Study Suggests Moral Values Predict Regional Differences in COVID-19 Vaccination Rates


The data showed moral concerns about fairness, loyalty, and purity influenced county-level vaccination rates, but care and authority did not.

A new study suggests that moral values and beliefs have a significant impact on regional disparities in vaccination rates, according to investigators from the University of Southern California who published their research findings in American Psychologist.

Despite the fact that COVID-19 vaccines are safe, effective, and widely available, many Americans are still hesitant. In some counties in the country, nearly all residents are vaccinated, whereas other counties have only a minority of vaccinated residents.

According to a press release, structural barriers such as access to health care, historic under-vaccination rates, and political barriers explained why residents of some counties were less likely to be vaccinated against COVID-19. This finding is in line with what was already known about vaccination behavior. However, the researchers also showed that Americans’ moral values were also an important aspect of understanding the stark disparities.

“If you look at a map of the proportion of vaccinations across US counties, you find very stark differences across counties, across regions, and across states,” said study co-author Nils Karl Reimer, PhD, in the press release. “Our goal is to interrogate why these differences in political ideology coincide with differences in vaccination rates.”

The study utilized moral foundation theory, which argues that there are 5 basic moral foundations: care, fairness, loyalty, authority, and purity. Using data from an online crowd-sourced website that collects a range of psychological data, the researchers estimated county-level moral values and conservatism. This data was combined with county-level vaccination rates from the CDC, the US COVID-19 Vaccine Coverage Index, and presidential election data to control for variables not included in the study.

The analysis found that moral concerns about fairness, loyalty, and purity influenced county-level vaccination rates, but care and authority did not. Counties with residents who prioritized purity were 0.8 times less likely to be vaccinated, and the researchers pointed to previous research showing that “conservatives care more about contamination and things they find disgusting.”

“We found that some values that are traditionally associated with conservatism were associated with lower vaccination rates, the biggest of which was a desire for bodily and spiritual purity,” Reimer said in the press release. “Endorsing these beliefs is related to all kinds of opinions such as being opposed to non-mainstream sexual practices or immigration.”

On the other hand, the investigators found that counties with higher loyalty were 1.14 times more likely to have higher vaccination rates. Or, if loyalty increased while other values remained the same, the vaccination rate could have been expected to rise 3% countywide. Placing a high value on fairness was associated with a 2% increase in vaccination rates in similar conditions.

To verify the accuracy of the model, the researchers compared it against 2 other models, one of which included only structural and demographic predictor variables, and the other in which partisanship was an additional predictor variable. Both models failed to predict county-level vaccination rates as accurately as the third model, which included county-level endorsement of moral concerns.

Although the researchers’ hypotheses were largely borne out in the study, they did see a few surprising trends. Notably, loyalty is typically associated with conservative values, which in turn are associated with vaccine skepticism. However, the study found that loyalty is associated with higher vaccination rates, but only when controlling for the 4 other moral foundations.

“The loyalty finding is quite surprising because there is a lot of rhetoric about anti-vaccination among conservatives. However, what we’re showing is that typical conservatives do not tend to be anti-vaxxers,” said co-author Morteza Dehghani, PhD, in the press release. “The anti-vaxxers tend to be not high on loyalty, but high on purity. These include conservatives who are low on loyalty, and also liberals who tend to prioritize purity concerns, most likely focusing on bodily aspects of purity contamination.”

Although the findings support the idea that county-level moral values can predict COVID-19 vaccination rates, the authors urged policymakers to exercise caution when utilizing the insights. Notably, the results from the county level cannot be extrapolated to smaller (cities, neighborhoods, or individuals) or larger (states) groups.

However, policymakers and public health communicators could use the findings to reframe their public health communications related to COVID-19. The researchers suggest appealing to loyalty concerns by framing vaccination as a patriotic duty to fellow citizens. In regions prioritizing purity, they suggest communications emphasizing the vaccine’s ability to protect from spreading the virus.

“I think a lot of people who are skeptical of vaccination might think of it as a foreign chemical introduced into your body,” Reimer said in the press release. “This sounds very scary, like something you wouldn’t necessarily want to put in your body, but I think framing it in terms of the natural immune system response could resonate with some skeptics. These things are, importantly, mere speculation before further experiments, but our findings could point toward public health messaging that could be tested.”


Moral values explain differences in COVID-19 vaccination rates across US counties. News release. USC News; September 15, 2022. Accessed September 23, 2022. 

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