Vaccination behavior is not homogenous: Role of irrationality and mistrust in the healthcare system

Abstract

Background. Refusing or postponing vaccination is an individual decision that can have serious consequences for personal and public health. These behaviors can be rooted in irrational beliefs that contradict scientific principles or in cognitive biases (errors in judgment and decision-making), or result from mistrust in the healthcare system. We tested the predictiveness of these factors to two categories of vaccination behaviors: self-vaccinating against COVID-19 and postponing/refusing to vaccinate one’s child according to the official immunization schedule. Methods. In a community sample of Serbian adults (N = 582; 249 reported having children), we measured irrational beliefs (conspiracy beliefs, magical health beliefs, superstitiousness), cognitive biases (illusory correlation, omission bias, naturalness bias), trust in the healthcare system and professionals, health, socioeconomic status, age, gender, and education. Findings. While 22% of the sample was not COVID-19 vaccinated, 2% of parents refused, and 15% postponed vaccinating their children. Expectedly, COVID-19 vaccination was predicted by older age (β = .19), poorer health status (β = -.10), lower conspiracy (β = -.14) and magical health beliefs (β = -.20), lower naturalness bias (β = -.18), and higher trust in the healthcare system (β = .15) and professionals (β = .14) (all ps <. 01). However, postponing/refusing vaccinating children was not predicted by an irrational mindset or system mistrust. Younger participants rejected vaccinating their children more often (β = -.25, p < .001). Discussion. Results suggest that vaccination behavior is heterogeneous and has different roots, implying different intervention strategies are needed to address the different types of vaccine hesitancy.