People around the world who are vaccinated against COVID-19 look down on the unvaccinated as much or more than they do often-marginalized groups such as immigrants, drug addicts, and ex-convicts, while the unvaccinated display little rancor toward the vaccinated, suggests a study of more than 15,000 people from 21 countries with broad vaccine access.
In the study, published yesterday in Nature, researchers from Aarhus University in Denmark conducted three linked assessments using YouGov and Ipsos surveys of 15,233 participants during Omicron variant predominance—within about the past year.
Across the globe, sizeable groups are still unvaccinated, even in countries with easy vaccine access, the authors noted, and thus vaccination has been a subject of heated debate and protest in some countries. "Furthermore, vaccination status is consistently aligned with other political opinions such as trust in science and the authorities, and, in the case of the US, partisanship," they wrote.
Strong exclusionary attitudes
In study 1, in which 10,740 participants were asked to evaluate fictitious target profiles using six attributes, the vaccinated expressed discriminatory stances toward the unvaccinated, though Hungary and Romania had inconclusive results. The low regard was most apparent in cultures with stronger cooperative norms.
When asked to rate how unhappy they would be if a close relative were marrying an unvaccinated versus a vaccinated person, on average, vaccinated respondents were 13 percentage points (country-level range, 1 to 36) more unhappy.
Vaccinated participants' desire to exclude unvaccinated from family relationships (13 percentage points) was 2.5 times stronger than the desire to exclude other groups often marginalized in many Western countries, such as immigrants from the Middle East (5 percentage points).
There was a strong correlation between high country-level vaccination rates and more exclusionary attitudes, except for Argentina (high vaccination rate,
little prejudice) and South Africa (high prejudice, low vaccination rate). Exclusionary attitudes were most pronounced in Malaysia.
"Unvaccinated targets face significantly more exclusionary reactions than immigrants in 11 out of 21 countries, while immigrants do not face significantly more exclusionary reactions in any of the countries," the researchers wrote. "We do not suggest that the characteristics of these groups are comparable but this finding nonetheless suggests that the substantive size of the exclusionary reactions facing the unvaccinated is high."
But the unvaccinated showed no derision toward vaccinated people other than negative affect (a psychological term for negative emotions) in Germany and the United States, with an average AMCE of -2 percentage points; the AMCE difference between vaccinated and unvaccinated participants was 15 percentage points.
There were large differences in the effects of vaccination status among vaccinated participants on fear of infection (38 percentage points) and perceptions of untrustworthiness (13 percentage points) and incompetence (14 percentage points).
Enmity, despite lack of contact
In study 2, the researchers used YouGov survey results from six countries to compare antipathy toward the unvaccinated with that toward often-targeted groups: drug addicts, ex-convicts, mentally ill people, and atheists.
About 500 participants each were recruited from Germany, India, Indonesia, Morocco, South Africa, and the United Kingdom. The 3,045 respondents rated target profiles on a seven-point like-dislike scale.
Vaccinated respondents showed antipathy toward the unvaccinated, even in a neutral evaluation task without any indication that participants would physically meet the fictitious targets. Across all six countries, vaccinated respondents disliked unvaccinated targets more than vaccinated targets by, on average, 14 percentage points. But the unvaccinated didn't, on average, dislike vaccinated targets significantly more than unvaccinated ones (1 percentage point).
On average, the unvaccinated were disfavored as much as drug addicts (15 percentage points) and significantly more so than ex-convicts (10 percentage points), atheists (7 percentage points), and those with mental illness (6 percentage points).
Analyses found that while antipathy is greatest among people with no contact with the disliked group (15 percentage points), it is still substantial across all contact levels (5 to 12 percentage points).
Desire to withhold basic rights
In study 3, a YouGov survey fielded only in the United States asked 1,448 respondents to assess five pairs of targets in terms of whether they thought they should be denied fundamental rights such as being allowed to move into their neighborhood, sit by them on public transportation, receive US citizenship, receive unemployment or welfare benefits, or freely express their political views on social media.
Vaccinated respondents had greater antipathy toward their unvaccinated peers (16 percentage points) and were also 28 percentage points less likely to respect their freedom of movement, 10 percentage points less likely to respect their freedom of residence, 8 percentage points less likely to support their application for citizenship, and 7 percentage points less likely both to respect their freedom of speech and support their application for welfare benefits.
The vaccinated also showed significantly stronger exclusionary attitudes toward the unvaccinated than against atheists on all six outcomes, the mentally ill on five outcomes, and ex-convicts and drug addicts on three outcomes.
"It is likely that we will encounter similar support for the restriction of rights in other countries, seeing as the prejudice and antipathy can be found across continents and cultures," senior author Michael Bang Petersen, PhD, said in an Aarhus University news release.
A widening social chasm
The animosity could have serious repercussions for society, the researchers said. "The conflict between those who are vaccinated against COVID-19 and
those who are not threatens societal cohesion as a new socio-political cleavage, and the vaccinated clearly seem to be the ones deepening this rift," lead author Alexander Bor, PhD, said in the release.
Vaccinated people resent those who they view as refusing to do their part in securing the public good. "The vaccinated react in quite a natural way against what they perceive as free-riding on a public good," Petersen said. "This is a well-known psychological mechanism and thus a completely normal human reaction. Nonetheless, it could have severe consequences for society."
In the short term, Petersen said, prejudice toward unvaccinated people may lead to mistrust, complicating pandemic management. "We know that mistrust hinders vaccination uptake," he said. "In the long run, it may mean that societies leave the pandemic more divided and polarised than they entered it."
Even though low uptake in many parts of the world is a challenge to pandemic management, the researchers warn authorities against using a rhetoric of moral condemnation to try to make more people get vaccinated, such as that used by French President Emmanuel Macron, who has said that he wants to "piss off" the unvaccinated to spur them to get vaccinated.
"Moral condemnation may strengthen the cleavages and further feelings of exclusion that have led many unvaccinated to refuse the vaccine in the first place," Petersen said. "Our prior research has shown that transparent communication about the safety and effectiveness of vaccines is a more viable public-health strategy for increasing vaccine uptake in the long term."