The association between vaccination status identification and societal polarization.

Public discord between those vaccinated and those unvaccinated for COVID-19 has intensified globally. Theories of intergroup relations propose that identifying with one's social group plays a key role in the perceptions and behaviours that fuel intergroup conflict. We test whether identification with one's vaccination status is associated with current societal polarization. The study draws on panel data from samples of vaccinated (n = 3,267) and unvaccinated (n = 2,038) respondents in Germany and Austria that were collected in December 2021 and February, March and July 2022. The findings confirm that vaccination status identification (VSI) explains substantial variance in a range of polarizing attitudes and behaviours. VSI was also related to higher psychological reactance toward mandatory vaccination policies among the unvaccinated. Higher levels of VSI reduced the gap between intended and actual counterbehaviours over time by the unvaccinated. VSI appears to be an important measure for predicting behavioural responses to vaccination policies.

Situational pathogen avoidance mediates the impact of social connectedness on preventive measures during the COVID-19 pandemic.

During the COVID-19 pandemic, physical distancing was one of the more important behaviours for reducing the spread of the virus. The present study investigated the influence on pathogen avoidance of familiarity with other people at private gatherings. Based on the social identity model of risk taking and the theory of the behavioural immune system, we assumed that greater familiarity with others would make people feel more connected with one another and decrease situational pathogen avoidance. This could result in lower perceptions of the risk of contracting COVID-19 and fewer protective behaviours. Two experiments (n1 = 1022, n2 = 994) showed that the negative influence of greater familiarity on the perceived risk of infection and protective behaviour is explained by an increased feeling of connectedness and less feeling of situational pathogen avoidance. In an additional survey, the participants (n = 23,023) rated the quality of their past social contacts. The correlational analyses showed that the familiarity of the other person was more important in explaining variance in protective behaviours than attitudes toward those behaviours or the pandemic situation itself. Understanding the process that result in an explosive increase in infection after social gatherings can improve infection control in the future.

A lay perspective on prioritization for intensive care in pandemic times: Vaccination status matters

During a pandemic, demand for intensive care often exceeds availability. Experts agree that allocation should maximize benefits and must not be based on whether patients could have taken preventive measures. However, intensive care units (ICUs) are often overburdened by individuals with severe COVID-19 who have chosen not to be vaccinated to prevent the disease. This article reports an experiment that investigated the German public's prioritization preferences during the fourth wave of the coronavirus pandemic (N?=?1014). In a series of scenarios, participants were asked to decide on ICU admission for patients who differed in terms of health condition, expected treatment benefits, and vaccination status. The results reveal an in-group bias, as vaccinated individuals preferred to allocate more resources to the vaccinated than to the unvaccinated. Participants also favored admitting a heart attack patient rather than a COVID-19 patient with the same likelihood of benefiting from ICU admission, indicating a preference for maintaining regular ICU services rather than treating those with severe COVID-19. Finally, participants were more likely to admit a patient to intensive care when this meant withholding rather than withdrawing care from another patient. The results indicate that lay prioritizations violate established allocation principles, presaging potential conflicts between those in need of intensive care and those who provide and allocate it. It is therefore recommended that allocation principles should be explained to enhance public understanding. Additionally, vaccination rates should be increased to relieve ICUs and reduce the need for such triage decisions.

Lessons learned about willingness to adopt various protective measures during the early COVID-19 pandemic in three countries.

BACKGROUND: Regarding the COVID-19 pandemic, concerted efforts have been invested in research to investigate and communicate the importance of complying with protective behaviors, such as handwashing and mask wearing. Protective measures vary in how effective they are in protecting the individual against infection, how much experience people have with them, whether they provide individual or societal protection, and how they are perceived on these dimensions. METHODS: This study assessed the willingness to follow recommended measures, depending on these features, among participants from Germany (n = 333), Hong Kong (n = 367), and the U.S. (n = 495). From April 24th to May 1st, 2020, individuals completed an online survey that assessed the antecedents of interest. RESULTS: It was shown that assumed effectiveness, previous experience, and intended self- and other-protection positively predicted willingness to comply across countries. When measures were mainly perceived as protecting others (vs. the self), individuals were less prone to adopt them. When a measure's effectiveness to protect the individual was perceived as lower, willingness to adopt the measure increased with higher levels of prior experience and collectivism. Moreover, protecting others was more strongly related to adoption when individuals had higher levels of collectivism and lower levels of individualism. CONCLUSIONS: Emphasizing the benefit for others could be a means to lower the potential detrimental effects of low assumed effectiveness for individual protection.

Attitude toward a mandatory COVID-19 vaccination policy and its determinants: Evidence from serial cross-sectional surveys conducted throughout the pandemic in Germany.

BACKGROUND: Mandating vaccination against COVID-19 is often discussed as a means to counter low vaccine uptake. Beyond the potential legal, ethical, and psychological concerns, a successful implementation also needs to consider citizens' support for such a policy. Public attitudes toward vaccination mandates and their determinants might differ over time and, hence, should be monitored. METHODS: Between April 2020 and April 2021, we investigated public support for mandatory vaccination policies in Germany and examined individual correlates, such as vaccination intentions, confidence in vaccine safety, and perceived collective responsibility, using a series of cross-sectional, quota-representative surveys (overall N = 27,509). RESULTS: Support for a vaccination mandate declined before the approval of the first vaccine against COVID-19 in December 2020 and increased afterwards. However, at the end of April 2021, only half of respondents were in favor of mandatory regulations. In general, mandates were endorsed by those who considered the vaccines to be safe, anticipated practical barriers, and felt responsible for the collective. On the contrary, perceiving vaccination as unnecessary and weighing the benefits and risks of vaccination was related to lower support. Older individuals and males more often endorsed vaccination mandates than did younger participants and females. Interestingly, there was a gap between vaccination intentions and support for mandates, showing that the attitude toward mandatory vaccination was not only determined by vaccination-related factors such as vaccine safety or prosocial considerations. CONCLUSIONS: Because of low public support, mandatory vaccination against COVID-19 should be considered a measure of last resort in Germany. However, if removing barriers to vaccination and educational campaigns about vaccine safety and the societal benefits of high vaccination uptake are not sufficient for increasing vaccination uptake to the required levels, mandates could be introduced. In this case, measures to ensure and increase acceptance and adherence should be taken.

Money is not everything: experimental evidence that payments do not increase willingness to be vaccinated against COVID-19.

Rapid, large-scale uptake of new vaccines against COVID-19 will be crucial to decrease infections and end the pandemic. In a recent article in this journal, Julian Savulescu argued in favour of monetary incentives to convince more people to be vaccinated once the vaccine becomes available. To evaluate the potential of his suggestion, we conducted an experiment investigating the impact of payments and the communication of individual and prosocial benefits of high vaccination rates on vaccination intentions. Our results revealed that none of these interventions or their combinations increased willingness to be vaccinated shortly after a vaccine becomes available. Consequently, decision makers should be cautious about introducing monetary incentives and instead focus on interventions that increase confidence in vaccine safety first, as this has shown to be an especially important factor regarding the demand for the new COVID-19 vaccines.

The four weeks before lockdown during the COVID-19 pandemic in Germany: a weekly serial cross-sectional survey on risk perceptions, knowledge, public trust and behaviour, 3 to 25 March 2020.

BackgroundDuring the COVID-19 pandemic, public perceptions and behaviours have had to adapt rapidly to new risk scenarios and radical behavioural restrictions.AimTo identify major drivers of acceptance of protective behaviours during the 4-week transition from virtually no COVID-19 cases to the nationwide lockdown in Germany (3-25 March 2020).MethodsA serial cross-sectional online survey was administered weekly to ca 1,000 unique individuals for four data collection rounds in March 2020 using non-probability quota samples, representative of the German adult population between 18 and 74 years in terms of age × sex and federal state (n = 3,910). Acceptance of restrictions was regressed on sociodemographic variables, time and psychological variables, e.g. trust, risk perceptions, self-efficacy. Extraction of homogenous clusters was based on knowledge and behaviour.ResultsAcceptance of restrictive policies increased with participants' age and employment in the healthcare sector; cognitive and particularly affective risk perceptions were further significant predictors. Acceptance increased over time, as trust in institutions became more relevant and trust in media became less relevant. The cluster analysis further indicated that having a higher education increased the gap between knowledge and behaviour. Trust in institutions was related to conversion of knowledge into action.ConclusionIdentifying relevant principles that increase acceptance will remain crucial to the development of strategies that help adjust behaviour to control the pandemic, possibly for years to come. Based on our findings, we provide operational recommendations for health authorities regarding data collection, health communication and outreach.

Empirical evidence to understand the human factor for effective rapid testing against SARS-CoV-2.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rapid antigen point-of-care and home tests are available to laypeople. In four cross-sectional mixed-methods data collections conducted between December 2020 and March 2021 (n = 4,026), we showed that a majority of subjects were willing to test despite mistrust and ignorance regarding rapid tests' validity. Experimental evidence shows that low costs and access to events could increase testing intentions. Mandatory reporting and isolation after positive results were not identified as major barriers. Instead, assuming that testing and isolation can slow down the pandemic and the possibility to protect others were related to greater willingness to get tested. While we did not find evidence for risk compensation for past tests, experimental evidence suggests that there is a tendency to show less mask wearing and physical distancing in a group of tested individuals. A short communication intervention reduced complacent behavior. The derived recommendations could make rapid testing a successful pillar of pandemic management.

Allocation of COVID-19 vaccination: when public prioritisation preferences differ from official regulations.

As vaccines against COVID-19 are scarce, many countries have developed vaccination prioritisation strategies focusing on ethical and epidemiological considerations. However, public acceptance of such strategies should be monitored to ensure successful implementation. In an experiment with N=1379 German participants, we investigated whether the public's vaccination allocation preferences matched the prioritisation strategy approved by the German government. Results revealed different allocations. While the government had top-prioritised vulnerable people (being of high age or accommodated in nursing homes for the elderly), participants preferred exclusive allocation of the first available vaccines to medical staff and personnel caring for the elderly. Interestingly, allocation preferences did not change when participants were told how many individuals were included in each group. As differences between allocation policies and public preferences can affect trust in the government and threaten the social contract between generations, we discuss possible strategies to align vaccination prioritisations.

From polarization to vaccination and back: Reply to Weisel

Reply by the current author to the comments made by Ori Weisel (see record 2021-33496-001) on the original article (see record 2020-50506-003). In his comment, Ori Weisel conducted a preregistered experiment that closely followed the methodology and analysis in our paper. He examined whether vaccination against COVID-19 can be understood as a social contract even given strong animosity between existing natural groups. The experiment conceptually replicated our findings and thus addressed a limitation noted in the original paper: external validity. Specifically, the study revealed that participants' natural group membership did not affect their conditional generosity toward vaccinated vs. unvaccinated others;this replicated previous findings based on artificially created group memberships. The findings therefore provide a stress test for the external validity and generalizability of the social contract hypothesis. While we endorse the contribution of this additional study, we would like to discuss an aspect of this issue that was not addressed by Weisel. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Public Preferences for Exit Strategies From COVID-19 Lockdown in Germany-A Discrete Choice Experiment.

Objectives: To decrease the rapid growth of SARS-CoV-2 in Germany, a stepped lockdown was conducted. Acceptance and compliance regarding entering and exiting lockdown measures are key for their success. The aim of the present study was to analyse the population's preferences for exiting lockdown measures. Methods: To evaluate population's preferences and identify trade-offs between different exit strategies, a discrete choice experiment was conducted on 28-29 April (n = 1,020). Overall, six attributes and 16 choice sets (fractional-factorial design) without an opt-out were chosen. Conditional logit and latent class models were conducted. Results: Most attributes proved to be significant. Two attributes dominated all others: Avoiding a mandatory tracing app, and providing sufficient intensive care capacities. Preventing a high long-term unemployment rate and avoiding the isolation of persons aged 70+, were relevant, though utilities were comparatively lower. We identified subgroups (elderly persons and persons with school children) with different utilities, which indicates specific attributes affecting them dissimilarly. Conclusions: The population prefers cautious re-opening strategies and is at least sceptical about the adoption of severe protection measures. Government should balance interests between subgroups.

School opening during the SARS-CoV-2 pandemic: Public acceptance of wearing fabric masks in class.

OBJECTIVES: Policy decisions regarding mask wearing in schools in times of the SARS-CoV-2 pandemic will likely be made despite a lack of scientific data. Public acceptance is therefore an important indicator to inform the communication activities that accompany the introduction of a new policy. The goal was to assess acceptance and relevant target groups for communication activities. STUDY DESIGN: Cross-sectional online survey embedded in the regular German COVID-19 monitoring. METHODS: Besides sociodemographic information, trust in institutions, knowledge about COVID-19 and protective behaviors, as well as risk perceptions, we assessed public acceptance of school-related mask policies of parents and non-parents (total N â€‹= â€‹957). RESULTS: In the absence of mandatory mask policies in schools in Germany in August 2020, the general agreement with mask wearing in school was low. Those living in bigger cities or communities - where class sizes are usually larger - agreed more with mask wearing in class; those who felt a greater risk, had greater trust in institutions, or felt higher self-efficacy in fighting the outbreak also wanted children to wear a mask in class. Women were more likely than men to disagree with mask wearing in class. Agreement was highest that policies should uniformly apply for all institutions within a state/province and should not be regulated at the school level or federal/country level. CONCLUSIONS: Implementing mask policies in school will require intense communication. Acceptance of these policies from teachers and pupils should be considered as well. Women seem to be an important target group as they supported mask wearing in class less than men. Women's roles in controlling infectious diseases in school should therefore receive special attention and support.

[Public trust in institutions in the first half of the Corona pandemic: findings from the COVID-19 Snapshot Monitoring (COSMO) project]. / Vertrauen der Bevölkerung in staatliche Institutionen im ersten Halbjahr der Coronapandemie: Erkenntnisse aus dem Projekt COVID-19 Snapshot Monitoring (COSMO).

BACKGROUND: In the coronavirus pandemic, two institutions play a central role in the evidence-based classification of events for politics and the population. The Robert Koch Institute (RKI) coordinates the fight against the pandemic, prepares well-founded recommendations for medical professionals, the media and the population, and advises politicians. The Federal Centre for Health Education (BZgA) informs the population and institutions. GOALS: The COVID-19 Snapshot Monitoring (COSMO) project monitors whether and how trust in institutions changes over the pandemic. Which population groups show trust and how this is related to attitudes, risk perception and behaviour are analysed. METHODS: Cross-sectional studies with approximately N = 1000 respondents per survey were conducted since March 2020 to investigate risk perception, behaviour, acceptance of measures and trust in institutions. RESULTS: Trust in the RKI and BZgA was generally high but declined over the course of the pandemic. Higher trust for both institutions was associated with higher age of respondents, higher education, higher risk perception and higher acceptance of measures. Behaviours such as physical distancing and handwashing were shown more frequently. Men and the chronically ill showed lower trust. DISCUSSION: The results show that trust should be further promoted. This could be achieved, among other things, by taking into account the population's perspective (e.g. through COSMO) in the development and justification of strategies and measures. Communication strategies and recommendations for action should aim to support and relieve people with high-risk perceptions.

Social and behavioral consequences of mask policies during the COVID-19 pandemic.

Mandatory and voluntary mask policies may have yet unknown social and behavioral consequences related to the effectiveness of the measure, stigmatization, and perceived fairness. Serial cross-sectional data (April 14 to May 26, 2020) from nearly 7,000 German participants demonstrate that implementing a mandatory policy increased actual compliance despite moderate acceptance; mask wearing correlated positively with other protective behaviors. A preregistered experiment (n = 925) further indicates that a voluntary policy would likely lead to insufficient compliance, would be perceived as less fair, and could intensify stigmatization. A mandatory policy appears to be an effective, fair, and socially responsible solution to curb transmissions of airborne viruses.

Ten considerations for effectively managing the COVID-19 transition.

Governments around the world have implemented measures to manage the transmission of coronavirus disease 2019 (COVID-19). While the majority of these measures are proving effective, they have a high social and economic cost, and response strategies are being adjusted. The World Health Organization (WHO) recommends that communities should have a voice, be informed and engaged, and participate in this transition phase. We propose ten considerations to support this principle: (1) implement a phased approach to a 'new normal'; (2) balance individual rights with the social good; (3) prioritise people at highest risk of negative consequences; (4) provide special support for healthcare workers and care staff; (5) build, strengthen and maintain trust; (6) enlist existing social norms and foster healthy new norms; (7) increase resilience and self-efficacy; (8) use clear and positive language; (9) anticipate and manage misinformation; and (10) engage with media outlets. The transition phase should also be informed by real-time data according to which governmental responses should be updated.