The Effect of Public Tolerance towards Corruptive Behaviour on Healthcare Efficiency and Equity – The Case of the UK’s COVID-19 Vaccination Programme

Abstract

Over the past four years, the COVID-19 pandemic has caused significant uncertainty, suffering, and economic disruption worldwide. Consequently, governments have faced pressure to ensure fair vaccine access while achieving vaccination targets quickly. Such challenging circumstances can create opportunities for nepotism and bribery, increasing attention to corruption risks associated with the pandemic response. This study investigates the relationship between public attitudes towards corruptive behaviour and the efficiency and equity of the UK's COVID-19 vaccination programme. It combines primary data on public tolerance towards corruptive behaviour with secondary data on the efficiency of the vaccination program at the local authority level in England and Scottland. We employ a survival analysis approach, estimating Cox Proportional Hazards Models, which examine the time taken to reach vaccination targets. Our findings suggest moderate tolerance towards nepotism/favouritism and bribery among the British public, with 28% of survey participants considering monetary bribery and 34% considering nepotism/favouritism as acceptable means to secure early vaccination access. Moreover, while public tolerance towards corruptive behaviour generally had a negative impact on the efficiency of the vaccination programme, it appears to have expedited the vaccination rollout in politically aligned local authorities governed by the Conservative and Unionist Party. However, this positive effect on efficiency appears to have come at the expense of reduced equity in vaccine distribution. These findings underscore the trade-off between efficiency and equity in vaccine distribution during public health crises, emphasising the need for health policies that balance efficiency with equity to ensure fair and effective distribution of vaccines in the future.