Understanding moral trade-offs in pandemic response: A discrete choice experiment on avian influenza policies.

Pandemic preparedness requires navigating trade-offs between health, economic, and social impacts; choices that often involve moral tensions. This study investigates how the Dutch public evaluates such trade-offs in the context of a potential outbreak of highly pathogenic avian influenza (HPAI). Using a discrete choice experiment (DCE) administered to a representative sample of 1,045 respondents from the LISS panel, we examined preferences across six policy outcomes: mortality, lasting physical and mental injuries, postponed healthcare, social restrictions, and one-off tax payments. A latent class logit model identified four distinct preference profiles, revealing substantial heterogeneity in moral and economic reasoning. Two classes exhibited taboo trade-off aversion (TTOA) when values such as life or human dignity were traded against monetary costs. Respondents displaying TTOA emphasized solidarity and governmental responsibility, while cost-sensitive groups prioritized economic efficiency. These findings highlight that public acceptance of pandemic policies depends not only on effectiveness and cost but also on perceived moral legitimacy. Accounting for TTOA in economic evaluation can improve the ethical considerations and societal acceptability of future pandemic preparedness strategies.