Vaccines or Lockdowns? The Role of Global Preference Assessment in Informing Public Health Policy

Abstract

Background Vaccine hesitancy and low uptake threaten the transition to the COVID-19 endemic phase, favouring virus transmission and the emergence of new variants (1,2). This may force governments to impose societal restrictions or vaccination mandates on a cyclical basis to increase uptake. Understanding the trade-offs between vaccine and policy restrictions features in vaccination decisions may help governments design effective vaccine campaigns in the long run. Methods A stated preference survey was administered to 51,600 respondents from 21 countries on six continents between July 2022 and January 2023 to explore preferences and trade-offs between vaccine features and social restrictions and predicted uptake of vaccination against Covid-19. Each respondent answered 12 choice tasks. A follow-up question with an opt-out option was also included. Each option had seven attributes (five vaccine features and two policy restrictions). A mixed multinomial logit model was used to explore preference heterogeneity within and across countries and calculate willingness to accept risk Results Respondents preferred a vaccine with higher effectiveness (b=1.27, 95%CI=1.24,1.30), a lower side effect (b=-0.03, 95%CI=-0.03,-0.03), a longer duration of immunity (b=-0.01, 95%CI=0.01,0.01), and a longer time to market approval (b=\0.00, 95%CI=\0.00,\0.00). Social restrictions negatively influenced preferences (b=-0.31, 95%CI=-0.29,-0.32). We found significant heterogeneity across countries. Some countries (e.g., Russia) considered the origin of the vaccine to be the most important attribute. Respondents were willing to accept a 0.04% increase in the risk of severe side effects to obtain a locally manufactured vaccine. In some countries vaccine mandates positively influenced preferences Conclusions This is the first stated preference survey to consider vaccine and societal restriction features in a multicounty setting. Vaccine characteristics appear to be more important than social restrictions. Investing in the development of more effective vaccines whilst imposing some forms of restrictions proportional to the underlying epidemiological situation could be a successful long-term strategy for mitigating the effects of the pandemic.