Searching for the Cognitive Basis of Anti-Vaccination Attitudes

"...vaccine skepticism may share a common cognitive root with other epistemically suspect beliefs..."

Studies on the relationship between cognitive abilities and vaccination attitudes are scarce. Much past research on the determinants of vaccine hesitancy has focused on factors closely linked to vaccines or vaccination - for example, on people's trust in health authorities. The present study focuses on cognitive factors that are not conceptually related to vaccines but that have been linked to other epistemically suspect beliefs, such as conspiracy theories and belief in fake news. It offers concrete recommendations for vaccine promotion based on the findings.

The theoretical framework of this study is based on Stanovich's tripartite theory of the mind, which postulates three different types of cognitive processes - reflective, algorithmic, and autonomous - that together shape how we think. The main focus here is on reflective cognition, which embodies beliefs and attitudes, knowledge, and habitual thinking styles. Specifically, the study investigates intuitive and analytic styles of thinking. Intuitive thinkers tend to to trust their initial feelings and first impressions, place trust in personal experiences, and prefer to go by their instincts even for important decisions. People with an analytic style, in contrast, like to consider various points of view before drawing conclusions, and their confidence in their opinions tends to depend on the amount of supporting evidence.

Three hundred and fifty-six Finnish participants completed an online questionnaire as part of a larger, two-stage study before the COVID-19 pandemic. The results showed that anti-vaccination attitudes decreased slightly with cognitive abilities and analytic thinking styles, and strongly with scientific literacy. In addition, anti-vaccination attitudes increased strongly with an intuitive thinking style, religious and paranormal beliefs, and ontological biases (in which one misattributes properties of one type of thing to another). These attitudes increased slightly with teleological bias, in which natural phenomena are explained by incorrectly referring to their intentional design or purpose. Overall, the strongest connections with anti-vaccination attitudes were found for (poor) scientific literacy, intuitive thinking, religious and non-religious supernatural beliefs, and ontological confusions.

These results suggest that the same cognitive mechanisms that predispose people to other epistemically suspect beliefs may predispose them to anti-vaccination attitudes as well. The findings imply that:

• Pro-vaccination communication should focus on early prevention: fostering positive attitudes towards science from early childhood and later, in early adolescence, increasing general knowledge about biological, physical, and mental phenomena, their crucial differences, the characteristics of reliable and unreliable information, and the reasons why intuition and personal experiences can be misleading in matters belonging to the scope of science.
• Interventions against vaccine hesitancy should strive to be intuitively appealing. Logical arguments, statistics, probabilities, risk ratios, and other scientific and abstract information are not effective for individuals who habitually rely on their intuitions. Instead, intuitive thinkers are receptive to the type of information provided by the advocates of anti-vaccination and other pseudoscientific campaigns. This information is concrete, pictorial, and emotional, and it includes narratives, metaphors, and in particular, personal experiences and testimonies. In light of the present results, it would be useful to use this kind of intuitively appealing communication also in pro-vaccination communication because it has the potential to outperform scientific communication about vaccines.

"Like enacting changes in vaccine institutes to make them more trustworthy in countries where trust in the institutions is low..., these projects need large political investments, because the projects are much broader than fighting vaccine hesitancy alone."

Reflecting on the findings, the researchers note that a cognitive profile characterised as a strong confidence in gut feelings, emotional testimonies, intuitively appealing socially circulating narratives, and cognitive biases can predispose individuals towards decreased science knowledge and diverse unfounded beliefs that may at the outset concern widely different issues. (For instance, beliefs that vaccines are unsafe cluster together with beliefs in blood type diet and beliefs that the earth is flat.) Future studies should aim at increasing our knowledge about this cognitive profile and its relative importance with respect to other predictors of vaccine skepticism, like vaccine- and health-specific attitudes, and emotions towards vaccination, as well as the cause-and-effect relationships of these factors.