Vaccination Acceptance Across Cultures: The Roles of Collectivism, Empathy, and Homophily

"...offers timely guidance on the promotion of vaccine acceptance among populations with high vaccination hesitancy."

Even with effective vaccines for highly contagious diseases, humankind remains at risk from vaccine hesitancy. There is much variation across countries in the public's willingness to inoculate against COVID-19. Drawing on cultural dimensions theory, this study assesses whether the cultural dimension of collectivism affects the public's acceptance of COVID-19 vaccination. Collectivistic people view themselves as highly embedded in their social groups and tend to value interdependence over independence. Collectivism could positively influence vaccination acceptance through its positive effect on empathy, which in turn may be enhanced when there is high homophily (similarity) with another person.

The researchers test their conceptual model (see Figure 1 in the paper) and hypothesised relationships (i.e., high homophily with those afflicted by the pandemic may strengthen the collectivism-empathy relationship and thereby increase COVID-19 vaccination acceptance) across four studies. Individual-level measures come from the COVID-19 Beliefs, Behaviors, and Norms Survey (BBNS); country-level collectivism scores were estimated using scores from four prior studies.

Specifically:

• Study 1 assesses the relationship between collectivism and vaccination intentions. Across 51 countries and 429,536 survey respondents, collectivism, estimated at the country level, related positively to respondents' willingness to inoculate against COVID-19.
• Study 2a tests the relationship between collectivism and vaccination intentions at the individual level while also assessing empathy for those afflicted by the pandemic as a potential mediator. One hundred seventy people living in England who had not yet been vaccinated against COVID-19 participated in this study. The results suggest that within a given country, individual differences in the endorsement of collectivistic values predict vaccination acceptance. In addition, empathy for those afflicted by COVID-19 mediated the positive effect of collectivism on vaccination intentions, and these results were consistent with and without controlling for perceived and objective risks from COVID-19.
• Study 2b experimentally manipulates the extent to which individuals endorse collectivistic values to assess causality and mediation. Two hundred forty-three people residing in the United States participated in the study. The results of Study 2b reaffirm those found in Study 2a: The endorsement of collectivistic values leads to more empathy for those afflicted by COVID-19, which, in turn, leads to higher vaccination acceptance. The randomised experiment helps rule out alternative explanations regarding the relationship between collectivism and vaccination acceptance.
• Study 3 assesses the full conceptual model by manipulating homophily with a person experiencing COVID-19. Three hundred twenty-two people living in England who had not yet been vaccinated against COVID-19 participated in the study. The results support the earlier findings while also indicating that the indirect effect of collectivism on vaccination intentions, through empathy, depends on the level of homophily between a person considering vaccination and a person with COVID-19. High (vs. low) homophily with a person with COVID-19 strengthened the positive effect of collectivism on empathy and, as a result, led to higher vaccination intentions. This finding suggests that the relationship between collectivism and empathy is especially strong when those higher in collectivism are exposed to a person experiencing COVID-19 who is similar (vs. dissimilar) to themselves.

In short, the experiment reveals that COVID-19 vaccination intentions are higher among people from countries that are higher in cultural collectivism (Study 1). Follow-up studies indicate that vaccination acceptance is higher among people who endorse collectivistic values because they feel more empathy for those afflicted by the disease (Studies 2a, 2b, 3), especially when those with the disease have characteristics (e.g., political affiliation, lifestyle, personality) similar to themselves (Study 3). Together, the findings identify a conditional process by which collectivism affects vaccination acceptance.

Reflecting on the findings, the researchers suggest that public health organisations should direct their promotional efforts toward cultures, regions, and individuals that are less likely to accept vaccination - namely, those that are relatively low on collectivism. Promotional efforts may benefit from strategies that evoke empathy and encourage concern for the well-being of others. Linguistic strategies such as using the pronouns "we" and "us" instead of "I" and "they" could promote an interdependent mindset among otherwise individualistic populations. Campaigns could also foster empathy using storytelling and the portrayal of an "identifiable victim". Inducing empathy directly has also been shown to increase prosocial behaviours and might be enhanced through the portrayal of COVID-19-positive people who share similar characteristics with the message recipients.

The researchers stress that, although they conducted this research during the COVID-19 pandemic, the findings should apply to vaccination acceptance more broadly. Because vaccine hesitancy is not unique to COVID-19, the suggestion that vaccination communication efforts focus on enhancing feelings of interdependence and responsibility for the well-being of others could be considered when addressing hesitancy toward any vaccines that offer prosocial benefits.