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How Does Culture Affect Vaccination Acceptance?

How Does Culture Affect Vaccination Acceptance?

hand with white latex glove filing a syringe from a glass vial.

By James M. Leonhardt

Why do some people vaccinate against COVID-19 while others do not? Our recent work, published in the Journal of International Marketing, addresses this question through the lens of culture, empathy, and homophily—i.e., the extent to which we share similarities with others.

The debate between pro- and anti-vaxxers is not new to COVID-19. In 2019, the World Health Organization considered vaccine hesitancy the leading cause of measles outbreaks among schoolchildren and a significant threat to global health. Likewise, vaccine hesitancy continues during the COVID-19 pandemic and remains a significant threat to consumer wellbeing worldwide.  

In our paper’s first study, the prominent cultural dimension of collectivism accounted for significant variability in COVID-19 vaccination acceptance across countries. Our sample consisted of more than 50 countries and 400,000 people who responded to the COVID-19 Beliefs, Behaviors, and Norms Survey administered by the Massachusetts Institute of Technology


In our subsequent studies (2a, 2b, and 3), we probed the relationship between the endorsement of collectivistic values and COVID-19 vaccination acceptance to understand how collectivism increases vaccination acceptance. In each of these studies, the endorsement of collectivistic values was found to increase vaccination acceptance by increasing empathic concern for those afflicted by COVID-19.

Higher empathy for those afflicted by COVID-19 helps explain why endorsing collectivistic values leads to a higher willingness to inoculate against the disease. The finding aligns with prior work suggesting that the interdependent self-view fostered by collectivism promotes empathy, increasing the likelihood of engaging in preventative health behaviors, such as handwashing and mask-wearing.

We also assessed whether collectivism’s positive effect on empathy depends on one’s homophily or similarity with those afflicted by the disease. In the experiment, participants read about an apparent victim of COVID-19 who had similar characteristics (versus different) as themselves (e.g., political affiliation, lifestyle, personality). We found that empathic concern and vaccination intentions among those higher in collectivism were especially strong when a victim’s characteristics were similar to those of the participants.

Returning to our initial question, these findings help to answer the question of how to encourage worldwide acceptance of vaccines and COVID-19 vaccines, in particular. First, given the robust positive association between collectivism and vaccine acceptance, we suggest that public health messaging be targeted toward those relatively lower in collectivism with the messaging strategy of enhancing recipients’ sense of interdependence, reliance, and similarity with others.

Second, given the positive association between empathy and vaccine acceptance, promotional strategies should strive to enhance our empathic concern for the pandemic victims. As we demonstrate, empathy can be enhanced by portraying victims who share similar characteristics with the message recipients. Similarly, storytelling and using an “identifiable victim” versus mere statistics should also help heighten empathic concern.

Vaccine hesitancy continues to threaten the suppression of COVID-19, and curbing outbreaks from vaccine-preventable diseases, such as measles, remains an ongoing public health challenge. Several strategies have been proposed to address vaccine hesitancy in general. Building on the present research, there remains the challenge of identifying ways that enhance feelings of interdependence and responsibility for the well-being of others to encourage prosocial preventative health behaviors, including vaccine uptake.  

This article originally appeared on SAGE Publishing’s Perspectives blog and is reprinted with permission.

Read the full article

James M. Leonhardt and Todd Pezzuti (2022),Vaccination Acceptance Across Cultures: The Roles of Collectivism, Empathy, and Homophily, Journal of International Marketing, 30 (2), 13-27.