Vaccine Hesitancy Is Driven by Everyday Ethical Concerns

Is it possible to be ‘morally opposed’ to the COVID-19 vaccine?

Posted Mar 01, 2021 | Reviewed by Lybi Ma

Photo by CDC on Unsplash
Source: Photo by CDC on Unsplash
  • Vaccine hesitancy will become a major public health problem. And some people feel morally opposed to the vaccine; they value personal freedom, spiritual-physical purity, and distrust of the establishment.
  • Those who score high in moral concerns about spiritual purity are also prone to concerns about germs and disease; they prefer the body’s natural immune system. Modern medicine is sometimes suspect.
  • Moral reframing might help, as well as delivering messages that are consistent with the values and ethics of the hesitant.

We’re seeing some light at the end of the COVID-19 tunnel. There is a contagious feeling of joy among healthcare workers and recipients of the vaccine, with positive cases and deaths falling.

And yet, a startlingly high number of people are hesitant, if not outright refusing to accept the new vaccine. For right now, the demand for vaccines is greater than the supply, but very soon vaccine hesitancy will become a major public health problem with potentially devastating consequences.

For context, vaccine hesitancy is higher among people who estimate low risk from COVID-19, and among “anti-vaxxers” who believe conspiratorial misinformation about vaccines. In addition, people in marginalized groups (such as African-Americans and LGBTQ+ Americans) feel hesitant based on mistrust of the medical establishment.

Why Do Some People Feel Morally Opposed to Vaccines?
But could it also be the case that some folks are morally opposed to vaccines? Is it even possible to perceive vaccinations as ethically wrong?

Moral Foundations Theory describes a diversity of ethical concerns that people may have, including care (being kind to others) fairness (treating people equally) loyalty (patriotism toward communities and social groups) authority (respect for leaders and institutions) sanctity (spiritual purity) and liberty (freedom and autonomy).

There is some research connecting moral foundations to compliance with COVID-19 restrictions, such as social distancing and mask-wearing, and pre-pandemic vaccine hesitancy. The data suggest that vaccine-hesitant folks score higher in sanctity and liberty and lower in authority compared to the rest of us. That is, these folks emphasize values involving personal freedom, spiritual/physical purity, and active distrust or rebelliousness toward established leaders.

This is paradoxical. First, these values don’t align with a clear conservative or liberal worldview; we can’t just chalk it up to partisanship. Plenty of liberals, moderates, and conservatives oppose vaccinations, as do both secular and religious folks. Second, other studies have found that those who score high in moral concerns about spiritual purity are also prone to concerns about germs and disease, which would theoretically make those folks *even more* receptive to vaccines, to avoid getting sick. But instead, we see the opposite pattern. How can we make sense of this? It may be the case that while people are concerned about germs, they prefer the body’s “natural” immune system, while viewing modern medicine and technology as “unnatural” and therefore “impure.”

Moral Reframing of Vaccinations Might Help
One approach to tackling this problem is moral reframing. This is done by empathizing with the person or group you’re trying to persuade and delivering messages that are consistent with *their* values and ethics, rather than your own.

As an example, consider attitudes toward environmental policies. Studies show that liberals are more concerned about climate change than conservatives, and more willing to take swift government action to stop it. As climate activism becomes fused with liberal values, pro-climate messaging tends to focus on moral foundations of care and fairness (protecting vulnerable populations, and promoting climate justice). But conservatives are less receptive to those messages; a solution would be to re-frame them to reflect conservative virtues. Researchers Matt Feinberg and Rob Willer showed that when environmental messages reflect sanctity concerns (pollution is disgusting and we should clean up the air and water) then conservatives endorse strong environmental policies as much as liberals do.

This works for other issues too. Liberals show more support for military spending when it’s framed in terms of justice (veteran programs help reduce income inequality) compared to traditional conservative patriotism messaging about the American military as our country’s strength. These studies show that anyone can have a change of heart on a given issue if it’s framed the right way.

What would this look like for vaccines? Perhaps we can work on creatively crafting messages geared toward overcoming this particular hesitancy. If people resistant to vaccines are very concerned about personal liberty, a morally re-framed message might involve reminding people of all the things they’ll be free to do (like travel or go to sports/concerts) once restrictions are lifted after the pandemic. Basically, vaccines are a pathway to freedom.

Conversely, it would be unwise to use messages with authority figures, because this might backfire with more institutional distrust. For sanctity, perhaps re-framed messages could focus on how vaccines complement the human body’s natural immune system, in addition to showing recently vaccinated people healthy and thriving.

Saying Science Works Does Not Help
It’s unfortunate to see some leaders using mainly generic, amoral messages about how “science works,” which may be effective for some but not for those already skeptical about vaccines. It’s also disheartening to hear inconsistent and confusing messages about herd immunity, unnecessary restrictions on outdoor activities, or school reopening, which can all fuel public mistrust.

Moral reframing could be a powerful tool to improve public health messaging. However, Feinberg and Willer suggest that many people refuse to reframe their messages on principle, believing it to be a kind of deceitful “mind trick,” or because they don’t want to compromise on their convictions.

But this view is stubbornly agnostic toward the utilitarian goal of saving lives. In a pandemic, our objective should be simple: get shots in arms. To do that, we need to use words that appeal to people’s ethical instincts. The scientific evidence supports moral reframing as a strategy based on empathy and tolerance for others. The practice of reframing our messages for others (even those we dislike) is morally virtuous.

If you want to practice reframing moral messages so they have broader appeal, send me your suggestions @seltermosby.

References

Chan E. Y. (2021). Moral foundations underlying behavioral compliance during the COVID-19 pandemic. Personality and individual differences, 171, 110463. https://doi.org/10.1016/j.paid.2020.110463

Amin, A. B., Bednarczyk, R. A., Ray, C. E., Melchiori, K. J., Graham, J., Huntsinger, J. R., & Omer, S. B. (2017). Association of moral values with vaccine hesitancy. Nature Human Behaviour, 1(12), 873-880.

Rossen, I., Hurlstone, M. J., Dunlop, P. D., & Lawrence, C. (2019). Accepters, fence sitters, or rejecters: Moral profiles of vaccination attitudes. Social Science & Medicine, 224, 23-27.

Wagemans, F., Brandt, M. J., & Zeelenberg, M. (2018). Disgust sensitivity is primarily associated with purity-based moral judgments. Emotion, 18(2), 277–289. https://doi.org/10.1037/emo0000359

Feinberg, M., & Willer, R. (2019). Moral reframing: A technique for effective and persuasive communication across political divides. Social and Personality Psychology Compass, 13(12), e12501.