Association of moral values with vaccine hesitancy

  • Nature Human Behaviourvolume 1pages873880 (2017)
  • doi:10.1038/s41562-017-0256-5
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Clusters of unvaccinated children are particularly susceptible to outbreaks of vaccine-preventable disease1,2. Existing messaging interventions demonstrate short-term success, but some may backfire and worsen vaccine hesitancy3. Values-based messages appeal to core morality, which influences the attitudes individuals then have on topics like vaccination4,5,6,7. We must understand how underlying morals, not just attitudes, differ by hesitancy type to develop interventions that work with individual values. Here, we show in two correlational studies that harm and fairness foundations are not significantly associated with vaccine hesitancy, but purity and liberty foundations are. We found that medium-hesitancy parents were twice as likely as low-hesitancy parents to highly emphasize purity (adjusted odds ratio: 2.08; 95% confidence interval: 1.27–3.40). High-hesitancy respondents were twice as likely to strongly emphasize purity (adjusted odds ratio: 2.15; 95% confidence interval: 1.39–3.31) and liberty (adjusted odds ratio: 2.19; 95% confidence interval: 1.50–3.21). Our results demonstrate that endorsement of harm and fairness—ideas often emphasized in traditional vaccine-focused messages—are not predictive of vaccine hesitancy. This, combined with significant associations of purity and liberty with hesitancy, indicates a need for inclusion of broader themes in vaccine discussions. These findings have the potential for application to other health decisions and communications as well.

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No external funding source support was used for this work. No funders had any role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

Author information


  1. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA

    • Avnika B. Amin
    • , Robert A. Bednarczyk
    •  & Saad B. Omer
  2. Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA

    • Robert A. Bednarczyk
    •  & Saad B. Omer
  3. Department of Psychology, College of Arts and Sciences, Loyola University Chicago, Chicago, IL, USA

    • Cara E. Ray
    •  & Jeffrey R. Huntsinger
  4. Department of Psychology, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA, USA

    • Kala J. Melchiori
  5. Department of Management, Eccles School of Business, University of Utah, Salt Lake City, UT, USA

    • Jesse Graham
  6. Emory Vaccine Center, Atlanta, GA, USA

    • Saad B. Omer
  7. Department of Pediatrics, School of Medicine, Emory University, Atlanta, GA, USA

    • Saad B. Omer


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S.B.O. and R.A.B. developed and designed study 1. A.B.A. collected and analysed the data for study 1. A.B.A. interpreted the data from study 1 with input from S.B.O. and R.A.B. J.R.H. developed the initial idea for study 2. C.E.R. and K.J.M. designed study 2 and collected and analysed the associated data. C.E.R., K.J.M. and J.R.H. interpreted the data from study 2. A.B.A. drafted the paper and most of the supplementary materials, with pertinent sections from study 2 drafted by C.E.R. and J.R.H. S.B.O., R.A.B., C.E.R., K.J.M., J.G. and J.R.H. provided critical revision of the paper.

Competing interests

The authors declare no competing interests.

Corresponding author

Correspondence to Avnika B. Amin.

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