Americans' willingness to give to global immunization programs: Political heterogeneity in preferences for program management and response to priming communications.

To develop effective private donation campaigns that support vaccine distribution in low- and middle-income countries (LMICs), one must understand donors' willingness to give, response to stimuli, and preferences for program management. We use a contingent valuation method to estimate United States citizens' willingness to give to nongovernmental COVID-19 immunization programs in LMICs during the emergency phase of the pandemic. Using split-sample treatments, we evaluate the impact of the immunization program administrator (generic NGO or COVAX) and the role of priming communications on inequality in income and vaccination rates between the US and recipient countries. Results show that the median American would donate $42 towards global immunization programs. Preferences for program management and responses to priming communications are heterogeneous across political affiliations, after controlling for altruistic motives, experiences with COVID, giving behaviors, and sociodemographic characteristics. Specifically, Democrats and Independents are more likely to donate to the COVAX-administered fund, and more responsive to priming statements regarding vaccine-gaps. Policy implications are discussed.

Willingness to give amid pandemics: a contingent valuation of anticipated nongovernmental immunization programs.

Given that altruism is crucial in assisting impoverished households to cope with health and economic crises, it is important to improve our understanding of how preferences and motives for giving differ during a pandemic. We implemented a web-based, contingent valuation survey to estimate Americans' willingness to give for nongovernmental immunization programs in the context of the COVID-19 pandemic. Our results indicate that the median person is willing to give a one-time donation of $26, or at least $13 when willingness-to-give estimates are corrected for uncertainty regarding future donations. We find that willingness to give is related to income, concern levels, vaccine usage, and sociodemographic characteristics. Our findings also shed light on purely and impurely altruistic motives underlying the willingness to fund immunization programs.

Will Americans Get Vaccinated? Predicting COVID-19 Vaccine Uptake Rates Under Contingent Scenarios.

OBJECTIVES: Amid a pandemic, vaccines represent a promising solution for mitigating public health and economic crises, and an improved understanding of individuals' vaccination intentions is crucial to design optimal immunization campaigns. This study predicts uptake rates for different COVID-19 vaccine specifications and identifies personal characteristics that moderate an individual's responsiveness to vaccine attributes. METHODS: We developed an online survey with contingent specifications of a COVID-19 vaccine, varying in effectiveness, risks of side effects, duration of immunity, and out-of-pocket cost. Using population-averaged logit models, we estimated vaccine uptake rates that account for uncertainty, heterogeneity across respondents, and interactions between vaccine and personal characteristics. RESULTS: We obtained 3047 completed surveys. The highest uptake rate for an annual vaccine, 62%, is predicted when vaccine effectiveness is 80% to 90%, side effects are minimal, and the vaccine is provided at zero cost, with decreases seen in the uptake rate for less effective vaccines, for example, 50% for 50% to 60% effectiveness. Moreover, we found that Americans' response to vaccine effectiveness depends on their self-reported concern, that is, concerned respondents report a higher willingness to get vaccinated. Our findings also indicate that COVID-19 vaccine uptake rates decrease with vaccine cost and that responsiveness to vaccine cost is moderated by income. CONCLUSIONS: Although providing the COVID-19 vaccine at zero cost will motivate many individuals to get vaccinated, a policy focused exclusively on vaccine cost may not be enough to reach herd immunity thresholds. Although those concerned with COVID-19 will participate, further evidence is needed on how to incentivize participation among the unconcerned (43%) to prevent further pandemic spread.

Immediate and informative feedback during a pandemic: Using stated preference analysis to predict vaccine uptake rates.

In response to an emerging pandemic, there is urgent need for information regarding individual evaluation of risk and preferences toward mitigation strategies such as vaccinations. However, with social distancing policies and financial stress during an outbreak, traditional robust survey methodologies of face-to-face, probabilistic sampling, may not be feasible to deploy quickly, especially in developing countries. We recommend a protocol that calls for a sensitive survey design, acceptance of a web-based approach and adjustments for uncertainty of respondents, to deliver urgently needed information to policymakers as the public health crisis unfolds, rather than in its aftermath. This information is critical to tailor comprehensive vaccination campaigns that reach critical immunity thresholds. We apply our recommendations in a regional study of 16 Latin American countries in the month following index cases of COVID-19. We use a split-sample, contingent valuation approach to evaluate the effects of cost, duration of immunity and effectiveness of the vaccine. Our results show that cost and duration of immunity are significant factors in the decision to vaccinate, while the degree of effectiveness is insignificant, unless the vaccine is 100% effective. Income as well as perceived risk and severity of the virus are important determinants also.

COVID-19 Risk Perceptions and Social Distancing Practice in Latin America.

OBJECTIVES: Many developing countries use social distancing as part of their mitigation strategy during epidemics. This study aimed to understand individual decisions to practice different social distancing measures in the immediate emergence of COVID-19. STUDY DESIGN: Utilizing social media advertising and snowball sampling, a web-based survey was administered in 16 Latin American countries. METHODS: We estimated seemingly unrelated Probit models to identify factors associated with the decision to implement social distancing practices. RESULTS: From 5,480 respondents, estimated marginal effects indicate that risk perceptions are positively related to distancing from friends or relatives and avoiding public places but do not seem to influence the decision to stay home. Results also indicate that risk perceptions are related to household income, the number of reported COVID-19 cases in the country, and perceived preparedness of the health care system. CONCLUSIONS: Our findings support the notion that people will follow social distancing measures if there is a clear understanding of risk. Providing the public ways to access accurate numbers of confirmed cases can inform perception of disease severity. Since household income was a determinant of practicing social distancing, without financial assistance, some will be forced to break regulations in order to procure food or resources for their survival.

The value of COVID-19 tests in Latin America.

Testing is a crucial strategy to control the spread of a pandemic. Voluntary participation in this strategy will depend on individual preferences towards and willingness-to-pay (WTP) for test results. We distributed a web-based, contingent valuation survey to social-media users in 16 Latin American countries to evaluate regional attitudes towards the emerging COVID-19 outbreak and WTP for COVID-19 testing. We observe that the cost of the test and household income are important determinants of testing intentions. We find higher WTP among those reporting greater concern relative to the average respondent. Accounting for uncertainty, our results indicate a WTP of approximately $45 dollars or 4.2 % of monthly income among respondents. These results, paired with our predicted participation rate of between 84-94 % for a $1 test, suggest that local officials will be able to effectively recruit participation in this mitigation strategy given the appropriate subsidization structure.