LAUSR

In the year since our experiment was fielded (1), vaccination rates around the world have exhibited marked variation. In their response to our original article, Spreco et al. (2) highlight an important challenge for global public health officials; states with a lower vaccinated population fraction also tend to be more corrupt, as measured by the corruption perception index (CPI) (2). Vaccines are a public good, and hence, governments play a critical role in vaccinating their populations. In contexts with high levels of governmental corruption, citizens will and should be skeptical as to whether they will have appropriate access to this critical public good. We concur with the authors that this skepticism could affect citizen preferences for how vaccines are distributed to the general public. Citizens in high-corruption countries may prefer alternative vaccine distribution strategies based on markets and private provisions, if this avoids issues of government inefficacy. That said, a very reasonable concern is that private modes of distribution would be inequitable, with access favoring the rich over the poor. We would, therefore, also expect that support for private distribution would be tempered by individuals’ financial ability to purchase vaccines on the private market.