Preferences for COVID-19 vaccine distribution strategies in the US: A discrete choice survey

Background The COVID-19 vaccination campaign in the US has been immensely successful in vaccinating those who are receptive, further increases in vaccination rates however will require more innovative approaches to reach those who remain hesitant. Developing vaccination strategies that are modelled on what people want could further increase uptake. Methods and findings To inform COVID-19 vaccine distribution strategies that are aligned with public preferences we conducted a discrete choice experiment among the US public (N = 2,895) between March 15 to March 22, 2021. We applied sampling weights, evaluated mean preferences using mixed logit models, and identified latent class preference subgroups. On average, the public prioritized ease, preferring single to two dose vaccinations (mean preference: -0.29; 95%CI: -0.37 to -0.20), vaccinating once rather than annually (mean preference: -0.79; 95%CI: -0.89 to -0.70) and reducing waiting times at vaccination sites. Vaccine enforcement reduced overall vaccine acceptance (mean preference -0.20; 95%CI: -0.30 to -0.10), with a trend of increasing resistance to enforcement with increasing vaccine hesitancy. Latent class analysis identified four distinct preference phenotypes: the first prioritized inherent “vaccine features” (46.1%), the second were concerned about vaccine “service delivery” (8.8%), a third group desired “social proof” of vaccine safety and were susceptible to enforcement (13.2%), and the fourth group were “indifferent” to vaccine and service delivery features and resisted enforcement (31.9%). Conclusions This study identifies several critical insights for the COVID-19 public health response. First, identifying preference segments is essential to ensure that vaccination services meet the needs of diverse population subgroups. Second, making vaccination easy and promoting autonomy by simplifying services and offering the public choices (where feasible) may increase uptake in those who remain deliberative. And, third vaccine mandates have the potential to increase vaccination rates in susceptible groups but may simultaneously promote control aversion and resistance in those who are most hesitant.

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Strategies that make vaccination easy and promote autonomy could increase COVID-19 vaccination in those who remain hesitant.

10.1101/2021.05.19.21257355 ◽

2021 ◽

Author(s):

Ingrid Eshun-Wilson ◽

Aaloke Mody ◽

Khai Hoan Tram ◽

Cory Bradley ◽

Alexander Scheve ◽

...

Keyword(s):

Waiting Times ◽

Vaccination Campaign ◽

Vaccine Hesitancy ◽

Public Preferences ◽

Black African ◽

Vaccination Rates ◽

The Public ◽

The Us ◽

Vaccine Distribution ◽

Vaccination Campaigns

The COVID-19 vaccination campaign in the US has been immensely successful in vaccinating those who are receptive, further increases in vaccination rates however will require more innovative approaches to reach those who remain hesitant, deliberative or indifferent. Phenomena such empty mass vaccination sites and wasted vaccine doses in some regions suggest that in addition to dispelling misinformation and building trust, developing more person-centered vaccination strategies, that are modelled on what people want could further increase uptake. To inform vaccine distribution strategies that are aligned with public preferences for COVID-19 vaccination campaign features we conducted a survey and discrete choice experiment among a representative sample of 2,895 people in the US, between March 15 and March 22, 2021. We found that on average the public prioritized ease, preferring single to two dose vaccinations, vaccinating once rather than annually and reduced waiting times at vaccination sites - for some these were the primary preference drivers. Vaccine enforcement reduced overall vaccine acceptance, with a trend of increasing control aversion with increasing vaccine hesitancy, particularly among those who were young, Black/African American or Republican. These data suggest that making vaccination easy and promoting autonomy by offering the public choices of vaccination brands and locations may increase uptake, and that vaccine mandates could compromise autonomy and increase control aversion in those who are hesitant - reducing vaccination in such groups and potentially undermining the goals of COVID-19 vaccination campaigns.

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Public Preferences for Social Distancing Behaviors to Mitigate the Spread of COVID-19: A Discrete Choice Experiment

10.1101/2020.12.12.20248103 ◽

2020 ◽

Author(s):

Ingrid Eshun Wilson ◽

Aaloke Mody ◽

Ginger McKay ◽

Mati Hlatshwayo ◽

Cory Bradley ◽

...

Keyword(s):

Public Health ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Choice Experiment ◽

Latent Class ◽

Latent Class Models ◽

Second Phase ◽

Sampling Weights ◽

Social Distancing ◽

The Public

AbstractPolicies to promote social distancing can minimize COVID-19 transmission, but come with substantial social and economic costs. Quantifying relative preferences of the public for such practices can inform policy prioritization and optimize uptake. We used a discrete choice experiment (DCE) to quantify relative “utilities” (preferences) for five COVID-19 pandemic social distances strategies (e.g., closure of restaurants, restriction of large gatherings) against the hypothetical risk of acquiring COVID-19 and anticipated income loss. The survey was distributed in Missouri in May-June, 2020. We applied inverse probability sampling weights to mixed logit and latent class models to generate mean preferences and identify preference classes. Overall (n=2,428), the strongest preference was for the prohibition of large gatherings, followed by preferences to keep outdoor venues, schools, and social and lifestyle venues open, 75% of the population showing probable support for a strategy that prohibited large gatherings and closed lifestyle and social venues. Latent class analysis, however revealed four preference sub-groups in the population - “risk eliminators”, “risk balancers”, “altruistic” and “risk takers”, with men twice as likely as women to belong to the risk-taking group. In this setting, public health policies which as a first phase prohibit large gatherings, as well as close social and lifestyle venues may be acceptable and adhered to by the public. In addition, policy messages that address preference heterogeneity, for example by targeting public health messages at men, could improve adherence to social distancing measures and prevent further COVID-19 transmission prior to vaccine distribution and in the event of future pandemics.Significance StatementPreferences drive behavior – DCE’s are a novel tool in public health that allow examination of preferences for a product, service or policy, identifying how the public prioritizes personal risks and cost in relation to health behaviors. Using this method to establish preferences for COVID-19 mitigation strategies, our results suggest that, firstly, a tiered approach to non-essential business closures where large gatherings are prohibited and social and lifestyle venues are closed as a first phase, would be well aligned with population preferences and may be supported by the public, while school and outdoor venue closures may require more consideration prior to a second phase of restrictions. And secondly, that important distinct preference phenotypes - that are not captured by sociodemographic (e.g., age, sex, race) characteristics - exist, and therefore that messaging should be target at such subgroups to enhance adherence to prevention efforts.

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Public, medical professionals’ and patients’ preferences for the allocation of donor organs for transplantation: study protocol for discrete choice experiments

BMJ Open ◽

10.1136/bmjopen-2018-026040 ◽

2018 ◽

Vol 8 (10) ◽

pp. e026040 ◽

Cited By ~ 4

Author(s):

Carina Oedingen ◽

Tim Bartling ◽

Christian Krauth

Keyword(s):

Discrete Choice ◽

Study Protocol ◽

Systematic Reviews ◽

Latent Class ◽

Choice Experiments ◽

Fractional Factorial ◽

Discrete Choice Experiments ◽

Medical Professionals ◽

The Public ◽

Donor Organs

IntroductionOrgan transplantation is the treatment of choice for patients with severe organ failure. Nevertheless, donor organs are a scarce resource resulting in a large mismatch between supply and demand. Therefore, priority-setting leads to the dilemma of how these scarce organs should be allocated and who should be considered eligible to receive a suitable organ. In order to improve the supply–demand mismatch in transplantation medicine, this study explores preferences of different stakeholders (general public, medical professionals and patients) for the allocation of donor organs for transplantation in Germany. The aims are (1) to determine criteria and preferences, which are relevant for the allocation of scarce donor organs and (2) to compare the results between the three target groups to derive strategies for health policy.Methods and analysisWe outline the study protocol for discrete choice experiments, where respondents are presented with different choices including attributes with varied attribute levels. They were asked to choose between these choice sets. First, systematic reviews will be conducted to identify the state of art. Subsequently, focus group discussions with the public and patients as well as expert interviews with medical professionals will follow to establish the attributes that are going to be included in the experiments and to verify the results of the systematic reviews. Using this qualitative exploratory work, discrete choice studies will be designed to quantitatively assess preferences. We will use a D-efficient fractional factorial design to survey a total sample of 600 respondents according to the public, medical professionals and patients each. Multinomial conditional logit model and latent class model will be analysed to estimate the final results.Ethics and disseminationThis study has received Ethics Approval from the Hannover Medical School Human Ethics Committee (Vote number: 7921_BO_K_2018). Findings will be disseminated through conference presentations, workshops with stakeholders and peer-reviewed journal articles.

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The comparison of vaccine hesitancy of COVID-19 vaccination in China and the United States

10.1101/2021.04.29.21256317 ◽

2021 ◽

Author(s):

Taoran Liu ◽

Zonglin He ◽

Jian Huang ◽

Ni Yan ◽

Qian Chen ◽

...

Keyword(s):

United States ◽

Propensity Score ◽

Propensity Score Matching ◽

Discrete Choice ◽

Choice Experiments ◽

The United States ◽

Discrete Choice Experiments ◽

Vaccine Hesitancy ◽

The Us ◽

The Cost

AbstractObjectivesTo investigate the differences in vaccine hesitancy and preference of the currently available COVID-19 vaccines between two countries, viz. China and the United States (US).MethodA cross-national survey was conducted in both China and the US, and discrete choice experiments as well as Likert scales were utilized to assess vaccine preference and the underlying factors contributing to the vaccination acceptance. A propensity score matching (PSM) was performed to enable a direct comparison between the two countries.ResultsA total of 9,077 (5,375 and 3,702, respectively, from China and the US) respondents have completed the survey. After propensity score matching, over 82.0% respondents from China positively accept the COVID-19 vaccination, while 72.2% respondents form the US positively accept it. Specifically, only 31.9% of Chinese respondents were recommended by a doctor to have COVID-19 vaccination, while more than half of the US respondents were recommended by a doctor (50.2%), local health board (59.4%), or friends and families (64.8%). The discrete choice experiments revealed that respondents from the US attached the greatest importance to the efficacy of COVID-19 vaccines (44.41%), followed by the cost of vaccination (29.57%), whereas those from China held a different viewpoint that the cost of vaccination covers the largest proportion in their trade-off (30.66%), and efficacy ranked as the second most important attribute (26.34%). Also, respondents from China tend to concerned much more about the adverse effect of vaccination (19.68% vs 6.12%) and have lower perceived severity of being infected with COVID-19.ConclusionWhile the overall acceptance and hesitancy of COVID-19 vaccination in both countries are high, underpinned distinctions between countries are observed. Owing to the differences in COVID-19 incidence rates, cultural backgrounds, and the availability of specific COVID-19 vaccines in two countries, the vaccine rollout strategies should be nation-dependent.

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Vaccine Hesitancy in the Time of COVID-19: Attitudes and Intentions of Teens and Parents Regarding the COVID-19 Vaccine

Vaccines ◽

10.3390/vaccines10010004 ◽

2021 ◽

Vol 10 (1) ◽

pp. 4

Author(s):

Amy B. Middleman ◽

Judy Klein ◽

Jane Quinn

Keyword(s):

Vaccine Coverage ◽

Vaccine Safety ◽

Negative Influence ◽

Demographic Variables ◽

Vaccine Hesitancy ◽

Vaccination Rates ◽

Time Points ◽

Parental Concerns ◽

The Us ◽

Coverage Rates

To assess attitudes and intentions related to the COVID-19 vaccine during the pandemic, we surveyed adolescents aged 13–18 years and the parents of 13–18-year-olds using national research panels on three occasions or “waves”: before the COVID-19 vaccine was available, after it was available for adults, and after it was available for ages ≥12 years. Data on experiences with COVID-19, the importance of adolescent vaccines, and intentions regarding COVID-19 vaccination were analyzed across time points. We found that parental concerns about vaccine safety significantly increased from Wave 1 to 2. Social media had a negative influence on parents’ and adolescents’ opinions about vaccine safety. Demographic variables were associated with vaccination rates reported in Wave 3, consistent with known inequities related to vaccine access. Parents (70%) were supportive of concomitant COVID-19 vaccination with other adolescent vaccines for teens. It is important to address variables associated with vaccine hesitancy to increase COVID-19 vaccine coverage rates in the US.

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New decade, new response: Altering the public health response to toxigenic cutaneous diphtheria

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.833 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

N C Marshall ◽

M Baxi ◽

C MacDonald ◽

C Sikora ◽

G J Tyrrell

Keyword(s):

Public Health ◽

Respiratory Disease ◽

Diphtheria Toxin ◽

Laboratory Testing ◽

Asymptomatic Carrier ◽

Public Health Response ◽

Vaccination Rates ◽

The Public ◽

Health Response

Abstract Background Classical diphtheria is a potentially fatal respiratory disease mediated by the diphtheria toxin of Corynebacterium diphtheriae. Due to high vaccination rates against this toxin in Canada, the national incidence of respiratory diphtheria is near zero, and the toxin plays no recognized role in cutaneous diphtheria. Therefore, in this study, we assessed the diagnostic and public health benefits of diphtheria toxin testing and cutaneous diphtheria investigations in a highly vaccinated population. Methods Over the last 10 years, we retrospectively determined: the number of C. diphtheriae isolates identified in the province of Alberta, Canada; the disease state of each individual tested (disease vs asymptomatic carrier); the source (cutaneous vs respiratory); and the number of toxin tests performed. Results In 10 years, zero cases of respiratory diphtheria and three cases of toxigenic cutaneous diphtheria were identified. Despite zero cases of respiratory disease, diphtheria toxin testing significantly increased (p = 0.0001), with 86% of toxin tests performed on cutaneous isolates. Subsequent public health investigations of each case of toxigenic cutaneous diphtheria mandated the collection of 315 total specimens from 92 individuals, revealing low rates of C. diphtheriae colonization among contacts and no further cases. Conclusions This study challenges the value of reflexive diphtheria toxin testing in uncomplicated cutaneous diphtheria among highly vaccinated populations. Cutaneous diphtheria investigations demanded disproportionate public health and laboratory resources and demonstrated a discrepancy between toxin pathophysiology and disease. Therefore, we recommend stewarding diphtheria toxin tests for toxin-mediated disease forms and ensuring adequate vaccination. This approach would spare public health and laboratory resources by customizing responses around the role of the diphtheria toxin in each form of disease. Key messages Investigations for cutaneous diphtheria increased demand for toxin testing in Alberta, Canada, though the toxin plays no role in this form of disease. In populations with high vaccination rates against diphtheria toxoid, cutaneous diphtheria cases do not require additional laboratory testing for the presence of the diphtheria toxin.

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Youth Perspectives on Integrated Youth Services: A Discrete Choice Conjoint Experiment

The Canadian Journal of Psychiatry ◽

10.1177/07067437211044717 ◽

2021 ◽

pp. 070674372110447

Author(s):

Joanna Henderson ◽

Lisa D. Hawke ◽

Srividya N. Iyer ◽

Em Hayes ◽

Karleigh Darnay ◽

...

Keyword(s):

Mental Health ◽

Service Delivery ◽

Social Services ◽

Discrete Choice ◽

Latent Class ◽

Target Population ◽

Latent Classes ◽

Youth Services ◽

Model Of Care ◽

Health And Social Services

Objective Integrated youth services (IYS) are an emerging model of care offering a broad range of mental health and social services for youth in one location. This study aimed to determine the IYS service characteristics most important to youth, as well as to determine whether different classes of youth have different service preferences, and if so, what defines these classes. Methods Ontario youth aged 14–29 years with mental health challenges were recruited to participate in a discrete choice experiment (DCE) survey. The DCE contained 12 attributes, each represented by 4 levels representing core characteristics of IYS models. To supplement the DCE questions, demographic information was collected and a mental health screener was administered. Preferences were examined, latent class analyses were conducted, and latent classes were compared. Results As a whole, participants endorsed the IYS model of service delivery. Among 274 youth, there were three latent classes: 1) the Focused Service (37.6%) latent class prioritized efficient delivery of mental health services. 2) The Holistic Services (30.3%) latent class prioritized a diverse array of mental health and social services delivered in a timely fashion. 3) The Responsive Services (32.1%) latent class prioritized services that matched the individual needs of the youth being served. Differences between classes were observed based on sociodemographic and clinical variables. Conclusions IYS is an acceptable model of care, in that it prioritizes components that reflect youth preferences. The differences in preference profiles of different groups of youth point to the need for flexible models of service delivery. Service design initiatives should take these preferences into account, designing services that meet the needs and preferences of a broad range of youth. Working locally to co-design services with the youth in the target population who wish to be engaged will help meet the needs of youth.

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Vaccine Education in the Library: Lessons Learned from a Hot Topic Program

Children and Libraries ◽

10.5860/cal.18.2.21 ◽

2020 ◽

Vol 18 (3) ◽

pp. 21

Author(s):

Katherine Hickey ◽

Annie Emmons

Keyword(s):

Human Services ◽

Lessons Learned ◽

World Health ◽

Vaccine Hesitancy ◽

Vaccination Rates ◽

Health And Human Services ◽

Department Of Health ◽

The Us ◽

The World ◽

Health Organization

Recent data from the US Department of Health and Human Services indicate a small but growing number of unvaccinated children under the age of two. Low vaccination rates can result in outbreaks of preventable diseases and even death. The World Health Organization (WHO) identified vaccine hesitancy as one of the top ten threats to global health in 2019.

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Vaccine breakthrough and the invasion dynamics of SARS-CoV-2 variants

10.1101/2021.12.13.21267725 ◽

2021 ◽

Author(s):

Chadi M Saad-Roy ◽

Simon A Levin ◽

Julia Rose Gog ◽

Jeremy Farrar ◽

Caroline E Wagner ◽

...

Keyword(s):

Vaccination Coverage ◽

Epidemiological Model ◽

Vaccine Hesitancy ◽

Invasion Dynamics ◽

Vaccination Rates ◽

Number Of Factors ◽

Potential Benefits ◽

Protection Against Infection ◽

Vaccine Distribution

Vaccination provides a powerful tool for mitigating and controlling the COVID-19 pandemic. However, a number of factors reduce these potential benefits. The first problem arises from heterogeneities in vaccine supply and uptake: from global inequities in vaccine distribution, to local variations in uptake derived from vaccine hesitancy. The second complexity is biological: though several COVID-19 vaccines offer substantial protection against infection and disease, 'breakthrough' reinfection of vaccinees (and subsequent retransmission from these individuals) can occur, driven especially by new viral variants. Here, using a simple epidemiological model, we show that the combination of infection of remaining susceptible individuals and breakthrough infections of vaccinees can have significant effects in promoting infection of invading variants, even when vaccination rates are high and onward transmission from vaccinees relatively weak. Elaborations of the model show how heterogeneities in immunity and mixing between vaccinated and unvaccinated sub-populations modulate these effects, underlining the importance of quantifying these variables. Overall, our results indicate that high vaccination coverage still leaves no room for complacency if variants are circulating that can elude immunity, even if this happens at very low rates.

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Public Perceptions of Current COVID-19 Vaccinations. Results of a Pilot Survey

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/10760296211066942 ◽

2021 ◽

Vol 27 ◽

pp. 107602962110669

Author(s):

Bulent Kantarcioglu ◽

Krishan Patel ◽

Joseph Lewis ◽

Omer Iqbal ◽

Fakiha Siddiqui ◽

...

Keyword(s):

Vaccination Rate ◽

Public Perceptions ◽

Faculty Members ◽

Vaccine Hesitancy ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Safety And Efficacy ◽

The Public ◽

The Us ◽

And Gender

Introduction We conducted a cross-sectional survey as a part of an educational program in collaboration with the Global Thrombosis Forum (GTF), an affiliate of North American Thrombosis Forum (NATF), and Loyola University about public perceptions of COVID-19 and COVID-19 vaccinations in the US. In this study, we are reporting the results of this survey. Materials and Methods The survey, in the form of a questionnaire, has been developed by GTF and faculty members. A prepared questionnaire was sent to the members of the Georgia and Illinois communities. Results In our current study, the COVID-19 vaccine willingness rate was 94.5% and vaccination rate was 90.9%. In multivariate analysis believing to have enough information about the safety and efficacy of COVID-19 vaccines (OR: 3.730, 95% CI: 1.199–11.603, p: 0.023) and gender (OR: 0.123, 95% CI: 0.016–0.967, p: 0.046) were significant predictors for vaccine willingness. Previous COVID-19 infection (OR: 0.215, 95% CI: 0.061–0.758, p: 0.017), moderate and severe effects of COVID-19 pandemic on participant's life (OR: 4.631, 95% CI 1.681–12.760, p: 0.003) and believing to have enough information about the safety and efficacy of COVID-19 vaccines (OR: 4.119, 95% CI: 1.508–11.253, p: 0.006) were significant predictors for final vaccination status. Conclusion In conclusion, currently vaccination remains one of the most effective tools in the fight against the COVID-19 pandemic. The vaccine hesitancy is a complex phenomenon that is driven by individuals' perceptions of safety, and efficiency of the vaccines. We must continue to educate the public and communities that vaccines are safe, that they are effective and that they are still required even after a COVID-19 infection.

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