Lottery or triage? Controlled experimental evidence from the COVID-19 pandemic on public preferences for allocation of scarce medical resources

Thomas, Rhys, Rooper, Laurence, Duch, Raymond, Robinson, Thomas ORCID: 0000-0001-7097-1599, Zhakarov, Alexei and Clarke, Philip (2025) Lottery or triage? Controlled experimental evidence from the COVID-19 pandemic on public preferences for allocation of scarce medical resources. Medical Decision Making. ISSN 0272-989X (In Press)

Text (Duch_2025_Lottery_or_triage) - Accepted Version Pending embargo until 1 January 2100. Available under License Creative Commons Attribution. Download (1MB)

Abstract

Context: Bioethicists have long advocated lottery allocation to distribute scarce healthcare resources. Lotteries offer benefits which may make them attractive in the face of growing global healthcare challenges. Such schemes were adopted in some settings during the COVID-19 pandemic, including in the United States. Nonetheless, limited evidence exists on public attitudes towards lotteries and their political acceptability. Methods: During the pandemic, we conducted a survey-based experiment to understand levels of public agreement with lottery allocation compared with allocation by a medical committee. Data were collected on 15,554 respondents from 14 economically and culturally diverse countries, representing roughly half the world’s population. Respondents were randomly allocated (1:1) to two versions of a hypothetical question concerning ways to ration COVID-19 vaccine doses among nurses: (i) an unweighted lottery; (ii) prioritization based on assessment by an independent committee of experts. The main outcome was the level of agreement on a scale from 0 (“strongly disagree”) to 100 (“strongly agree”), with differences stratified by a range of covariates. Findings: Average levels of agreement with lottery allocation varied substantially between countries, from 21.75 (19.24-24.25) in France to 61.86 (59.92- 63.79) in China. In every country, there was significantly higher agreement with committee allocation, though the difference in scores varied widely across countries, from 6.85 (4.36-9.35) in China to 32.34 (28.88-35.72) in Spain. Greater agreement with lotteries was observed among males, higher-income individuals, those with the lowest levels of education, and those identifying with a right-leaning political ideology. Conclusions: On average, there was low agreement with lotteries being used to allocate scarce medical resources; however, substantial variation in its agreeability was observed. Successful future implementation of lottery allocation will require greater engagement from health policymakers to ensure they garner public support and communicate the potential benefits.

Item Type:	Article
Additional Information:	© 2025 The Author(s)
Divisions:	Methodology
Subjects:	R Medicine
Date Deposited:	12 Aug 2025 09:12
Last Modified:	11 Sep 2025 12:30
URI:	http://eprints.lse.ac.uk/id/eprint/129114

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