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The magnitude of prejudice and aversion against individuals refusing COVID-19 vaccination was detailed in three studies spanning 21 countries.

In data from the U.S., vaccinated people were 16 percentage points (95% CI 14-19) more likely to have antipathy toward those who remain unvaccinated than toward the vaccinated.

"Incompetence" was endorsed 14 percentage points more often and "untrustworthy" 13 percentage points more often by the vaccinated about the unvaccinated, Michael Bang Petersen, PhD, of Aarhus University in Denmark, and colleagues reported in .

"The conflict between those who are vaccinated against COVID-19 and those who are not threatens societal cohesion as a new socio-political cleavage," co-author Alexander Bor, PhD, of Aarhus University, said in a press release. "The vaccinated clearly seem to be the ones deepening this rift."

Unlike the attitudes expressed by vaccinated persons, the study authors did not find that unvaccinated people expressed discriminatory attitudes toward vaccinated people (with the exception of some negativity among unvaccinated respondents in Germany and the U.S.). "But we do not find statistical evidence in favor of negative stereotyping or exclusionary attitudes," the study authors noted.

A 'Natural' Reaction?

In these situations when people feel they have made a sacrifice to get vaccinated in part to protect others, they may have a strong reaction to those who are not willing to do the same -- "what they perceive as free-riding on a public good," Petersen warned in a press release. But this could have "severe consequences for society."

"In the short run, prejudice toward the unvaccinated may complicate pandemic management because it leads to mistrust, and we know that mistrust hinders vaccination uptake," he said. "In the long run, it may mean that societies leave the pandemic more divided and polarized than when they entered it."

Punitive public policy is not necessarily effective, the researchers argued, and can create a "cleavage" between members of society with different attitudes. They cited the example of French President Emmanuel Macron, who said he wanted to "piss off" the unvaccinated population to a degree that will make them get vaccinated.

"While moralistic communication of collective responsibilities may be an effective strategy to increase vaccination uptake, such strategies may have unintended negative consequences in the form of eliciting prejudice, especially in cultures with strong cooperative norms," Petersen and co-authors wrote, which "may have negative long-term effects ... hurting well-being, eroding identification with majority society, and breeding mistrust of the state, including health authorities."

However, the language used in the study, including the word "prejudice" and "discrimination" may evoke the wrong public reactions to the information, commented Maxwell Smith, PhD, a public health ethicist at the University of Western Ontario in London, Ontario.

"You can be exclusionary for the right reasons, or bad reasons," he told 木瓜直播 in an interview.

"Consider whether we'd say women who refuse to have sex with men who are unwilling to wear a condom have 'exclusionary attitudes' or that they're being 'punitive.' No, we wouldn't," Smith said. "It's fine to want to protect your health, and there are scientific reasons to believe ... condom-wearing will protect your health."

He expressed concern that people might take certain findings from the study out of context to suggest this form of discrimination is "just as bad" as other discrimination, whereas "there is no suggestion that it's morally bad" to discriminate.

Peterson told 木瓜直播 that the reaction to the study on social media has perhaps added fuel to the divisiveness. Although the study "does not speak at all to the vaccination decision itself," he said that "we are seeing very strong endorsement from people who are skeptical of vaccination and so on."

Rather than using the results to debate vaccine attitudes, Smith said, the findings should help develop better public policy.

Peterson agreed that it's important to communicate to both groups in a way that decreases tension as much as possible and called on authorities to mitigate punitive attitudes.

Study Results

Combining data from three studies involving 15,233 people from 21 countries, the researchers found that, around the world, vaccinated people were prejudiced against unvaccinated people.

In the U.S. specifically, the vaccinated were 10 percentage points (95% CI 8-12) less likely to respect an unvaccinated person's "right to residence," such as to live in their neighborhood, and 8 percentage points (95% CI 6-10) less likely to support an unvaccinated person's application for citizenship. They were 28 percentage points (95% CI 25-31) more likely to agree that the unvaccinated should have limited freedom of movement (for example, not being allowed to sit beside them on a bus).

Further, vaccinated persons were more likely to not respect unvaccinated people's freedom of speech (e.g., on social media) or support social assistance benefits for them (difference 7 percentage points for both, 95% CI 5-9).

All those response differences were statistically significant (P<0.001).

The studies were conducted through experimental methods, including the use of the "Dictator Game," in which participants reported emotions and allocated resources accordingly. Questions were asked in different ways, such that participants were both asked to rate their agreement with statements like "I would be unhappy if this person married one of my close relatives" and were forced to respond to a decision scenario on the same issue.

The researchers noted that the experimental nature of the studies was a limitation. Also, since the studies were performed online, it's not clear to what degree their responses would carry through to real-world attitudes and actions.

Notably, the studies were conducted "while the vaccine-evading Omicron variant was dominant, and vaccine-induced immunity against infection spread was waning," the researchers noted.

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