Despite the widespread availability of COVID-19 vaccines, the United States has a depressed rate of vaccination relative to similar countries. Understanding the psychology of vaccine refusal, particularly the possible sources of variation in vaccine resistance across U.S. subpopulations, can aid in designing effective intervention strategies to increase vaccination across different regions. Here, we demonstrate that county-level moral values (i.e., Care, Fairness, Loyalty, Authority, and Purity) are associated with COVID-19 vaccination rates across 3,106 counties in the contiguous United States. Specifically, in line with our hypothesis, we find that fewer people are vaccinated in counties whose residents prioritize moral concerns about bodily and spiritual purity. Further, we find that stronger endorsements of concerns about Fairness and Loyalty to the group predict higher vaccination rates. These associations are robust after adjusting for structural barriers to vaccination, the demographic makeup of the counties, and their residents' political voting behavior. Our findings have implications for health communication, intervention strategies based on targeted messaging, and our fundamental understanding of the moral psychology of vaccination hesitancy and behavior.
Public Significance StatementWhy do people refuse to get vaccinated against COVID-19 even when vaccines are widely available, safe, and efficacious? We show that differences in moral values can help us understand discrepancies in vaccination rates across U.S. counties. Specifically, Purity This document is copyrighted by the American Psychological Association or one of its allied publishers.This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.Morteza Dehghani https://orcid.org/0000-0002-9478-4365 Mohammad Atari and Farzan Karimi-Malekabadi contributed equally to this work.Nils Karl Reimer played the lead role in formal analysis and an equal role in data curation, methodology, writing of original draft, and writing of review and editing. Mohammad Atari played the lead role in writing of original draft, a supporting role in methodology, and an equal role in data curation and writing of review and editing. Farzan Karimi-Malekabadi played the lead role in data curation and visualization and an equal role in investigation, methodology, writing of original draft, and writing of review and editing. Jackson Trager played a supporting role in data curation, writing of original draft, and writing of review and editing. Brendan Kennedy played a supporting role in project administration, supervision, writing of original draft, and writing of review and editing. Jesse Graham played a supporting role in funding acquisition, supervision, and writing of review and editing.Morteza Dehghani played the lead role in conceptualization, funding acquisition, and supervision; a supporting role in writing of original draft; and an equal role in writing of review and editing.