Resistance to COVID-19 vaccination and the social contract: evidence from Italy

Abstract

Confronted with stalled vaccination efforts against COVID-19, many governments embraced mandates and other measures to incentivize vaccination that excluded the unvaccinated from aspects of social and economic life. Even still, many citizens remained unvaccinated. We advance a social contract framework for understanding who remains unvaccinated and why. We leverage both observational and individual-level survey evidence from Italy to study the relationship between vaccination status and social context, social trust, political partisanship, and adherence to core institutional structures such as the rule of law and collective commitments. We find that attitudes toward the rule of law and collective commitments outside the domain of vaccination are strongly associated with compliance with vaccine mandates and incentives. Partisanship also corresponds with vaccine behaviors, as supporters of parties whose leaders criticized aggressive policies to incentivize or mandate vaccination and emphasized individual liberty are least likely to comply. Our findings suggest appeals emphasizing individual benefits may be more effective than appeals emphasizing collective responsibility.

Fig. 1. Regional Social Capital and Rate of Unvaccinated Residents.

a plots the percentage of residents who have not received even a single dose of a COVID-19 vaccine by region. b plots an index of macro social capital (capturing civic-mindedness and observance of rules) constructed by Miccucci and Nuzzo. c shows the bivariate relationship between regional social capital and the share of population unvaccinated. d plots coefficients and 95% confidence intervals from an OLS regression modeling the % unvaccinated as a function of a region’s social capital and COVID-19 death rate.

Fig. 2. Social Trust, Attachments to the Rule of Law, and Vaccination Status.

Predicted probabilities of being unvaccinated by social trust (a) and attachments to the rule of law (b), holding all other factors constant at their medians. Shaded bands indicate 95% confidence intervals.

Fig. 3. Political Partisanship and Vaccination Status.

Bars presents the percentage unvaccinated by supporters of each party. None of the 17 supporters of Italia Viva (IV) reported being unvaccinated. I-bars present 95% confidence intervals.

Fig. 4. Relationship between Being Unvaccinated and Attitudes toward Ukraine War.

Note: Marginal effects for indicator variable identifying unvaccinated individuals from three logistic regressions. Each logistic regression also controlled for political partisanship and demographic factors. Horizontal lines present 95% confidence intervals.