19 Vaccination Delivery: What We Learn and What We May Use for the Future. Vaccines (Basel) 2023; 11:1496. [PMID: 37766172 PMCID: PMC10535057 DOI: 10.3390/vaccines11091496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/03/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
Vaccination has been the most effective way to control the outbreak of the COVID-19 pandemic. The numbers and types of vaccines have reached considerable proportions, even if the question of vaccine procedures and frequency still needs to be resolved. We have come to learn the necessity of defining vaccination distribution strategies with regard to COVID-19 that could be used for any future pandemics of similar gravity. In fact, vaccine monitoring implies the existence of a strategy that should be measurable in terms of input and output, based on a mathematical model, including death rates, the spread of infections, symptoms, hospitalization, and so on. This paper addresses the issue of vaccine diffusion and strategies for monitoring the pandemic. It provides a description of the importance and take up of vaccines and the links between procedures and the containment of COVID-19 variants, as well as the long-term effects. Finally, the paper focuses on the global scenario in a world undergoing profound social and political change, with particular attention on current and future health provision. This contribution would represent an example of vaccination experiences, which can be useful in other pandemic or epidemiological contexts.
Collapse
Affiliation(s)
- Giuseppe Tradigo
- Department of Computer Science, eCampus University, 22060 Novedrate, Italy;
| | - Jayanta Kumar Das
- Longitudinal Studies Section, Translation Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA;
| | - Patrizia Vizza
- Department of Surgical and Medical Science, Magna Græcia University, 88100 Catanzaro, Italy;
| | - Swarup Roy
- Network Reconstruction & Analysis (NetRA) Lab, Department of Computer Applications, Sikkim University, Gangtok 737102, India;
| | - Pietro Hiram Guzzi
- Department of Surgical and Medical Science, Magna Græcia University, 88100 Catanzaro, Italy;
| | - Pierangelo Veltri
- Department of Computer Science, Modelling, Electronics and Systems, University of Calabria, 87036 Rende, Italy;
| |
Collapse
|
6
|
Ceccato I, Di Crosta A, La Malva P, Cannito L, Mammarella N, Palumbo R, Palumbo R, Di Domenico A. Public opinion in vaccine allocation priority: who comes first? Psychol Health 2023; 38:1194-1214. [PMID: 34822253 DOI: 10.1080/08870446.2021.2007914] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/12/2021] [Accepted: 11/12/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE We investigated people's preferences in COVID-19 vaccine allocation priority, comparing different social categories based on age and occupation. Vaccine allocation preferences were related to perceived health vulnerability and economic backlash (economic negative consequences) endured by the different social groups during the pandemic. In-group favoritism in vaccine allocation preferences was analyzed. DESIGN Data were collected through an online survey in Italy (n = 506) before the start of the vaccination campaign. MAIN OUTCOME MEASURES Vaccine allocation preferences, health vulnerability, and economic backlash due to COVID-19, measured through ranking tasks. RESULTS The healthcare workers category was placed at the top of the ranking in vaccine allocation priority by 65% of the respondents. Vaccine allocation priority was related to perceived health vulnerability and not economic difficulties. Limited self-preference effects emerged. People who did not consider healthcare workers a priority (1/5 of the sample) had a lower education level, were more worried about COVID-19 infection risk, and did not trust vaccines. CONCLUSIONS A consensus emerged on who should be vaccinated first. Governments and policymakers should be aware of these preferences when designing and communicating vaccine allocation plans to predict and foster the public's acceptance of the COVID-19 vaccination programs created by experts.
Collapse
Affiliation(s)
- Irene Ceccato
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
- Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Adolfo Di Crosta
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Pasquale La Malva
- Department of Psychological, Health and Territorial Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Loreta Cannito
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
- Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Nicola Mammarella
- Department of Psychological, Health and Territorial Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Riccardo Palumbo
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
- Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Rocco Palumbo
- Department of Psychological, Health and Territorial Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Alberto Di Domenico
- Department of Psychological, Health and Territorial Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| |
Collapse
|
7
|
Chen X, Dong Y, Wu M. Medical capacity investment for epidemic disease: The effects of policymaker's confidence and public trust. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2023; 43:1187-1211. [PMID: 35822620 DOI: 10.1111/risa.13988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Due to the server bed shortage, which has raised ethical dilemmas in the earliest days of the COVID-19 crisis, medical capacity investment has become a vital decision-making issue in the attempt to contain the epidemic. Furthermore, economic strength has failed to explain the significant performance difference across countries in combatting COVID-19. Unlike common diseases, epidemic diseases add substantial unpredictability, complexity, and uncertainty to decision-making. Knowledge miscalibration on epidemiological uncertainties by policymaker's over- and underconfidence can seriously impact policymaking. Ineffective risk communication may lead to conflicting and incoherent information transmission. As a result, public reactions and attitudes could be influenced by policymakers' confidence due to the level of public trust, which eventually affects the degree to which an epidemic spreads. To uncover the impacts of policymakers' confidence and public trust on the medical capacity investment, we establish epidemic diffusion models to characterize how transmission evolves with (and without) vaccination and frame the capacity investment problem as a newsvendor problem. Our results show that if the public fully trusts the public health experts, the policymaker's behavioral bias is always harmful, but its effect on cost increment is marginal. If a policymaker's behavior induces public reactions due to public trust, both the spread of the epidemic and the overall performance will be significantly affected, but such impacts are not always harmful. Decision bias may be beneficial when policymakers are pessimistic or highly overconfident. Having an opportunity to amend initially biased decisions can debias a particular topic but has a limited cost-saving effect.
Collapse
Affiliation(s)
- Xin Chen
- School of Business Administration, South China University of Technology, Guangzhou, China
| | - Yucheng Dong
- Center for Network Big Data and Decision-Making, Business School, Sichuan University, Chengdu, China
| | - Meng Wu
- Business School, Sichuan University, Chengdu, China
| |
Collapse
|
8
|
Wu M, Zhang Y, Markley M, Cassidy C, Newman N, Porter A. COVID-19 knowledge deconstruction and retrieval: an intelligent bibliometric solution. Scientometrics 2023:1-31. [PMID: 37360228 PMCID: PMC10230150 DOI: 10.1007/s11192-023-04747-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 05/16/2023] [Indexed: 06/28/2023]
Abstract
COVID-19 has been an unprecedented challenge that disruptively reshaped societies and brought a massive amount of novel knowledge to the scientific community. However, as this knowledge flood continues surging, researchers have been disadvantaged by not having access to a platform that can quickly synthesize emerging information and link the new knowledge to the latent knowledge foundation. Aiming to fill this gap, we propose a research framework and develop a dashboard that can assist scientists in identifying, retrieving, and understanding COVID-19 knowledge from the ocean of scholarly articles. Incorporating principal component decomposition (PCD), a knowledge mode-based search approach, and hierarchical topic tree (HTT) analysis, the proposed framework profiles the COVID-19 research landscape, retrieves topic-specific latent knowledge foundation, and visualizes knowledge structures. The regularly updated dashboard presents our research results. Addressing 127,971 COVID-19 research papers from PubMed, the PCD topic analysis identifies 35 research hotspots, along with their inner correlations and fluctuating trends. The HTT result segments the global knowledge landscape of COVID-19 into clinical and public health branches and reveals the deeper exploration of those studies. To supplement this analysis, we additionally built a knowledge model from research papers on the topic of vaccination and fetched 92,286 pre-Covid publications as the latent knowledge foundation for reference. The HTT analysis results on the retrieved papers show multiple relevant biomedical disciplines and four future research topics: monoclonal antibody treatments, vaccinations in diabetic patients, vaccine immunity effectiveness and durability, and vaccination-related allergic sensitization.
Collapse
Affiliation(s)
- Mengjia Wu
- Australian Artificial Intelligence Institute, Faculty of Engineering and Information Technology, University of Technology Sydney, Sydney, Australia
| | - Yi Zhang
- Australian Artificial Intelligence Institute, Faculty of Engineering and Information Technology, University of Technology Sydney, Sydney, Australia
| | | | | | | | - Alan Porter
- Search Technology, Inc., Norcross, USA
- Science, Technology & Innovation Policy, Georgia Institute of Technology, Atlanta, USA
| |
Collapse
|
9
|
Emanuel EJ, Persad G. The shared ethical framework to allocate scarce medical resources: a lesson from COVID-19. Lancet 2023:S0140-6736(23)00812-7. [PMID: 37172603 PMCID: PMC10168660 DOI: 10.1016/s0140-6736(23)00812-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/20/2023] [Accepted: 01/31/2023] [Indexed: 05/15/2023]
Abstract
The COVID-19 pandemic has helped to clarify the fair and equitable allocation of scarce medical resources, both within and among countries. The ethical allocation of such resources entails a three-step process: (1) elucidating the fundamental ethical values for allocation, (2) using these values to delineate priority tiers for scarce resources, and (3) implementing the prioritisation to faithfully realise the fundamental values. Myriad reports and assessments have elucidated five core substantive values for ethical allocation: maximising benefits and minimising harms, mitigating unfair disadvantage, equal moral concern, reciprocity, and instrumental value. These values are universal. None of the values are sufficient alone, and their relative weight and application will vary by context. In addition, there are procedural principles such as transparency, engagement, and evidence-responsiveness. Prioritising instrumental value and minimising harms during the COVID-19 pandemic led to widespread agreement on priority tiers to include health-care workers, first responders, people living in congregate housing, and people with an increased risk of death, such as older adults and individuals with medical conditions. However, the pandemic also revealed problems with the implementation of these values and priority tiers, such as allocation on the basis of population rather than COVID-19 burden, and passive allocation that exacerbated disparities by requiring recipients to spend time booking and travelling to appointments. This ethical framework should be the starting point for the allocation of scarce medical resources in future pandemics and other public health conditions. For instance, allocation of the new malaria vaccine among sub-Saharan African countries should be based not on reciprocity to countries that participated in research, but on maximally reducing serious illness and deaths, especially among infants and children.
Collapse
Affiliation(s)
- Ezekiel J Emanuel
- Healthcare Transformation Institute, Department of Medical Ethics & Health Policy, Perelman School of Medicine and Wharton School, University of Pennsylvania, Philadelphia, PA, USA.
| | - Govind Persad
- Sturm College of Law, University of Denver, Denver, CO, USA
| |
Collapse
|
10
|
Barnawi NA, Alraqei B, Hilwan A, Al-Otibi M, Alsubaie R, Altowymy S, Abolfotouh MA. Impact of a Video-Based Educational Intervention on the Levels of Knowledge and Concerns about COVID-19 Vaccination. Vaccines (Basel) 2023; 11:vaccines11040727. [PMID: 37112639 PMCID: PMC10145043 DOI: 10.3390/vaccines11040727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/09/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023] Open
Abstract
Background. The hesitancy to receive the COVID-19 vaccine plays a role in delaying the current global and national COVID-19 management strategies. Evidence has highlighted the importance of examining the public’s concerns and knowledge about COVID-19 vaccines in sustaining public prevention of the further spread of the virus worldwide. This study aimed to assess the impact of a video-based educational session on the Saudi public’s levels of knowledge and concerns about the COVID-19 vaccination. Methods. In a double-blind, randomized posttest-only control group study design, 508 Saudis were randomized to an experimental group (n = 253) and a control group (n = 255). The experimental group was exposed to a video-based educational session, while the control group was not. Then both groups were subjected to a validated questionnaire to assess their level of knowledge and concerns about the vaccine. Results. In comparison to the control group, the experimental group showed a significantly lower proportion of overall high concern (0.4% vs. 5.5%, p < 0.001) and a higher proportion of overall good knowledge (74.2% vs. 55.7%, p < 0.001). After adjustment for possible confounders, the experimental group showed a significantly lower percent mean score of overall concern (45.0% vs. 65.0%, p < 0.001) and a higher percent mean score of overall knowledge (74.2% vs. 55.7%, p < 0.001) than the control group. Conclusions. The video-based educational intervention positively impacted the levels of knowledge and concerns about COVID-19 vaccination among the experimental group. These interventions safeguard against the rumors and misconceptions about COVID-19 vaccinations. Further studies on the impacts of such interventions on vaccine uptake are recommended.
Collapse
|
11
|
Karki A, Rijal B, Koirala B, Makai P, Kc P, Adhikary P, Joshi S, Basnet S, Bhattarai S, Karki J. Management of COVID-19 and vaccination in Nepal: A qualitative study. Health Expect 2023; 26:1170-1179. [PMID: 36797845 PMCID: PMC10154840 DOI: 10.1111/hex.13732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 01/31/2023] [Accepted: 02/05/2023] [Indexed: 02/18/2023] Open
Abstract
OBJECTIVE The aim of this research is to investigate the perspective of citizens of Nepal on the management COVID-19, the roll-out of the vaccine, and to gain an understanding of attitudes towards the governments' handling of the COVID-19 pandemic. METHOD A qualitative methodology was used. In-depth interviews were conducted with 18 males and 23 females aged between 20 and 86 years old from one remote and one urban district of Nepal. Interviews were conducted in November and December 2021. A thematic approach was used to analyse the data, utilising NVivo 12 data management software. RESULT Three major themes were identified: (1) Peoples' perspective on the management of COVID-19, (2) people's perception of the management of COVID-19 vaccination and (3) management and dissemination of information. It was found that most participants had heard of COVID-19 and its mitigation measures, however, the majority had limited understanding and knowledge about the disease. Most participants expressed their disappointment concerning poor testing, quarantine, vaccination campaigns and poor accountability from the government towards the management of COVID-19. Misinformation and stigma were reported as the major factors contributing to the spread of COVID-19. People's knowledge and understanding were mainly shaped by the quality of the information they received from various sources of communication and social media. This heavily influenced their response to the pandemic, the preventive measures they followed and their attitude towards vaccination. CONCLUSION Our study concludes that the study participants' perception was that testing, quarantine centres and vaccination campaigns were poorly managed in both urban and rural settings in Nepal. Since people's knowledge and understanding of COVID-19 are heavily influenced by the quality of information they receive, we suggest providing contextualised correct information through a trusted channel regarding the pandemic, its preventive measures and vaccination. This study recommends that the government proactively involve grassroots-level volunteers like Female Community Health Volunteers to effectively prepare for future pandemics. PATIENT AND PUBLIC CONTRIBUTION This study was based on in-depth interviews with 41 people from diverse socioeconomic backgrounds. This study would not have been possible without their participation.
Collapse
|
12
|
Munzert S, Ramirez-Ruiz S, Çalı B, Stoetzer LF, Gohdes A, Lowe W. Prioritization preferences for COVID-19 vaccination are consistent across five countries. HUMANITIES & SOCIAL SCIENCES COMMUNICATIONS 2022; 9:439. [PMID: 36530547 PMCID: PMC9735138 DOI: 10.1057/s41599-022-01392-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 09/30/2022] [Indexed: 06/17/2023]
Abstract
Vaccination against COVID-19 is making progress globally, but vaccine doses remain a rare commodity in many parts of the world. New virus variants require vaccines to be updated, hampering the availability of effective vaccines. Policymakers have defined criteria to regulate who gets priority access to the vaccination, such as age, health complications, or those who hold system-relevant jobs. But how does the public think about vaccine allocation? To explore those preferences, we surveyed respondents in Brazil, Germany, Italy, Poland, and the United States from September to December of 2020 using ranking and forced-choice tasks. We find that public preferences are consistent with expert guidelines prioritizing health-care workers and people with medical preconditions. However, the public also considers those signing up early for vaccination and citizens of the country to be more deserving than later-comers and non-citizens. These results hold across measures, countries, and socio-demographic subgroups.
Collapse
|
13
|
COVID-19 Vaccine Hesitancy in Denmark and Russia: A qualitative typology at the nexus of agency and health capital. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100116. [PMID: 35721031 PMCID: PMC9192108 DOI: 10.1016/j.ssmqr.2022.100116] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/08/2022] [Accepted: 06/10/2022] [Indexed: 01/12/2023]
Abstract
Vaccination of the world population is being embraced by 184 countries as the main strategy to end the COVID-19 pandemic; vaccination rates are stalling even in countries with high vaccine availability, though. This article investigates the phenomenon of vaccine hesitancy in two such countries, the Kingdom of Denmark and the Russian Federation, through a qualitative study of the different types of hesitancy to COVID-19 vaccination programs and their underlying mechanisms. The analysis reveals a typology along the dimensions of agency and health capital: resisting hesitancy based on mistrust of authority, paralyzed hesitancy based on personal fear, informed hesitancy based on informed choice, and empowered hesitancy based on empowered choice. While the mechanisms underlying vaccine hesitancy are to a great extent comparable between the two countries, differences in population size, societal cohesion, and political culture seem to impact the prevalence and severity of types and, thereby, the outcomes of national COVID-19 vaccination programs and national campaigns for mitigating COVID-19 vaccine hesitancy. The implications of these findings extend beyond the particular context of COVID-19 and the countries studied, supporting and nuancing existing models for vaccine hesitancy, as well as providing a starting point for tailored campaigns for mitigating vaccine hesitancy.
Collapse
|
14
|
Schmidt H, Shaikh SJ, Sadecki E, Buttenheim A, Gollust S. Public attitudes about equitable COVID-19 vaccine allocation: a randomised experiment of race-based versus novel place-based frames. JOURNAL OF MEDICAL ETHICS 2022; 48:993-999. [PMID: 35927020 DOI: 10.1136/jme-2022-108194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 07/07/2022] [Indexed: 06/15/2023]
Abstract
Equity was-and is-central in the US policy response to COVID-19, given its disproportionate impact on disadvantaged communities of colour. In an unprecedented turn, the majority of US states used place-based disadvantage indices to promote equity in vaccine allocation (eg, through larger vaccine shares for more disadvantaged areas and people of colour).We conducted a nationally representative survey experiment (n=2003) in April 2021 (before all US residents had become vaccine eligible), that examined respondents' perceptions of the acceptability of disadvantage indices relative to two ways of prioritising racial and ethnic groups more directly, and assessed the role of framing and expert anchors in shaping perceptions.A majority of respondents supported the use of disadvantage indices, and one-fifth opposed any of the three equity-promoting plans. Differences in support and opposition were identified by respondents' political party affiliation. Providing a numerical anchor (that indicated expert recommendations and states' actual practices in reserving a proportion of allocations for prioritised groups) led respondents to prefer a lower distribution of reserved vaccine allocations compared with the randomised condition without this anchor, and the effect of the anchor differed across the frames.Our findings support ongoing uses of disadvantage indices in vaccine allocation, and, by extension, in allocating tests, masks or treatments, especially when supply cannot meet demand. The findings can also inform US allocation frameworks in future pandemic planning, and could provide lessons on how to promote equity in clinical and public health outside of the pandemic setting.
Collapse
Affiliation(s)
- Harald Schmidt
- Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sonia Jawaid Shaikh
- Amsterdam School of Communication of Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Emily Sadecki
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alison Buttenheim
- Department of Family and Community Health, Penn Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sarah Gollust
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| |
Collapse
|
15
|
Kappes A, Zohny H, Savulescu J, Singh I, Sinnott-Armstrong W, Wilkinson D. Race and resource allocation: an online survey of US and UK adults' attitudes toward COVID-19 ventilator and vaccine distribution. BMJ Open 2022; 12:e062561. [PMID: 36410823 PMCID: PMC9679868 DOI: 10.1136/bmjopen-2022-062561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 10/27/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE This study aimed to assess US/UK adults' attitudes towards COVID-19 ventilator and vaccine allocation. DESIGN Online survey including US and UK adults, sampled to be representative for sex, age, race, household income and employment. A total of 2580 participated (women=1289, age range=18 to 85 years, Black American=114, BAME=138). INTERVENTIONS Participants were asked to allocate ventilators or vaccines in scenarios involving individuals or groups with different medical risk and additional risk factors. RESULTS Participant race did not impact vaccine or ventilator allocation decisions in the USA, but did impact ventilator allocation attitudes in the UK (F(4,602)=6.95, p<0.001). When a racial minority or white patient had identical chances of survival, 14.8% allocated a ventilator to the minority patient (UK BAME participants: 24.4%) and 68.9% chose to toss a coin. When the racial minority patient had a 10% lower chance of survival, 12.4% participants allocated them the ventilator (UK BAME participants: 22.1%). For patients with identical risk of severe COVID-19, 43.6% allocated a vaccine to a minority patient, 7.2% chose a white patient and 49.2% chose a coin toss. When the racial minority patient had a 10% lower risk of severe COVID-19, 23.7% participants allocated the vaccine to the minority patient. Similar results were seen for obesity or male sex as additional risk factors. In both countries, responses on the Modern Racism Scale were strongly associated with attitudes toward race-based ventilator and vaccine allocations (p<0.0001). CONCLUSIONS Although living in countries with high racial inequality during a pandemic, most US and UK adults in our survey allocated ventilators and vaccines preferentially to those with the highest chance of survival or highest chance of severe illness. Race of recipient led to vaccine prioritisation in cases where risk of illness was similar.
Collapse
Affiliation(s)
| | - Hazem Zohny
- Oxford Uehiro Centre for Practical Ethics, Univeristy of Oxford, Oxford, UK
| | - Julian Savulescu
- Oxford Uehiro Centre for Practical Ethics, Univeristy of Oxford, Oxford, UK
- Centre for Biomedical Ethics, National University of Singapore, Singapore
| | - Ilina Singh
- Psychiatry, University of Oxford, Oxford, UK
| | | | - Dominic Wilkinson
- Oxford Uehiro Centre for Practical Ethics, Univeristy of Oxford, Oxford, UK
- Newborn Care Unit, John Radcliffe Hospital, Oxford, UK
| |
Collapse
|
16
|
Helbling M, Maxwell R, Munzert S, Traunmüller R. The importance of citizenship for deserving COVID-19 treatment. HUMANITIES & SOCIAL SCIENCES COMMUNICATIONS 2022; 9:302. [PMID: 36068810 PMCID: PMC9436734 DOI: 10.1057/s41599-022-01311-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 08/15/2022] [Indexed: 06/15/2023]
Abstract
Immigrant non-citizens are often considered less deserving than citizens of welfare and other public services. The logic is that valuable and scarce public resources must be limited somehow, and the club of citizens is one way of drawing a boundary. In this paper, we examine how far that boundary extends, by analyzing the extent to which Germans prioritize citizens over non-citizens for access to life-saving healthcare. We implement a conjoint experiment to elicit preferences in the context of the COVID-19 pandemic. The data were collected between April 2020 and March 2021, in 23 waves of an online rolling cross-sectional survey with roughly 17,000 respondents. Our main finding is that citizens are viewed as more deserving of healthcare than non-citizen immigrants, a relationship that is sizeable and robust. Our findings have implications for debates about social boundaries and how to allocate resources in Western Europe.
Collapse
Affiliation(s)
- Marc Helbling
- Department of Sociology, University of Mannheim, Mannheim, Germany
| | - Rahsaan Maxwell
- Department of Political Science, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Simon Munzert
- The Hertie School, Data Science and Public Policy, Berlin, Germany
| | | |
Collapse
|
17
|
Iida T, Kawata K, Nakabayashi M. The citizen preferences-positive externality trade-off: A survey study of COVID-19 vaccine deployment in Japan. SSM Popul Health 2022; 19:101191. [PMID: 35992967 PMCID: PMC9381943 DOI: 10.1016/j.ssmph.2022.101191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/26/2022] [Accepted: 07/29/2022] [Indexed: 11/17/2022] Open
Abstract
Objective Medicine is a scarce resource and a public good that benefits others by bettering patients’ health. COVID-19 vaccines in shortage are, 1) a scarce resource and 2) a public good with the positive externality of building herd immunity. These features are expected to drive citizens’ attitudes in opposite directions, exclusionist and inclusionist, respectively. Scarcity would drive citizens’ exclusionism, while the positive externality might mitigate exclusionism. Setting and design We recruited 15,000 Japanese adults and asked them to rank, in the context of a COVID-19 vaccine shortage, the deservingness of hypothetical vaccine recipients who differed according to 1) citizenship status, 2) visa type and duration of stay (if foreign), 3) occupation, 4) age, 5) whether they lived with a child, and 6) whether they lived with an elderly individual. Citizenship options were Japanese, Chinese, Taiwanese, South Korean, American, or European. The occupations were healthcare, education, other employed, self-employed, or not employed. The 6 attributes were randomly combined, and respondents were shown 3 hypothetical vaccine recipients: one was Japanese, and the others were foreigners. Treatments First, through a conjoint design, we created hypothetical vaccine recipients whose attributes were randomized except for the benchmark citizenship, Japanese national. Second, we randomly presented two scenarios for vaccination payments: 1) billed at cost or 2) fully subsidized by the government. Results 1) Whether the vaccines were billed at cost or fully subsidized did not affect the rankings of deservingness. 2) Japanese citizenship was prioritized. 3) The penalty for being a foreigner was higher for individuals from nations with which Japan has geopolitical tensions. 4) Working in health or education reduced the penalty on foreigners, indicating that the positive externality related to occupation amplifies the positive externality associated with vaccination and mitigates exclusionist attitudes. Conclusions The positive occupational externalities that amplify the positive externality of vaccination substantially allay the foreigner penalty.
Collapse
|
18
|
Nair G, Peyton K. Building mass support for global pandemic recovery efforts in the United States. PNAS NEXUS 2022; 1:pgac123. [PMID: 36714837 PMCID: PMC9802409 DOI: 10.1093/pnasnexus/pgac123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 08/09/2022] [Indexed: 02/01/2023]
Abstract
Containing the COVID-19 pandemic will confer global benefits that greatly exceed the costs but effective solutions require the redistribution of vaccines, technology, and other scarce resources from high-income to low-income countries. The United States has played a central role in coordinating responses to previous global health challenges, and its policy choices in the current pandemic will have a far-reaching impact on the rest of the world. Yet little is known about domestic support for international recovery efforts. We use a series of conjoint and persuasive messaging experiments, fielded on two national surveys of the US adult population (N = 5,965), to study mass support for international redistribution. We find clear evidence that the general population strongly supports allocating vaccines to own-country recipients before others. But despite this "vaccine nationalism," Americans are also willing to support the US government playing a major role in global pandemic recovery efforts, provided policymakers forge international agreements that ensure moderate domestic costs, burden-sharing with other countries, and priority for certain types of resources, such as domestically manufactured vaccines and patent buyouts. Finally, we test five different persuasive messaging strategies and find that emphasizing the relatively low costs and large economic benefits of global vaccination is the most promising means of increasing domestic support for international redistribution. Overall, our results demonstrate that policymakers can secure broad public support for costly international cooperation by crafting responses aligned with the economic interests of the United States.
Collapse
|
19
|
Barceló J, Sheen GCH, Tung HH, Wu WC. Vaccine nationalism among the public: A cross-country experimental evidence of own-country bias towards COVID-19 vaccination. Soc Sci Med 2022; 310:115278. [PMID: 35994879 PMCID: PMC9376148 DOI: 10.1016/j.socscimed.2022.115278] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/03/2022] [Accepted: 08/08/2022] [Indexed: 12/20/2022]
Abstract
What types of vaccines are citizens most likely to accept? We argue that citizens' identification with their nation may lead them to prefer vaccines developed and produced within their national borders, to the exclusion and/or detriment of vaccines from other nations. We administered a conjoint experiment requesting 15,000 adult citizens across 14 individual countries from around the world to assess 450,000 profiles of vaccines that randomly varied on seven attributes. Beyond vaccine fundamentals such as efficacy rate, number of doses, and duration of the protection, we find that citizens systematically favor vaccines developed and produced in their own country of residence. The extent of preference in favor of vaccines developed and produced within the national borders is particularly large among citizens who identify more strongly with their nation, suggesting nationalism plays a role in explaining the bias in favor of vaccines developed and produced locally. This public opinion bias on vaccine preferences has significant theoretical and practical implications.
Collapse
Affiliation(s)
- Joan Barceló
- Division of Social Science, New York University Abu Dhabi, United Arab Emirates
| | | | - Hans H Tung
- Department of Political Science and Center for Research in Econometric Theory and Applications, National Taiwan University, Taiwan
| | - Wen-Chin Wu
- Institute of Political Science, Academia Sinica, Taiwan
| |
Collapse
|
20
|
Awad E, Bago B, Bonnefon JF, Christakis NA, Rahwan I, Shariff A. Polarized Citizen Preferences for the Ethical Allocation of Scarce Medical Resources in 20 Countries. MDM Policy Pract 2022; 7:23814683221113573. [PMID: 35911175 PMCID: PMC9326829 DOI: 10.1177/23814683221113573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/14/2022] [Indexed: 11/20/2022] Open
Abstract
Objective. When medical resources are scarce, clinicians must make difficult triage decisions. When these decisions affect public trust and morale, as was the case during the COVID-19 pandemic, experts will benefit from knowing which triage metrics have citizen support. Design. We conducted an online survey in 20 countries, comparing support for 5 common metrics (prognosis, age, quality of life, past and future contribution as a health care worker) to a benchmark consisting of support for 2 no-triage mechanisms (first-come-first-served and random allocation). Results. We surveyed nationally representative samples of 1000 citizens in each of Brazil, France, Japan, and the United States and also self-selected samples from 20 countries (total N = 7599) obtained through a citizen science website (the Moral Machine). We computed the support for each metric by comparing its usability to the usability of the 2 no-triage mechanisms. We further analyzed the polarizing nature of each metric by considering its usability among participants who had a preference for no triage. In all countries, preferences were polarized, with the 2 largest groups preferring either no triage or extensive triage using all metrics. Prognosis was the least controversial metric. There was little support for giving priority to healthcare workers. Conclusions. It will be difficult to define triage guidelines that elicit public trust and approval. Given the importance of prognosis in triage protocols, it is reassuring that it is the least controversial metric. Experts will need to prepare strong arguments for other metrics if they wish to preserve public trust and morale during health crises.
Collapse
Affiliation(s)
- Edmond Awad
- Department of Economics and Institute for Data Science and Artificial Intelligence, University of Exeter, UK
| | - Bence Bago
- Artificial and Natural Intelligence Toulouse Institute and Institute for Advanced Study in Toulouse, Toulouse, France
| | | | - Nicholas A. Christakis
- Departments of Medicine, Ecology and Evolutionary Biology, and Sociology, Yale University, USA
| | - Iyad Rahwan
- Centre for Humans & Machines, Max-Planck Institute for Human Development, Berlin, Germany
| | - Azim Shariff
- Department of Psychology, University of British Columbia, Vancouver
| |
Collapse
|
21
|
Jecker NS. Achieving Global Vaccine Equity: The Case for an International Pandemic Treaty. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2022; 95:271-280. [PMID: 35782474 PMCID: PMC9235252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This paper presents an ethical argument in support of an international Pandemic Treaty. It argues that an international Pandemic Treaty is the best way to mark progress on global vaccine equity and broader issues of global pandemic preparedness and response which came to light during the coronavirus disease 2019 (COVID-19) pandemic. Section I evaluates principles of multilateral charity, national security, and international diplomacy standardly invoked in debates about global vaccine allocation and argues that these approaches fall short. Section II explicates notions of solidarity, duties to the least well-off, and mutual aid as ethical values more fitting for an era of emerging infectious diseases. Section III relates the discussion to an international Pandemic Treaty and presents legal, pragmatic, and ethical reasons to support it. The paper concludes that in an interconnected world, fair sharing of vaccines between nations is morally mandatory.
Collapse
Affiliation(s)
- Nancy S. Jecker
- To whom all correspondence should be addressed:
Nancy S. Jecker, PhD, University of Washington School of Medicine, Seattle, WA
98195-7120; ; ORCID iD:
https://orcid.org/0000-0002-5642-748X
| |
Collapse
|
22
|
Luyten J, Beutels P, Vandermeulen C, Kessels R. Social preferences for adopting new vaccines in the national immunization program: A discrete choice experiment. Soc Sci Med 2022; 303:114991. [PMID: 35594739 DOI: 10.1016/j.socscimed.2022.114991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 04/17/2022] [Accepted: 04/22/2022] [Indexed: 10/18/2022]
Abstract
Governments regularly have to decide whether new vaccines should be adopted in their national immunization program. These choices imply complex trade-offs of epidemiological, medical and socio-economic criteria. We investigated how the population in Flanders (Belgium) wants their government to set vaccine-funding priorities. In December 2019, we executed a discrete choice experiment in a sample of the Flemish population (N = 1636). In total, we analysed 16 360 choices between vaccines competing for funding, described in terms of eight characteristics. Using a panel mixed logit model, we quantified the relative importance of each characteristic and investigated differences in preferences across respondent groups. The observed vaccine priorities were different from those that would be identified through cost-effectiveness analysis. People valued the health impact from infectious diseases differently than their weight expressed in QALYs would suggest. Mortality and frequently occurring mild illness were valued higher, whereas lasting morbidity received lower weight. Contribution of the vaccine to disease eradication and uncertainty in vaccine effectiveness were both highly influential factors. Health equity impact was also important whereas the economic impact of the disease did not matter at all. Our results can be used to incorporate public values into vaccine decision-making.
Collapse
Affiliation(s)
- Jeroen Luyten
- KU Leuven, Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, Kapucijnenvoer 35, 3000, Leuven, Belgium.
| | - Philippe Beutels
- University of Antwerp, Centre for Health Economics Research & Modelling Infectious Diseases, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Corinne Vandermeulen
- KU Leuven, Environment and Health, Department of Public Health and Primary Care, Kapucijnenvoer 35, 3000, Leuven, Belgium
| | - Roselinde Kessels
- Maastricht University, Department of Data Analytics and Digitalization, PO Box 616, 6200 MD, Maastricht, The Netherlands; University of Antwerp, Department of Economics, City Campus, Prinsstraat 13, 2000, Antwerp, Belgium
| |
Collapse
|
23
|
Reply to Spreco et al.: Perceived corruption and preferences for COVID-19 vaccine allocations. Proc Natl Acad Sci U S A 2022; 119:e2201847119. [PMID: 35507874 PMCID: PMC9171753 DOI: 10.1073/pnas.2201847119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
24
|
Corruption should be taken into account when considering COVID-19 vaccine allocation. Proc Natl Acad Sci U S A 2022; 119:e2122664119. [PMID: 35507880 PMCID: PMC9171641 DOI: 10.1073/pnas.2122664119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
25
|
Lee I, Tipoe E. Global COVID-19 vaccine inequity: Preferences for overseas vaccine donations over booster shots. Brain Behav Immun Health 2022; 21:100447. [PMID: 35308083 PMCID: PMC8920110 DOI: 10.1016/j.bbih.2022.100447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/21/2022] [Accepted: 03/12/2022] [Indexed: 11/03/2022] Open
Abstract
As the supply of COVID-19 vaccines to low-income countries (LICs) remains limited, governments of high-income countries face a trade-off between domestic containment through booster shots and global containment by helping LICs acquire first doses ("vaccine nationalism" vs "vaccine internationalism"). We provide empirical evidence on how residents of a high-income country view this ethical dilemma by surveying 1527 UK adults recruited online. Support for vaccine donations to LICs is high. On average, study participants chose to donate 65% of UK's COVID-19 vaccines, which were ordered for booster shots, to LICs. Holding all other factors constant, women, younger individuals, and those who are not fully vaccinated preferred to donate a larger percentage to LICs. The UK public's preferences for prioritizing vaccine donations over booster shot programs suggest broad support for national policies that strike a balance between domestic containment and global philanthropy.
Collapse
Affiliation(s)
- Ines Lee
- Faculty of Economics, University of Cambridge, United Kingdom
| | - Eileen Tipoe
- School of Economics and Finance, Queen Mary University of London, United Kingdom
| |
Collapse
|
26
|
Awad E, Levine S, Anderson M, Anderson SL, Conitzer V, Crockett MJ, Everett JAC, Evgeniou T, Gopnik A, Jamison JC, Kim TW, Liao SM, Meyer MN, Mikhail J, Opoku-Agyemang K, Borg JS, Schroeder J, Sinnott-Armstrong W, Slavkovik M, Tenenbaum JB. Computational ethics. Trends Cogn Sci 2022; 26:388-405. [PMID: 35365430 DOI: 10.1016/j.tics.2022.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/14/2022] [Accepted: 02/25/2022] [Indexed: 12/11/2022]
Abstract
Technological advances are enabling roles for machines that present novel ethical challenges. The study of 'AI ethics' has emerged to confront these challenges, and connects perspectives from philosophy, computer science, law, and economics. Less represented in these interdisciplinary efforts is the perspective of cognitive science. We propose a framework - computational ethics - that specifies how the ethical challenges of AI can be partially addressed by incorporating the study of human moral decision-making. The driver of this framework is a computational version of reflective equilibrium (RE), an approach that seeks coherence between considered judgments and governing principles. The framework has two goals: (i) to inform the engineering of ethical AI systems, and (ii) to characterize human moral judgment and decision-making in computational terms. Working jointly towards these two goals will create the opportunity to integrate diverse research questions, bring together multiple academic communities, uncover new interdisciplinary research topics, and shed light on centuries-old philosophical questions.
Collapse
Affiliation(s)
- Edmond Awad
- Department of Economics, University of Exeter, Exeter, UK; Institute for Data Science and AI, University of Exeter, Exeter, UK; Center for Humans and Machines, Max-Planck Institute for Human Development, Berlin, Germany.
| | - Sydney Levine
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology (MIT), Cambridge, MA, USA; Department of Psychology, Harvard University, Cambridge, MA, USA.
| | - Michael Anderson
- Department of Computer Science, University of Hartford, West Hartford, CT, USA
| | | | - Vincent Conitzer
- Department of Computer Science, Duke University, Durham, NC, USA; Department of Economics, Duke University, Durham, NC, USA; Department of Philosophy, Duke University, Durham, NC, USA; Institute for Ethics in AI, University of Oxford, Oxford, UK
| | - M J Crockett
- Department of Psychology, Yale University, New Haven, CT, USA
| | | | | | - Alison Gopnik
- Department of Psychology, University of California, Berkeley, CA, USA
| | - Julian C Jamison
- Department of Economics, University of Exeter, Exeter, UK; Global Priorities Institute, Oxford University, Oxford, UK
| | - Tae Wan Kim
- Ethics Group, Tepper School of Business, Carnegie Mellon University, Pittsburgh, PA, USA
| | - S Matthew Liao
- Center for Bioethics, New York University, New York, NY, USA
| | - Michelle N Meyer
- Center for Translational Bioethics and Health Care Policy, Geisinger Health System, Danville, PA, USA; Steele Institute for Health Innovation, Geisinger Health System, Danville, PA, USA; Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - John Mikhail
- Georgetown University Law Center, Washington, DC, USA
| | - Kweku Opoku-Agyemang
- International Growth Centre, London School of Economics, London, UK; Machine Learning X Doing, Toronto, ON, Canada; Development Economics X, Toronto, ON, Canada
| | - Jana Schaich Borg
- Social Science Research Institute, Duke University, Durham, NC, USA; Duke Institute for Brain Sciences, Duke University, Durham, NC, USA
| | - Juliana Schroeder
- Haas School of Business, University of California, Berkeley, CA, USA
| | - Walter Sinnott-Armstrong
- Department of Philosophy, Duke University, Durham, NC, USA; Duke Institute for Brain Sciences, Duke University, Durham, NC, USA; Kenan Institute for Ethics, Duke University, Durham, NC, USA
| | - Marija Slavkovik
- Department of Information Science and Media Studies, University of Bergen, Bergen, Norway
| | - Josh B Tenenbaum
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology (MIT), Cambridge, MA, USA; Computer Science and Artificial Intelligence Laboratory, MIT, Cambridge, MA, USA; Center for Brains, Minds, and Machines, MIT, Cambridge, MA, USA
| |
Collapse
|
27
|
Demographic Characteristics and Status of Vaccinated Individuals with a History of COVID-19 Infection Pre- or Post-Vaccination: A Descriptive Study of a Nationally Representative Sample in Saudi Arabia. Vaccines (Basel) 2022; 10:vaccines10020323. [PMID: 35214781 PMCID: PMC8875240 DOI: 10.3390/vaccines10020323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/11/2022] [Accepted: 02/13/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Saudi Arabia expedited the approval of some COVID-19 vaccines and launched mass vaccination campaigns. The aim of this study was to describe the demographics of vaccinated COVID-19 cases and compare the mortality rates of COVID-19 cases who were infected post-vaccination in Saudi Arabia. Methods: This was a retrospective cohort study. We retrieved data for COVID-19 cases who were infected pre- or post-vaccination and had received at least one injection of the Oxford–AstraZeneca or Pfizer–BioNTech vaccine from 4 December 2020 to 15 October 2021. Results: The number of patients who were infected and had received at least one dose of a COVID-19 vaccine was 281,744. Approximately 45% of subjects were infected post-vaccination, and 75% of subjects had received the Pfizer–BioNTech vaccine. Only 0.342% of the patients who were infected post-vaccination died, and 447 patients were admitted to ICUs. Most of the patients who were infected with COVID-19 post-vaccination and were admitted to ICUs (69.84%) had received only one dose of the vaccine (p < 0.0001). The mean time to infection for patients who had received one and two doses of the Oxford–AstraZeneca vaccine were 27 and 8 days longer than their counterparts who had received one and two doses of Pfizer–BioNTech vaccine, respectively. No difference in the odds of mortality between the Pfizer–BioNTech and Oxford–AstraZeneca vaccines was found (OR = 1.121, 95% CI = [0.907–1.386], p-value = 0.291). Patients who had received two doses of the vaccine had significantly lower odds of mortality compared to those who had received one dose (p < 0.0001). Conclusions: Vaccines are vital in combating the COVID-19 pandemic. The results of this study show no difference between the Pfizer–BioNTech and Oxford–AstraZeneca vaccines in the rate of mortality. However, the number of vaccine doses was significantly associated with a lower risk of mortality. Future studies should examine the effectiveness of different COVID-19 vaccines using real-world data and more robust designs.
Collapse
|
28
|
Roope LSJ, Barnett A, Candio P, Violato M, Duch R, Clarke PM. Is There Broad-Based Support in High-Income Countries for COVID-19 Vaccine Donation? Evidence from Seven Countries. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:55-65. [PMID: 34841474 PMCID: PMC8627792 DOI: 10.1007/s40258-021-00696-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/26/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Many high-income countries (HICs) have now vaccinated a substantial proportion of their population against COVID-19. Many low-income countries (LICs) may need to wait until at least 2022 before even the most vulnerable 20% of their populations are vaccinated. Beyond ethical considerations, some redistribution of doses would reduce the risk of the emergence and spread of new variants and benefit the economy, both globally and in donor countries. However, the willingness of HIC governments to donate vaccine doses is likely to depend on public support. While previous work has indicated strong average levels of public support in HIC for donation, little is known about how broad-based this support is. OBJECTIVE To investigate the extent to which support for donation holds across both pre-specified and exploratory subgroups. METHODS From 24 November-28 December 2020 we conducted an online survey of 8209 members of the general public in seven HIC (Australia, Canada, France, Italy, Spain, UK and USA). We conducted tests of proportions and used Bayesian ordinal logistic regression models to assess the extent of support for donation across population subgroups. RESULTS We found broad-based support for donations in terms of age, gender, socio-economic status and political ideology. We found no strong evidence that support for donations was higher among those with greater income or a university education. Support for donation among those on the political right and centre was lower than on the left, but 51% (95% confidence interval 48-53%) of respondents who identified with the right supported some level of donation. Those in the more altruistic half of the sample (as captured by willingness to donate money to a good cause) were more likely to support donation than those who were not, but around half of the less altruistic group supported some level of donation. CONCLUSION There is broad-based support for policymakers in HICs to donate some of their countries' COVID-19 vaccine doses for distribution to LICs.
Collapse
Affiliation(s)
- Laurence S J Roope
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
- National Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK.
| | - Adrian Barnett
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Paolo Candio
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- National Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
- Centre for Economics of Obesity, University of Birmingham, Birmingham, UK
| | - Mara Violato
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- National Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
| | - Raymond Duch
- Nuffield College, University of Oxford, Oxford, UK
| | - Philip M Clarke
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- National Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
- Melbourne School of Population and Global Health, Centre for Health Policy, University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
29
|
Duch R, Roope LSJ, Violato M, Fuentes Becerra M, Robinson TS, Bonnefon JF, Friedman J, Loewen PJ, Mamidi P, Melegaro A, Blanco M, Vargas J, Seither J, Candio P, Gibertoni Cruz A, Hua X, Barnett A, Clarke PM. Citizens from 13 countries share similar preferences for COVID-19 vaccine allocation priorities. Proc Natl Acad Sci U S A 2021; 118:e2026382118. [PMID: 34526400 PMCID: PMC8463843 DOI: 10.1073/pnas.2026382118] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2021] [Indexed: 11/21/2022] Open
Abstract
How does the public want a COVID-19 vaccine to be allocated? We conducted a conjoint experiment asking 15,536 adults in 13 countries to evaluate 248,576 profiles of potential vaccine recipients who varied randomly on five attributes. Our sample includes diverse countries from all continents. The results suggest that in addition to giving priority to health workers and to those at high risk, the public favors giving priority to a broad range of key workers and to those with lower income. These preferences are similar across respondents of different education levels, incomes, and political ideologies, as well as across most surveyed countries. The public favored COVID-19 vaccines being allocated solely via government programs but were highly polarized in some developed countries on whether taking a vaccine should be mandatory. There is a consensus among the public on many aspects of COVID-19 vaccination, which needs to be taken into account when developing and communicating rollout strategies.
Collapse
Affiliation(s)
- Raymond Duch
- Nuffield College, University of Oxford, Oxford OX1 1NF, United Kingdom;
| | - Laurence S J Roope
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, United Kingdom
- National Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
| | - Mara Violato
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, United Kingdom
- National Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
| | | | - Thomas S Robinson
- School of Government and International Affairs, Durham University, Durham DH1 3TU, United Kingdom
| | - Jean-Francois Bonnefon
- Toulouse School of Economics, CNRS, Université Toulouse Capitole, 31000 Toulouse, France
| | - Jorge Friedman
- Facultad de Administracion y Economia, Universidad de Santiago de Chile, Santiago 9170022, Chile
| | - Peter John Loewen
- Department of Political Science, Munk School of Global Affairs and Public Policy, University of Toronto, Toronto, ON M5S1A4, Canada
| | - Pavan Mamidi
- Center for Social and Behavioral Change, Ashoka University, Sonipat, Haryana 131029, India
| | - Alessia Melegaro
- Dondena Centre for Research on Social Dynamics and Public Policies, Department of Social and Political Science, Bocconi University, 20136 Milan, Italy
| | - Mariana Blanco
- Facultad de Economia, Universidad del Rosario, Bogotá 111711, D.C. Colombia
| | - Juan Vargas
- Facultad de Economia, Universidad del Rosario, Bogotá 111711, D.C. Colombia
| | - Julia Seither
- Facultad de Economia, Universidad del Rosario, Bogotá 111711, D.C. Colombia
| | - Paolo Candio
- National Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, United Kingdom
| | - Ana Gibertoni Cruz
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, United Kingdom
| | - Xinyang Hua
- Centre For Health Policy, University of Melbourne, Parkville, VIC 3010, Australia
| | - Adrian Barnett
- Institute of Health Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Philip M Clarke
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, United Kingdom
- National Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
- Centre For Health Policy, University of Melbourne, Parkville, VIC 3010, Australia
| |
Collapse
|