Overcoming COVID-19 vaccination resistance when alternative policies affect the dynamics of conformism, social norms, and crowding out - PubMed (original) (raw)

Overcoming COVID-19 vaccination resistance when alternative policies affect the dynamics of conformism, social norms, and crowding out

Katrin Schmelz et al. Proc Natl Acad Sci U S A. 2021.

Abstract

What is an effective vaccination policy to end the COVID-19 pandemic? We address this question in a model of the dynamics of policy effectiveness drawing upon the results of a large panel survey implemented in Germany during the first and second waves of the pandemic. We observe increased opposition to vaccinations were they to be legally required. In contrast, for voluntary vaccinations, there was higher and undiminished support. We find that public distrust undermines vaccine acceptance, and is associated with a belief that the vaccine is ineffective and, if enforced, compromises individual freedom. We model how the willingness to be vaccinated may vary over time in response to the fraction of the population already vaccinated and whether vaccination has occurred voluntarily or not. A negative effect of enforcement on vaccine acceptance (of the magnitude observed in our panel or even considerably smaller) could result in a large increase in the numbers that would have to be vaccinated unwillingly in order to reach a herd-immunity target. Costly errors may be avoided if policy makers understand that citizens' preferences are not fixed but will be affected both by the crowding-out effect of enforcement and by conformism. Our findings have broad policy applicability beyond COVID-19 to cases in which voluntary citizen compliance is essential because state capacities are limited and because effectiveness may depend on the ways that the policies themselves alter citizens' beliefs and preferences.

Keywords: crowding out intrinsic motivation; endogenous preferences; policy implementation; state capacities; trust.

Copyright © 2021 the Author(s). Published by PNAS.

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Conflict of interest statement

The authors declare no competing interest.

Figures

Fig. 1.

Fig. 1.

Reduced support for enforced vaccination. (A) Average agreement to get vaccinated if it is voluntary or enforced in the two waves of the survey (in Likert scale units). Error bars represent 95% CI. (B) Cumulative distributions of agreement in case of enforced versus voluntary vaccination for the two waves of the survey. For example, the dashed and solid red lines show that 44% and 28% of respondents fully agreed to get vaccinated in case of enforcement in the first and second waves of the survey, respectively. The sum of those expressing either agreement level 3 or 4 under enforcement amounts to 56% in wave 1 and 42% in wave 2. Opposition to enforcement (levels 0 and 1) was expressed by 29% in wave 1 and 42% in wave 2 (1–0.71 and 1–0.58, respectively, that is, the final two steps in the graph).

Fig. 2.

Fig. 2.

Predictors of support for voluntary and enforced vaccinations in the second wave of the survey (A and B) and of changes in support between the two waves (C). Shown are the coefficients and 95% CI, estimated in ordinary least squares linear regressions with standardized variables (

SI Appendix, Tables S3 and S4

). The regression model for B is identical to the one for A, except that the two variables on effectiveness and freedom are included in B. C shows that a standard deviation (SD) decrease in public trust between the two waves is associated with a decline in support for enforced vaccination of 10% of a SD and a decline in support for voluntary vaccination of 5% of a SD. These estimates are unchanged if the effectiveness and freedom variables are excluded. Note that the scale of the horizontal axis is the same in A and B but differs for C. The two questions concerning attitudes towards the vaccine were asked only in the second wave.

Fig. 3.

Fig. 3.

A model of the fractions preferring being vaccinated to not being vaccinated and the dynamics of vaccination under a voluntary and enforced policy. A is the “optimistic” scenario in which a recommended and voluntary vaccination policy surpasses the target level. B is the “pessimistic” scenario, as the target level of vaccinations will not be reached without enforcement.

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