Acceptability of Nonpharmaceutical Interventions to Prevent the Risk of COVID-19 Infection in the United States

Background. Nonpharmaceutical interventions (NPIs) were critical for mitigating COVID-19 transmission, yet their social and economic costs generated substantial public resistance. We aimed to quantify US adults' acceptance of key NPIs. Methods. We conducted a national discrete-choice experiment between May and December 2024 among a quota-based panel of US adults, considering 6 NPIs: mask mandates, reduced public transit capacity, school closures with/without remote learning, closure of crowded indoor venues, and closure of nonessential businesses (e.g., restaurants). Scenarios varied by COVID-19 infection risk and health care restrictions. Results. A total of 5,047 adults participated, with age, gender, race, and income distributions reflecting those of the US population. Participants considered mask mandates, reduced transit capacity, and school closures with remote learning acceptable even if they do not reduce cases. School closures without remote learning and closure of nonessential businesses were acceptable only if they reduced cases by at least 75 per 100 persons within 1 mo. Restricted access to primary and optional care was strongly objected to. Male participants, Republicans, Independents, adults ≥65 y, and those without chronic conditions showed the lowest acceptance of NPIs regardless of projected benefit. Female participants, younger adults, those living with children, and those with chronic conditions were more receptive. Still, they required a reduction of >50 cases per 100 persons to accept school closures without remote learning and closure of nonessential businesses. Limitations. Temporal distancing may have affected participants' recollection of their experiences with NPIs. Conclusions. US adults displayed heterogeneous but generally high thresholds for accepting school closures without remote learning, closure of nonessential businesses, and health care restrictions. These findings can guide pandemic preparedness plans that balance public acceptance with disease-control goals.

What levels of COVID-19 risk reduction were required for US adults to accept nonpharmaceutical interventions (NPIs) such as school or business closures?In a discrete-choice experiment of 5,047 US adults, mask mandates and other moderate NPIs were broadly acceptable even if they do not reduce cases. School closures without remote learning and closure of nonessential businesses were acceptable only if they reduced infections by ≥75 per 100 persons per month.Our survey participants did not find pandemic response plans that rely on disruptive NPIs acceptable but found indoor mask mandates and school closures with remote learning acceptable, independent of their impact on infection risk.