How should COVID-19 vaccines be distributed between the global north and south: a discrete choice experiment in six european countries

  1. Janina I Steinert  Is a corresponding author
  2. Henrike Sternberg
  3. Giuseppe A Veltri
  4. Tim Büthe
  1. Technical University of Munich, Germany
  2. University of Trento, Italy

Abstract

Background: The global distribution of COVID-19 vaccinations remains highly unequal. We examine public preferences in six European countries regarding the allocation of COVID-19 vaccines between the Global South and Global North.

Methods: We conducted online discrete choice experiments with adult participants in France (n=766), Germany (n=1964), Italy (n=767), Poland (n=670), Spain (n=925), and Sweden (n=938). Respondents were asked to decide which one of two candidates should receive the vaccine first. The candidates varied on four attributes: age, mortality risk, employment, and living in a low- or high-income country. We analysed the relevance of each attribute in allocation decisions using conditional logit regression.

Results: In all six countries, respondents prioritised candidates with a high mortality and infection risk, irrespective of whether the candidate lived in the respondent's own country. All else equal, respondents in Italy, France, Spain, and Sweden gave priority to a candidate from a low-income country, whereas German respondents were significantly more likely to choose the candidate from their own country. Female, younger, and more educated respondents were more favourable to an equitable vaccine distribution.

Conclusions: Given these preferences for global solidarity, European governments should promote vaccine transfers to poorer world regions.

Funding: Funding was provided by the European Union's Horizon H2020 research and innovation programme under grant agreement 101016233 (PERISCOPE).

Data availability

All data generated or analysed during this study are made publicly available via the Open Science Framework under the following link: https://osf.io/72jrq/

The following data sets were generated

Article and author information

Author details

  1. Janina I Steinert

    TUM School of Social Sciences and Technology, Technical University of Munich, Munich, Germany
    For correspondence
    janina.steinert@tum.de
    Competing interests
    The authors declare that no competing interests exist.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0001-7120-0075
  2. Henrike Sternberg

    TUM School of Social Sciences and Technology, Technical University of Munich, Munich, Germany
    Competing interests
    The authors declare that no competing interests exist.
  3. Giuseppe A Veltri

    Department of Sociology and Social Research, University of Trento, Trento, Italy
    Competing interests
    The authors declare that no competing interests exist.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0002-9472-2236
  4. Tim Büthe

    TUM School of Social Sciences and Technology, Technical University of Munich, Munich, Germany
    Competing interests
    The authors declare that no competing interests exist.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0002-4724-5000

Funding

Horizon 2020 Framework Programme (No 101016233 (PERISCOPE))

  • Janina I Steinert
  • Giuseppe A Veltri

The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.

Reviewing Editor

  1. Margaret Stanley, University of Cambridge, United Kingdom

Ethics

Human subjects: The study received approvals from the ethics committees of the medical faculty at the Technical University of Munich (TUM, IRB 227/20 S) and the ethics board at the University of Trento (Trento, IRB 2021-027). Participants were given an individual link to the survey, where they first received information about the study's purpose, data protection regulations, and voluntary participation. All participants provided written electronic consent to participate in the study prior to commencing the survey. Personally identifying information such as names and contact details were not collected and data is thus fully anonymised. After completing the survey, participants received a voucher worth three to five Euros, which was distributed by the survey company.

Version history

  1. Received: April 27, 2022
  2. Preprint posted: May 19, 2022 (view preprint)
  3. Accepted: October 3, 2022
  4. Accepted Manuscript published: October 18, 2022 (version 1)
  5. Version of Record published: October 24, 2022 (version 2)

Copyright

© 2022, Steinert et al.

This article is distributed under the terms of the Creative Commons Attribution License permitting unrestricted use and redistribution provided that the original author and source are credited.

Metrics

  • 792
    Page views
  • 110
    Downloads
  • 4
    Citations

Article citation count generated by polling the highest count across the following sources: PubMed Central, Crossref, Scopus.

Download links

A two-part list of links to download the article, or parts of the article, in various formats.

Downloads (link to download the article as PDF)

Open citations (links to open the citations from this article in various online reference manager services)

Cite this article (links to download the citations from this article in formats compatible with various reference manager tools)

  1. Janina I Steinert
  2. Henrike Sternberg
  3. Giuseppe A Veltri
  4. Tim Büthe
(2022)
How should COVID-19 vaccines be distributed between the global north and south: a discrete choice experiment in six european countries
eLife 11:e79819.
https://doi.org/10.7554/eLife.79819

Share this article

https://doi.org/10.7554/eLife.79819

Further reading

    1. Epidemiology and Global Health
    Yuchen Zhang, Yitang Sun ... Kaixiong Ye
    Research Article

    Background:

    Circulating omega-3 and omega-6 polyunsaturated fatty acids (PUFAs) have been associated with various chronic diseases and mortality, but results are conflicting. Few studies examined the role of omega-6/omega-3 ratio in mortality.

    Methods:

    We investigated plasma omega-3 and omega-6 PUFAs and their ratio in relation to all-cause and cause-specific mortality in a large prospective cohort, the UK Biobank. Of 85,425 participants who had complete information on circulating PUFAs, 6461 died during follow-up, including 2794 from cancer and 1668 from cardiovascular disease (CVD). Associations were estimated by multivariable Cox proportional hazards regression with adjustment for relevant risk factors.

    Results:

    Risk for all three mortality outcomes increased as the ratio of omega-6/omega-3 PUFAs increased (all Ptrend <0.05). Comparing the highest to the lowest quintiles, individuals had 26% (95% CI, 15–38%) higher total mortality, 14% (95% CI, 0–31%) higher cancer mortality, and 31% (95% CI, 10–55%) higher CVD mortality. Moreover, omega-3 and omega-6 PUFAs in plasma were all inversely associated with all-cause, cancer, and CVD mortality, with omega-3 showing stronger effects.

    Conclusions:

    Using a population-based cohort in UK Biobank, our study revealed a strong association between the ratio of circulating omega-6/omega-3 PUFAs and the risk of all-cause, cancer, and CVD mortality.

    Funding:

    Research reported in this publication was supported by the National Institute of General Medical Sciences of the National Institute of Health under the award number R35GM143060 (KY). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

    1. Ecology
    2. Epidemiology and Global Health
    Aleksandra Kovacevic, David RM Smith ... Lulla Opatowski
    Research Article

    Non-pharmaceutical interventions implemented to block SARS-CoV-2 transmission in early 2020 led to global reductions in the incidence of invasive pneumococcal disease (IPD). By contrast, most European countries reported an increase in antibiotic resistance among invasive Streptococcus pneumoniae isolates from 2019 to 2020, while an increasing number of studies reported stable pneumococcal carriage prevalence over the same period. To disentangle the impacts of the COVID-19 pandemic on pneumococcal epidemiology in the community setting, we propose a mathematical model formalizing simultaneous transmission of SARS-CoV-2 and antibiotic-sensitive and -resistant strains of S. pneumoniae. To test hypotheses underlying these trends five mechanisms were built into the model and examined: (1) a population-wide reduction of antibiotic prescriptions in the community, (2) lockdown effect on pneumococcal transmission, (3) a reduced risk of developing an IPD due to the absence of common respiratory viruses, (4) community azithromycin use in COVID-19 infected individuals, (5) and a longer carriage duration of antibiotic-resistant pneumococcal strains. Among 31 possible pandemic scenarios involving mechanisms individually or in combination, model simulations surprisingly identified only two scenarios that reproduced the reported trends in the general population. They included factors (1), (3), and (4). These scenarios replicated a nearly 50% reduction in annual IPD, and an increase in antibiotic resistance from 20% to 22%, all while maintaining a relatively stable pneumococcal carriage. Exploring further, higher SARS-CoV-2 R0 values and synergistic within-host virus-bacteria interaction mechanisms could have additionally contributed to the observed antibiotic resistance increase. Our work demonstrates the utility of the mathematical modeling approach in unraveling the complex effects of the COVID-19 pandemic responses on AMR dynamics.