Global health resource distribution during COVID-19 and in future pandemics: Here’s what people say

Abstract During the COVID-19 pandemic, countless individuals across the world needed novel and sophisticated health care resources simultaneously, leading to dramatic global shortages. How to distribute resources in such situations? This dilemma is neither new nor understudied: Its complexity is well known to medical ethicists, public health scientists and philosophers. Building on this knowledge, powerful global distribution frameworks were proposed already early into the pandemic. Despite this knowledge, no globally consensual regulations existed (and exist) on the political sphere. Worse still, numerous countries hoarded resources for themselves, increasing global inequalities and prolonging the pandemic for everyone. For future emergencies, it is thus necessary to develop immediately applicable strategies. Because public acceptance is key for such interventions, evidence on the public opinion towards allocation principles is strongly needed. In 2021, we asked representative samples of N = 2694 adults in England and Germany to rate seven COVID-19-specific global allocation principles. In line with literature on justice attitudes in general, extensions of bifactor(S-1) models showed that participants would have preferred a more equity- or equality-based global resource distribution during the pandemic, presenting themselves as more cosmopolitan than global leaders. Trying to understand these attitudes better, we tested preregistered hypotheses on relations with other constructs and found positive associations between equity- and equality-directed preferences and global human identification, among others. To ensure generalisability on future pandemics, we collected data from a second cohort in spring 2024. All results will be presented in detail. With their responses, European citizens call upon the development of fairer and more efficient global distribution mechanisms. This global public health perspective could inform preparations for future global emergencies. Key messages • European citizens would have preferred a more equity- or equality-based global distribution of scarce health care resources during the COVID-19 pandemic than global leaders organised. • Citizens’ global perspective on public health and their strong emphasis on global fairness should inform preparations for future pandemics and other global emergencies.