Mandates likely work to increase vaccine uptake

Though almost 190 million people in the United States are fully vaccinated against COVID-19, that’s less than 60% of the country’s population. To increase that number, the federal government set in motion requirements that businesses with 100-plus employees mandate the vaccine.  

Some headlines decried such a move, saying it would hamper, not help the effort. But new research from a University of Pennsylvania team shows that such fears are unfounded. Rather than causing a backlash, the mandates strengthen vaccination intentions, results the researchers published in the journal Scientific Reports.

“Our experiments show very clearly that these requirements do not have any negative effects on vaccination intentions,” says Dolores Albarracín, the Alexandra Heyman Nash Penn Integrates Knowledge University Professor with appointments in the Annenberg School for Communication and the School of Nursing. “And, actually, they have positive effects across various ethnic groups and for people who have a tendency to oppose anything seemingly forced on them,” what’s known as psychological reactance, she says.  

Albarracín, a social psychologist who also directs the Science of Science Communication Division at the Annenberg Public Policy Center, is particularly interested in the psychological impact of science-relevant policies.

The research, from Albarracín and colleagues Andy Tan and Jessica Fishman, postdoc Haesung Jung, and data analyst Wen Song, started with two questions: Is mandating a COVID-19 shot likely to promote vaccine uptake or increase resistance to it? How would such a requirement compare to allowing people to freely choose the vaccine?

“Last winter, when these vaccines started getting distributed, there was a great deal of controversy over potential mandates in hospitals and throughout other industries,” says Fishman, who runs the Message Effects Lab at Penn. “Today, many leaders still worry that they could make a difficult situation worse if they mandate vaccination. We wanted to better understand the psychological effects of these policies.” 

Much like Fishman’s lab, Albarracín’s Social Action Lab and Tan’s Health Communication & Equity Lab focus on this kind of analysis with an eye toward understanding which factors and communication types influence behavior change. With that in mind, the researchers constructed a series of studies, which included an initial survey and three experiments. 

The survey provided about 300 people basic information about the vaccine, then asked them to answer two yes-or-no questions: “Will you get the COVID-19 vaccine if it is required to work, travel, or go to school?” and “If you could get the COVID-19 vaccine for free today, would you want to be vaccinated today?” 

More participants responded “yes” to the first question than to the second. “In other words, people are more willing to get the vaccine if it’s required,” says Tan, an associate professor of communication at Annenberg. “That prompted the subsequent experiments, which were intended to help us replicate what we learned from the survey.” 

About 1,300 people took part in the three experiments. Two of the experiments offered three conditions. In one, participants were asked to consider vaccine requirements for school, work, or travel. Another discussed the choice participants had to get vaccinated of their own accord, and the third emphasized the potential freedom people might gain from vaccination. The final experiment compared only two conditions: the requirement and the free-choice situation.

“If people who encounter a vaccine mandate experienced psychological reactance, either of the two freedom conditions would do better than the requirement,” Albarracín says. “The theory of psychological reactance assumes that requiring a behavior can be demotivating.” But the reality looked different. “We found that if vaccines were mandated, people would choose to get vaccinated versus a control condition where they’re not being forced,” Tan says. “This is good news.” 

The results held across racial and ethnic groups and for those with a disposition for psychological reactance, “those who will tell you, ‘I don’t like to feel controlled. If someone tells me that I should do something, I like to do the opposite,’” Albarracín says. “Even people who agree with these statements are more persuaded by the requirement.” 

As the vaccine mandate debate rages, the researchers say they believe their findings can help guide new polices and reinforce those already in place. “Many company leaders and politicians still wonder whether they should oppose or embrace mandates,” Fishman says. “Hopefully, these findings give them some assurance that mandates can help.” 

Despite some limitations to the work—the outcome centered around vaccination intentions rather than behavior, for example—Albarracín says she feels these results ground some of the mandate speculation in fact. In the future, she plans to study how mandates work in situations with minority opposition; in these studies, mandates strengthened intention even when participants knew the vaccine was not popular.

“It’s incredibly reassuring,” she says. “After almost two years of resistance to public health measures, especially to regulating them in any way in a lot of places, this provides preliminary evidence that mandates can work.” 

Funding for this research came from the National Science Foundation and from Penn’s Annenberg School for Communication and Perelman School of Medicine. 

Dolores Albarracín is the Alexandra Heyman Nash Penn Integrates Knowledge University Professor with appointments in the Annenberg School for Communication and the Department of Family and Community Health in the School of Nursing. She has secondary appointments in the Department of Psychology in the School of Arts & Sciences and the Department of Health Care Management in the Wharton School. She is also director of the Science of Science Communication Division at the Annenberg Public Policy Center and of the Social Action Lab. 

Jessica Fishman, director of the Message Effects Lab, is a faculty research associate at Penn’s Annenberg School for Communication, with a joint appointment in the Department of Psychiatry at the Perelman School of Medicine.

Andy Tan is an associate professor of communication at Penn’s Annenberg School for Communication and director of the Health Communication & Equity Lab.

Other Annenberg School for Communication research contributors included Haesung Jung, a postdoctoral fellow in the Social Action Lab, and Wen Song, a data analyst and research coordinator.