Background: The efficacy of testing and tracing programs to reduce COVID-19 transmission hinges not only on widespread access to testing, but also on the public’s willingness to participate in them. To the extent that testing intentions are patterned by social determinants of health, this constitutes an understudied mechanism of disparities in COVID-19 morbidity and mortality. Design: Using data from a representative household probability sample, the Person to Person Health Interview Study (n = 935), sociodemographic, economic, and psychological determinants of testing considerations were evaluated across six domains: treatment affordability, ability to work if positive, hospital effectiveness, symptom severity, proximity to infected, and risk of transmitting to others. Results: Findings demonstrated significant differences in testing motivations across race/ethnicity, education level, socioeconomic status, and worry about self and loved ones. Notably, Black (p<0.01) and Latino (p<0.05) respondents and those experiencing financial strain (p<0.001) were disproportionately likely to indicate that resource factors would influence their decision to get tested. Desire to reduce transmission and concern about proximity to the infected were reported among those who expressed COVID-19 worries (p<0.001). Conclusion: Public health efforts to combat the COVID-19 pandemic must address social, economic, and psychological factors that enable and constrain individual behavior. Increasing access to preventative interventions and technologies, including vaccines, is unlikely to markedly reduce morbidity and mortality without effective messaging and economic support to improve uptake in vulnerable populations.

Identifying the drivers of vaccine adoption decisions under varying levels of perceived disease risk and benefit provides insight into what can limit or enhance vaccination uptake. To address the relationship of perceived benefit relative to temporal and spatial risk, we surveyed 432 pastoralist households in northern Tanzania on vaccination for foot-and-mouth disease (FMD). Unlike human health vaccination decisions where beliefs regarding adverse, personal health effects factor heavily into perceived risk, decisions for animal vaccination focus disproportionately on dynamic risks to animal productivity. We extended a commonly used stated preference survey methodology, willingness to pay, to elicit responses for a routine vaccination strategy applied biannually and an emergency strategy applied in reaction to spatially variable, hypothetical outbreaks. Our results show that households place a higher value on vaccination as perceived risk and household capacity to cope with resource constraints increase, but that the episodic and unpredictable spatial and temporal spread of FMD contributes to increased levels of uncertainty regarding the benefit of vaccination. In addition, concerns regarding the performance of the vaccine underlie decisions for both routine and emergency vaccination, indicating a need for within community messaging and documentation of the household and population level benefits of FMD vaccination.

Vaccination for foot-and-mouth (FMD) disease remains low in parts of Africa despite the existence of vaccines. In East Africa, the presence of multiple virus serotypes and sub-types makes matching a vaccine with the circulating virus type in the field, or providing a high potency vaccine, a challenge. In this paper we use game theory to show that the resulting vaccine uncertainty associated with these vaccination conditions in an endemic setting help explain the low vaccine uptake. We evaluate vaccination for FMD in the context of East Africa due to FMD being endemic in the region, the diversity of FMD virus types, and barriers to implementing other disease control measures, such as controlled movements. We incorporate these conditions into a vaccination game setting and compare the payoffs to those of a traditional vaccination game for seasonal influenza and commercial livestock vaccination in a developed country context. In showing that vaccination provides households with a lower payoff than not vaccinating, our simple game theoretical explanation supports existing evidence calling for improved vaccine quality and efforts to enhance surveillance to provide early information on disease status.

Anaplasmosis is a costly livestock disease that persists across the United States and the world. While the traditional control options of feed additives, vaccination, and post-infection antibiotic treatments exist, the highly infectious, often asymptomatic onset of anaplasmosis in cattle makes the optimal combination of disease control measures uncertain. Reducing the infection uncertainty through early detection may help producer management decisions and reduce the economic impact of anaplasmosis. To address this, we calculate the costs of applying a range of anaplasmosis control decisions for a representative cow-calf producer in the United States and extend existing analyses to incorporate early detection through diagnostic testing. We use parameters from extant literature, including for mortality, morbidity, and treatment costs to populate a stochastic, dynamic model. Updating the cost estimates finds that production losses account for the majority of anaplasmosis costs, following previous empirical estimates. Using these estimates in our decision model, the outcomes suggest that diagnostic testing with preventative treatments is the optimal herd management strategy. By further framing our findings in the context of three anaplasmosis infection regions in the United States (endemic, disease free, non-endemic buffer), we show that additional considerations exist, which can make sub-optimal control strategies competitive. Our analysis provides an initial exploration of the economic feasibility of diagnostic testing, while helping to assess the burden of anaplasmosis more accurately.

• Compared to vaccination, the collective approach to diagnostic testing presents a low-fixed cost. • Existing household livestock-health behaviors increase the likelihood for uptake of preventative health practices. • Initial evidence to support household investments in livestock preventative health over therapeutic treatments.