U.S. public support for COVID-19 vaccine donation to low- and middle-income countries during the COVID-19 pandemic

Correlates of support for international vaccine solidarity during the COVID-19 pandemic: Cross-sectional survey evidence from Germany

During the COVID-19 pandemic, many residents of high-income countries (HICs) were eligible for COVID-19 vaccine boosters, while many residents of lower-income countries (LICs) had not yet received a first dose. HICs made some efforts to contribute to COVID-19 vaccination efforts in LICs, but these efforts were limited in scale. A new literature discusses the normative importance of an international redistribution of vaccines. Our analysis contributes an empirical perspective on the willingness of citizens in a HIC to contribute to such efforts (which we term international vaccine solidarity). We analyse the levels and predictors of international vaccine solidarity. We surveyed a representative sample of German adults (n = 2019) who participated in a two-wave YouGov online survey (w1: Sep 13-21, 2021 and w2: Oct 4-13, 2021). International vaccine solidarity is measured by asking respondents preferences for sharing vaccine supplies internationally versus using that supply as boosters for the domestic population. We examine a set of pre-registered hypotheses. Almost half of the respondents in our sample (48%) prioritize giving doses to citizens in less developed countries. A third of respondents (33%) prefer to use available doses as boosters domestically, and a fifth of respondents (19%) did not report a preference. In line with our hypotheses, respondents higher in cosmopolitanism and empathy, and those who support domestic redistribution exhibit more support for international dose-sharing. Older respondents (who might be more at risk) do not consistently show less support for vaccine solidarity. These results help us to get a better understanding of the way citizens' form preferences about a mechanism that redistributes medical supplies internationally during a global crisis.

Politics matters for individual attitudes toward vaccine donation: cross-national evidence from the United States and Taiwan

BACKGROUND

Vaccine equity has been a major concern during the COVID-19 pandemic. According to the principle of vaccine equity, donor countries should apply the criterion of needs to make decisions about vaccine donation instead of considering recipient countries' economic status. We examine whether people follow the same criterion or consider other factors to decide which country to donate vaccines and how many vaccines should be delivered.

METHODS

We conducted online surveys with the design of conjoint experiment in the United States and Taiwan in 2021. 1,532 American citizens and 1,587 Taiwanese citizens were interviewed. The respondents were broadly quota-matched to their respective demographic proportions on the dimensions of age, gender, and education. We estimated the average marginal component effects (AMCEs) of the conjoint attributes by using the OLS regression models with standard errors clustered at the respondent level.

RESULTS

15,320 and 15,870 decisions on vaccine donation generated by conjoint experiment respectively in the United States and Taiwan were included in the analysis. Both American and Taiwanese people tend to donate vaccines to countries that suffer severe consequences of COVID-19 and democracies compared to authoritarian countries. However, they are less willing to donate vaccines to those with higher levels of capability in response to COVID-19. Taiwanese people tend to donate vaccines to countries having formal diplomatic relations with Taiwan (AMCE 13.4%, 95% CI 11.8%-15.1%). Nonetheless, American people would rather donate vaccines to countries without formal diplomatic relations with the United States (AMCE - 4.0%, 95% CI -5.6%--2.4%).

CONCLUSIONS

The findings reveal that politics plays a significant role in people's decisions about vaccine donation. Under electoral pressure, political leaders must think about how to respond to the public's preferences over vaccine donation to achieve vaccine equity and address the global health crisis.

Audience segmentation analysis of public intentions to get a COVID-19 vaccine in Australia

While previous studies provide broad categories of the public who intend to get a COVID-19 vaccine, few systematically segment and help understand and engage with distinct publics to improve COVID-19 vaccine uptake. Using data from a national sample of the Australian public (N = 1054) and using measures primarily based on the Theory of Planned Behaviour, a latent class analysis of 16 items was undertaken to identify COVID-19 audience segments for potential future message targeting. We found five different segments of COVID-19 vaccine intentions: vaccine enthusiasts (28%), supporters (26%), socials (20%), hesitant (15%) and sceptics (10%). These five audience segments also differ on demographic variables and their level of trust in mainstream media, scientists and health experts, social media and family and friends. Understanding the COVID-19 vaccine attitudinal and information-seeking characteristics of these sub-publics will help inform appropriate messaging campaigns.

Prioritization preferences for COVID-19 vaccination are consistent across five countries

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.

Public opinion towards global distribution of COVID-19 vaccines - Data from Germany and the United States

This study gathered evidence from Germany and the United States on public opinion towards fair distribution of COVID-19 vaccines across the world. Analytical Hierarchy Process and discrete choice experiments were used for this purpose. The sample is nationally representative of adults (aged 18 and above) for both countries using quotas on age, gender, education, state, and COVID-19 vaccination rates at the time of the fieldwork (25 May 2021 to 26 June 2021). Overall 1,003 responses in Germany and 1,000 in the United States were collected.

Measurement(s)	Public opinion
Technology Type(s)	Questionnaire

System dynamics analysis on the effectiveness of vaccination and social mobilization policies for COVID-19 in the United States

The COVID-19 pandemic has presented significant public health and economic challenges worldwide. Various health and non-pharmaceutical policies have been adopted by different countries to control the spread of the virus. To shed light on the impact of vaccination and social mobilization policies during this wide-ranging crisis, this paper applies a system dynamics analysis on the effectiveness of these two types of policies on pandemic containment and the economy in the United States. Based on the simulation of different policy scenarios, the findings are expected to help decisions and mitigation efforts throughout this pandemic and beyond.

Public opinion on global distribution of COVID-19 vaccines: Evidence from two nationally representative surveys in Germany and the United States

Despite ongoing calls for a more even global distribution of COVID-19 vaccines, there remains a great disparity between high- and low-income countries. We conducted representative surveys among the adult populations in the United States (N = 1,000) and Germany (N = 1,003) in June 2021 to assess public opinion in these countries on the distributive justice of COVID-19 vaccines. We conducted two instances of analytic hierarchy processes (AHP) to elicit how the public weighs different principles and criteria for vaccine allocation. In further discrete choice experiments, respondents were asked to split a limited supply of vaccine doses between a hypothetical high-income and a hypothetical low-income country. AHP weights in the United States and Germany were 37.4% (37.2–37.5) and 49.4% (49.2–49.5) for “medical urgency”, 32.7% (32.6–32.8) and 25.4% (25.2–25.5) for “equal access for all”, 13.7% (13.6–13.8) and 13.3% (13.2–13.4) for “production contribution”, and 16.3% (16.2–16.4) and 12.0% (11.9–12.1) for “free market rules”, respectively, with 95% CI shown in parentheses. In the discrete choice experiment, respondents in the United States and Germany split available vaccine doses such that the low-income country, which was three times more populous than the high-income country, on average received 53.9% (95% CI: 52.6–55.1) and 57.5% (95% CI: 56.3–58.7) of available doses, respectively. When faced with a dilemma where a vulnerable family member was waiting for a vaccine, 20.7% (95% CI: 18.2–23.3) of respondents in the United States and 18.2% (95% CI: 15.8–20.6) in Germany reduced the amount they allocated to the low-income country sufficiently to secure a vaccine for their family member. Our results indicate that the public in the United States and Germany favours utilitarian and egalitarian distribution principles of vaccines for COVID-19 over libertarian or meritocratic principles. This implies that political decisions favouring higher levels of redistribution would be supported by public opinion in these two countries.

Vaccine stockpile sharing for selfish objectives

The COVAX program aims to provide global equitable access to life-saving vaccines. Despite calls for increased sharing, vaccine protectionism has limited progress towards vaccine sharing goals. For example, as of April 2022 only ~20% of the population in Africa had received at least one COVID-19 vaccine dose. Here we use a two-nation coupled epidemic model to evaluate optimal vaccine-sharing policies given a selfish objective: in which countries with vaccine stockpiles aim to minimize fatalities in their own population. Computational analysis of a suite of simulated epidemics reveal that it is often optimal for a donor country to share a significant fraction of its vaccine stockpile with a recipient country that has no vaccine stockpile. Sharing a vaccine stockpile reduces the intensity of outbreaks in the recipient, in turn reducing travel-associated incidence in the donor. This effect is intensified as vaccination rates in a donor country decrease and epidemic coupling between countries increases. Critically, vaccine sharing by a donor significantly reduces transmission and fatalities in the recipient. Moreover, the same computational framework reveals the potential use of hybrid sharing policies that have a negligible effect on fatalities in the donor compared to the optimal policy while significantly reducing fatalities in the recipient. Altogether, these findings provide a self-interested rationale for countries to consider sharing part of their vaccine stockpiles.

Is There Broad-Based Support in High-Income Countries for COVID-19 Vaccine Donation? Evidence from Seven Countries

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.

Examining Factors Influencing COVID-19 Vaccine Tourism for International Tourists

Since early 2020, the COVID-19 pandemic has had a devastating impact on global tourism. Vaccine tourism is a novel health tourism concept, which provides an opportunity for countries with a vaccine surplus to offer medical tourism packages to entice international tourists from countries with vaccine shortages to visit for sightseeing and receive vaccine inoculations. Understanding the factors that influence people to adopt vaccine tourism is one of the strategies that could boost a country’s tourism sector and help to revive the local economy. This study aims to examine the factors influencing the intention to adopt and recommend COVID-19 vaccine tourism among young travelers. A total of 179 questionnaire surveys were collected from traveling-related social media outlets. Partial least squares structural equation modeling (PLS-SEM) was performed to analyze the data. The results indicate that young tourists in Thailand are inclined to promote vaccine tourism to others. Price value appears to be the most significant influencing factor on intentions to both adopt and recommend vaccine tourism. Additionally, trust in the foreign healthcare system was positively associated with young travelers’ intention to recommend vaccine tourism to others. Theoretically, this research adds to the medical tourism literature, suggesting that, while trust is an important factor influencing the medical tourism decision, it appears to be insignificant in the context of vaccine tourism.

COVID-19 Vaccine Donations-Vaccine Empathy or Vaccine Diplomacy? A Narrative Literature Review

Introduction: Vaccine inequality inflames the COVID-19 pandemic. Ensuring equitable immunization, vaccine empathy is needed to boost vaccine donations among capable countries. However, damaging narratives built around vaccine donations such as “vaccine diplomacy” could undermine nations’ willingness to donate their vaccines, which, in turn, further exacerbate global vaccine inequality. However, while discussions on vaccine diplomacy are on the rise, there is limited research related to vaccine diplomacy, especially in terms of its characteristics and effects on vaccine distribution vis-à-vis vaccine empathy. Thus, to bridge the research gap, this study aims to examine the defining attributes of vaccine diplomacy and its potential effects on COVID-19 immunization, particularly in light of vaccine empathy. Methods: A narrative review was conducted to shed light on vaccine diplomacy’s defining attributes and effects in the context of COVID-19 vaccine distribution and dissemination. Databases such as PubMed and Medline were utilized for literature search. Additionally, to ensure up-to-date insights are included in the review, validated reports and reverse tracing of eligible articles’ reference lists in Google Scholar have also been conducted to locate relevant records. Results: Vaccine empathy is an individual or a nation’s capability to sympathize with other individuals or nations’ vaccine wants and needs, whereas vaccine diplomacy is a nation’s vaccine efforts that aim to build mutually beneficial relationships with other nations ultimately. Our findings show that while both vaccine empathy and vaccine diplomacy have their strengths and weaknesses, they all have great potential to improve vaccine equality, particularly amid fast-developing and ever-evolving global health crises such as COVID-19. Furthermore, analyses show that, compared to vaccine empathy, vaccine diplomacy might be a more sustainable solution to improve vaccine donations mainly because of its deeper and stronger roots in multilateral collaboration and cooperation. Conclusion: Similar to penicillin, automated external defibrillators, or safety belts amid a roaring global health disaster, COVID-19 vaccines are, essentially, life-saving consumer health products that should be available to those who need them. Though man-made and complicated, vaccine inequality is nonetheless a solvable issue—gaps in vaccine distribution and dissemination can be effectively addressed by timely vaccine donations. Overall, our study underscores the instrumental and indispensable role of vaccine diplomacy in addressing the vaccine inequality issue amid the COVID-19 pandemic and its potentials for making even greater contributions in forging global solidarity amid international health emergencies. Future research could investigate approaches that could further inspire and improve vaccine donations among capable nations at a global scale to advance vaccine equity further.

Investigating the Links Between Vaccination Against COVID-19 and Public Attitudes Toward Protective Countermeasures: Implications for Public Health

The COVID-19 pandemic caused by the novel coronavirus, SARS-CoV-2, is spreading globally at an unprecedented rate. To protect the world against this devastating catastrophe, vaccines for SARS-CoV-2 have been produced following consistent clinical trials. However, the durability of a protective immune response due to vaccination has not been confirmed. Moreover, COVID-19 vaccination against SARS-CoV-2 is not 100% guaranteed, as new variants arise due to mutations. Consequently, health officials are pleading with the public to take extra precautions against the virus and continue wearing masks, wash hands, and observe physical distancing even after vaccination. The current research collected data from 4,540 participants (1,825 vaccinated and 2,715 not vaccinated) in China to analyze this phenomenon empirically. The propensity score matching (PSM) model is employed to analyze the impact of vaccination against COVID-19 on participants' attitudes toward protective countermeasures. The findings showed that gender, age, education level, occupation risk, individual health risk perception, public health risk perception, social responsibility, peer effect, and government supervision are the main drivers for participants to be vaccinated with COVID-19's vaccines. The results further show that vaccination lessened participants' frequency of hand washing by 1.75 times and their compliance frequency intensity of observing physical distancing by 1.24 times. However, the rate of mask-wearing did not reduce significantly, implying that China's main countermeasure of effective mask-wearing effectively controls COVID-19. Moreover, the findings indicate that a reduction in the frequency of hand washing and observing physical distance could cause a resurgence of COVID-19. In conclusion, factors leading to the eradication of SARS-CoV-2 from the world are complex to be achieved, so the exploration of COVID-19 vaccination and people's attitude toward protective countermeasures may provide insights for policymakers to encourage vaccinated people to follow protective health measures and help in completely defeating the COVID-19 from the globe.