US Adults’ Preferences for Allocating 500 Million Free COVID-19 Tests

Complementing other efforts, the Biden Administration recently announced the purchase of 500 million rapid antigen self-tests, to help address ongoing issues with access to COVID-19 tests. A website, launched on Jan 18, 2022 (https://www.covidtests.gov) enables those wishing to receive tests to register their interest. But it is currently not clear how tests will be allocated, particular in case demand exceeds supply. The question of allocation is critical, as the use of websites in the initial vaccine allocation demonstrated inequitable outcomes. On both equity and public health grounds, it is important that more disadvantaged communities are not left behind. We assessed, in a nationally representative survey experiment fielded from January 4 to 6, 2022 (N=2,019), the public acceptability of 3 major options for allocating tests: 1) First come, first served, 2) Random draw/Lottery, 3) 80% by random draw/lottery, and 20% as a guaranteed amount to more disadvantaged communities (analogous to an approach implemented by the majority of US states for vaccine allocation).We found significant differences in support across the 3 allocation options, and that 76% of respondents randomized to the equity-promoting frame (and majorities of both Republicans and Democrats) favor additional allocations to more disadvantaged communities larger than 20% (median additional allocations: 44%). We also found that just 29% of all respondents supported sending 4 tests per household—which is the ultimately announced policy—whereas 71% favored adjusting the number sent by household size (e.g., 4 tests for each person in the household).If the approach of sending 4 tests per household is sustained, the need for adjusting allocations through measures such as geographic disadvantage indices increases in order to advance equity in test allocation, given relationships between household size and economic or social disadvantage