Rationing of a scarce life-saving resource: Public preferences for prioritizing COVID-19 vaccination.

In the face of limited COVID-19 vaccine supply, governments have had to identify priority groups for vaccination. In October 2020, when it was still uncertain whether COVID-19 vaccines would be shown to work in trials, we conducted a discrete choice experiment and a best-worst ranking exercise on a representative sample of 2060 Belgians in order to elicit their views on how to set fair vaccination priorities. When asked directly, our respondents prioritized the groups that would later receive priority: essential workers, the elderly or those with pre-existing conditions. When priorities were elicited indirectly, through observing choices between individuals competing for a vaccine, different preferences emerged. The elderly were given lower priority and respondents divided within two clusters. While both clusters wanted to vaccinate the essential workers in the second place, one cluster (N = 1058) primarily wanted to target virus spreaders in order to control transmission whereas the other cluster (N = 886) wanted to prioritize those who were most at risk because of a pre-existing health condition. Other strategies to allocate a scarce resource such as using a "lottery", "first-come, first-served" approach or highest willingness-to-pay received little support.

Willingness to get vaccinated against Covid-19 and attitudes toward vaccination in general.

BACKGROUND: High uptake of Covid-19 vaccination is required to reach herd immunity. METHODS: A representative sample of 2,060 Belgians were surveyed in October 2020. Regression analyses identified the predictors associated with willingness to get vaccinated against Covid-19, and attitudes toward vaccination in general. RESULTS: 34% of the participants reported that they will definitely get vaccinated against Covid-19 and 39% that they would "probably". Intended uptake was strongly associated with age, opinion on the government's dealing with the Covid-19 pandemic, medical risk, spoken language, gender, and to a lesser extent with having known someone who was hospitalised because of Covid-19. Similar predictors were identified for attitudes to vaccination in general. Covid-19 vaccine hesitancy was more marked in age groups below 54 years old. We further analysed a sample of 17% (N = 349) found favourable to vaccination in general but not willing to be vaccinated against Covid-19. They were mainly female, young, French speaking, slightly less educated, working, and did not belong to a Covid-19 risk group. They were very dissatisfied with the government's dealing with the pandemic, and did not know someone who was hospitalised because of Covid-19. CONCLUSIONS: Vaccine hesitancy was higher for Covid-19 vaccines than for other vaccines. The part of the population being convinced of the utility of vaccination in general but hesitant about the Covid-19 vaccine is a primary interest group for tailored communication campaigns in order to reach the vaccine coverage needed for herd immunity.