Previous studies that examine individuals’ attitudes to inequality in standard, non-critical situations, show that people accept inequality to a larger extent when they find disparities to be fair or legitimate. In other words, when they believe individuals mostly deserve what they have. For instance, people show larger tolerance to income inequality and oppose more to redistribution when they believe economic success is mostly due to individual effort rather than circumstances, which are factors that are beyond individuals’ control, such as parental background, gender, or luck. Likewise, health inequality is less of a concern when people believe health habits, and not inborn health conditions, are largely responsible for health status. 

Are circumstances also important in critical situations when the commodity to be distributed can save lives in a pandemic period when people are at risk of death? To answer this question, Martín Brun, Conchita D’Ambrosio, Ada Ferrer-i-Carbonell, and Xavier Ramos, authors of BSE Working Paper Nº 1392, “After you. Cognition and Health-Distribution Preferences”, ask citizens of five European countries whom they would give priority to in vaccination. Respondents report their preferences in March 2021, when limited supply and high demand, together with the efforts made by the European Commission to coordinate a joint EU vaccination procurement programme to avoid small countries to be left behind, sparked societal debates about the slow rollout of vaccines in Europe and about what population groups should be given priority. The authors investigate whether citizens give priority to individuals who are more exposed to COVID because of factors that are beyond their control, such as belonging to a clinically vulnerable group or being a front-line worker, or to individuals who make the effort of taking preventive measures. The authors also examine whether stated distributive preferences are related to individuals’ cognitive ability. 

Opinions regarding vaccine distribution reveal what is behind preferences for redistribution

COVID-19 vaccines prevented illness (that could lead to death) and enabled mobility. Those who received the vaccines were free to go out, whereas those who did not were restricted from some services, such as entering restaurants. Governments used their budgets to purchase vaccines for their population while citizens contribute to government budget differently, according mostly to their income. Therefore, the distribution of vaccines is a form of redistribution. 

Opinions on vaccine allocation and priority groups can offer insights into how members of society think health status should be distributed. The study explores the answers of respondents in five countries (France, Germany, Italy, Spain, and Sweden) to the three questions the authors introduced in the “COVID-19, MEntal HEalth, REsilience and Self-regulation” or the COME-HERE survey, during the pandemic. The three questions refer to vaccines’ distribution within respondent’s own country, across EU member states, and across the World. 

Cognitive ability plays a crucial role in preferences for redistribution

The study shows that circumstances are important for preferences. Within each country, the vast majority of individuals (83%) choose vaccination schemes that give priority to clinically vulnerable individuals and front-line workers while only a tiny minority choose schemes that give priority individuals who took more care in avoiding infection. Across European countries, most respondents (68%) prefer allocating vaccines proportional to the Member State’s clinically vulnerable population, irrespective of the country’s lockdown measures while only a small group prefer allocating vaccines proportional to the Member State’s stringency of lockdown measures enforced or to their contribution to the EU budget. Given the lower chances of poor countries to buy vaccines and the efforts of some initiatives, such as Worlds Health Organization’s COVAX, to guarantee fair and equitable access to vaccines for every country in the world, respondents are also invited to choose the way they would buy and distribute vaccines across all world countries. Here, most individuals (52%) prefer an international organization to take care of purchasing the vaccines as opposed to letting countries purchase vaccines through the market and would like vaccines to be distributed across countries according to their needs and not to their economic contribution to the budget. 

High cognition individuals seem to have more voice as they have greater access to leadership positions and vote more often in elections. The study shows that high cognition individuals are about 10 percent more likely to favour circumstance-prioritized schemes. Figure 1 shows, on the horizonal axis, how much more or less likely are high cognitive-able individuals to support each of the vaccine distribution schemes (displayed on the vertical axis), relative to lower cognitive-able ones. For instance, panel (c) shows that, within a country, high cognition individuals are more likely to choose schemes that give priority to the most vulnerable (bottom) and less likely to choose schemes that give priority to schemes that give priority to individuals who took more care in avoiding contagion (top).

Note: 0 on the horizontal axis means no difference between high- and low-cognition groups. Dots show point estimates and whiskers show 95% confidence interval. When whiskers cross the vertical red line, point estimates are not very reliable, which means that there is no difference between high-and low-cognitive able groups.

The reasons supporting the findings come from prosociality

Why do high cognition individuals show a larger preference for vaccination schemes that give priority to circumstances? One possibility could be that individuals sought their self-interest, and thus preferred schemes that are good for themselves. Since high-cognition people prefer schemes that give priority to vulnerable groups, they should have a higher likelihood of belonging to vulnerable groups. The authors reject such self-interest explanation as they find that high- and low-cognition respondents have the same chances of being in vulnerable groups; that is, they are of similar age and show similar previous health conditions, as panel (a) in Figure 2 shows. Moreover, panels (b) and (c) show that if high-cognition individuals sought self-interest, they should prefer schemes that give priority to those who made efforts to avoid infection. 

Note: 0 on the horizontal axis means no difference between high- and low-cognition groups. Dots show point estimates and whiskers show 95% confidence interval. When whiskers cross the vertical red line, point estimates are not very reliable, which means that there is no difference between high-and low-cognitive able groups.

What seems to be driving individuals’ preferences is concern about the fairness of situations. High-cognition individuals are more likely to perceive inequality of opportunities and luck as factors preventing economic success. Circumstances seem then to be more salient and important for high-cognition individuals. Therefore, in front of the unequal opportunities that some individuals face to protect themselves from bad health and diseases such as COVID-19, high-cognition individuals tend to support schemes prioritizing circumstances.

This study shows that in critical moments, an influential group in collective decision-making prioritizes those individuals whose circumstances placed them in a worse situation. This suggests that fairness concerns may explain the success of several social programs, such as food stamps or housing assistance, as other studies also point out.