Effect of COVID-19 vaccine allocation strategies on vaccination refusal: a national survey

Abstract

Currently, one of the most pressing public health challenges is encouraging people to get vaccinated against COVID-19. Due to limited supplies, some people have had to wait for the COVID-19 vaccine. Consumer research has suggested that people who are overlooked in initial distribution of desired goods may no longer be interested. Here, we therefore examined people’s preferences for proposed vaccine allocation strategies, as well as their anticipated responses to being overlooked. After health-care workers, most participants preferred prioritizing vaccines for high-risk individuals living in group-settings (49%) or with families (29%). We also found evidence of reluctance if passed over. After random assignment to vaccine allocation strategies that would initially overlook them, 37% of participants indicated that they would refuse the vaccine. The refusal rate rose to 42% when the vaccine allocation strategy prioritized people in areas with more COVID-19 – policies that were implemented in many areas. Even among participants who did not self-identify as vaccine hesitant, 22% said they would not want the vaccine in that case. Logistic regressions confirmed that vaccine refusal would be largest if vaccine allocation strategies targeted people who live in areas with more COVID-19 infections. In sum, once people are overlooked by vaccine allocation, they may no longer want to get vaccinated, even if they were not originally vaccine hesitant. Vaccine allocation strategies that prioritize high-infection areas and high-risk individuals in group-settings may enhance these concerns.

Keywords:

• COVID-19
• vaccine allocation
• vaccine hesitancy

Acknowledgements

The project described in this paper relies on data from survey(s) administered by the Understanding America Study, which is maintained by the Center for Economic and Social Research (CESR) at the University of Southern California. Marco Angrisani, Daniel Bennett, Jill Darling, Tania Gutsche, and Arie Kapteyn are gratefully acknowledged for their help with this study.

Disclosure statement

Wändi Bruine de Bruin reports consulting income from the UK’s Behavioural Insights Team and Save The Children. Aulona Ulqinaku has no financial disclosures. In the past three years, Dr. Goldman has received research support, speaker fees, travel assistance, or consulting income from the following sources: ACADIA Pharmaceuticals, Amgen, The Aspen Institute, Biogen, Blue Cross Blue Shield of Arizona, BMS, Cedars Sinai Health System, Celgene, Edwards Lifesciences, Gates Ventures, Genentech, Gilead Sciences, GRAIL, Johnson & Johnson, Kaiser Family Foundation, National Institutes of Health, Novartis, Pfizer, Precision Health Economics, Roche, and Walgreens Boots Alliance.

Data availability statement

The survey and data are publicly available from the University of Southern California’s Understanding America Study (https://uasdata.usc.edu; survey 264).

Additional information

Funding

The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of USC or UAS. The collection of the UAS COVID-19 survey data was supported in part by the Bill & Melinda Gates Foundation and by grants U01AG054580 and P30AG024968 (Roybal Center for Behaviorial Interventions in Aging) from the National Institute on Aging. Additional funding for the collection of the presented survey data was provided by the Schaeffer Center for Health Policy and Economics and the University of Leeds. Wändi Bruine de Bruin was supported by the National Science Foundation (#2028683) and the Swedish Riksbankens Jubileumsfond Program on Science and Proven Experience ‘Science and Proven Experience’ The funding agreements ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report.