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Problem
Policymakers must decide on interventions to control the pandemic. These decisions are driven by weighing the risks and benefits of various non-pharmaceutical intervention alternatives. Due to the nature of the pandemic, these decisions are not based on sufficient evidence regarding the effects, nor are decision-makers informed about the wi...
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The stage of the pandemic significantly affects people’s preferences for (the societal impacts of) COVID-19 policies. No discrete choice experiments were conducted when the COVID-19 pandemic was in a transition phase.
This is the first study to empirically investigate how citizens weigh the key societal impacts of pandemic policies when the COVID-1...
Citations
... We also contribute to the literature that investigates potential barriers and determinants of (general) vaccination uptake and prevention, ranging from socio-demographic factors, social norms and beliefs, and previous experiences [29][30][31], people's level of religiosity [32,33] or cognitive factors such as susceptibility and severity [34]. At the aggregate level, the literature emphasizes the role of the trustworthiness of public organizations or institutions [35][36][37], cost of vaccines [38], and anticipated consequences of non-pharmaceutical interventions [39]. Furthermore, Böhm and Betsch [40] and Böhm, Betsch, and Korn [41] find that pro-social concerns increase vaccination uptake. ...
Background
Even though the COVID-19 vaccination roll-out in general can be considered as one of the most successful public health campaigns in the history of medicine, general vaccination hesitancy has remained an issue of concern throughout the world. We add to a deeper understanding of vaccination hesitancy by identifying what drives primary vaccination and booster uptake, as well as adherence to simple preventive measures such as physical distancing by investigating the role of Dark Triad personality traits, i.e. Machiavellianism, narcissism, and psychopathy.
Methods
We investigate data from Germany and the United Kingdom from the European Covid Survey which was collected from 23 December 2021 to 10 January 2022. Logit regressions and random effects regressions were performed to study the effect of dark personality traits on COVID-19-related prevention.
Results
We find a statistically significant association between Dark Triad personality traits and prevention efforts, primary vaccinations, and booster uptake against COVID-19. Specifically, individuals scoring high in psychopathy are associated with a lower likelihood of having received primary immunization. The marginal effect amounts to 3.31%-points. High narcissistic personality traits are correlated with a substantially higher likelihood (4.52%-points) to refuse booster shots after having received the primary vaccinations. Dark Triad personality traits may be relevant factors associated with vaccine-related decision-making. In addition, individuals with higher psychopathic tendencies report significantly lower engagement in other simple preventive behavior, while higher scores in narcissism are associated with higher reported adherence to simple preventive measures.
Conclusions
Our findings highlight the crucial role that personality plays in pandemic-related prevention. Policymakers, health professionals, and those in charge of health messaging may take these factors into account when devising communication strategies to improve the vaccination uptake and adherence to preventive behaviors. Future pandemics and public health crises would benefit from targeted, nuanced approaches to public health messaging to promote greater public adherence and public health.
... A first stream of literature measures acceptance of COVID-19 measures using survey methods [e.g., [3][4][5][6][7]. Other studies use discrete choice experiments to assess relative preferences for different COVID-19 measures (and/or outcome scenarios) in various hypothetical scenarios with a wide range of choice sets [8][9][10][11][12][13]. Using within-subjects designs might lead to higher hypothetical bias [e.g., as shown in a meta-analysis on measuring willingness to pay [14]. ...
... Using within-subjects designs might lead to higher hypothetical bias [e.g., as shown in a meta-analysis on measuring willingness to pay [14]. Furthermore, these studies were conducted during the later stages of the pandemic [e.g., [10][11][12], when individuals may have demonstrated significantly different behavioral patterns compared to the early stages, where collective cooperation was crucial in preventing the spread of infection and averting a global outbreak. Consequently, insights on early-stage individual response to restrictions are scarce. ...
... In addition, this work adds new insights to the literature on ethical behavior and cooperation during crises [e.g., 15]. Our work also contributes to the COVID-19 literature, particularly to the literature on the acceptance of COVID-19 measures [e.g., 3,4,8,9,12,13]. Our findings provide implications for policy makers when confronted with a social crisis. ...
Crisis management often requires decisions that prioritize the collective good over individual interests. Effective crisis communication strategies can influence individuals’ behavior towards the collective good, preventing negative societal externalities. However, little is known about how these strategies affect individual acceptance of decisions that involve trade-offs between individual and collective interests. We study individual choice behavior regarding maintaining or lifting government-imposed restrictions on private and public life in a referendum setting in the context of the COVID-19 pandemic. Maintaining or lifting the restrictive measures represents a social dilemma that involves trade-offs between civil liberties, health safety, and economic consequences. In three online experiments, we test the impact of communication strategies that focus on health and/or economic factors, as well as risk attribution (i.e. who is at risk by an increase of infections), on individual acceptance of restrictive measures. Results across all experiments show that the majority favors maintaining the COVID-19 measures, indicating that individuals act ethically by trading off individual harm (i.e., restrictions on private and public life) for the prevention of increased societal harm (i.e., infections, deaths). When communication focuses only on health factors, acceptance levels remain robust, regardless of whether the risk is attributed to others, the individual’s group, or the individual. However, when economic factors (i.e., unemployment rates) are included, acceptance of restrictive measures significantly drops. Notably, in an economic-focused communication, attributing risk to the individual’s group increases acceptance such that significantly less individuals vote to lift measures when their group is at higher risk. Overall, these results demonstrate the impact of communication strategies on acceptance of crisis management measures: Our findings have implications for policy makers who design communication strategies to enforce restrictive policies in times of crisis.
... Methodically, different methods have their own advantages in eliciting health preferences, and their findings can be integrated as shown in this study. In some occasions, there are attributes not suitable to be incorporated in a DCE, such as the various types of AEs that would induce a cognitive burden for DCE respondents, which may be investigated using less complicated methods such as BWS [41]. ...
Patients may get more treatment options with off-label use of drugs while exposed to unknown risks of adverse events. Little is known about the public or demand-side perspective on off-label drug use, which is important to understand how to use off-label treatment and devise financial assistance. This study aimed to quantify public preference for off-label cancer treatment outcomes, process, and costs, and perceived importance of associated adverse events.
A discrete choice experiment and a best-worst scaling were conducted in Hong Kong in December 2022. Quota sampling was used to randomly select the study sample from a territory-wide panel of working-age adults. Preferences and willingness to pay (WTP) for treatment effectiveness, risk of adverse events, mode of drug administration, and availability of off-label treatment guidelines were estimated using a random parameter logit model and latent class model. The relative importance of different adverse events was elicited using Case 1 best-worst scaling.
A total of 435 respondents provided valid responses. In the discrete choice experiment, the respondents indicated that extra overall survival as treatment effectiveness (WTP: HK448,000/US57,400 for 12-month vs 3-month extra survival) was the most important attribute for off-label drugs, followed by the risk of adverse events (WTP: HK318,000/US40,800 for 10% chance to have adverse event vs 55%), mode of drug administration (WTP: HK42,000/US5300 for oral intake vs injection), and availability of guidelines (WTP: HK31,000/US4000 for available versus not available). Four groups with distinct preferences were identified, including effectiveness oriented, off-label use refusal, oral intake oriented, and adverse event risk aversion. In the best-worse scaling, hypothyroidism, nausea/vomiting, and arthralgia/joint pain were the three most important adverse events based on the perceptions of respondents. Risk-averse respondents, who were identified from the discrete choice experiment, had different perceived importance of the adverse events compared with those with other preferences.
Knowing the preference and WTP for cancer treatment-related characteristics from a societal perspective facilitates doctors’ communications with patients on decision making and treatment goal-setting for off-label treatment, and enables devising financial assistance for related treatments. This study also provides important insight to inform evaluations of public acceptance and information dissemination in drug development as well as future economic evaluations.
... Aligning decisions on COVID-19 measures with citizens' preferences can increase public support and adherence [1]. Hence, during the pandemic, preference elicitation studies, such as discrete choice experiments (DCEs), were conducted, in which citizens were asked to choose between policy scenarios specified in terms of societal impacts [2][3][4][5][6][7][8][9][10][11][12][13]. ...
... The DCEs regarding the trade-offs of societal impacts that were carried out in the second wave of the pandemic revealed that citizens wanted their government to strongly focus their policies on societal impacts other than the prevention of COVID-19 deaths. For instance, Mühlbacher et al. [1] show, in a study conducted in October-November 2020, that the economic effects of COVID-19 measures, such as individual income decreases, had a large impact on the preferences of German citizens for and against lockdown scenarios. Prevention of excess mortality and a decrease in gross domestic product were also important factors influencing citizens' preferences. ...
... Mühlbacher et al. [1] established that the consequences of pandemic measures, such as excess mortality, risk of infection, a decrease in income and a decrease in gross domestic product, had the most significant impact on citizens' preferences. Respondents disfavoured any closures of sectors, but curfews, contact restrictions, personal data transmissions and mandatory masking in public had a lesser impact on people's preferences. ...
The stage of the pandemic significantly affects people’s preferences for (the societal impacts of) COVID-19 policies. No discrete choice experiments were conducted when the COVID-19 pandemic was in a transition phase.
This is the first study to empirically investigate how citizens weigh the key societal impacts of pandemic policies when the COVID-19 pandemic transitions into an endemic.
We performed two discrete choice experiments among 2181 Dutch adults that included six attributes: COVID-19 deaths, physical health problems, mental health problems, financial problems, surgery delays and the degree to which individual liberties are restricted. We used latent class choice models to identify heterogeneous preferences for the impacts of COVID-19 measures across different groups of respondents.
A large majority of the participants in this study was willing to accept deaths to avoid that citizens experience physical complaints, mental health issues, financial problems and the postponement of surgeries. The willingness to tolerate COVID-19 deaths to avoid these societal impacts differed substantially between participants. When participants were provided with information about the stringency of COVID-19 measures, they assigned relatively less value to preventing the postponement of non-urgent surgeries for 1–3 months across all classes.
Having gone through a pandemic, most Dutch citizens clearly prefer pandemic policies that consider citizens’ financial situations, physical problems, mental health problems and individual liberties, alongside the effects on excess mortality and pressure on healthcare.
... As pointed out by Mühlbacher et al [53], restrictive measures in the event of a pandemic can only be successful if they are accepted by the population and if political decision makers can count on the approval of a large with the majority of citizens. ...
Background
Mass testing campaigns were proposed in France during the first wave of the COVID-19 pandemic to detect and isolate asymptomatic individuals infected by SARS-CoV-2. During mass testing in Saint-Étienne (February 2021), we performed a survey of the general population.
Objective
We evaluated, on the scale of a city’s population, the literacy level about SARS-CoV-2 transmission, barrier gesture respect, and isolation acceptability or possibility in case of SARS-CoV-2 infection.
Methods
We used the validated CovQuest-CC questionnaire. Data were analyzed and correlated with volunteer characteristics and their SARS-CoV-2 screening results using multivariate analysis.
Results
In total, 4707 participants completed the CovQuest-CC questionnaire. Multivariate analysis revealed that female sex was a determinant of a higher score of knowledge about SARS-CoV-2 transmission (adjusted β coefficient=0.14, 95% CI 0.04-0.23; corrected P=.02). Older ages of 50-59 years (adjusted β coefficient=0.25, 95% CI 0.19-0.31; corrected P<.001) and ≥60 years (adjusted β coefficient=0.25, 95% CI 0.15-0.34; corrected P<.001) were determinants of a higher score on barrier gesture respect compared to ages 20-49 years considered as reference. Female sex was also a determinant of a higher score on barrier gesture respect (adjusted β coefficient=0.10, 95% CI 0.02-4.63; corrected P<.001). The knowledge score was correlated with the score on barrier gesture respect measures (adjusted β coefficient=0.03, 95% CI 0.001-0.004; corrected P=.001). Older ages of 50-59 years (adjusted β coefficient=0.21, 95% CI 0.13-0.29; corrected P<.001) and ≥60 years (adjusted β coefficient=0.25, 95% CI 0.1-0.38; corrected P<.001) were determinants of a higher score on isolation acceptability or possibility compared to the age of 20-49 years considered as reference. Finally, the knowledge score regarding SARS-CoV-2 transmission was significantly associated with a lower risk of RT-PCR (reverse transcriptase–polymerase chain reaction) positivity (adjusted odds ratio 0.80, 95% CI 0.69-0.94; corrected P<.03), implying that a 1-point increase in the knowledge score lowers the risk of positivity by 20% on average.
Conclusions
This study identified factors associated with health literacy regarding SARS-CoV-2 infection in asymptomatic individuals in a large French city’s population. We can confirm that in the context of the COVID-19 pandemic, the determinants of better health literacy are not the same as those in other contexts. It seems critical to obtain a more detailed understanding of the determinants of individual citizens’ behavior, as part of a strategy to combat the large-scale spread of the virus. The harsh experience of this pandemic should teach us how to nurture research to structure customized interventions to encourage the adoption of ad hoc behaviors to engage citizens in adapting behaviors more favorable to their health.
... We also contribute to the literature that investigates potential barriers and determinants of (general) vaccination uptake and prevention, ranging from socio-demographic factors, social norms and beliefs, and previous experiences [58,73,71], peopleŠs level of religiosity [62,33] or cognitive factors such as susceptibility and severity [3]. At the aggregate level, the literature emphasizes the role of the trustworthiness of public organizations or institutions [19,55,15], cost of vaccines [38], and anticipated consequences of non-pharmaceutical interventions [43]. Furthermore, Böhm and Betsch [8] and Böhm, Betsch, and Korn [9] Ąnd that pro-social concerns increase vaccination uptake. ...
Background: Even though the COVID-19 vaccination roll-out in general can be considered as one of the most successful public health campaigns in the history of medicine, general vaccination hesitancy has remained an issue of concern throughout the world. We add to a deeper understanding of vaccination hesitancy by identifying what drives primary vaccination and booster uptake, as well as adherence to simple preventive measures such as physical distancing by investigating the role of Dark Triad personality traits, i.e. Machiavellianism, narcissism, and psychopathy.
Methods: We investigate data from Germany and the United Kingdom from the European Covid Survey which was collected from 23 December 2021 to 10 January 2022. Logit regressions and random effects regressions were performed to study the effect of dark personality traits on COVID-19-related prevention.
Results: We show that Dark Triad personality traits have a substantial impact on prevention efforts, primary vaccinations and booster uptake against COVID-19. Specifically, individuals scoring high in psychopathy have significantly less likely received primary immunization. The difference amounts to 10.5%-points. High narcissistic personality traits imply a substantially higher likelihood (15.3%-points) to refuse booster shots after having received the primary vaccinations. Therefore, the Dark Triad personality traits may constitute a special case in the demand for vaccines. In addition, individuals with higher psychopathic tendencies engage significantly less in other simple preventive behavior, while higher scores in narcissism lead to higher reported adherence to simple preventive measures.
Conclusions: Our findings highlight the crucial role that personality plays in pandemic related prevention. Policymakers, health professionals, and those in charge of health messaging may take these factors into account when devising communication strategies to improve the vaccination uptake and adherence to preventive behaviors. Future pandemics and public health crises would benefit from targeted, nuanced approaches to public health messaging to promote greater public adherence and public health.
... These objectives were examined using a discrete choice experiment (DCE), a health-economics method that has successfully been used in assessing preferences for pharmaceutical and non-pharmaceutical COVID-19 interventions [16][17][18][19][20][21] and other healthcare products and services [22,23]. ...
We aimed to investigate whether individuals’ trade-offs between vaccine effectiveness and vaccine safety vary if they are asked to consider the perspective of a policymaker making decisions for others compared with the decisions they would make for themselves.
A web-enabled discrete choice experiment survey was administered between 1 April and 1 May 2022 to participants recruited from the general population of two Southeast Asian countries (Indonesia and Vietnam). In each country, 500 participants were randomly assigned to make decisions regarding coronavirus disease 2019 (COVID-19) vaccines for others as a policymaker or in a personal capacity for their own use. Vaccines were characterized by three attributes: (1) effectiveness of the vaccine in reducing infection rate; (2) effectiveness of the vaccine in reducing hospitalization among those infected; and (3) risk of death from vaccine-related serious adverse events. A mixed logit model was utilized for analyses.
Based on the attributes and levels used in this study, the most important vaccine attribute was the risk of death from vaccine-related adverse events, followed by effectiveness in reducing infection rate and hospitalizations. Compared with personal decisions, the mean probability of choosing a vaccine was (1) lower, and (2) more sensitive to the changes in risk of death from adverse events in policy decisions (p ≤ 0.01).
Our results suggest that, in the face of an infectious disease pandemic, individuals are likely to be more risk-averse to vaccine-related deaths when making decisions for others as a policymaker than they would for themselves.
... The strong heterogeneity in citizens' preferences for COVID-19 policies is found in various studies that were conducted after the The uptake rates are shown separately for each class as well as adjusted for class probability first wave of the COVID-19 pandemic (e.g. [34,35]), which contrasts with the results of studies conducted during the first wave of the pandemic in which a large majority of citizens prioritized health outcomes over other societal impacts (e.g. [36,37]) Elderly citizens were more likely to favour a COVID-19 certificate, while respondents who did not (plan to) get vaccinated were more likely not to support a certificate. ...
Objective:
Here we investigate public preferences for coronavirus disease 2019 (COVID-19) certificates in the Netherlands, and whether these preferences differ between subgroups in the population.
Methods:
A survey including a discrete choice experiment was administered to 1500 members of the adult population of the Netherlands. Each participant was asked to choose between hypothetical COVID-19 certificates that differed in seven attributes: the starting date, and whether the certificate allowed gathering with multiple people, shopping without appointment, visiting bars and restaurants, visiting cinemas and theatres, attending events, and practising indoor sports. Latent class models (LCMs) were used to determine the attribute relative importance and predicted acceptance rate of hypothetical certificates.
Results:
Three classes of preference patterns were identified in the LCM. One class a priori opposed a certificate (only two attributes influencing preferences), another class was relatively neutral and included all attributes in their decision making, and the final class was positive towards a certificate. Respondents aged > 65 years and those who plan to get vaccinated were more likely to belong to the latter two classes. Being allowed to shop without appointment and to visit bars and restaurants was most important to all respondents, increasing predicted acceptance rate by 12 percentage points.
Conclusions:
Preferences for introduction of a COVID-19 certificate are mixed. A certificate that allows for shopping without appointment and visiting bars and restaurants is likely to increase acceptance. The support of younger citizens and those who plan to get vaccinated seems most sensitive to the specific freedoms granted by a COVID-19 certificate.
... It is particularly relevant in the context of a crisis, when unprecedented measures must be adopted in short time frames [6,7]. DCE studies have been used in the context of COVID-19, not only to measure how the citizens value the costs and benefits of lockdown policies [8][9][10][11][12] but also to understand potential barriers and preferences towards the uptake of COVID-19 measures, such as testing, contact-tracing and vaccination [13][14][15][16]. ...
... Our results are broadly in line with other DCE studies focusing on a similar question in the Netherlands [8], United States of America [12], Australia [10] and Germany [11], even though these studies collected responses at an earlier phase of the pandemic: Chorus (2020) [8] in April 2020, Reed (2020) [12] in May 2020, Manipis (2020) [10] between July and August 2020, Li (2021) [9] end of August 2020 and Mühlbacher (2022) [11] from October to November 2020). Although there are some differences between the domains studied, attributes related to COVID-19 excess mortality were consistently those with a larger effect on individual's preferences. ...
... Our results are broadly in line with other DCE studies focusing on a similar question in the Netherlands [8], United States of America [12], Australia [10] and Germany [11], even though these studies collected responses at an earlier phase of the pandemic: Chorus (2020) [8] in April 2020, Reed (2020) [12] in May 2020, Manipis (2020) [10] between July and August 2020, Li (2021) [9] end of August 2020 and Mühlbacher (2022) [11] from October to November 2020). Although there are some differences between the domains studied, attributes related to COVID-19 excess mortality were consistently those with a larger effect on individual's preferences. ...
The need to control the sanitary situation during the COVID-19 pandemic has led governments to implement several restrictions with substantial social and economic impacts. We explored people’s trade-offs in terms of their income, life restrictions, education, and poverty in the society, compared to their willingness to avoid deaths. We applied a web-based discrete choice experiment to elicit preferences of the Portuguese citizens for these attributes and computed the marginal rate of substitution in terms of avoided deaths. We recorded 2,191 responses that faced the possibility of having 250 COVID-19 related deaths per day as the worst possible outcome from the choice levels presented. Estimates suggested that individuals would be willing to sacrifice 30% instead of 10% of their income to avoid approximately 47 deaths per day during the first six months of 2021. For the same period, they would also accept 30% of the students’ population to become educationally impaired, instead of 10%, to avoid approximately 25 deaths; a strict lockdown, instead of mild life restrictions, to avoid approximately 24 deaths; and 45% of the population to be in risk of poverty, instead of 25%, to avoid approximately 101 deaths. Our paper shows that avoiding deaths was strongly preferred to the remaining societal impacts; and that being a female, as well as working on site, led individuals to be more averse to such health hazards. Furthermore, we show how a DCE can be used to assess the societal support to decision-making during times of crisis.
