Study suggests support across Europe for COVID-19 vaccine equity

Europeans are willing to prioritize COVID-19 vaccines for individuals at risk in the Global South over those in their own countries, suggests a study published today in eLife.

The study of individuals from six countries finds that Europeans support transferring COVID-19 vaccines to poorer nations and prioritizing those with the greatest need regardless of their country of residence.

Vaccine nationalism, in which countries secure vaccines for their populations without regard to global vaccine needs, has been widespread during the pandemic. This trend leads to disproportionate pandemic impacts in countries with limited health resources and aggravates global health inequity.

In low-incomes countries, it is estimated that only around 20% of individuals have received a vaccine dose. The unchecked spread of the virus in some regions can also promote the emergence of new variants of the SARS-CoV-2 virus that can spread globally and prolong the pandemic.

"Understanding public preferences for global COVID-19 vaccine distribution is paramount to driving more equitable vaccine policies," says Janina Steinert, Assistant Professor at the School of Social Sciences and Technology at the Technical University of Munich, Germany.

"Governments are not likely to donate vaccines to less wealthy countries or participate in global vaccine alliances if they think they will pay the price for it at the ballot box."

Steinert and Henrike Sternberg, a research associate and doctoral candidate at Technical University of Munich, were co-lead authors of the study.

To measure public sentiment about vaccine distribution in Europe, the team surveyed 6,030 individuals open to vaccination but not yet vaccinated against COVID-19 in France, Germany, Italy, Poland, Spain and Sweden. The surveys were completed in Germany in April 2021 amidst the third COVID-19 wave and in the other five countries during a relative pandemic lull in June 2021.

The survey included eight questions on whether participants would prioritize person A or B for a COVID-19 vaccine. In each scenario, the participants chose between a person in their country, with a robust health system, or a person in a low-income country with fewer healthcare resources. The prospective vaccine candidates varied by age, their risk of dying from COVID-19, and their employment status.

Participants in all six countries prioritized the individuals most vulnerable regardless of whether that individual lived in their country. They also consistently prioritized employed individuals, front-line workers, or those who lost income during the pandemic, over unemployed individuals.

Holding other attributes constant, in Italy, France, Sweden and Spain gave the highest priority to vaccination candidates from low-income countries. German participants were more likely to prioritize their fellow citizens for vaccination.

The authors suggest this may reflect the fact that the participants were facing a COVID-19 surge when they completed the survey, the older age of German participants, and their greater risk of severe COVID-19 infection among other factors. Meanwhile, the potential recipient's country of residence did not make a difference in Poland. The authors note that each country's sample size limited the study's power to detect country-by-country differences.

Across all surveyed countries, females, younger participants and those with higher levels of education were more likely to prioritize vaccinations for individuals from the Global South over people in their own country. Those most at risk of severe outcomes were least supportive of distributing vaccines outside the Global North.

"We hope policymakers will find these insights useful for anticipating which groups will support vaccine donations to other countries and which groups may need more information about the benefits of global vaccine distribution," suggests Sternberg.

The study shows that European governments should expect strong public support for equitable vaccine distribution, according to senior author Tim Büthe, Professor and Chair for International Relations at the Technical University of Munich.

"Public support for vaccine donations to the Global South is likely even higher now since most at-risk individuals in the survey countries have now been vaccinated or even received their booster dose," says Büthe.

"Additionally, the availability of new variant-specific vaccines and boosters renews the sense of urgency to combat global vaccine inequity," adds Giuseppe Alessandro Veltri, Professor of Computational Social Science and Cognitive Sociology at the Department of Sociology and Social Research, University of Trento, Italy.