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ABSTRACT
This paper offers an explanation for subjects’ lack of confidence in vaccines’ safety, which in turn is widely recognized as one of the main determinants of vaccine hesitancy. I argue that among the psychological roots of this lack of confidence there is a kind of intuitive thinking that can be traced back to a specific superstitious belief: the belief that “it is bad luck to tempt fate”. Under certain conditions, subjects perceive the choice to undergo vaccinations as an action that “tempts fate”, and this leads them to overestimate its risks. When an action is perceived as “tempting fate”, indeed, its possible negative outcomes are anticipated as highly aversive, and as such they capture subjects’ imagination, thereby feeling more subjectively probable. This has important consequences for practical pro-vaccine interventions. Part of what makes an action perceived as “tempting fate” is its being free, arbitrary, and departing from one’s typical behavior: insofar as vaccine hesitancy is driven by beliefs about tempting fate, then, we can predict the success of interventions that make vaccinations nearly mandatory, or build vaccination opportunities into health care routines as opt-out, rather than opt-in options, making them closer to something that subjects passively accept rather actively seek.
Acknowledgments
I thank Ema Sullivan-Bissett and two anonymous reviewers for their extremely helpful comments on earlier drafts of this paper, as well as Gabriele Contessa for some stimulating exchanges on vaccine hesitancy and related topics, which informed my views on these issues. I am also grateful to the British Academy for funding a project of which this paper is a natural part (Conspiratorial Ideation and Pathological Belief, grant no. SRG21\210992).
Disclosure statement
No potential conflict of interest was reported by the author(s).
Notes
1. Here I speak of superstitious “beliefs”, assuming that the mental states in question are doxastic in nature. Elsewhere, I defended a non-doxastic account of (most forms of) superstitions, arguing that they are better described in different terms – such as imaginings, or other sorts of non-doxastic states (Ichino, Citation2020). I do still think that non-doxasticism about superstitions is correct; but this does not really matter much for the sake of my argument in this paper – which is why I will keep speaking in the common terms of belief, using “belief” in a deliberately broad way.
2. Both these mechanisms are well attested and documented (see, Kahneman, Citation2011: Ch. 12 and 28 for overviews of each of them).
3. Risen and Gilovich seem to hold that the prediction in question is correct: there is indeed evidence that we tend to engage in tormenting counterfactual thinking and self-blame for things we regret having done. However, some studies suggest that we’re better than we think at overcoming regret and forgiving ourselves for past mistakes (see, Gilbert et al., Citation2004). At least in some cases, then, we may anticipate more regret than we’ll actually end up experiencing.
4. Cases like this sound very much like some of the cases for which Gendler (Citation2008) introduced the cognitive category of “aliefs”. Although, as I argued elsewhere (Currie & Ichino, Citation2012), I do not find the case for aliefs overall compelling, I already noted that I am more than open to the view that the sort of superstitious thinking I am discussing here may be better explained in non-doxastic terms than in terms of beliefs (see fn.1 above).
5. According to other authors, system 2 endorsement of superstitious intuitions is more common than Risen and colleagues think (see e.g. Vyse, Citation2014).
6. As it has been noted, complacency in some cases may also be due to the fact that “vaccinations are victims of their own success” (Janko, Citation2012): they are so effective that people do not see their need anymore. Complacency is also fostered by anti-vax propaganda, which trivializes vaccine-preventable diseases, downplaying their risks (just think of the widespread view – pushed also by prominent political actors like Donald Trump – according to which COVID-19 is “just a flu”).
7. Through the superstitious mechanism I’ve been describing, then, two opposite forms of distorted risk perception that have been highlighted as independent causes of vaccine hesitancy – i.e., people’s tendency to underestimate the risks of the relevant diseases, on the one hand, and to overestimate the risks of the vaccines, on the other hand – turn out to be causally linked, at least to some extent: insofar as my suggestion is correct, it is partly because some people tend to perceive the risk the disease as low, that they perceive the action of getting vaccinated as an action that tempts fate, and therefore overestimate its potential dangers. The claim that people’s tendency to underestimate the risk of the relevant diseases is part of what leads them to overestimate the risk of the vaccines is compatible with the view that both these opposite forms of distorted risk perception are causally dependent on some further, common factor – such as a generalized mistrust in experts and authorities.
8. Actually, there are adults for whom receiving vaccinations is more common: those who get every year an anti-flu shot. But indeed, various studies suggest that those adults are not typically among those who are hesitant toward the COVID-19 vaccine; and that, conversely, not being vaccinated against influenza in previous years is often associated with COVID-19 vaccine hesitancy (see e.g. Fisher et al., Citation2019; Kreps et al., Citation2020). These results are in line with my suggestion according to which those for whom getting vaccinated is not a “typical behaviour” may be more likely to see that action as tempting fate, hence to be hesitant to perform it. As an anonymous reviewer helpfully pointed out, the emphasis on the unnaturalness of vaccines that characterized much recent no-vax rhetoric might also have played a role here – consolidating the feeling that getting vaccinated is a needless departure from standard, “natural” conditions (see the vax-skeptic website www.naturalnews.com for many examples of arguments of this sort; for a general discussion of the role of appeals to “nature” in promoting vaccine hesitant attitudes, see Moran et al., Citation2016).
9. According to some authors, the status quo bias is in itself an effect of the omission bias – see Ritov and Baron (Citation1992) for an extensive discussion of the relation between the two.
10. See Goldenberg (Citation2021) for an extensive and paradigmatic example; see also Levy (Citation2021) for a thoroughly social approach to phenomena like vaccine hesitancy and the “bad beliefs” they involve.
11. Here note also that the above-mentioned “complacency”- i.e., people’s tendency to underestimate the risk of the relevant vaccine preventable diseases, which we identified as one of the reasons why people take vaccinations as involving a needless risk – is circumscribed to specific social groups.
12. As we shall see by the end of this section, these subjects of course may have also other reasons to distrust vaccines and take them to be unsafe – such as past negative experiences with the healthcare system (Goldenberg, Citation2021), and/or the endorsement of no-vax conspiracy theories (Soveri et al., Citation2021). My point is just that the belief that getting their shot is tempting fate is one of the factors that contribute to their distrust in vaccines and their distorted risk-evaluation.
13. For a comprehensive review, taxonomy, and assessment of vaccine mandates across different countries in the last decades, see Atwell and Navin (Citation2019).
14. Of course, I’m not suggesting that the success of vaccine mandates and passes depends entirely on the mechanism I described; other factors – such as indeed the costs of not getting vaccinated – surely play a key role. But the mechanism I described can play an important role, especially in the long run, since it tackles one of the roots of vaccine hesitancy.
15. As various authors pointed out, mandates cannot in any case be the only solution: they should always be accompanied by a number of (surely trickier to envisage and implement, but crucial) measures aimed at improving social justice, cohesion, and transparent, trustful relationships between citizens and institutions/experts (see Goldenberg, Citation2021 for an extensive discussion; see also Omer et al., Citation2019, p. 471; Mills & Ruttenauer, Citation2022, p. 22).
16. Making the refusal of vaccinations more practically difficult should go hand in hand with making the access to them smoother and easier, thereby tackling another important root of vaccine hesitancy that has been identified in the literature: what in the “5 Cs” model of vaccine hesitancy is often labeled as “convenience”, which has to do with the practical barriers that may get in the way of subjects’ adherence to vaccination campaigns (see e.g. Betsch et al., Citation2018; Razai et al., Citation2021).
17. My discussion here is not meant to exhaust the list of practical interventions that my account would predict to be successful. Insofar as I am right that subjects’ overestimation of vaccines’ risks is indirectly influenced by their underestimation of the risks of the relevant vaccine preventable diseases – i.e. by so-called “complacency” – another obvious measure that could prove effective to reduce lack of confidence in vaccines’ safety would involve addressing complacency itself, by promoting a better awareness of the relevant diseases’ risks.
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Anna Ichino
Anna Ichino is Associate Professor at the Department of Philosophy of the University of Milan, working primarily in the philosophy of mind and cognitive sciences.