Understanding institutional and regulatory responses, behaviors and public preferences and decision-making trade-offs of COVID-19

This PhD thesis aims to identify, map, and evaluate the trade-offs involved in responding to a pandemic, characterizing the uncertainty and hesitancy of decision-makers. The perspectives considered encompass government, healthcare systems, and individual levels. While a substantial body of literature has focused on policy responses to COVID-19 and public acceptance of non-pharmaceutical interventions (NPIs) and vaccination policies, the thesis provides novel tools for analyzing the issue. The thesis consists of seven distinct but interconnected studies conducted at different stages of the pandemic. The first study offers a multidisciplinary, generalizable framework for categorizing policy responses using a public health-economic rationale. The second analyzes government policies, their timing as an indicator of policy hesitancy, and their impact on health and non-health outcomes, considering the scaling-up and scaling-down of interventions using Italy as a case study. The third study conducts a systematic review and meta-analysis to investigate the effects of NPIs, particularly related to mobility restrictions, on healthcare services competing for the same resources as COVID-19 interventions before the availability of vaccines. The fourth synthesizes evidence on the economic and institutional factors contributing to the successful rollout of COVID-19 vaccines in France, Israel, Italy, and Spain. The fifth study describes the methodology and data collected from a global stated choice experiment that explored preferences for hypothetical vaccination programs across 22 countries. The sixth study investigates the drivers of vaccination decisions by measuring time preferences and vaccination behaviors using a choice list methodology. The final study explores the data collected with the DCE, quantifying the trade-offs individuals make between vaccine attributes and policy restriction features, comparing these trade-offs across different countries. Collectively, these studies provide a significant contribution to inform post-pandemic reviews of policy responses and future outbreak planning. They also enhance our understanding of hesitancy and decision-making under uncertainty with practical applications.