Public Preferences for Government Response Policies on Outbreak Control

Preferences of citizens in Peru for school opening during a public-health crisis: A participatory value evaluation study

BACKGROUND

The outbreak of COVID-19 was followed by an unprecedented package of measures to protect public health. Over 150 countries mandated school closures to reduce the risk of transmission. Decisions on whether to close schools involve trade-offs between important effects on public health, learning outcomes, well-being of children, productivity of parents.

OBJECTIVES

Investigate Peruvian citizens' preferences for schools opening during a public-health crisis such as the COVID-19 pandemic in two scenarios: (i) when the threat from COVID-19 is low and schools are open; and, (ii) when the threat from COVID-19 is high and schools are closed.

METHODS

We conducted a Participatory Value Evaluation (PVE) from 22 September to 17 October 2022, on which 2007 respondents assessed which policy measures to implement in the two scenarios. (i) In Scenario 1 "Schools are open", children go to school, teachers and parents go to their jobs, but children still experience learning deficits from previous school closures. (ii) In Scenario 2 "Schools are closed", children cannot go to school and do not receive any formal teaching, leading to learning losses; many teachers must change careers; and, many parents have to stay at home to take care of their children and lose income. Respondents were shown a range of policy measures in each of the scenarios and received information about the effects of each measure on public health, children's well-being and learning loss.

RESULTS

We found that most respondents in Scenario 1 preferred mandatory vaccination for teachers and quarantine measures. In Scenario 2 we found that most respondents were positive towards reopening school policies. In both Scenarios respondents prioritized mandatory vaccination and quarantine measures over other mitigation measures. In Scenario 2, most respondents from the Highland region selected opening schools with 100% on-location teaching while hybrid teaching was mostly selected in the Coast region. Most respondents (82%) evaluated PVE as a good method to involve citizens in policy decision-making.

CONCLUSIONS

Policies that focus on prevention (e.g. mandatory vaccination for teachers and quarantine measures) can count on substantial support in a scenario when schools are open. The strong preference for opening schools with a noticeable difference in the way classes are provided (e.g. teaching on location most preferred by respondents from the Highlands and hybrid teaching by respondents from the Coast) show the importance of introducing differentiated strategies among regions.

Preferences for the Societal Impacts of a Pandemic when it Transitions into an Endemic: A Discrete Choice Experiment

BACKGROUND

The stage of the pandemic significantly affects people's preferences for (the societal impacts of) COVID-19 policies. No discrete choice experiments were conducted when the COVID-19 pandemic was in a transition phase.

OBJECTIVES

This is the first study to empirically investigate how citizens weigh the key societal impacts of pandemic policies when the COVID-19 pandemic transitions into an endemic.

METHODS

We performed two discrete choice experiments among 2181 Dutch adults that included six attributes: COVID-19 deaths, physical health problems, mental health problems, financial problems, surgery delays and the degree to which individual liberties are restricted. We used latent class choice models to identify heterogeneous preferences for the impacts of COVID-19 measures across different groups of respondents.

RESULTS

A large majority of the participants in this study was willing to accept deaths to avoid that citizens experience physical complaints, mental health issues, financial problems and the postponement of surgeries. The willingness to tolerate COVID-19 deaths to avoid these societal impacts differed substantially between participants. When participants were provided with information about the stringency of COVID-19 measures, they assigned relatively less value to preventing the postponement of non-urgent surgeries for 1-3 months across all classes.

CONCLUSIONS

Having gone through a pandemic, most Dutch citizens clearly prefer pandemic policies that consider citizens' financial situations, physical problems, mental health problems and individual liberties, alongside the effects on excess mortality and pressure on healthcare.

Navigating Public Policy Responses to a Pandemic: The Balancing Act Between Physical Health, Mental Health, and Household Income

OBJECTIVE

During COVID-19, governments imposed restrictions that reduced pandemic-related health risks but likely increased personal and societal mental health risk, partly through reductions in household income. This study aimed to quantify the public's willingness to accept trade-offs between pandemic health risks, household income reduction, and increased risk of mental illness that may result from future pandemic-related policies.

METHODS

A total of 547 adults from an online panel participated in a discrete choice experiment where they were asked to choose between hypothetical future pandemic scenarios. Each scenario was characterized by personal and societal risks of dying from the pandemic, experiencing long-term complications, developing anxiety/depression, and reductions in household income. A latent class regression was used to estimate trade-offs.

RESULTS

Respondents state a willingness to make trade-offs across these attributes if the benefits are large enough. They are willing to accept 0.8% lower household income (0.7-1.0), 2.7% higher personal risk of anxiety/depression (1.8-3.6), or 3.2% higher societal rate of anxiety/depression (1.7-4.7) in exchange for 300 fewer deaths from the pandemic.

CONCLUSION

Results reveal that individuals are willing to accept lower household income and higher rates of mental illness, both personal and societal, if the physical health benefits are large enough. Respondents placed greater emphasis on maintaining personal, as opposed to societal, mental health risk and were most interested in preventing pandemic-related deaths. Governments should consider less restrictive policies when pandemics have high morbidity but low mortality to avoid the prospect of improving physical health while simultaneously reducing net social welfare.

Stepping into the shoes of the policy maker: Results of a Participatory Value Evaluation for the Dutch long term COVID-19 strategy

BACKGROUND

The COVID-19 outbreak early 2020 was followed by an unprecedented package of measures. The relative calmness of the pandemic early 2022 provides a momentum to prepare for various scenarios.

OBJECTIVES

As acceptance of COVID-19 measures is key for public support we investigated citizens' preferences towards imposing measures in four scenarios: 1) spring/summer scenario with few hospitalizations; 2) autumn/winter scenario with many hospitalizations; 3) a new contagious variant, the impact on hospitalizations is unclear; 4) a new contagious variant, hospitalizations will substantially increase.

METHODS

Study 1 comprised a Participatory Value Evaluation (PVE) in which 2011 respondents advised their government on which measures to impose in the four scenarios. Respondents received information regarding the impact of each measure on the risk that the health system would be overloaded. To triangulate the results, 2958 respondents in Study 2 evaluated the acceptability of the measures in each scenario.

RESULTS

Measures were ranked similarly by respondents in Study 1 and 2: 1) the majority of respondents thought that hygiene measures should be upheld, even in the spring/summer; 2) the majority supported booster vaccination, working from home, encouraging self-testing, and mandatory face masks from scenario 2 onwards; 3) even in scenario 4, lockdown measures were not supported by the majority. Young respondents were willing to accept more risks for the health system than older respondents.

CONCLUSION

The results suggest that policies that focus on prevention (through advising low-impact hygiene measures) and early response to moderate threats (by scaling up to moderately restrictive measures and boostering) can count on substantial support. There is low support for lockdown measures even under high-risk conditions, which further emphasizes the importance of prevention and a timely response to new threats. Our results imply that young citizens' concerns, in particular, should be addressed when restrictive COVID-19 measures are to be implemented.

Population preferences for non-pharmaceutical interventions to control the SARS-CoV-2 pandemic: trade-offs among public health, individual rights, and economics

PROBLEM

Policymakers must decide on interventions to control the pandemic. These decisions are driven by weighing the risks and benefits of various non-pharmaceutical intervention alternatives. Due to the nature of the pandemic, these decisions are not based on sufficient evidence regarding the effects, nor are decision-makers informed about the willingness of populations to accept the economic and health risks associated with different policy options. This empirical study seeks to reduce uncertainty by measuring population preferences for non-pharmaceutical interventions.

METHODS

An online-based discrete choice experiment (DCE) was conducted to elicit population preferences. Respondents were asked to choose between three pandemic scenarios with different interventions and impacts of the Corona pandemic. In addition, Best-worst scaling (BWS) was used to analyze the impact of the duration of individual interventions on people's acceptance. The marginal rate of substitution was applied to estimate willingness-to-accept (WTA) for each intervention and effect by risk of infection.

RESULTS

Data from 3006 respondents were included in the analysis. The DCE showed, economic effect of non-pharmaceutical measures had a large impact on choice decisions for or against specific lockdown scenarios. Individual income decreases had the most impact. Excess mortality and individual risk of infection were also important factors influencing choice decisions. Curfews, contact restrictions, facility closures, personal data transmissions, and mandatory masking in public had a lesser impact. However, significant standard deviations in the random parameter logit model (RPL) indicated heterogeneities in the study population. The BWS results showed that short-term restrictions were more likely to be accepted than long-term restrictions. According to WTA estimates, people would be willing to accept a greater risk of infection to avoid loss of income.

DISCUSSION

The results can be used to determine which consequences of pandemic measures would be more severe for the population. For example, the results show that citizens want to limit the decline in individual income during pandemic measures. Participation in preference studies can also inform citizens about potential tradeoffs that decision-makers face in current and future decisions during a pandemic. Knowledge of the population's preferences will help inform decisions that consider people's perspectives and expectations for the future. Survey results can inform decision-makers about the extent to which the population is willing to accept certain lockdown measures, such as curfews, contact restrictions, lockdowns, or mandatory masks.