Vaccine Donations vs Booster Shots - What Does the UK Public Think?

As part of our 7-Day Study Challenge, researchers Ines Lee (University of Cambridge) and Eileen Tipoe (Queen Mary University of London) were awarded a grant to measure UK residents’ preferences regarding global vaccine distribution. 
 

TL;DR

• We measured UK residents’ preferences regarding global vaccine distribution.
• Support for vaccine donations to low-income countries is high: on average, respondents chose to donate almost two-thirds (65%) of COVID-19 vaccines, ordered for booster shots, to low-income countries.
• Women, younger individuals, and those who are not fully vaccinated preferred to donate a larger percentage.

Global Context

The global distribution of COVID-19 vaccines is very unequal. While most adults in many high-income countries have been fully vaccinated, fewer than 2% of people in low-income countries have had at least one dose of a COVID-19 vaccine (as of 8 September 2021).

In response to the highly transmissible delta variant, France, Germany, Israel, and many Middle Eastern countries have started giving booster shots (an additional dose to fully vaccinated people). Other high-income countries, including the US and the UK, are planning to offer booster shots to some or most adults in the coming months.

This decision to offer booster shots while some countries are struggling to supply first shots has proven controversial. Recently, the World Health Organization (WHO) called on countries to stop administering booster shots so that vaccine supplies could go low-income countries instead (e.g. via the WHO’s COVAX program).

Measuring preferences over booster shots vs COVAX donations

We surveyed over 1,500 UK residents aged 18 and above in August 2021. The representative sample matched the composition of the UK population in age, gender, and ethnicity. Respondents were asked to indicate how they would distribute the 60 million Pfizer-BioNTech vaccines ordered by the UK government (intended for use in late 2021), between UK residents and individuals in a low-income (COVAX recipient) country (Figure 1).

Figure 1. Survey question measuring respondents’ preferred distribution of COVID-19 vaccines.

Support for vaccine donations to low-income countries among UK respondents is generally high

On average, respondents chose to donate almost two-thirds (65%) of COVID-19 vaccines, ordered for booster shots, to low-income countries. However, there is substantial variation in opinions across respondents: 1 in 3 respondents chose to donate 90% or more of these vaccines, while 1 in 10 chose to donate fewer than 10% of these vaccines (Figure 2).

Figure 2. How respondents chose to distribute the UK’s incoming vaccines between low-income countries (COVAX) as first doses and the UK as booster shots. The figure shows that 10.5% and 32.9% of respondents chose to donate fewer than 10% and over 90% of vaccines to COVAX, respectively.

Preferences about the distribution of COVID-19 vaccines vary across population subgroups

The preferred distribution of COVID-19 vaccines varies across characteristics such as age, gender, and attitudes toward COVID-19 policies (Figure 3).

Holding all other characteristics constant, on average, female respondents chose to donate nearly 5 more percentage points of vaccines compared to male respondents. The preferred percentage of vaccines donated to low-income countries was also higher, on average, among respondents who:

• Strongly believe that COVID-19 is a global rather than national problem,
• Believe that COVAX donation is more effective in containing COVID-19 (both globally and in the UK) than booster shots,
• Care about or trust people living outside the UK as much as UK residents (foreign universalism),
• Prefer equal outcomes over unequal outcomes (inequality aversion).

In contrast, respondents who are fully vaccinated or are older were less supportive of vaccine donation: compared to respondents aged 18-24, on average, the preferred percentage of vaccines donated to COVAX was 13-15 percentage points lower among respondents aged 40 and above.

Figure 3. Correlations between the preferred distribution of COVID-19 vaccines and individual characteristics. The reported numbers show the percentage point change in vaccines donated for a one-standard-deviation increase in preferences and attitudes (left panel), or having a particular characteristic (right panel).

Why are these findings important?

As the supply of COVID-19 vaccines worldwide remains limited and scientific evidence on the efficacy of booster shots remains unclear, governments face a trade-off between providing booster shots to their residents and helping low-income countries acquire first doses. While the WHO clearly states that first doses to low-income countries should be the global priority, it is unclear what UK residents think about this trade-off.

This study indicates that the majority of UK residents support COVID-19 vaccine donations, though support varies with demographic characteristics, preferences about global equality, and beliefs about the effectiveness of COVAX donations in containing COVID-19.

Age is an important factor influencing the preferred distribution of vaccines, possibly because older people are at higher risk of severe illness or death if infected with COVID-19, holding all other factors constant. The link between support for vaccine donations and personal need is consistent with a survey conducted by Imperial College and YouGov in June 2021, which found that 78% of respondents in the UK were willing to donate their booster shot to people in low-income countries if an antibody test showed they were sufficiently protected against COVID-19.

Whatever governments ultimately choose, public support for this decision relies on clear communication of the scientific evidence on the length and types of protection that COVID-19 vaccines provide.