Morality of Vaccination: The Influence of Moral Conviction on Vaccination Decisions

"Morality undeniably plays a role in vaccination."

Vaccine hesitancy persists despite vaccination's important role in global health. Vaccination can be seen as a social obligation based on the principles of harm prevention and fairness: Attaining and sustaining herd immunity is important to the health of those who cannot receive vaccinations due to age or other factors. However, the moral significance attached to certain issues, including vaccination, varies across time, cultures, and individuals. Furthermore, there is a gap between moral cognition and moral actions, as attitudes do not necessarily translate into behaviour. This paper reports on two studies that explored the role of moral convictions in vaccination decisions during the COVID-19 pandemic.

Study 1 (N = 485) revealed that moral conviction (the extent to which individuals thought about vaccination in moral terms - e.g., "How much are your feelings about vaccinations based on fundamental questions of right and wrong?") predicted an emphasis on the social benefits of herd immunity, subsequently culminating in higher vaccination intentions. Emotions and moral piggybacking (when new experiences or information cause behaviour that was previously unrelated to moral principles to be seen as either consistent with or in conflict with those principles) positively predicted moral convictions. However, the design of Study 1 does not allow for causal inference. Therefore, the researchers conducted an experimental study to examine the effects of different kinds of arguments about vaccination on moral convictions.

Specifically, in Study 2 (N = 1,111), the researchers evaluated the effects of emotional, moral, and scientific pro-vaccination arguments on moral convictions, support for mandatory vaccination, and tolerance of dissenting views. Study 2 investigated two proposed consequences of moral convictions: a focus on ends over means (via participants' views of mandatory vaccination) and a decreased tolerance for differing viewpoints (via the desired social distance from dissenting others). Moral convictions were correlated with increased support for mandatory vaccination but also with a reduced tolerance of dissenting opinions. Contrary to initial expectations, moral convictions and vaccine-related outcomes were not influenced by moral and emotional versus scientific pro-vaccination arguments. This lack of success could be attributed, in part, to reactance, particularly among unvaccinated participants. Public and private pressure to conform to vaccination recommendations may have caused hesitant individuals to feel that their decisions were not respected. Notably, those refusing vaccination were less morally convicted of their stance and more tolerant of those who were vaccinated. As non-moralised attitudes are easier to change, this finding may hold promise for public health.

Emphasis on the individual benefits of herd immunity has been found to encourage freeriding (enjoying the benefits of others' vaccination without incurring any costs by vaccinating oneself) in other studies. In these two studies, however, the influence of societal benefits outweighed that of individual benefits. Consequently, it seems advisable for public health campaigns to emphasise the collective benefits of vaccination in addition to the individual benefits. Nevertheless, while the protection of others accounted partly for vaccination intentions, the researchers argue that it is essential to recognize the contribution of other factors within the 7C framework (confidence, complacency, constraints, calculation, collective responsibility, compliance, and conspiracy). Identifying which of these factors are influential in specific contexts is necessary for successful interventions.

The researchers note that the findings underscore the importance of culturally sensitive approaches to public health initiatives, as universal solutions are unlikely. The present sample consisted predominantly of individuals from Western Europe, yet cultural differences in vaccination decisions have been found. Individuals with individualistic or hierarchical worldviews have been found to exhibit higher levels of anti-vaccination attitudes, whereas greater cultural collectivism correlated with higher COVID-19 vaccination intentions and acceptance. In addition, vaccine hesitancy has been found to vary across ethnic minority groups.

In conclusion: "In local and global health, it is imperative to account for psychological factors. The extent to which individuals view vaccination through a moral lens influences their behavior and attitudes toward those who disagree. While moral convictions can enhance compliance with essential public health measures, the risk of discrimination also increases."