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The COVID-19 pandemic considerably impacted the lives of European citizens. This study aims to provide a nuanced picture of well-being patterns during the pandemic across Europe with a special focus on relevant socio-economic sub-groups. This observational study uses data from a repeated, cross-sectional, representative population survey with nine waves of data from seven European countries from April 2020 to January 2022. The analysis sample contains a total of 25,062 individuals providing 64,303 observations. Well-being is measured using the ICECAP-A, a multi-dimensional instrument for approximating capability well-being. Average levels of ICECAP-A index values and sub-dimension scores were calculated across waves, countries, and relevant sub-groups. In a fixed effects regression framework, associations of capability well-being with COVID-19 incidence, mortality, and the stringency of the imposed lockdown measures were estimated. Denmark, the Netherlands, and France experienced a U-shaped pattern in well-being (lowest point in winter 2020/21), while well-being in the UK, Germany, Portugal, and Italy followed an M-shape, with increases after April 2020, a drop in winter 2020, a recovery in the summer of 2021, and a decline in winter 2021. However, observed average well-being reductions were generally small. The largest declines were found in the well-being dimensions attachment and enjoyment and among individuals with a younger age, a financially unstable situation, and lower health. COVID-19 mortality was consistently negatively associated with capability well-being and its sub-dimensions, while stringency and incidence rate were generally not significantly associated with well-being. Further investigation is needed to understand underlying mechanisms of presented patterns., (© 2023. The Author(s).)

Across the globe, populations with low socioeconomic status have borne a disproportionate burden of the COVID-19 pandemic. This article examines the relationship between two socioeconomic factors (education and income) and all-cause mortality and health care use to improve understanding of the impact of the pandemic on socioeconomic disparities in Germany, a high-income country with a universal health care system. We used mortality rates from the period 2011-21 and hospitalizations from the period 2014-21. We examined rates of all-cause mortality and all hospital admissions as well as admissions for respiratory, emergency, cancer surgery, elective, and ambulatory care-sensitive care. Although the use of some health care services was affected by the pandemic, our findings suggest that Germany endured COVID-19 without amplifying socioeconomic disparities in all-cause mortality and large segments of inpatient utilization.

Introduction: Given the initial shortage of vaccines to protect against coronavirus disease 2019 (COVID-19), many countries set up priority lists, implying that large parts of the population had to wait. We therefore elicited the willingness to pay (WTP) for access to two hypothetical COVID-19 vaccines., Methods: Respondents were asked how much they would be willing to pay to get an immediate COVID-19 vaccination rather than waiting for one through the public system. We report data collected in January/February 2021 from the European COVID Survey (ECOS) comprising representative samples of the population in Denmark, France, Germany, Italy, Portugal, the Netherlands, and the UK (N = 7068)., Results: In total, 73% (68.5%) of respondents were willing to pay for immediate access to a 100% (60%) effective vaccine, ranging from 66.4% (59.4%) in the Netherlands to 83.3% (81.1%) in Portugal. We found a mean WTP of 54.36 euros (median 37 euros) for immediate access to the 100% effective COVID-19 vaccine and 43.83 euros (median 31 euros) for the 60% effective vaccine. The vaccines' effectiveness, respondents' age, country of residence, income, health state and well-being were significant determinants of WTP. Willingness to be vaccinated (WTV) was also strongly associated with WTP, with lower WTV being associated with lower WTP. A higher perceived risk of infection, higher health risk, more trust in the safety of vaccines, and higher expected waiting time for the free vaccination were all associated with a higher WTP., Conclusion: We find that most respondents would have been willing to pay for faster access to COVID vaccines (jumping the queue), suggesting welfare gains from quicker access to these vaccines. This is an important result in light of potential future outbreaks and vaccines., (© 2023. The Author(s).)

Aim: This paper investigates the prevalence and determinants of three main states of people's willingness to be vaccinated (WTBV) against COVID-19 - willing, unwilling and hesitant - and the occurrence and predictors of shifts between these states over time. Understanding the dynamics of vaccine intentions is crucial for developing targeted campaigns to increase uptake and emergency response preparedness., Study Design: A panel survey consisting of 9 quarterly waves of data collected between April 2020 and January 2022. Baseline data included 24 952 adults from Germany, UK, Denmark, the Netherlands, France, Portugal, and Italy recruited from online panels to construct census-matched nationally representative samples., Methods and Measures: Self-reported COVID-19 vaccine intention was the main outcome. Multinomial logit random effects models were used to analyze the relationships of interest. All results reported as relative risk ratios (RRR)., Results: Hesitancy to get vaccinated was the most unstable vaccine intention, with on average 42% of ever hesitant respondents remaining in this state through future waves, followed by the 'unwilling' (53%) and 'willing (82%). Following COVID-19 news, trust in information from the government, GPs and the WHO, risk preferences, risk perceptions, and confidence in vaccines (or lack thereof) predicted vaccination intention reversals. Risk preferences acted both as an impediment and as a facilitator for the vaccine uptake depending on the initial vaccine intention., Conclusions and Relevance: This study revealed the dynamic nature of COVID-19 vaccine intentions and its predictors in 7 European countries. The findings provide insights to policymakers for designing more effective communication strategies, particularly targeted at hesitant and unwilling to vaccinate population groups, to increase vaccine uptake for future public health emergencies., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Iryna Sabat reports financial support, article publishing charges, and travel were provided by Horizon 2020 Research and Innovation Programme of the European Union through the Marie Sklodowska-Curie Grant Agreement 721402. Tom Stargardt reports financial support was provided by German Research Foundation (DFG) under grant number 466310982. Tom Stargardt reports financial support, article publishing charges, and travel were provided by Horizon 2020 Research and Innovation Programme of the European Union through the Marie Sklodowska-Curie Grant Agreement 721402. Jonas Schreyogg reports financial support was provided by German Research Foundation (DFG) under grant number 466310982. Jonas Schreyogg reports financial support was provided by Excellence Strategy by the German federal and state governments. Jonas Schreyogg reports financial support, article publishing charges, and travel were provided by Horizon 2020 Research and Innovation Programme of the European Union through the Marie Sklodowska-Curie Grant Agreement 721402. Pedro Pita Barros reports financial support was provided by Nova School of Business and Economics Lisbon Chair BPI Fundacao La Caixa on Health Economics. Pedro Pita Barros reports financial support, article publishing charges, and travel were provided by Horizon 2020 Research and Innovation Programme of the European Union through the Marie Sklodowska-Curie Grant Agreement 721402. Sebastian Neumann-Bohme reports financial support, article publishing charges, and travel were provided by Horizon 2020 Research and Innovation Programme of the European Union through the Marie Sklodowska-Curie Grant Agreement 721402. Aleksandra Torbica reports financial support, article publishing charges, and travel were provided by Horizon 2020 Research and Innovation Programme of the European Union through the Marie Sklodowska-Curie Grant Agreement 721402. Job van Exel reports financial support, article publishing charges, and travel were provided by Horizon 2020 Research and Innovation Programme of the European Union through the Marie Sklodowska-Curie Grant Agreement 721402. Werner Brouwer reports financial support, article publishing charges, and travel were provided by Horizon 2020 Research and Innovation Programme of the European Union through the Marie Sklodowska-Curie Grant Agreement 721402., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Purpose: To investigate health-related quality of life (HRQoL) over the course of the COVID-19 pandemic in seven European countries and its association with selected sociodemographic as well as COVID-19-related variables., Methods: We used longitudinal data from nine quarterly waves collected between April 2020 and January 2022 (sample size per wave ranging from N = 7025 to 7300) of the European COvid Survey (ECOS), a representative survey of adults in Germany, United Kingdom, Denmark, Netherlands, France, Portugal and Italy. HRQoL was measured using the EQ-5D-5L. The association of self-reported COVID-19 infection, perceived health risk from COVID-19, selected sociodemographic variables and the COVID-19 stringency index with HRQoL was analyzed by logistic and linear fixed effects regressions., Results: On average across all nine waves, the proportion of respondents reporting any problems in at least one of the EQ-5D dimensions ranged between 63.8% (Netherlands) and 71.0% (Denmark). Anxiety/depression was the most frequently affected EQ-5D dimension in four countries (Portugal: 52.0%; United Kingdom: 50.2%; Italy: 49.2%; France: 49.0%), whereas pain/discomfort ranked first in three countries (Denmark: 58.3%; Germany: 55.8%; Netherlands: 49.0%). On average across all nine waves, the EQ-VAS score ranged from 70.1 in the United Kingdom to 78.4 in Portugal. Moreover, the EQ-5D-5L index ranged from .82 in Denmark to .94 in France. The occurrence of COVID-19 infection, changes in the perceived risk to one's own health from COVID-19, the occurrence of income difficulties and an increase in the COVID-19 stringency index were associated with increased likelihood of problems in EQ-5D dimensions, reduced EQ-VAS score and reduced EQ-5D-5L index., Conclusions: Across seven European countries, we found large proportions of respondents reporting problems in HRQoL dimensions throughout the pandemic, especially for anxiety/depression. Various sociodemographic and COVID-19-related variables were associated with HRQoL in longitudinal analysis., (© 2023. The Author(s).)

We aimed to investigate the prevalence of probable depression and anxiety and their correlates during later stages of the COVID-19 pandemic in eight European countries. Longitudinal data (wave 7 in June/July 2021: n=8,032; wave 8 in September 2021: n=8,250; wave 9 in December 2021/January 2022: n=8,319) were used from the European COvid Survey - a representative sample of community-dwelling adults from several European countries (Germany, United Kingdom, Denmark, Netherlands, France, Portugal, Italy and Spain). In wave 7 (wave 8; wave 9), 23.8% (22.0%; 24.3%) of all respondents had probable depression and 22.6% (22.1%; 23.7%) had probable anxiety. These prevalence rates substantially differed between the European countries. Regressions showed that emerging difficulties with the income were associated with both increases in depressive symptoms and anxiety symptoms. An increase in one's own perceived risk of getting infected with the SARS-CoV-2, the birth of a child and an increase in the Covid-19 stringency index were associated with increases in depressive symptoms. The significance of probable depression and anxiety during later stages of the COVID-19 pandemic in eight European countries was highlighted. Avoiding income difficulties may also contribute to mental health., Competing Interests: Declaration of Competing Interest The authors have no competing interests to declare that are relevant to the content of this article., (Copyright © 2022. Published by Elsevier B.V.)

Background: Our aim was to present data on the prevalence of probable depression and anxiety and to determine their correlates during the COVID-19 pandemic in seven European countries using a longitudinal approach., Methods: Longitudinal data (wave 4 in November 2020: n = 7,115; wave 5 in January 2021: n = 7,068; wave 6 in April 2021: n = 7,204) were taken from the European COvid Survey (ECOS), a representative sample of non-institutionalized inhabitants from Germany, United Kingdom, Denmark, Netherlands, France, Portugal and Italy aged 18+. Probable depression and anxiety were quantified using the established and validated PHQ-4 (2-item depression scale, PHQ-2 / 2-item anxiety scale, GAD-2)., Results: In wave 4 (wave 5; wave 6), 26.6% (25.5%; 23.8%) of all respondents had probable depression and 25.7% (23.6%; 22.1%) had probable anxiety. Prevalence rates for probable depression and probable anxiety differed significantly between countries. Among all countries and waves, particularly high prevalence rates were found among individuals aged 18 to 29 years. Longitudinal analysis showed that the likelihood of probable depression was positively associated with increasing age, great income difficulties and lower health-related quality of life. The likelihood of probable anxiety was positively associated with income difficulties, and lower health-related quality of life., Limitations: Screening tool was used to quantify the outcomes., Conclusion: The magnitude of probable depression and anxiety during the COVID-19 pandemic in European countries was highlighted. Moreover, determining the factors associated with probable depression or anxiety (e.g., income difficulties, worse health-related quality of life) may assist in identifying individuals at increased risk., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: In this survey, we aimed to provide early insight into the impact of COVID-19 on blood donors and their motivation to donate during the crisis., Study Design and Methods: We asked representative samples in 7 European countries (Denmark, France, Germany, Italy, Portugal, the Netherlands and the UK) about their blood donation activity and motivation to donate using an online survey. We analysed donor turnout during the COVID-19 period descriptively and using logistic regression., Results: Of the 7122 people that responded to the survey, 1205 (16·9%) blood donors were identified, with 33·8% donating during the first 4-5 months of the COVID-19 period. We observed that around half of donors donated less than normal. The vast majority of donors that did donate made a special effort to do so in response to COVID-19. The majority of donors were also not aware of their blood being tested for COVID-19 antibodies. Although the perceived risk of infection among all respondents whilst donating blood was relatively low, those who anticipated a high risk of infection were much less likely to donate (OR = 0·540; P-value = 0·006). Furthermore, those that were adherent to COVID guidelines were also less likely to donate (OR = 0·583; P-value = 0·000)., Discussion: We suggest that blood collection services consider specialist campaigns that focus on the altruistic motivation of donors during the crisis and that they continue to communicate the additional safety measures in place with the aim of reducing the fear of infection whilst donating blood., (© 2021 The Authors. Vox Sanguinis published by John Wiley & Sons Ltd on behalf of International Society of Blood Transfusion.)

Background: Risk communication is a key component of public health interventions during an outbreak. As the coronavirus pandemic unfolded in late 2019, the World Health Organization (WHO) was at the forefront in the development of risk communication strategies. The WHO introduced a range of activities with the purpose of enabling the public to avail verified and timely information on COVID-19 prevention behaviors. Given the various WHO activities to protect the public health during COVID-19, it is important to investigate the extent of familiarity and uptake of the WHO recommendations among the public during the first wave of the pandemic., Methods: To do this, we conducted a large-scale Pan-European survey covering around 7500 individuals that are representative of populations from seven European countries, collected online during April 2-April 15, 2020. We use descriptive statistics including proportions and correlations and graphical representations such as bar charts to analyze and display the data., Results: Our findings suggest that information from the WHO in the context of COVID-19 is well trusted and acted upon by the public. Overall familiarity and adherence were quite high in most countries. Adherence was higher for social distancing recommendations compared to hygiene measures. Familiarity and adherence were higher among older, female, and highly educated respondents. However, country level heterogeneities were observed in the level of trust in information from the WHO, with countries severely affected by the pandemic reporting lower levels of trust., Conclusion: Our findings call for efforts from health authorities to get regular feedback from the public on their familiarity and compliance with recommendations for preventive measures at all stages of the pandemic, to further develop and adapt risk communication as the pandemic evolves., Competing Interests: The authors have declared that no competing interests exist.

An introduction is presented in which the editor discusses articles in the issue on topics including vaccination rates; COVID-19 outbreaks; and herd immunity.