Discriminatory attitudes against unvaccinated people during the pandemic

Asymmetric polarization by vaccination status identification during the COVID-19 pandemic

COVID-19 prevention measures and vaccine policies have led to substantial polarization across the world. I investigate whether and how vaccination status and vaccination status identification affect the sympathy and prejudice for vaccinated and unvaccinated individuals. Drawing on a preregistered vignette survey experiment in a large representative sample from Germany (n = 6,100) in December 2021, I show that prejudice was greater among the vaccinated towards the unvaccinated than vice versa. Furthermore, I find that differences in sympathy ratings are strongly subject to vaccination status identification. If individuals do not identify with their vaccination status, there are no differences in the evaluation of the in- and outgroups. Stronger vaccination status identification is, however, associated with greater prejudice among the vaccinated towards the unvaccinated but not for the unvaccinated towards the vaccinated. The results therefore show a stronger polarization on the side of the vaccinated that increases with the identification of one's vaccination status.

Social Stigma and COVID-19 Vaccine Refusal in France

CONTEXT

In 2021, French health authorities strongly promoted vaccination against COVID-19. The authors assumed that refusing this vaccine became a stigma, and they investigated potential public stigma toward unvaccinated people among the French population.

METHODS

A representative sample of the French adult population (N = 2,015) completed an online questionnaire in September 2021. The authors focused on participants who were already vaccinated against COVID-19 or intended to get vaccinated (N = 1,742). A cluster analysis was used to obtain contrasted attitudinal profiles, and the authors investigated associated factors with logistic regressions.

FINDINGS

Regarding attitudes toward unvaccinated people, a majority of respondents supported several pejorative statements, and a significant minority also endorsed social rejection attitudes. The authors found four contrasting attitudinal profiles: moral condemnation only (32% of respondents), full stigma (26%), no stigma (26%), and stigma rejection (16%). Early vaccination, civic motives for it, faith in science, rejection of political extremes, and being aged 65 or older were the main factors associated with stigmatizing attitudes toward unvaccinated people.

CONCLUSIONS

The authors found some evidence of stigmatization toward unvaccinated people, but further research is needed, especially to investigate perceived stigmatization among them. The authors discuss their results with reference to the concept of "folk devils" and from a public health perspective.

Asymmetric affective polarization regarding COVID-19 vaccination in six European countries

While recent research has shown that supporters and opponents of COVID-19 vaccination have polarizing political attitudes and beliefs, we lack a thorough understanding of how these two groups think about each other. To investigate the feelings and stereotypes between supporters and opponents of COVID-19 vaccination, this study draws on cross-sectional survey data from six European countries (France, Germany, Italy, Spain, Switzerland, and the United Kingdom), collected between January and March 2022 (n = 6379). Our findings indicate an opinion-based affective polarization between supporters and opponents of COVID-19 vaccination. Both groups not only adopt different positions on the issue but also display dynamics of in-group favoritism and out-group hostility. Most notably, our assessment of thermometer scores and character trait ratings shows that this affective polarization is asymmetric, as it is stronger among the pro-vaccination group. Our findings are critical to the control of infectious diseases because affective polarization has been shown to influence health behaviors such as compliance with government policies. The issue is even more pressing as globalization boosts the threat of pandemic emergence and accelerates the global transmission of diseases.

Exploring associations between the Big Five personality traits and cognitive ability with COVID-19 vaccination hesitancy and uptake among mothers and offspring in a UK prospective cohort study

BACKGROUND

Vaccines reduce the severity of symptoms, and risk of hospitalisation and death from infectious diseases. Yet, vaccination hesitancy persists. Research identifying psychological risk factors for vaccination hesitancy is limited and reports conflicting results. This study sought to address these inconsistencies and explore the role of personality and cognitive ability in COVID-19 vaccination hesitancy and uptake in a prospective cohort study.

METHODS

Data came from young adults (Generation-1; G1) and their mothers (Generation-0; G0) in the Avon Longitudinal Study of Parents and Children (ALSPAC). Multinomial logistic regressions, adjusting for several sociodemographic confounders, were used to explore whether personality and cognitive ability were associated with COVID-19 vaccination hesitancy and uptake. 4,960 G1 and 4,853 G0 mothers were included in the study population.

FINDINGS

Among G1, 38.4% exhibited vaccination hesitancy, yet 91.9% of the cohort received the vaccine. In adjusted models, higher levels of openness, agreeableness, conscientiousness, and cognitive ability were associated with an increased probability of wanting the vaccine. Similarly, higher levels of agreeableness, openness and cognitive ability were associated with an increased probability of vaccination uptake. However, the evidence of associations with vaccine uptake were generally weaker than with vaccination hesitancy. 56.7% of the offspring who did not want the vaccine either received the vaccine or intended to, whilst 43.3% still had no intention.Among G0 mothers, 25.6% were vaccination hesitant, yet 99.0% of the cohort received the vaccine. 3.1% said they did not want the vaccine; approximately 80% of these either received the vaccine or intended to. We found inconclusive evidence for an association between cognitive ability and vaccination hesitancy among G0 mothers.

INTERPRETATION

This study identified psychological factors associated with vaccination hesitancy and uptake. If these associations are causal, these findings may help design more effective vaccination hesitancy interventions.

Vaccinating without complete willingness against COVID-19: Personal and social aspects of Israeli nursing students and faculty members

Soon after the coronavirus disease 2019 (COVID-19) pandemic outbreak, it became clear that vaccination will be the most useful tool to combat the disease. Despite the apparent safety and efficacy of the developed anti-COVID-19 vaccines, relatively high percentages of the population worldwide refused to get vaccinated, including many health workers and health students. The present cross-sectional study examined the motives, attitudes, and personal characteristics of those who did not get vaccinated against COVID-19 or vaccinated without complete willingness among nursing students and nursing faculty members in Israel (n = 472). Results show that the vast majority of the study participants (97%) received at least one dose of the anti-COVID-19 vaccine. Nearly 37% of the participants indicated that they received the vaccine without complete willingness. As compared to faculty members, nursing students reported lower trust in the efficacy of the vaccine, perceived the COVID-19 pandemic as a health threat to a lesser extent, exhibited lower institutional and personal trust, and had higher levels of posttraumatic stress disorder symptoms. Non-Jewish participants were at risk of vaccinating without complete willingness. These findings underscore the need for developing evidence-based strategies to promote the safety and efficacy of the anti-COVID-19 vaccines in nursing schools.

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.

How perceived coercion polarizes unvaccinated people: The mediating role of conspiracy beliefs

During the COVID-19 pandemic, different policies were implemented to increase vaccination uptake. Meanwhile, conspiracy theories spread widely, and vaccinated versus unvaccinated people increasingly polarized against each other. This study examined the associations between perceived vaccination coercion, conspiracy beliefs and polarization. We tested the relationship of vaccination status with perceived vaccination coercion, conspiracy beliefs, and polarization, with a total sample size of N = 1202 (n = 400 in China, n = 401 in the US, and n = 401 in the UK), among them n = 603 were vaccinated and n = 599 were unvaccinated. As pre-registered, unvaccinated people perceived more vaccination coercion and endorsed more conspiracy theories. Conspiracy mentality was positively related to perceived coercion. Contrary to our hypotheses, vaccinated people were more polarized toward unvaccinated people than vice versa. Finally, conspiracy beliefs mediated the link between perceived coercion and polarization among unvaccinated people.

Examining double standards in layoff preferences and expectations for gender, age, and ethnicity when violating the social norm of vaccination

Whether vaccination refusal is perceived as a social norm violation that affects layoff decisions has not been tested. Also unknown is whether ascribed low-status groups are subject to double standards when they violate norms, experiencing stronger sanctions in layoff preferences and expectations, and whether work performance attenuates such sanctioning. Therefore, we study layoff preferences and expectations using a discrete choice experiment within a large representative online survey in Germany (N = 12,136). Respondents chose between two employee profiles, each with information about ascribed characteristics signaling different status groups (gender, age, and ethnicity), work performance (work quality and quantity, and social skills), and whether the employees refused to vaccinate against COVID-19. We found that employees who refused vaccination were more likely to be preferred and expected to be laid off. Respondents also expected double standards regarding layoffs due to vaccination refusal, hence, harsher treatment of females and older employees. Nonetheless, their preferences did not reflect such double standards. We found little support that high work performance attenuates these sanctions and double standards, opening questions about the conditions under which social biases arise. Our results suggest detrimental consequences of vaccination refusal for individuals, the labor market, and acceptance of health policies.

Gene-based COVID-19 vaccines: Australian perspectives in a corporate and global context

Pandemic management requires societal coordination, global orchestration, respect for human rights and defence of ethical principles. Yet some approaches to the COVID-19 pandemic, driven by socioeconomic, corporate, and political interests, have undermined key pillars of ethical medical science. We explore significant mistakes that may have occurred in recent pandemic control, in order to better navigate the future. Within corporate and geopolitical infrastructure, we review the COVID-19 pandemic and novel mRNA and viral-vector DNA COVID-19 vaccines, deployed by wealthy western countries. The pandemic, together with rollouts of unconventional, gene-based vaccine technology, has provided experimental opportunity to engineer social control of entire populations. The haste and scale of development, production, and distribution of these new pharmaceuticals is unprecedented in history. Key phase III clinical trials for these products are yet to be fully completed, despite administration to billions of people. Mass vaccination of workforces has been mandated, and vaccine mandates correlate with excess mortality. Many independent data sets concur - we have experienced a pandemic of viral illness, followed by a pandemic of vaccine injury. For Australia, matters have operated the other way around. Vaccination followed later by the main viral wave. Australian excess mortality data correlates with this. Neither risk nor cost can justify these products for the vast majority of people. Lack of efficacy against infection and transmission, and the equivalent benefits of natural immunity, obviate mandatory therapeutics. With the many gene-based pharmaceuticals planned, a new era of pathology lies ahead. We should pause, reflect, and reaffirm essential freedoms, welcome the end of the COVID-19 pandemic, embrace natural immunity, and lift all mandated medical therapy.

How orientations to expertise condition the acceptance of (mis)information

This review explores psychological barriers to the acceptance of expert guidance. Specifically, the constructs of epistemic overconfidence, institutional distrust, anti-expert sentiments, anti-establishment orientations, science populism, and conspiracist worldviews are jointly considered as orientations to expertise. I review the state of the literature on their origins, prevalence, and effects on misinformation endorsement and acceptance of corrections. Addressing these psychological barriers requires building trust in institutions, backed by transparent communication and the involvement of community-based, non-expert messengers. As the review synthesizes disparate research strands, it underscores the need for future studies to compare, validate, and consolidate different orientations to expertise, understand causal relationships, and explore generalizability to diverse contexts.

Recruiting a Hard-to-Reach, Hidden and Vulnerable Population: The Methodological and Practical Pitfalls of Researching Vaccine-Hesitant Parents

While recruitment is an essential aspect of any research project, its challenges are rarely acknowledged. We intend to address this gap by discussing the challenges to the participation of vaccine-hesitant parents defined here as a hard-to-reach, hidden and vulnerable population drawing on extensive empirical qualitative evidence from seven European countries. The difficulties in reaching vaccine-hesitant parents were very much related to issues concerning trust, as there appears to be a growing distrust in experts, which is extended to the work developed by researchers and their funding bodies. These difficulties have been accentuated by the public debate around COVID-19 vaccination, as it seems to have increased parents' hesitancy to participate. Findings from recruiting 167 vaccine-hesitant parents in seven European countries suggest that reflexive and sensible recruitment approaches should be developed.

Historical narratives about the COVID-19 pandemic are motivationally biased

How people recall the SARS-CoV-2 pandemic is likely to prove crucial in future societal debates on pandemic preparedness and appropriate political action. Beyond simple forgetting, previous research suggests that recall may be distorted by strong motivations and anchoring perceptions on the current situation1-6. Here, using 4 studies across 11 countries (total n = 10,776), we show that recall of perceived risk, trust in institutions and protective behaviours depended strongly on current evaluations. Although both vaccinated and unvaccinated individuals were affected by this bias, people who identified strongly with their vaccination status-whether vaccinated or unvaccinated-tended to exhibit greater and, notably, opposite distortions of recall. Biased recall was not reduced by providing information about common recall errors or small monetary incentives for accurate recall, but was partially reduced by high incentives. Thus, it seems that motivation and identity influence the direction in which the recall of the past is distorted. Biased recall was further related to the evaluation of past political action and future behavioural intent, including adhering to regulations during a future pandemic or punishing politicians and scientists. Together, the findings indicate that historical narratives about the COVID-19 pandemic are motivationally biased, sustain societal polarization and affect preparation for future pandemics. Consequently, future measures must look beyond immediate public-health implications to the longer-term consequences for societal cohesion and trust.

The COVID-19 pandemic eroded system support but not social solidarity

While the World was busy mitigating the disastrous health and economic effects of the novel coronavirus, a less direct, but not less concerning peril has largely remained unexplored: the COVID-19 crisis may have disrupted some of the most fundamental social and political relationships in democratic societies. We interviewed samples resembling the national population of Denmark, Hungary, Italy and the US three times: in April, June and December of 2020 (14K observations). We show that multiple (but not all) measures of support for the political system decreased between April and December. Exploiting the panel setup, we demonstrate that within-respondent increases in indicators of pandemic fatigue (specifically, the perceived subjective burden of the pandemic and feelings of anomie) correspond to decreases in system support and increases in extreme anti-systemic attitudes. At the same time, we find no systematic trends in feelings of social solidarity, which are largely unaffected by changes in pandemic burden.

Difference in the risk of discrimination on psychological distress experienced by early wave infected and late wave infected COVID-19 survivors in Japan

The psychological distress experienced by coronavirus disease of 2019 (COVID-19) survivors after recovery from the illness is amplified by discrimination endured because of their infection status. However, the difference in the risk of facing discrimination and risk of experiencing psychological distress in the early and late waves of the COVID-19 pandemic remain unclear. This study aimed to investigate whether the risk of facing discrimination because of infection status was lower in the early or late waves and whether risk of discrimination on psychological distress was more serious in later, rather than earlier waves. We conducted two online surveys to collect data from survivors divided into two groups. The participants with scores of five or more on the Kessler Psychological Distress Scale were identified as having experienced psychological distress. The participants were identified as having experienced discrimination based on infection status if they had endured being blamed, some type of discrimination, or having themselves or their families maligned. The timing of infection was split into infected during early waves of the pandemic for 2021 participants and infected during later waves of the pandemic for 2022 participants. Modified Poisson regression analyses were performed using experiences of discrimination as criteria and timing of infection as predictors. Modified Poisson regression analyses were further performed using the presence of psychological distress as a criteria and experiences of discrimination and timing of infection as the criteria, in addition to interaction effect of these es. The data of 6010 participants who were infected in early waves and 5344 participants who were infected in later waves were analyzed. The risks of being blamed, some forms of discrimination, and participants and their families being maligned were significantly lower in the group who were infected in later waves than those infected in earlier waves. Experiences of discrimination were highly associated with psychological distress in those infected in later waves than those infected in earlier waves, while only being blamed showed a significant association. Risk of discrimination was found to be lower in those infected in later waves, whereas risk of discrimination on psychological distress was shown to be more serious in those infected in later waves. Therefore, we submit that it is more important to support COVID-19 survivors who face discrimination, than it is to attempt to decrease the current discriminatory climate caused by the COVID-19 pandemic.

Do left-wingers discriminate? A cross-country study on the links between political orientation, values, moral foundations, and the Covid-19 passport

To increase Covid-19 vaccine uptake and protect vulnerable people, many countries have introduced a Covid-19 passport in 2021, allowing vaccinated individuals to access indoor facilities more freely and travel to foreign countries. However, the passport has had unintended consequences as it discriminates against those who do not want to get vaccinated for medical, religious, or political reasons, or those who do not have access to vaccines. The present study (N = 678) assessed across Brazil, UK, USA, and a group of other countries, the links between political orientation, human values, and moral foundations, and attitudes towards the Covid-19 passport and whether people perceive it as a discriminatory measure. Results showed that left-wingers, typically more inclined to recognize discrimination, favor the passport more and perceive it as less discriminatory than right-wingers. This pattern remains consistent even after controlling for human values and moral foundations, independently predicting attitudes towards the passport. Overall, our findings provide novel insights into a context in which left-wingers support measures that involuntarily discriminate against certain groups.

Supplementary information

The online version contains supplementary material available at 10.1007/s12144-023-04554-9.

Examining an Altruism-Eliciting Video Intervention to Increase COVID-19 Vaccine Intentions in Younger Adults: A Qualitative Assessment Using the Realistic Evaluation Framework

COVID-19 vaccine-induced immunity wanes over time, and with the emergence of new variants, additional "booster" doses have been recommended in Canada. However, booster vaccination uptake has remained low, particularly amongst younger adults aged 18-39. A previous study by our research team found that an altruism-eliciting video increased COVID-19 vaccination intentions. Using qualitative methods, the present study aims to: (1) identify the factors that influence vaccine decision-making in Canadian younger adults; (2) understand younger adults' perceptions of an altruism-eliciting video designed to increase COVID-19 vaccine intentions; and (3) explore how the video can be improved and adapted to the current pandemic context. We conducted three focus groups online with participants who: (1) received at least one booster vaccine, (2) received the primary series without any boosters, or (3) were unvaccinated. We used deductive and inductive approaches to analyze data. Deductively, informed by the realist evaluation framework, we synthesized data around three main themes: context, mechanism, and intervention-specific suggestions. Within each main theme, we deductively created subthemes based on the health belief model (HBM). For quotes that could not be captured by these subthemes, additional themes were created inductively. We found multiple factors that could be important considerations in future messaging to increase vaccine acceptance, such as feeling empowered, fostering confidence in government and institutions, providing diverse (such as both altruism and individualism) messaging, and including concrete data (such as the prevalence of vulnerable individuals). These findings suggest targeted messaging tailored to these themes would be helpful to increase COVID-19 booster vaccination amongst younger adults.