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Political ideology and vaccination willingness: implications for policy design

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The COVID-19 pandemic has forced governments to impose major restrictions on individual freedom in order to stop the spread of the virus. With the successful development of a vaccine, these restrictions are likely to become obsolete-on the condition that people get vaccinated. However, parts of the population have reservations against vaccination. While this is not a recent phenomenon, it might prove a critical one in the context of current attempts to manage the COVID-19 pandemic. Consequently, the task of designing policies suitable for attaining high levels of vaccination deserves enhanced attention. In this study, we use data from the Eurobarometer survey fielded in March 2019. They show that 39% of Europeans consider vaccines to cause the diseases which they should protect against, that 50% believe vaccines have serious side effects, that 32% think that vaccines weaken the immune system, and that 10% do not believe vaccines are tested rigorously before authorization. We find that-even when controlling for important individual-level factors-ideological extremism on both ends of the spectrum explains skepticism of vaccination. We conclude that policymakers must either politicize the issue or form broad alliances among parties and societal groups in order to increase trust in and public support for the vaccines in general and for vaccines against COVID-19 in particular, since the latter were developed in a very short time period and resulted-in particular in case of the AstraZeneca vaccine-in reservations because of the effectiveness and side effects of the new vaccines. Supplementary information: The online version contains supplementary material available at 10.1007/s11077-021-09428-0.
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Policy Sciences (2021) 54:477–491
https://doi.org/10.1007/s11077-021-09428-0
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DISCUSSION ANDCOMMENTARY
Political ideology andvaccination willingness: implications
forpolicy design
MarcDebus1 · JaleTosun2
Accepted: 29 May 2021 / Published online: 16 June 2021
© The Author(s) 2021
Abstract
The COVID-19 pandemic has forced governments to impose major restrictions on indi-
vidual freedom in order to stop the spread of the virus. With the successful development of
a vaccine, these restrictions are likely to become obsolete—on the condition that people get
vaccinated. However, parts of the population have reservations against vaccination. While
this is not a recent phenomenon, it might prove a critical one in the context of current
attempts to manage the COVID-19 pandemic. Consequently, the task of designing policies
suitable for attaining high levels of vaccination deserves enhanced attention. In this study,
we use data from the Eurobarometer survey fielded in March 2019. They show that 39% of
Europeans consider vaccines to cause the diseases which they should protect against, that
50% believe vaccines have serious side effects, that 32% think that vaccines weaken the
immune system, and that 10% do not believe vaccines are tested rigorously before authori-
zation. We find that—even when controlling for important individual-level factors—ideo-
logical extremism on both ends of the spectrum explains skepticism of vaccination. We
conclude that policymakers must either politicize the issue or form broad alliances among
parties and societal groups in order to increase trust in and public support for the vaccines
in general and for vaccines against COVID-19 in particular, since the latter were developed
in a very short time period and resulted—in particular in case of the AstraZeneca vac-
cine—in reservations because of the effectiveness and side effects of the new vaccines.
Keywords Attitudes· Beliefs· COVID-19· Europe· Ideology· Policy design
* Marc Debus
marc.debus@uni-mannheim.de
Jale Tosun
jale.tosun@ipw.uni-heidelberg.de
1 School ofSocial Sciences, University ofMannheim, A5, 6, 68131Mannheim, Germany
2 Institute ofPolitical Science, Heidelberg University, Bergheimer Straße 58, 69115Heidelberg,
Germany
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Introduction
The COVID-19 pandemic has forced national governments around the world to impose
major restrictions on individual freedom in order to stop the spread of the virus. These
restrictions have not only sparked severe protests by groups of citizens, but also resulted in
the strengthening of populist movements and their political representatives, who are gen-
erally skeptical of policies that help to stem the spread of the COVID-19 virus—a phe-
nomenon labeled as ‘medical populism’ (Lasco, 2020). Already before the outbreak of
COVID-19, vaccination was a conflictual issue, and several studies have highlighted and
demonstrated empirically that the ideological orientation of citizens has a direct effect on
attitudes toward vaccines.
The already existing and—possibly due to COVID-19—increasing skepticism of vac-
cination is likely to have a major impact on the chances of governments being able to end
the restrictions on individual freedom. The implications of this skepticism are compounded
by the fact that the influence of misinformation on political life and on the rationale behind
implemented policies is rising (Perl etal., 2018). Only if a large majority of people are in
favor of receiving one of the developed and authorized vaccines against viruses that could
lead to a (global) pandemic like COVID-19 can governments retract some or even all of the
restrictions imposed on individual freedom to stem the spread of the virus. It is therefore
important for policymakers who are designing a vaccination strategy against viruses like
COVID-19 or ones that might appear in the future to know which factors drive skepticism
and opposition against vaccination.
Consequently, this contribution asks which factors have an impact on skeptical positions
toward vaccines and vaccination in Europe. Because of the increasing ideological polariza-
tion in Europe over the last decade (e.g., Torgerson, 2017), which has resulted in the elec-
toral success of left- and right-wing populist parties (e.g., Caiani & Graziano, 2019), we
highlight the role of ideology in developing skeptical positions on vaccines and vaccina-
tion and argue that ideological extremism, regardless of its orientation, is likely to increase
opposition toward vaccines and vaccination. On the basis of Eurobarometer survey data
collected in March 2019 (European Commission, 2019), we find that—even when control-
ling for important individual-level factors, such as education, the economic situation, inter-
nal political efficacy, and trust in the government and the media—ideological extremism
explains skepticism of vaccines and vaccination.
We take these findings as a basis for discussing implications for policy design (Capano
& Howlett, 2019; Howlett & Lejano, 2013; Howlett etal., 2015; Peters etal., 2018). We
suggest that political decision-makers either politicize vaccination, so that parties from the
far-left or the far-right are prevented from taking ownership of the issue, or form broad alli-
ances among parties and the societal groups they represent in order to increase trust in and
public support for vaccines in general and against COVID-19 in particular. If such strate-
gies fail and people remain skeptical of vaccines and vaccination, we argue that the risk
is high that not enough people will opt to be vaccinated, meaning that a pandemic and its
negative socioeconomic effects will continue for some time.
The remainder of this study unfolds as follows: The next section provides a brief review
of the literature on the impact of ideology on the attitudes toward vaccines and vaccination
in democracies. On that basis, we develop our expectation that ideological extremism is
one of several driving forces that result in skepticism of vaccines and vaccination. “Data
for evaluating the relationship between political ideology and vaccination willingness” sec-
tion presents the data and the empirical strategy, while the results of the analysis—both in a
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descriptive and analytical manner—are shown in “Results: the more ideologically extreme,
the more negative toward vaccines and vaccination” section. The final section concludes
with suggestions for political decision-makers on designing a successful strategy that pro-
motes vaccination against viruses that result in a pandemic like COVID-19.
Ideological orientation andskepticism ofvaccination
Several studies shed light on the reasons why people are skeptical of vaccines and vaccina-
tion. These studies focus on individuals’ characteristics, such as their educational, religious
and psychosocial background on the one side and their trust in political institutions on the
other. Several of these studies stress the impact of a person’s ideological background on
their acceptance/rejection of vaccines and vaccination, but their results vary as they depend
on the geographical focus of the respective study.
In a study focusing on the USA, Baumgaertner etal. (2018) demonstrate that the indi-
viduals’ ideological orientation has a strong and statistically significant effect on theiratti-
tude toward vaccines and vaccination (see also Featherstone etal., 2019). Besides trust in
healthcare providers and trust in the government and medical experts, respondents who
identify as conservative express less intent to be vaccinated than individuals who iden-
tify with a different ideology. This finding is robust when controlling for income and the
age of the internet survey participants. A recent study that focusses on the willingness of
Australians to take a COVID-19 vaccine shows that—among other factors—the support
for established political parties increases the chances to take a coronavirus vaccine (Smith
etal., 2021).
A further US-based survey study by Estep (2017) supports the findings by Baumgaert-
ner etal. (2018). Estep (2017) studies the impact of the political context and one’s political
ideology on vaccine acceptance in California, and finds that context matters: citizens with
a conservative ideological orientation are significantly more likely to oppose vaccines, but
only if they live in a county were the Democrats received high vote shares. Lin and Wang
(2020) focus on the impact of personality on attitudes toward vaccination and report for the
USA that, among other factors such as income and education, people with ideologically
liberal orientations view vaccination as beneficial and support school vaccination. Further-
more, there is empirical evidence for the US case that parents with moderate and conserva-
tive ideological positions are less likely than liberals to report having fully vaccinated their
children prior to the age of two (Rabinowitz etal., 2016).
Turning to Europe, Czarnek etal. (2020) find—on the basis of the same Eurobarometer
data analyzed in this study—that the effects of right-wing ideology on vaccine attitudes are
not observable in the European context. The authors contend that ideology interacts with
the political interest of the participants in the survey. The more strongly people consider
themselves as right-wing and the more interested they are in politics, the more likely is
right-wing ideology to result in skeptical attitudes and beliefs toward vaccines and vac-
cination. This effect is not observable for survey participants who are less interested in
politics. Furthermore, Czarnek et al. (2020) show that the substantive effects of ideology
and political interest are only moderate and do not provide support for the expectation that
there is a “liberal bias” against vaccines and vaccination, which suggests that, unlike in
the USA, vaccines have not become a strongly politicized issue in Europe, even though
national laws on mandatory vaccinations for children resulted in intense political debates,
as the case of Italy in 2017 has shown (Cadeddu etal. 2020). However, the politicization of
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vaccination policy is likely to increase because of the conflicts between European political
parties over how to handle the COVID-19 crisis. Several right-wing populist parties are
campaigning against vaccination, in particular against mandatory vaccination, such as the
right-wing populist “Alternative for Germany” (AfD). In France, the supporters of the far-
right National Rally (NR) and the left-wing populist “Unsubmissive France” (“La France
Insoumise,” LFI) reject a vaccine against COVID-19. Indeed, Ward etal. (2020) find that
French who feel close to the established parties on the center-left, the center and the center-
right would opt to be vaccinated against COVID-19, whereas people who identify with the
far-left and the far-right parties or who do not identify with any party would reject such a
vaccine (see Żuk & Żuk, 2020 for a similar result for Poland). While Cadeddu etal. (2020)
find that Italians who place themselves to the right of the ideological left–right spectrum
tend to consider vaccines harmful, Engin and Vezzoni (2020), by contrast, do not find an
impact of political conservatism on anti-vaccination beliefs in Italy; rather, trust in political
institutions and the healthcare system has a strong impact on attitudes toward vaccination.
This brief overview of the recent literature reveals that the ideological background of
people seems to affect their views on vaccines and vaccination. However, while in the
USA people who place themselves on the right of the ideological spectrum tend to reject
vaccination or are at least skeptical of vaccines, research on European countries indicates
that—if at all—ideological extremism, that is, the distance from the center of the left–right
continuum, seems to affect people’s attitudes on vaccines and vaccination. On the basis of
these insights, we expect Europeans of more ideologically extreme orientations to be more
likely to be skeptical of vaccines.
Since the development and sale of vaccines can be highly profitable for pharmaceuti-
cal companies, some people with far-left ideological orientations have negative stances on
vaccination, whereas people who locate themselves on the far right tend to reject vaccines
because of their dis-identification with scientists and educational elites, their religious
views, their concerns over moral purity, and their strongly hierarchal worldviews (Hornsey
etal., 2020; Rabinowitz etal., 2016). Because authoritarian attitudes are a major compo-
nent of the ideology of populism and its political representatives (Mudde, 2004), we should
be able to observe a connection between negative positions regarding vaccines and vacci-
nation and people who no longer feel politically represented or who do not trust key politi-
cal institutions. We contend that information on individuals’ ideological stances should be
taken into consideration when designing a policy that aims to attain high rates of vaccina-
tion, as is the case with the policy responses to COVID-19 or any other virus that is likely
to result in a (global) pandemic.
Data forevaluating therelationship betweenpolitical ideology
andvaccination willingness
The Eurobarometer data collected in March 2019 (GESIS ZA study number 7562, see
European Commission, 2019) include information on the respondents’ attitudes and beliefs
vis-à-vis vaccination. To evaluate whether ideological extremism both to the left and the
right results in skeptical positions toward vaccines and vaccination, we rely on four indica-
tors, which test the knowledge of people regarding vaccines and vaccination, to construct
the outcome variable. More precisely, the survey participants were asked whether the fol-
lowing statements are true or false:
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vaccines overload and weaken the immune system;
vaccines can cause the disease against which they protect;
vaccines often produce serious side effects;
vaccines are rigorously tested before being authorized for use.
If a survey respondent considered the first three statements to be true and the last one false,
it indicated that he/she is skeptical of vaccines or vaccination. Since each of the state-
ments reflects a specific aspect of vaccination, such as a vaccine’s effects or its production,
we estimate four regression models with each of the variables as the respective outcome
variable. Each of these outcome variables is binary, with a score of 1 indicating skepti-
cal positions on vaccination and 0 indicating positive views of vaccination and vaccines.
We estimate logistic models and control for a whole battery of factors that reflect personal
characteristics of the survey respondents; these include age, gender, education, whether the
respondents have children, their professional background, their trust in institutions, their
satisfaction with life, whether they have experienced financial problems, whether they con-
sider that their voice counts in the political discourse of their respective country (internal
political efficacy), and their political interest.1
Our main explanatory variable are the individuals’ ideological beliefs. To be precise,
we are interested in testing whether ideological extremism results in skeptical attitudes
and positions on vaccines and vaccination; to this end, we calculate the absolute dis-
tance between the left–right self-placement of a survey respondent on the center of the
left–right dimension.2 The greater the distance from the center, the more negative people
should be toward vaccines and vaccination. To check the robustness of the findings, we
estimate additional models that include the squared distance between the ideological center
of the left–right dimension and the respondent’s self-placement on a left–right scale. A
further model includes a measure for people who locate themselves on the far-left or the
far-right of the left–right dimension. Finally, we simply include the left–right placement
of the survey respondents.3 The latter allows us to check whether—instead of ideological
extremism—a more right-wing orientation results in skeptical positions on vaccines and
vaccination, as several studies on the USA suggest. The detailed results of these robustness
checks are presented in online appendix, which is available here: https:// doi. org/ 10. 1007/
s11077- 021- 09428-0.
Results: themore ideologically extreme, themore negative
towardvaccines andvaccination
A significant share of people in Eastern and Western European countries have skeptical
attitudes toward vaccines and vaccination. Figures1, 2, 3, and 4 provide information on
the share of respondents that agree with (incorrect) statements on vaccines or vaccination.
1 See the online appendix (https:// doi. org/ 10. 1007/ s11077- 021- 09428-0) for a description on the coding of
the respective explanatory variables.
2 The left–right dimension in the Eurobarometer ranges from 1 (far left) to 10 (far right). The hypothetical
center of this dimension is 5.5, meaning that ideological extremism is measured by the absolute distance
between the self-placement of a survey respondent and the value 5.5.
3 Survey respondents who locate themselves with either a 1 or a 2 on the left–right axis are considered as
far-left, while voters [not ‘respondents’?] who place themselves with either a 9 or a 10 are considered as
far-right.
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While 32% of the respondents agree with the statement that vaccines overload and weaken
the immune system, the share is significantly lower in the Netherlands and Sweden (about
15%), while in Slovenia, Croatia, the Czech Republic, and Austria more than 40% agree
with the statement (see Fig.1). Figure2 demonstrates that almost 50% of the respondents
in Malta, Belgium,and Slovenia think that vaccines can cause the disease against which
they protect, while only 25% and 30% agree with this statement in Bulgaria and Greece.
Across Europe, almost 40% agree with the statement that vaccines can cause those diseases
which they should protect against. Roughly half of the respondents across all European
countries agrees with the statement that vaccines often have serious side effects. While
only one third of the Dutch and the Danes agree with that statement, almost two-thirds of
the respondents from Cyprus and Croatia and 60% of the French respondents think that
vaccines often have serious side effects (see Fig.3). Only 10% of the respondents across
Europe disagree with the statement that vaccines are tested rigorously before authori-
zation. There is, again, clear variation between the countries. In Romania, Croatia, and
Italy, 18–20% of the respondents think that vaccines are not rigorously tested before being
authorized. The share of respondents with the same position is below 5% in the cases of
Eastern Germany, the Netherlands, Portugal, and Malta (see Fig.4).
The level of cross-country variation indicates that we need to include variables that
identify the respective countries and regions when estimating the impact of ideological
extremity on the respondents’ positions regarding the four indicators of vaccine-skep-
ticism. In the following paragraphs, we present the results of the multivariate analyses,
so that we can evaluate whether ideological extremism matters for skepticism of vaccines
010 20 30 40 50
True: Vaccines overload and weaken the immune system (%)
Slovenia
Croatia
Czech Republic
Malta
Latvia
Austria
Cyprus
Hungary
Slovakia
Ireland
Germany (East)
France
Romania
Belgium
Italy
Germany (West)
Estonia
Lithuania
Luxembourg
Greece
Poland
Spain
United Kingdom
Portugal
Bulgaria
Denmark
Finland
Sweden
The Netherlands
Fig. 1 Share of respondents that agree with the statement, “vaccines overload and weaken the immune sys-
tem”. Comment: Line provides information on the share of people across all countries and regions
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and vaccination. The results of the logistic regression models presented in Table1 provide
information on why respondents agree with the statement “vaccines overload and weaken
the immune system” (model 1), “vaccines can cause the disease against which they pro-
tect” (model 2), “vaccines can cause the disease against which they protect” (model 3), and
“vaccines are not rigorously tested before being authorized for use” (model 4). While we
find no effect of ideological extremism for support of the statement that vaccines overload
and weaken the immune system in model 1, there is evidence that people who locate them-
selves on the far left of the ideological spectrum are more likely to support this statement
(see model 3 in TableA1). This is, however, not the case for people who consider them-
selves as far right-wing. There is also no evidence that with more right-wing positions peo-
ple think that vaccines overload and weaken the immune system (see model 4 in TableA1).
When shifting the perspective to the statement “vaccines can cause the disease against
which they protect” (see model 2 in Table1), we find evidence that ideological extremism
matters for vaccination skepticism: The more ideologically extreme respondents are, the
more likely they are to think that vaccines cause diseases against which they should protect
(see also model 2 in TableA2). The results of model 3 in TableA2 indicate that people
from the far-right are more likely to support this statement; however, there is—again—no
evidence that people are more likely to support this statement the further to the right they
place themselves on a left–right dimension (model 4 in TableA2).
We find similar patterns when shifting the perspective to the statement “vaccines
can often produce serious side-effects”. Here we find again that ideological extremism
matters: The further away people are from the center of the left–right dimension, the
010 20 30 40 50
True: Vaccines can cause the disease against which they protect (%)
Malta
Belgium
Slovenia
Denmark
Croatia
Lithuania
Czech Republic
France
Finland
Germany (East)
Cyprus
Latvia
Germany (West)
Luxembourg
The Netherlands
Austria
Slovakia
Hungary
Spain
Romania
Ireland
United Kingdom
Italy
Estonia
Sweden
Portugal
Poland
Greece
Bulgaria
Fig. 2 Share of respondents that agree with the statement, “vaccines can cause the disease against which
they protect”. Comment: Line provides information on the share of people across all countries and regions
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more likely they are to agree with the statement that vaccines often produce serious side
effects (see model 3 in Table1 and model 2 in TableA3). Furthermore, when differen-
tiating between people who consider themselves as far-left or far right-wing, we find
that both groups of people are more likely to think vaccines often produce negative side
effects (see model 3 in TableA3 in the online appendix).
Model 4 in Table1 provides evidence that ideological extremism helps to explain
why people disagree with the statement that vaccines are rigorously tested before being
authorized for use. The further away people are from the center of the left–right dimen-
sion, the more likely they are to think that vaccines are not rigorously tested before
authorization. Again, there is no evidence that only people who place themselves on the
far-right are skeptical of testing prior to the authorization of new vaccines (see models 3
and 4 in TableA4 in online appendix).
All these results are stable, even when controlling for a battery of further variables
that are usually included in empirical models when analyzing the positions and atti-
tudes of people toward vaccines and vaccination. In line with existing studies, we find
that trust in political institutions and in the media particularly matters: If people do not
trust the government or the media, they are more likely to be skeptical of vaccines and
vaccination. Moreover, the longer people spend in education, the less likely they are
to support statements that are skeptical of vaccines and vaccination according to the
findings presented here. In addition, self-reported financial problems and the feeling
that one’s own views are not considered in the respective countries’ political decision-
making process strengthen vaccine and vaccination skepticism. There is also evidence
020 40 60 80
True: Vaccines often produce serious side effects (%)
Cyprus
Croatia
Malta
France
Slovenia
Latvia
Ireland
Lithuania
United Kingdom
Luxembourg
Greece
Belgium
Romania
Czech Republic
Austria
Portugal
Germany (East)
Slovakia
Italy
Germany (West)
Hungary
Finland
Estonia
Spain
Bulgaria
Poland
Denmark
Sweden
The Netherlands
Fig. 3 Share of respondents that agree with the statement, “vaccines often produce serious side effects”.
Comment: Line provides information on the share of people across all countries and regions
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that a low degree of life satisfaction results in skeptical attitudes toward vaccines and
vaccination, while respondents that have children seem at least less likely to agree with
the statements that vaccines are rigorously tested before being authorized and that vac-
cines often produce serious side effects.
Overall, our findings indicate that in the case of three of the four statements regard-
ing vaccines and the vaccination process, ideological extremism matters: the further
away a respondent locates him- or herself from the center of the ideological left–right
dimension, the more likely it is that he or she thinks
that vaccines can cause the disease against which they should protect,
that vaccines often produce serious side effects, and
that vaccines are not rigorously tested before being authorized for use.
There is—with the exception of the statement that focused on the side effects of vac-
cines—no evidence that a greater right-wing orientation results in skepticism of vac-
cines and vaccination in the European geographical context. We therefore suggest that
governments and administrations should form broad alliances and coalitions between
groups and parties in society and politics in order to reduce skepticism of vaccines and
the vaccination process, as this will increase the chances of more people wishing to be
vaccinated against viruses that could result in a global pandemic like COVID-19. We
will discuss the implications of these findings in the next section in more detail.
05 10 15 20
False: Vaccines are rigorously tested before being authorized for use (%)
Romania
Croatia
Italy
Hungary
Poland
Ireland
Latvia
France
Finland
Austria
Sweden
Belgium
Greece
Luxembourg
Germany (West)
Spain
Estonia
Lithuania
Denmark
Cyprus
Czech Republic
Slovenia
Bulgaria
Slovakia
United Kingdom
Germany (East)
The Netherlands
Portugal
Malta
Fig. 4 Share of respondents that disagree with the statement, “vaccines are rigorously tested before being
authorized for use”. Comment: Line provides information on the share of people across all countries and
regions
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Table 1 Determinants of skeptical positions on vaccination
Agreement with the following statements “Vaccines overload and
weaken the immune system”
“Vaccines can cause the disease
against which they protect”
“Vaccines often produce
serious side effects”
“Vaccines are not rigorously
tested before being authorized
for use”
Focal explanatory variable
Ideological extremism 0.006 0.019+0.025* 0.068**
(0.011) (0.011) (0.011) (0.017)
Controls
“My voice does not count” 0.043* 0.014 −0.007 0.220**
(0.019) (0.018) (0.018) (0.029)
Political interest strong–low 0.033+0.022 0.042* −0.014
(0.018) (0.017) (0.017) (0.028)
Life satisfaction high–low 0.047+0.047* 0.032 0.065+
(0.025) (0.024) (0.024) (0.038)
Tend not to trust in nat. government 0.155** 0.159** 0.199** 0.169**
(0.036) (0.032) (0.033) (0.057)
Tend not to trust in the media 0.137** 0.127** 0.216** 0.307**
(0.034) (0.033) (0.031) (0.053)
Female 0.004 0.054+0.088** −0.036
(0.032) (0.030) (0.030) (0.049)
Years spent in the education system −0.040** −0.013+−0.039** −0.026*
(0.007) (0.007) (0.007) (0.011)
Respondent has children −0.028 −0.022 −0.067* −0.095+
(0.036) (0.034) (0.034) (0.055)
Age 0.001 0.014* −0.005 −0.011
(0.006) (0.006) (0.006) (0.009)
Age (squared) −0.000 −0.000** 0.000 0.000
(0.000) (0.000) (0.000) (0.000)
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Table 1 (continued)
Agreement with the following statements “Vaccines overload and
weaken the immune system”
“Vaccines can cause the disease
against which they protect”
“Vaccines often produce
serious side effects”
“Vaccines are not rigorously
tested before being authorized
for use”
Financial problems 0.262** 0.200** 0.179** 0.260**
(0.039) (0.038) (0.037) (0.058)
Self-assessment working class −0.049 0.000 0.004 −0.127+
(0.042) (0.040) (0.039) (0.065)
Self-assessment lower middle class 0.011 0.019 0.148** −0.008
(0.045) (0.043) (0.043) (0.069)
Occupation: manual worker 0.071 −0.013 0.063 0.177**
(0.045) (0.043) (0.043) (0.068)
Unemployed 0.063 −0.028 0.158* −0.033
(0.076) (0.073) (0.073) (0.117)
Retired −0.012 0.003 0.041 −0.203*
(0.055) (0.051) (0.051) (0.086)
Occupation: self-employed 0.115+−0.125* 0.147* 0.175+
(0.063) (0.061) (0.059) (0.095)
Country dummy variables Included Included Included Included
Constant −0.958** −0.891** 0.145 −2.824**
(0.196) (0.186) (0.184) (0.298)
N20,271 20,271 20,271 20,271
AIC 24,295.091 26,788.444 27,205.859 12,600.181
Log likelihood −12,100.546 −13,347.222 −13,555.929 −6253.091
Estimates from a logit model. Numbers in parentheses are standard errors. Significance levels: +p ≤ 0.1; *p ≤ 0.05; **p ≤ 0.01
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Policy Sciences (2021) 54:477–491
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Implications fordesigning vaccine policies
The COVID-19 pandemic has been an exceptional situation for both policymakers and the
public. Several studies offer insightful discussions of how the pandemic can be studied in a
meaningful manner by applying concepts and theories originating from comparative public
policy (Capano etal., 2020; Weible etal., 2020) and comparative politics (Rocco etal.,
2020). This literature has also elaborated on the question of how to design policy responses
to COVID-19 (Capano, 2020), to which we wish to contribute by emphasizing that the
ideological attitudes and beliefs of individuals are a critical factor to be considered when
designing policy responses.
The question of how to design policies promoting vaccination in general and vaccines
against COVID-19 in particular is particularly relevant in a phase of a pandemic when
restrictions to individual freedoms are still in force and not enough people are vaccinated
against a virus like COVID-19. It will not be possible to lift the restrictions imposed on
individual freedom unless the herd immunity thresholds are reached. However, this could
be challenging because of two main reasons. First, if a vaccine like the one against COVID-
19 was developed at an unprecedented speed, people may mistrust its safety and/or effec-
tiveness. The retracted recommendations of the AstraZeneca vaccine against COVID-19
for specific age groups are a prominent example in this regard. Second, the link established
by policymakers between vaccination levels and the prospect of revoking elements of the
pandemic regime may induce people to dismiss the vaccine because they feel indirectly
forced to get vaccinated.
Which guidance can the above analysis and findings offer for reasonably designing vac-
cination policies in response to COVID-19? As the empirical analysis revealed, there are
several factors that result in vaccine skepticism, including low levels of trust in political
institutions, a low degree of education, and a feeling of alienation. While governments
and administrations should start campaigns to inform less educated people about the huge
advantages of getting vaccinated against new and well-known viruses that cause diseases,
ideological extremism particularly matters in the European context for adopting skeptical
views of vaccines and vaccination, in particular in times of increasing support for populist
parties. In order to increase the number of people willing to be vaccinated, we consider
the processual dimension the most relevant. This dimension concerns how individuals are
informed about the vaccines and how the vaccination processand the correspondingcam-
paign are organized. Given the changing and at times inconsistentrecommendations by
national agenciesand theEuropean Medicines Agencywho should receive the AstraZen-
eca COVID-19 vaccine and in which time interval, the processual dimension seems to be
a key factor for explaining the confusion and severe mistrust of the public innewly devel-
oped vaccines.
One strategy for increasing vaccination willingness is to politicize the issue of vac-
cination itself. Ideology affects how people think of vaccines and vaccination, and some
political parties may use public distrust in vaccines to maximize their support and votes
in upcoming elections. Moderate parties and their representatives should bring the vac-
cine issue onto the political agenda, so that citizens can be persuaded of the need to be
vaccinated against, for instance, COVID-19 or against other diseases like measles which
emerged in the last years to some degree because of a decreasing acceptance of vaccines
and vaccination. If moderate parties and their politicians depoliticize the vaccine issue,
the risk is high that extremist parties will come to ‘own’ this topic, which could create
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489
Policy Sciences (2021) 54:477–491
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a situation in which individuals supporting and trusting these parties will be beyond the
reach of mainstream political forces and their (evidence-based) strategies for fighting the
pandemic.
An alternative strategy for governments and administrations as well as for mainstream
parties is to try to build alliances and coalitions with political parties and social groups that
represent the interests of people who locate themselves on the left or the right of the ideo-
logical spectrum. This is a very challenging task, since in some European countries main-
stream parties have refused to collaborate with such extremist parties on even less contro-
versial issues than vaccination. If all political parties are capable and willing to convey
the uniform message that vaccination is safe and effective, this could induce some—albeit
certainly not all—individuals with extremist beliefs to overcome their reservations and to
get vaccinated. This argument rests on the assumption that the credibility of an informa-
tion source matters, which Jennings and Russell (2019) have shown to affect the policy
addressees’ likelihood of accepting the presented information as reliable and of changing
their behavior according to the respective policy. This trust stems from the individuals’
assumption that people or institutions who disseminate information share the same norms
and values as they do (Smith & Mayer, 2018).
Along these lines, it further appears promising to form pro-vaccination alliances with
societal actors such as religious institutions like churches, minority representatives, labor
unions or welfare organizations. These actors could increase the acceptance of vaccination
among individuals who are alienated from politics and do not trust any political parties and
their representatives, including extremist parties. It is important to stress that there exist
multiple policy options and that only some of them are top-down strategies necessary to
end the pandemic as swiftly as possible. A complementary set of policy options consists of
bottom-up strategies that concern the improvement of science literacy (e.g., Austin etal.,
2021) and education of both youth and adults (e.g., Khubchandani etal., 2021), which pur-
sue the goal of being prepared if a similar situation occurs in the long run.
Overall, this stage of the COVID-19 pandemic, like earlier ones, offers a valuable test-
ing ground for examining how policymakers attempt to bring about intended changes in
behavior. In this context, we contend that the politics of policy design deserves more atten-
tion when studying policy responses to COVID-19 than to more standard policy problems.
The phase of vaccination in particular is predestined to conspiracy theories and misinfor-
mation, which could result in significant delays in overcoming this crisis or other pandem-
ics which might emerge in the future. Therefore, we invite policy scientists to investigate
the policy instruments adopted by governments in different countries in order to improve
our understanding of how changes in behavior can be attained among individuals who dis-
play low levels of trust in democratic institutions.
Supplementary Information The online version contains supplementary material available at https:// doi.
org/ 10. 1007/ s11077- 021- 09428-0.
Acknowledgements We thank two anonymous reviewers for their helpful comments. Nora El-Awadan
deserves credit for research assistance and Laurence Crumbie for language editing.
Funding Open Access funding enabled and organized by Projekt DEAL.Funding was provided by the Bun-
desministerium für Bildung und Forschung. Grant Number: Solikris. Funding was provided by theDeutsche
Forschungsgemeinschaft (Grant No. DE 1667/4-3).
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License,
which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as
you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons
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licence, and indicate if changes were made. The images or other third party material in this article are
included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the mate-
rial. If material is not included in the article’s Creative Commons licence and your intended use is not per-
mitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from
the copyright holder. To view a copy of this licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/.
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... Recent studies provide first insight on the impact of political factors on the willingness to get vaccinated (e.g. Debus and Tosun, 2021;Paul et al., 2021;Smith et al., 2021), and on attitudes towards compulsory vaccination (Paul et al., 2021;Graeber et al., 2021). With regard to this, and in order to provide a more profound insight on attitudes on compulsory vaccination, in this study, we argue that party cues as well as citizens' ideological positions are the main drivers of compulsory vaccination attitudes. ...
... Callaghan et al., 2020;Calvillo et al., 2020). Some recent studies have analyzed the impact of political ideologies on COVID-19 vaccination attitudes (Debus and Tosun, 2021;Paul et al., 2021;Smith et al., 2021). To provide further insight, this study aims to not only take into account the impact of left-right positions of citizens, but also the impact of populist attitudes. ...
... Moreover, only a few existing studies so far analyse the political factors that influence attitudes towards vaccination in general and compulsory vaccination more specifically (e.g. Debus and Tosun, 2021;Paul et al., 2021;Smith et al., 2021). Our article thus aims to provide further insight on political attitudes on compulsory vaccination by focusing on political ideologies and populism, and by using a survey experiment as well as attitudinal data. ...
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Vaccine hesitancy is one of the major obstacles for successfully combating the ongoing COVID-19 pandemic. To achieve a sufficiently high vaccination rate, calls for compulsory vaccinations have been discussed controversially. This study analyses what drives citizens’ attitudes towards compulsory vaccination during the COVID-19 pandemic. Specifically, we are interested in the impact of party- and expert cues on public attitudes. We further expect populist attitudes to be an important indicator of the rejection of compulsory vaccination due to their scepticism towards science. To test these expectations, we rely on a cueing experiment conducted on a sample of 2265 German citizens. We test for the effects of in-party and out-party cues as well as public health expert cues. We find evidence for in-party cues, meaning that respondents adjust their position on this issue in the direction of their most preferred party. Similar results can be found for public health expert cues. However, there is no evidence for out-party cues. Further analyses reveal that support for compulsory vaccinations is not affected by left-right placement directly. Instead, only the combination of right-wing attitudes and populism negatively affects support for compulsory vaccination.
... There is no question that throughout the world, political ideology presents a powerful predictor of individual perceptions of everything from support for COVID-19 vaccinations (Debus & Tosun, 2021) to support for climate change (McCright, Dunlap, & Marquart-Pyatt, 2016) to support for alternative energy (Clulow et al., 2021) to support for governmental spending on environmental protection (Yen & Zampelli, 2021). Yet, despite all of this, some studies (Mason, 2015) suggest that individuals dislike each other based on one's political ideology more than they disagree on policy issues. ...
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Political ideology is an increasingly powerful force in support of public policy. Historically, nuclear energy has found more support among political conservatives. This study updates the literature on political ideology and support for nuclear energy by examining how political ideology is associated with perceptions of nuclear energy and trust of nuclear information sources. After excluding participants with incomplete data, and participants within 50 miles of a nuclear reactor, the analytical sample size for the analysis examining political ideology and perceptions of nuclear energy was 4153. The analytical sample includes a total of 1035 participants within a 50‐mile radius of INL, 710 participants from within Idaho who lived further than 50 miles from INL, 1899 participants from other states (more than 50 miles from a nuclear reactor), and 509 Non‐Idaho participants living within 50 miles of a nuclear reactor. Logistic regression was used to determine how political ideology was associated with perceptions of nuclear energy and trust in different sources regarding radioactive waste, after controlling for demographics and location. While liberal participants near INL were less favorable towards nuclear energy, and more trusting in impact scientists to tell the truth about radioactive waste than their conservative counterparts, this was not consistent across the US. Our findings reveal the complexity of political ideology and the perceptions of nuclear issues and how proximity influences perceptions. The perceptions of political moderates were particularly important in providing a more complex understanding of political ideology and nuclear energy issues. 政治意识形态是支持公共政策的日益强大的力量。核能历来在政治保守派中得到更多的支持。本研究通过分析政治意识形态如何与核能感知及核信息源信任相联系,进而对有关政治意识形态和支持核能的文献作贡献。在排除数据不完整的参与者和核反应堆50英里范围内的参与者后,用于分析政治意识形态和核能感知的分析样本量为4153。分析样本包括爱达荷国家实验室(INL)50英里半径范围内的1035名参与者,710名居住在距离INL50英里以外地区的参与者,1899名来自其他州的参与者(居住地点距离核反应堆超过50英里),以及509居住在核反应堆50英里范围内的非爱达荷州参与者。在控制人口统计因素和位置因素后,使用逻辑回归,确定政治意识形态如何与核能感知以及“对关于放射性废物的不同来源的信任”相联系。尽管INL附近的自由派参与者不太支持核能,并且比保守派更相信有影响力的科学家所传播的放射性废物真相,但这并非在美国各地都如此。我们的研究结果揭示了政治意识形态的复杂性、核问题感知、以及邻近性如何影响感知。政治温和派的感知对“提供关于政治意识形态与核问题的更复杂的理解”一事尤为重要。 La ideología política es una fuerza cada vez más poderosa en apoyo de las políticas públicas. Históricamente, la energía nuclear ha encontrado más apoyo entre los conservadores políticos. Este estudio actualiza la literatura sobre ideología política y apoyo a la energía nuclear al examinar cómo la ideología política está asociada con las percepciones de la energía nuclear y la confianza en las fuentes de información nuclear. Después de excluir a los participantes con datos incompletos y los participantes dentro de las 50 millas de un reactor nuclear, el tamaño de la muestra analítica para el análisis que examinó la ideología política y las percepciones de la energía nuclear fue de 4153. La muestra analítica incluye un total de 1035 participantes dentro de un radio de 50 millas de INL, 710 participantes de Idaho que vivían a más de 50 millas de INL, 1899 participantes de otros estados (a más de 50 millas de un reactor nuclear) y 509 Participantes que no sean de Idaho y que vivan a menos de 50 millas de un reactor nuclear. Se utilizó la regresión logística para determinar cómo se asociaba la ideología política con las percepciones de la energía nuclear y la confianza en diferentes fuentes con respecto a los desechos radiactivos, después de controlar la demografía y la ubicación. Si bien los participantes liberales cerca de INL eran menos favorables a la energía nuclear y más confiados en los científicos de impacto para decir la verdad sobre los desechos radiactivos que sus contrapartes conservadoras, esto no fue consistente en los EE. UU. Nuestros hallazgos revelan la complejidad de la ideología política y las percepciones de los problemas nucleares y cómo la proximidad influye en las percepciones. Las percepciones de los políticos moderados fueron particularmente importantes para proporcionar una comprensión más compleja de la ideología política y las cuestiones nucleares.
... The trust subscale taps into individuals' general mistrust of the government, scientists, and pharmaceutical corporations responsible for developing and administering the vaccines. Similarly, vaccines have been equated as an instrument of governmental control, particularly with recent mandates that require vaccinations among essential workers [72][73][74], beliefs captured by the scepticism subscale. There have also been concerns over the efficacy of the vaccines, particularly in light of highly-publicized, albeit rare, cases where vaccinated individuals have been hospitalized with severe COVID-19, and reports of high infection rates among the vaccinated as new, highly contagious variants of the virus spread. ...
Article
Full-text available
Vaccines are highly effective in minimizing serious cases of COVID-19 and pivotal to managing the COVID-19 pandemic. Despite widespread availability, vaccination rates fall short of levels required to bring about widespread immunity, with low rates attributed to vaccine hesitancy. It is therefore important to identify the beliefs and concerns associated with vaccine intentions and uptake. The present study aimed to develop and validate, using the AMEE Guide, the Vaccination Concerns in COVID-19 Scale (VaCCS), a comprehensive measure of beliefs and concerns with respect to COVID-19 vaccines. In the scale development phase, samples of Australian (N = 53) and USA (N = 48) residents completed an initial open-response survey to elicit beliefs and concerns about COVID-19 vaccines. A concurrent rapid literature review was conducted to identify content from existing scales on vaccination beliefs. An initial pool of items was developed informed by the survey responses and rapid review. The readability and face validity of the item pool was assessed by behavioral science experts (N = 5) and non-experts (N = 10). In the scale validation phase, samples of Australian (N = 522) and USA (N = 499) residents completed scaled versions of the final item pool and measures of socio-political, health beliefs and outcomes, and trait measures. Exploratory factor analysis yielded a scale comprising 35 items with 8 subscales, and subsequent confirmatory factor analyses indicated acceptable fit of the scale structure with the data in each sample and factorial invariance across samples. Concurrent and predictive validity tests indicated a theoretically and conceptually predictable pattern of relations between the VaCCS subscales with the socio-political, health beliefs and outcomes, and trait measures, and key subscales predicted intentions to receive the COVID-19 vaccine. The VaCCS provides a novel measure to assess beliefs and concerns toward COVID-19 vaccination that researchers and practitioners can use in its entirety or select specific sub-scales to use according to their needs.
... In the context of COVID-19 vaccination behavior, a slate of individual difference and generalized beliefs have been identified as potentially salient correlates of intentions to get vaccinated (e.g. Debus & Tosun, 2021;Sherman et al., 2021). Most prominent of these is vaccine hesitancy, defined as individuals' stated expectation to delay or refuse to receive a vaccine (MacDonald, 2015). ...
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... Although many citizens are generally favorable to the inclusion of experts in policymaking (Bertsou & Caramani, in press), the coronavirus disease pandemic has shown that sustained crisis responses can provide momentum to political opposition against new social regulations. Integrated policy strategies, which touch upon many different policy sectors as they aim at comprehensiveness, might inadvertently strengthen such tendencies, e.g., they could reinforce political opposition against vaccines and against the use of information technologies to contain the pandemic (Debus & Tosun, 2021). ...
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This paper investigates negative attitudes toward vaccines in Italy, where anti-vaccination movements have gained significant momentum in recent years. Considering the substantial health risk to herd immunity the issue poses, particularly after the sudden outbreak of the Covid-19 pandemic, it has become increasingly urgent to study the prevalence and diffusion of anti-vaccination beliefs. Using data from the 2016 European Social Survey's (ESS) country specific questions for Italy, the prevalence of anti-vaccination attitudes is examined along with how they are influenced by demographic, attitudinal and value-oriented determinants. The results show that 15 percent of the Italian public strictly hold negative views toward vaccination, and the prevalence of anti-vaccination attitudes is most commonly found among those who are less educated and aged between 25 and 34. While religiosity and political conservatism do not have an effect on anti-vaccination beliefs, our results indicate a strong positive link between anti-vaccination attitudes and distrust in the country's health-care systems and political institutions.
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This paper uses the vocabulary of ‘medical populism’ to identify and analyse the political constructions of (and responses to) the COVID-19 pandemic in Brazil, the Philippines, and the United States from January to mid-July 2020, particularly by the countries’ heads of state: Jair Bolsonaro, Rodrigo Duterte, and Donald Trump. In all three countries, the leaders’ responses to the outbreak can be characterised by the following features: simplifying the pandemic by downplaying its impacts or touting easy solutions or treatments, spectacularizing their responses to crisis, forging divisions between the ‘people’ and dangerous ‘others’, and making medical knowledge claims to support the above. Taken together, the case studies illuminate the role of individual political actors in defining public health crises, suggesting that medical populism is not an exceptional, but a familiar response to them. This paper concludes by offering recommendations for global health in anticipating and responding to pandemics and infectious disease outbreaks.
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Background In 2017 the Italian government introduced compulsory vaccination for Italian school children for ten diseases, in response to an alarmingly decrease in coverage and measles outbreak. A hot social debate arose around the issue of the law. Studies on the opinion of Italians on this topic are rare, so we investigated the socio-cultural profile of Italians about beliefs towards vaccination. Methods Data were extracted from the Italian section of the European Social Survey (ESS), conducted by the Italian National Institute for Public Policies Analysis during 2017. The main outcome assessed was the opinion about the supposed harmfulness of vaccines. We analysed the association between the outcome and a selected group of socio-cultural characteristics, with a specific interest in examining the interaction between our main outcome and the perceived trust in the scientific community in regards to vaccines. A principal component analysis was then performed for determining the socio-cultural profile of respondents. Results Among the 2,626 subjects interviewed face to face, 19% believed that vaccines were harmful and 10% did not have trust in the scientific community in regards to vaccines. Out of the respondents who believed in the harmfulness of vaccines, 29% neither had trust in the scientific community. Principal Component Analysis suggested that this group (Anti-vax/science sceptic) was characterised by low participation in political and cultural life, being male, older of age and politically oriented towards the right. People agreeing about harmfulness of vaccines are mostly males, have a lower education level, poor attendance in political and cultural life and are politically oriented to the right. Conclusions The ESS survey is unique in its capacity to deal with emerging themes of the social debates. Results paint a picture of the opinions of Italians on vaccines. This profile may be useful for policymakers to design targeted vaccination campaigns and to intervene more efficaciously in the public debate.
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As the relationship between ideology and attitudes towards vaccinations is usually analysed on data coming from the US context, in our analysis we analysed European data with special focus on Poland. The current findings show that the effects of ideology on vaccine are insignificant, when European context is considered. Even if there is an interactive impact of ideology and political interest, the effects are not very strong and, furthermore, they do not provide support for the “liberal bias” against vaccination. We suggest that it lack of the effects of ideology on vaccines in European context is related to the fact that vaccines have not become a strongly politicized issue as in the US.