Moralization of Covid-19 health response: Asymmetry in tolerance for human costs

The vaccination divide: Exploring moral reasoning associated with intergroup antipathy between vaccinated and unvaccinated people

OBJECTIVES

There is growing evidence of intergroup hostility between vaccinated and unvaccinated individuals, a process of polarization that threatens to derail population health efforts. This study explores the moral underpinnings of intergroup antipathy between vaccinated and unvaccinated individuals.

DESIGN

A cross-sectional design was employed to investigate the associations between the view of vaccination as a social contract or individual choice, perceived vulnerability to disease, perceptions of outgroup morality, feelings of warmth, and experiences of schadenfreude.

METHODS

Data were extracted from an online, quantitative survey of 233 vaccinated and 237 unvaccinated participants collected between June and July 2022.

RESULTS

Results revealed that vaccinated people had stronger negative attitudes towards unvaccinated people than vice versa. In line with hypotheses, the extent to which vaccinated people saw vaccination as a social contract was significantly associated with perceiving unvaccinated people as immoral. For unvaccinated people, seeing vaccination as an individual choice (the opposite of a social contract) was significantly associated with perceiving vaccinated people as immoral. Among both groups, viewing the other as immoral was associated with feeling significantly less warmth towards the opposing vaccination group, and more schadenfreude in the face of an outgroup member's suffering. Participants' perceived vulnerability to disease played a relatively small role in explaining polarization between vaccinated and unvaccinated people.

CONCLUSIONS

This research builds on previous studies by identifying moral mechanisms associated with intergroup antipathy in the vaccine debate.

You can't nudge into vaccination: Comparing the effects of nudge types and Covid-19 vaccination attitudes on vaccine willingness

Nudges can be an effective strategy to promote vaccination. However, it is necessary to better identify the characteristics of nudges that produce the strongest effects and how they interact with individuals' attitudes. Here we sequentially test the effectiveness of three nudge characteristics (framing, nudge type, and presentation modality) and the role of participants' attitudes toward Covid-19 vaccination, social solidarity and authoritarianism in vaccination decisions. In studies 1-4, participants were presented with a nudge manipulating a target characteristic (e.g. positive/negative framing, nudge type) and measuring willingness to vaccinate and related variables compared a control nudge. Study 5 used a single combined nudge reflecting the combination of successful nudges in previous studies. Results over all studies show that nudging has unreliable effects while vaccine attitudes are more reliably linked to all measures of vaccines willingness. These results suggest that attitudes play a more reliable role on effective adoption of vaccinations.

Ethics of Nudging in the COVID-19 Crisis and the Necessary Return to the Principles of Shared Decision Making: A Critical Review

Nudging, a controversial technique for modifying people's behavior in a predictable way, is claimed to preserve freedom of choice while simultaneously influencing it. Nudging had been largely confined to situations such as promoting healthy eating choices but has been employed in the coronavirus disease 2019 (COVID-19) crisis in a shift towards measures that involve significantly less choice, such as shoves and behavioral prods. Shared decision making (SDM), a method for direct involvement and autonomy, is an alternative approach to communicate risk. Predominantly peer-reviewed scientific publications from standard literature databases like PubMed, PsycInfo, and Psyndex were evaluated in a narrative review. The so-called fear nudges, as well as the dissemination of strongly emotionalizing or moralizing messages can lead to intense psycho-physical stress. The use of these nudges by specialized units during the COVID-19 pandemic generated a societal atmosphere of fear that precipitated a deterioration of the mental and physical health of the population. Major recommendations of the German COVID-19 Snapshot Monitoring (COSMO) study, which are based on elements of nudging and coercive measures, do not comply with ethical principles, basic psychological principles, or evidence-based data. SDM was misused in the COVID-19 crisis, which helped to achieve one-sided goals of governments. The emphasis on utilitarian thinking is criticized and the unethical behavior of decision makers is explained by both using the concept of moral disengagement and the maturity level of coping strategies. There should be a return to an open-ended, democratic, and pluralistic scientific debate without using nudges. It is therefore necessary to return to the origins of SDM.

Blaming the unvaccinated during the COVID-19 pandemic: the roles of political ideology and risk perceptions in the USA

Individuals unvaccinated against COVID-19 (C19) experienced prejudice and blame for the pandemic. Because people vastly overestimate C19 risks, we examined whether these negative judgements could be partially understood as a form of scapegoating (ie, blaming a group unfairly for an undesirable outcome) and whether political ideology (previously shown to shape risk perceptions in the USA) moderates scapegoating of the unvaccinated. We grounded our analyses in scapegoating literature and risk perception during C19. We obtained support for our speculations through two vignette-based studies conducted in the USA in early 2022. We varied the risk profiles (age, prior infection, comorbidities) and vaccination statuses of vignette characters (eg, vaccinated, vaccinated without recent boosters, unvaccinated, unvaccinated-recovered), while keeping all other information constant. We observed that people hold the unvaccinated (vs vaccinated) more responsible for negative pandemic outcomes and that political ideology moderated these effects: liberals (vs conservatives) were more likely to scapegoat the unvaccinated (vs vaccinated), even when presented with information challenging the culpability of the unvaccinated known at the time of data collection (eg, natural immunity, availability of vaccines, time since last vaccination). These findings support a scapegoating explanation for a specific group-based prejudice that emerged during the C19 pandemic. We encourage medical ethicists to examine the negative consequences of significant C19 risk overestimation among the public. The public needs accurate information about health issues. That may involve combating misinformation that overestimates and underestimates disease risk with similar vigilance to error.

In masks we trust: explicit and implicit reactions to masked faces vary by political orientation

Previous studies in the context of the COVID-19 pandemic indicated that wearing a medical-style mask affects whether a stranger's face is judged as more trustworthy, socially desirable, or likely to be ill. However, given political controversies around mask use, these effects might vary by political orientation. In a pre-registered online experiment, we measured evaluations of trustworthiness, social desirability and perceived illness in masked and unmasked faces by 1241 British and US participants. We included questions on political orientation, along with the implicit online-VAAST approach/avoid task to test reaction times to masked/unmasked faces. There was a medium-sized effect of masks on trustworthiness and a significant interaction with political orientation, in that conservatives found masked faces less trustworthy than did liberals. Participants were quicker to approach masked than unmasked faces, but conservatives were relatively slower than liberals. The effects on trustworthiness suggest that differential moralization of novel social norms can affect how their adherents are evaluated in terms of their suitability for social interactions. Furthermore, the congruence between implicit and explicit methods implies that such differences can have deep-seated effects on reactions.

Values in Context: The (Dis)connections Between Moral Foundations and Moral Conviction

Moral foundations theory (MFT) argues that liberals and conservatives form different moral positions because liberals emphasize the values of harm and fairness, whereas conservatives emphasize the values of group loyalty, authority, and purity. In five studies (total N = 3,327), we investigated whether political orientation moderated the relationship between the perceived relevance of each moral foundation and moral conviction (i.e., the extent to which one perceives their attitude as based on morality) across four issues. Political differences in this relationship emerged but were inconsistent across issues and did not always align with the predictions of MFT or several other theoretical explanations. Our findings together with previous research indicate that MFT may do a better job predicting attitude position than it does predicting whether people perceive that their attitudes are moral convictions, and that some foundations may reflect conventional rather than moral values (e.g., authority).

How compliance with behavioural measures during the initial phase of a pandemic develops over time: A longitudinal COVID-19 study

In this longitudinal research, we adopt a complexity approach to examine the temporal dynamics of variables related to compliance with behavioural measures during the COVID-19 pandemic. Dutch participants (N = 2399) completed surveys with COVID-19-related variables five times over a period of 10 weeks (23 April-30 June 2020). With these data, we estimated within-person COVID-19 attitude networks containing a broad set of psychological variables and their relations. These networks display variables' predictive effects over time between measurements and contemporaneous effects during measurements. Results show (1) bidirectional effects between multiple variables relevant for compliance, forming potential feedback loops, and (2) a positive reinforcing structure between compliance, support for behavioural measures, involvement in the pandemic and vaccination intention. These results can explain why levels of these variables decreased throughout the course of the study. The reinforcing structure points towards potentially amplifying effects of interventions on these variables and might inform processes of polarization. We conclude that adopting a complexity approach might contribute to understanding protective behaviour in the initial phase of pandemics by combining different theoretical models and modelling bidirectional effects between variables. Future research could build upon this research by studying causality with interventions and including additional variables in the networks.

Moralization and Mismoralization in Public Health

Moralization is a social-psychological process through which morally neutral issues take on moral significance. Often linked to health and disease, moralization may sometimes lead to good outcomes; yet moralization is often detrimental to individuals and to society as a whole. It is therefore important to be able to identify when moralization is inappropriate. In this paper, we offer a systematic normative approach to the evaluation of moralization. We introduce and develop the concept of 'mismoralization', which is when moralization is metaethically unjustified. In order to identify mismoralization, we argue that one must engage in metaethical analysis of moralization processes while paying close attention to the relevant facts. We briefly discuss one historical example (tuberculosis) and two contemporary cases related to COVID-19 (infection and vaccination status) that we contend to have been mismoralized in public health. We propose a remedy of de-moralization that begins by identifying mismoralization and that proceeds by neutralizing inapt moral content. De-moralization calls for epistemic and moral humility. It should lead us to pull away from our tendency to moralize-as individuals and as social groups-whenever and wherever moralization is unjustified.

Using Moralization as a Persuasion Strategy in Public Health Messages: A Cross-Sectional, Experimental Study on Vaping

Using moralization in anti-vaping public health messages as a persuasion strategy was recently recommended to address the current vaping epidemic. However, previous findings indicated this could lead to moralized attitudes in the general population, which can be very difficult to change and could severely affect social cohesion and distort risk perception. Since the safety and efficiency of using electronic cigarettes as smoking cessation devices are still being investigated, we conducted a cross-sectional, experimental study on a convenience sample of 612 Romanian never vapers, never smokers to assess how exposure to moralizing public health messages about vaping might influence their trust in future scientific results about this topic. Participants were randomized into six groups according to the type of message ("moral," "immoral," "neutral") and the type of effects of vaping on smokers' health, documented in a future fictitious study ("health benefits," "health risks"). Results showed that the type of message moderated trust in future scientific results after controlling for participants' general trust in science. When vaping was framed as immoral, trust in future scientific results showing health benefits was decreased, and vice versa. Implications are discussed for using moralization strategically in public health messaging to curtail or promote certain health behaviors.

Face mask use as a categorical dimension in social perception

Prevention measures aimed at combating COVID-19 pandemic strongly impact several aspects of social life. In particular, interpersonal perception is affected as a function of whether the persons perceived wear or not face masks. In two experimental studies, we here explored whether people rely on the presence vs. absence of face masks when encoding information in memory about other individuals. In a memory confusion paradigm, participants were initially presented with individuals either wearing a face mask or not, each conveying a series of sentences. Next, participants were probed about the identity of the speaker of each sentence. Results showed that it was more likely to erroneously attribute a sentence to a speaker who also was wearing a face mask (or not) as the original speaker, demonstrating that the cue about wearing or not a face mask was spontaneously used to encode information. Study 2 ruled out an alternative explanation based on perceptual processes, suggesting that face masks represent meaningful social objects. Overall, it emerged that participants spontaneously categorize others as a function of whether they wear a mask or not. Findings also confirmed previous research evidence about the more positive evaluation of mask wearers as compared to non-wearers, and the overall detrimental impact that face masks may have on the correct identification of social targets.

Aggressive measures, rising inequalities, and mass formation during the COVID-19 crisis: An overview and proposed way forward

A series of aggressive restrictive measures were adopted around the world in 2020-2022 to attempt to prevent SARS-CoV-2 from spreading. However, it has become increasingly clear the most aggressive (lockdown) response strategies may involve negative side-effects such as a steep increase in poverty, hunger, and inequalities. Several economic, educational, and health repercussions have fallen disproportionately on children, students, young workers, and especially on groups with pre-existing inequalities such as low-income families, ethnic minorities, and women. This has led to a vicious cycle of rising inequalities and health issues. For example, educational and financial security decreased along with rising unemployment and loss of life purpose. Domestic violence surged due to dysfunctional families being forced to spend more time with each other. In the current narrative and scoping review, we describe macro-dynamics that are taking place because of aggressive public health policies and psychological tactics to influence public behavior, such as mass formation and crowd behavior. Coupled with the effect of inequalities, we describe how these factors can interact toward aggravating ripple effects. In light of evidence regarding the health, economic and social costs, that likely far outweigh potential benefits, the authors suggest that, first, where applicable, aggressive lockdown policies should be reversed and their re-adoption in the future should be avoided. If measures are needed, these should be non-disruptive. Second, it is important to assess dispassionately the damage done by aggressive measures and offer ways to alleviate the burden and long-term effects. Third, the structures in place that have led to counterproductive policies should be assessed and ways should be sought to optimize decision-making, such as counteracting groupthink and increasing the level of reflexivity. Finally, a package of scalable positive psychology interventions is suggested to counteract the damage done and improve humanity's prospects.

The dark side of belief in Covid-19 scientists and scientific evidence

We draw from an interdisciplinary literature on convictions to examine the manifestations and consequences of firmly held beliefs in Covid-19 (C19) science. Across three studies (N = 743), we assess participants' beliefs in C19 experts, and beliefs in supported and unsupported empirical evidence. Study 1 establishes the basic theoretical links and we show that an individual's belief in science on C19 is associated with dispositional belief in science and moralization of C19 mitigation measures. Our subsequent two studies show how stronger belief in C19 science influences distrust in unmasked individuals past the mandates, and greater endorsement of pandemic mitigation authoritarianism. We document the dark side that emerges when belief in C19 science extends beyond the generally desirable scientific literacy and manifests as a conviction that public health experts are the only ones who can handle the pandemic, and that even unsupported claims about C19 are supported by scientific evidence (e.g., risk of outdoor transmission is high). We also highlight our political ideology findings showing that both liberals and conservatives mis-calibrate C19 risks in different ways, and we conclude with discussing how examining the darker side of scientific beliefs can inform our understanding of people's reactions to the pandemic.

I'm wearing a mask, but are they?: Perceptions of self-other differences in COVID-19 health behaviors

As information about COVID-19 safety behavior changed, people had to judge how likely others were to protect themselves through mask-wearing and vaccination seeking. In a large, campus-wide survey, we assessed whether University of Kansas students viewed others' protective behaviors as different from their own, how much students assumed others shared their beliefs and behaviors, and which individual differences were associated with those estimations. Participants in our survey (N = 1, 704; 81.04% white, 64.08% female) estimated how likely they and others were to have worn masks on the University of Kansas campus, have worn masks off-campus, and to seek a vaccine. They also completed measures of political preference, numeracy, and preferences for risk in various contexts. We found that participants estimated that others were less likely to engage in health safety behaviors than themselves, but that their estimations of others were widely shared. While, in general, participants saw themselves as more unique in terms of practicing COVID-19 preventative behaviors, more liberal participants saw themselves as more unique, while those that were more conservative saw their own behavior as more similar to others. At least for masking, this uniqueness was false-estimates of others' health behavior were lower than their actual rates. Understanding this relationship could allow for more accurate norm-setting and normalization of mask-wearing and vaccination.

Moralizing the COVID-19 Pandemic: Self-Interest Predicts Moral Condemnation of Other's Compliance, Distancing, and Vaccination

The emergence of the novel coronavirus has put societies under tremendous pressure to instigate massive and rapid behavior change. Throughout history, an effective strategy to facilitate novel behaviors has been to morally condemn those who do not behave in an appropriate way. Accordingly, here, we investigate if complying with the advice of health authorities-for example, to physically distance or vaccinate-has emerged as a moralized issue during the COVID-19 pandemic. In Study 1, we rely on data (N = 94K) from quota-sampled rolling cross-sectional online surveys from eight countries (Denmark, Sweden, Germany, France, Italy, Hungary, the United Kingdom, and the United States). We find that large majorities find it justified to condemn those who do not keep a distance to others in public and around half of respondents blame ordinary citizens for the severity of the pandemic. Furthermore, we identify the most important predictors of condemnation to be behavior change and personal concern, while institutional trust and social distrust also play large but less consistent roles. Study 2 offers a registered replication of our findings on a representative sample of Britons (N = 1.5K). It shows that both moralization and condemnation of both vaccination and general compliance are best predicted by self-interested considerations.

The new normal: Covid-19 risk perceptions and support for continuing restrictions past vaccinations

I test the possibility that over-estimating negative consequences of COVID-19 (e.g., hospitalizations, deaths, and threats to children) will be associated with stronger support the 'new normal' (i.e., continuation of restrictions for an undefined period starting with wide-spread access to vaccines and completed vaccinations of vulnerable people). The new normal was assessed by endorsing practices such as vaccine passports, travel restrictions, mandatory masking, continuing contact tracing, and pursuing elimination. Results are based on five samples (N = 1,233 from April 2021 and N = 264 from January 2022) and suggest that people over-estimate COVID-19 risks to children and healthy people, as evidenced by median estimates that 5% of all global deaths were children, 29% were generally healthy people under 65, and that a healthy person under the age of 65 has 5% chance of dying from COVID-19. Over-estimates observed in this study align with those based on representative samples, and they were consistently related to stronger support for the new normal. This relationship emerged when participants estimated risks with percentages (core indicators) and indicated the extent to which risk-based statements are true/supported with evidence or false/unsupported (alternative indicators). People were notably more likely to support continuing restrictions if they believed that COVID-19 risk and risk mitigation tactics are true, even when they are not (e.g., children need to be prioritized for boosters). These relationships persisted when considering competing explanations (political ideology, statistics literacy, belief in conspiracy theories). I trace these effects to well-meaning efforts to prevent under-estimation. Public policy and people's perceptions of risks are intertwined, where even inaccurate judgments may influence decisions. Failure to combat all misinformation with equal rigor may jeopardize the restoration of the social and economic life essential for building adaptive post-pandemic societies.

Caught COVID-19? Covidiot!

Abstract. Many governments’ COVID-19 prevention messages highlighted individual accountability and the stigmatization of individuals who violate lockdown rules. The present study examined French people’s ( N = 567) attributions of humanness to and willingness to punish (i.e., whether the target deserved medical care, helping intentions toward the target) an individual who respected versus violated the rules of the country’s first (March to May) versus second (November to December) lockdowns. Participants attributed less humanness to and were more willing to punish the deviant target than the compliant target. These effects were stronger during the first lockdown than during the second lockdown. Perceived threat of COVID-19 to the national ingroup moderated these effects, and attributions of humanness mediated willingness to punish the target.

Moral Decision-Making During COVID-19: Moral Judgements, Moralisation, and Everyday Behaviour

The COVID-19 pandemic continues to pose significant health, economic, and social challenges. Given that many of these challenges have moral relevance, the present studies investigate whether the COVID-19 pandemic is influencing moral decision-making and whether moralisation of behaviours specific to the crisis predict adherence to government-recommended behaviours. Whilst we find no evidence that utilitarian endorsements have changed during the pandemic at two separate timepoints, individuals have moralised non-compliant behaviours associated with the pandemic such as failing to physically distance themselves from others. Importantly, our findings show that this moralisation predicts sustained individual compliance with government-recommended behaviours.

Balancing the Freedom-Security Trade-Off During Crises and Disasters

During crises and disasters, such as hurricanes, terrorist threats, or pandemics, policymakers must often increase security at the cost of freedom. Psychological science, however, has shown that the restriction of freedom may have strong negative consequences for behavior and health. We suggest that psychology can inform policy both by elucidating some negative consequences of lost freedom (e.g., depression or behavioral reactance) and by revealing strategies to address them. We propose four interlocking principles that can help policymakers restore the freedom-security balance. Careful consideration of the psychology of freedom can help policymakers develop policies that most effectively promote public health, safety, and well-being when crises and disasters strike.

Fighting COVID-19 with the team of 5 million: Aotearoa New Zealand government communication during the 2020 lockdown

Aotearoa New Zealand's response to the COVID-19 pandemic is considered one of the best in the world. A major component of the government response was the communication of public health measures. In this paper, we approach Prime Minister Jacinda Ardern's daily press briefings with the Director-General of Health, Ashley Bloomfield as a case study of government communication during a public health crisis. A reflexive thematic analysis leads us to identify three key themes: 1) open, honest and straightforward communication; 2) distinctive and motivational language; and 3) expressions of care. Situating our findings in the fields of crisis communication, science communication and psychology, we argue that the messages presented in the 2020 daily briefings supported the New Zealand Government's COVID-19 elimination strategy through building trust with the audience and framing the 'lockdown' as an urgent, collective and meaningful cause, mobilising New Zealanders to support public health measures.

The limitations of polling data in understanding public support for COVID-19 lockdown policies

Opinion polls regarding policies designed to tackle COVID-19 have shown public support has remained high throughout the first year of the pandemic in most places around the world. However, there is a risk that headline support over-simplifies people's views. We carried out a two-wave survey with six-month interval on a public sample (N = 212) in the UK, examining the factors that underpin lockdown policy support. We find that the majority of people support most public health measures introduced, but that they also see significant side effects of these policies, and that they consider many of these side effects as unacceptable in a cost-benefit analysis. We also find that people judged the threat of COVID-19 via the magnitude of the policy response, and that they do not use their perception of the personal threat to themselves or close others to guide their support for policy. Polling data only offer one simple perspective and do not illustrate the ambivalence many people feel around lockdown policies. There is also a meaningful risk of public opinion and government policy forming a symbiotic relationship, which impacts upon how effectively such policies are implemented both now, and in relation to future threats.