Public support for unequal treatment of unvaccinated people

Billions have been vaccinated against COVID-19, but unvaccinated people remain a challenge to public health because they are more likely to transmit the virus and especially become seriously ill. One way governments can provide incentives for people to become vaccinated is to enact more restrictive rules and regulations that apply to unvaccinated people. However, this involves a difficult balancing act between the extent to which such restrictions are perceived as legitimate. A new research project examined this situation in Denmark.

“We asked the general public whether they advocate more restrictions. There was clearly much greater support for restrictive policies that exclusively target unvaccinated people, which we interpret as support for unequal treatment of these people. Further, the attitudes of vaccinated and unvaccinated people are unsurprisingly polarised. But the study suggests that neither increases in the severity of the pandemic nor whether individuals trust public institutions correlate with support for unequal treatment,” explains a main author, Julian Schuessler, a Postdoctoral Fellow at the Centre for the Experimental-Philosophical Study of Discrimination, Aarhus University.

Minor and major differences

Much research has been carried out on such questions as vaccine hesitancy and attitudes towards compliance with restrictions such as COVID-19 certificates, but very little is known about what the general public thinks about potentially controversial regulations singling out unvaccinated people.

“We therefore decided to conduct a panel survey in Denmark in two waves – one in August and September and one in December 2021. We randomised the respondents so that we asked half whether potential rules should be applied to adults in general and half only to unvaccinated adults. We could therefore bypass the likely problem that respondents would be unwilling to admit a preference for making a decision on unequal treatment, since we know that many people in Denmark may have difficulty in admitting willingness to discriminate,” says Julian Schuessler.

Each respondent was asked whether they supported the following five proposed additional regulations.

1. Paying a small fee for COVID-19 tests
2. Discontinuing the less reliable rapid tests as proof of infection status
3. Abolishing the possibility to say one is exempt from showing the COVID-19 certificate
4. Abolishing wage compensation during mandatory isolation for public employees
5. Giving lower priority to COVID-19 patients compared to other patients if there is a shortage of hospital beds.

“The respondents then had to indicate on a scale from 1 to 5 whether they thought each restriction was acceptable. Abolishing the COVID-19 certificate exemption had the highest support, but this was regardless of whether it was applied to everyone or only to unvaccinated people. On the other hand, giving COVID-19 patients in hospital lower priority had relatively very little support in both groups,” explains Julian Schuessler.

Expected major variation

There was a great difference in support for introducing a fee for tests, with a fee for unvaccinated people receiving considerably higher support. The same was true for abolishing wage compensation during mandatory isolation, which was very unpopular (mean = 1.8) when applied to the general public but considerably more popular when applied solely to unvaccinated people (mean = 3.2).

“Corresponding to the patterns across regulations, the results for the overall index indicate that the respondents did not generally support further restrictions for all adults but generally supported applying new restrictions solely to unvaccinated people,” says Julian Schuessler.

The researchers were not surprised by the considerable differences between the answers given by the vaccinated and unvaccinated respondents. Unvaccinated people consistently expressed little support for unequal treatment for themselves compared with vaccinated people. Nevertheless, the fact that the attitudes of vaccinated people did not change either when the pandemic worsened and the regulations became stricter was surprising.

“Vaccinated people probably think that unvaccinated people pose the greatest risk of infecting other people, both themselves but also vulnerable people. In addition, many vaccinated people may think that unvaccinated people are free-riders who are not contributing to the public good of herd immunity. According to this logic, we had generally expected that support for unequal treatment would increase as the pandemic worsened, but we did not see this trend,” explains Julian Schuessler.

No decline in trust

There was most support for unequal treatment for financial penalties or restrictions but less support for unequal treatment in relation to healthcare. Although unequal treatment is common, the researchers say that distinguishing between unequal treatment and outright discrimination in treatment is important.

“In this case, imposing stricter rules on unvaccinated people can be justified from a public health perspective, since unvaccinated people have higher risks of being infected with and transmitting COVID-19. According to many conceptualisations, this would therefore not constitute discrimination. However, it would nonetheless conflict with the liberal principle of equal treatment,” says Julian Schuessler.

According to the researchers, the new study may prove to be important when politicians have to consider which measures to implement in connection with future pandemics. For example, during the COVID-19 pandemic, the Province of Quebec, Canada considered plans for a special tax to be paid by unvaccinated people, while the German government abolished isolation wage compensation for unvaccinated people.