The Cost of Equity: COVID Vaccine Priority, Deservingness and Disability

• In Event: COVID-19 and Disparities (Pre-Recorded)

Abstract

As the United States seeks to distribute COVID-19 vaccines, the country faces a variety of difficult logistical and ethical dilemmas. Most states have prioritized certain at-risk groups for receipt of vaccination. However, this prioritization may pose challenges in that it delays access to vaccination for the general population.

This paper will draw on monthly data collection planned for February-June 2021 within the Data for Progress Coronavirus tracking poll on public perceptions regarding whether particular at-risk populations should receive priority for vaccination, what level of delay members of the public will tolerate in their own receipt of a vaccine in order to allow such prioritization and public opinions regarding punishment for those who “cut the line” to access vaccination ahead of their prioritization tier.

Our study design asks respondents to indicate their support for prioritizing specific at-risk populations, including people with HIV, Down Syndrome, diabetes and cancer, residents of nursing homes, mental hospitals and prisons, and health care workers. After indicating a baseline level of support for prioritization of a specific group, respondents are asked to assess their support if they learnt that such prioritization would delay their own vaccination, with the length of time for such a delay randomized to provide variation. Finally, respondents are asked their opinion on recent proposals to make ‘line-jumping’ for vaccination a criminal offense, highlighting the at-risk group that would receive priority in the process.

Our paper offers multiple theoretical contributions to the political science literature regarding resource allocation, public opinion on health policy and perceptions of deservingness associated with various disability diagnoses. By testing multiple disability diagnoses alongside several comparison populations (health care workers, imprisoned persons), we gain further insight into public views of deservingness that may be able to help us generalize beyond the specific diagnosis (i.e: impact of childhood diagnoses, life-expectancy altering diagnoses, etc.) and inform an emerging literature around disability and deservingness. We expect a continuum of deservingness with health care workers at or near the top and people who are in prison at or near the bottom. Our work will help situation particular disability diagnoses along such a continuum.

In addition, this data will help us evaluate elasticities across different groups for the costs respondents are willing to pay (in the form of delay of their own vaccine receipt) for equity for particular groups. Utilizing temporal variation across our five waves and independent variables relating to perceptions of COVID, we hope to be able to assess the impact of feelings of personal threat on these elasticities (operating under the assumption that the growing success of the vaccination program will reduce feelings of COVID-related threat). Finally, by examining willingness to punish individuals who ‘line-jump’ ahead of members of a named at-risk group, we hope to yield useful insights regarding the different mechanisms behind perceptions of deservingness and their impact on both the willingness to allocate resources and to punish those who seek to obtain them through means that are perceived as illegitimate. The latter is a highly relevant concept to public debates about perceived disability fraud in Social Security Disability Insurance, parking spaces and other scarce resources allocated to people with disabilities.

The COVID-19 pandemic affords a unique opportunity to examine the role that personal threat plays on the public’s willingness to bear costs (or impose punishments) in the name of equity for marginalized populations. We believe that this data will offer useful contributions to an important emerging literature on disability, resource allocation and public opinion.

Authors

• Ari Neeman

• Monica C. Schneider, Miami University