Public attitudes about equitable COVID-19 vaccine allocation: a randomised experiment of race-based versus novel place-based frames

Harald Schmidt, Sonia Jawaid Shaikh, Emiily Sadecki, Alison Buttenheim, Sarah Gollust

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Equity was - and is - central in the US policy response to COVID-19, given its disproportionate impact on disadvantaged communities of colour. In an unprecedented turn, the majority of US states used place-based disadvantage indices to promote equity in vaccine allocation (eg, through larger vaccine shares for more disadvantaged areas and people of colour). We conducted a nationally representative survey experiment (n=2003) in April 2021 (before all US residents had become vaccine eligible), that examined respondents' perceptions of the acceptability of disadvantage indices relative to two ways of prioritising racial and ethnic groups more directly, and assessed the role of framing and expert anchors in shaping perceptions. A majority of respondents supported the use of disadvantage indices, and one-fifth opposed any of the three equity-promoting plans. Differences in support and opposition were identified by respondents' political party affiliation. Providing a numerical anchor (that indicated expert recommendations and states' actual practices in reserving a proportion of allocations for prioritised groups) led respondents to prefer a lower distribution of reserved vaccine allocations compared with the randomised condition without this anchor, and the effect of the anchor differed across the frames. Our findings support ongoing uses of disadvantage indices in vaccine allocation, and, by extension, in allocating tests, masks or treatments, especially when supply cannot meet demand. The findings can also inform US allocation frameworks in future pandemic planning, and could provide lessons on how to promote equity in clinical and public health outside of the pandemic setting.

Original languageEnglish (US)
Article number108194
Pages (from-to)993-999
Number of pages7
JournalJournal of Medical Ethics
Issue number12
StatePublished - Aug 4 2022

Bibliographical note

Funding Information:
This study was supported by a Policy Accelerator Program grant of the Leonard Davis Institute of Health Economics at the University of Pennsylvania.

Publisher Copyright:


  • COVID-19
  • ethics- medical
  • politics
  • public policy

PubMed: MeSH publication types

  • Journal Article
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't


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