Are distributional preferences for safety stable? A longitudinal analysis before and after the COVID-19 outbreak.

Policy makers aim to respect public preferences when making trade-offs between policies, yet most estimates of the value of safety neglect individuals' preferences over how safety is distributed. Incorporating these preferences into policy first requires measuring them. Arroyos-Calvera et al. (2019) documented that people cared most about efficiency, but that equity followed closely, and self-interest mattered too, but not enough to override preferences for efficiency and equity. Early 2020 saw the outbreak of the COVID-19 pandemic. This event would impose major changes in how people perceived and experienced risk to life, creating an opportunity to test whether safety-related preferences are stable and robust to important contextual changes. Further developing Arroyos-Calvera et al.'s methodology and re-inviting an international general population sample of participants that had taken part in pre-pandemic online surveys in 2017 and 2018, we collected an April 2020 wave of the survey and showed that overall preferences for efficiency, equity and self-interest were remarkably stable before and after the pandemic outbreak. We hope this offers policy makers reassurance that once these preferences have been elicited from a representative sample of the population, they need not be re-estimated after important contextual changes.

The efficiency-equity trade-off, self-interest, and moral principles in health and safety valuation.

Policy makers try to take account of public preferences when making trade-offs between policy options. Yet most estimates of the value of health and safety reflect only individuals' self-interested preferences, neglecting their preferences over the distribution of public resources. We conduct an experiment in which participants choose between policy options that differ in their efficiency (expected number of fatalities or cases of ill health they would prevent) and their equity (defined in terms of the balance of risk reductions for different sections of the population). The policy options were framed as interventions to improve a hypothetical city's water supply that would reduce the risk of death or ill health for people in different areas of the city to varying degrees. In order to examine whether self-interest would affect the trade-offs, we asked half of the sample about scenarios where they would personally benefit from some options. Our results suggest that efficiency is the most important single factor determining preferences between policy options, but decisions were influenced almost as much by equity as by efficiency. The effect of self-interest was smaller than that of the general concern for efficiency. We also elicited participants' stated moral principles regarding trade-offs between equity, efficiency and self-interest, and found that their expressed principles were well-aligned with their choices. Our findings contribute to the growing evidence that distributional concerns matter when evaluating health interventions.