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

Philipp Sprengholz; Lars Korn; Sarah Eitze; Lisa Felgendreff; Regina Siegers; Laura Goldhahn; Freia De Bock; Lena Huebl; Robert Böhm; Cornelia Betsch

doi:10.1016/j.vaccine.2022.01.065

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

Vaccine. 2022 Dec 5;40(51):7370-7377. doi: 10.1016/j.vaccine.2022.01.065. Epub 2022 Feb 7.

Authors

Affiliations

¹ Media and Communication Science, University of Erfurt, Germany. Electronic address: philipp.sprengholz@uni-erfurt.de.
² Media and Communication Science, University of Erfurt, Germany; Center for Empirical Research in Economics and Behavioral Sciences, University of Erfurt, Germany.
³ Media and Communication Science, University of Erfurt, Germany.
⁴ Federal Centre for Health Education (BZgA), Germany.
⁵ Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
⁶ Department of Psychology, University of Copenhagen, Denmark; Department of Economics, University of Copenhagen, Denmark; Copenhagen Center for Social Data Science, University of Copenhagen, Denmark.

Abstract

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.

Keywords: COVID-19; Mandates; Vaccination.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Attitude
COVID-19 Vaccines
COVID-19* / prevention & control
Cross-Sectional Studies
Female
Germany / epidemiology
Humans
Male
Pandemics*
Policy

Substances

COVID-19 Vaccines