Religious Affiliation and Philosophical and Moral Beliefs about Vaccines: A Longitudinal Study

"...hypothesized and found evidence that religious identity shapes vaccine attitudes and behaviors through philosophical and moral beliefs about health and disease management."

Prior research on vaccination intentions and behaviours has documented noteworthy associations with affiliation with an organised religion and level of religiosity (i.e., individual differences in how people interpret and practice their religion). This study examines the associations of attitudes and behaviours relevant to the flu, measles-mumps-rubella (MMR), and human papillomavirus (HPV) vaccines with religious affiliations, as well as with philosophical and moral beliefs.

In laying out the framework for the study, the researchers explain that philosophical beliefs entail judgments about the natural order and can include fatalistic ideas about God controlling health outcomes. Moral beliefs relevant to vaccination are associated with judgments about sex and, particularly, sex outside of a marital union and sex during the early teenage years. This type of belief has been widely studied, particularly when it comes to the HPV vaccine. The researchers predicted that religious affiliations may be associated with different endorsement of philosophical and moral beliefs. In turn, stronger religious beliefs may predict less-positive attitudes toward vaccines over time, and these less favourable vaccine attitudes may predict weaker intentions to encourage others to vaccinate and lower vaccination rates.

Respondents were 3,005 adults from a probability-based, 4-wave panel survey in the United States (US) conducted during 2018-2019. Longitudinal structural equation modeling examined how religious affiliations and philosophical/moral beliefs shaped attitudes toward vaccines and actual vaccination.

The sample included a variety of religious groups that represent the religious diversity of the US. When asked directly, only 3% (N = 67) of respondents reported that their religion forbids vaccination (mostly Roman Catholic and Protestant respondents), and only half of those 67 respondents (N = 30, 2% of the total sample) reported they followed that mandate.

Select findings include:

1. Religious affiliations predicted moral and philosophical beliefs; these results were consistent across the three vaccines. For philosophical views (e.g., that health is controlled by God), the researchers found that identifying as Protestant, Just Christian, and Muslim had consistently stronger beliefs, and Mormons tended to have stronger beliefs in the case of the flu vaccine. For moral beliefs (e.g., that premarital sex is immoral), the researchers observed a very similar pattern.
2. Philosophical and moral beliefs had different contributions to vaccine attitudes and intention/behaviours, and this differed across vaccine types. On the one hand, stronger philosophical beliefs predicted more negative vaccine attitudes. On the other hand, moral beliefs were negatively associated with attitudes toward the HPV vaccine but positively with attitudes towards the flu and MMR vaccines. For the flu vaccine, this association was similar for intentions to encourage vaccination and actual vaccination as well. Stronger philosophical beliefs predicted weaker intention to encourage others to vaccinate as well as less actual vaccination, whereas stronger moral beliefs predicted stronger intention to encourage vaccination as well as more vaccination.
3. There was a positive association between attitude toward the flu vaccine and actual vaccination.

In short, stronger philosophical beliefs predicted more negative attitudes toward each vaccine and stronger moral beliefs more negative attitudes toward the HPV vaccine. Negative vaccine attitudes then predicted weaker intentions to encourage others to vaccinate and lower probability of receiving a vaccine. These results contribute to the prior evidence showing a positive association between philosophical beliefs and vaccine hesitancy.

Theoretical and public health messaging implications are discussed. For example, health campaigns could focus on philosophical and moral beliefs instead of religious identity, as messages on identity may backfire more easily. Messages could target religious beliefs more precisely and frame vaccination recommendations in ways that highlight compatibility with (or absence of direct antagonism toward) religious attitudes. As noted here, it is important to not isolate religious identities by pinpointing blame in the public discourse on vaccine hesitancy. Moreover, the mixed findings pertaining to moral beliefs suggest the need for customised messages targeting vaccine attitudes versus uptake.

The researchers stress that, when considering any messaging, it is important to remember that countries differ widely in the role of religion in society, social and political culture, the influence of religious leaders, and the historical background of religion. A US intelligence agency admitted to collecting DNA samples during polio vaccination campaigns in Pakistan, which led to religious fatwas (rulings on points of Islamic law) opposing vaccination within a complex social and political context. Future research should consider religious factors in tandem with other social and political issues - in the US and beyond. Other future research directions explored here include examining distinctions within affiliations too, such as between Orthodox Jews and other Jews, when it comes to vaccination behaviours.

In conclusion: "Understanding the role of religious affiliations and beliefs in vaccine attitudes and behaviors is important...at the individual level but also at the macro level given the policy discussions on religious freedoms and exemptions. Since micro and macro level processes influence each other, greater vaccine hesitancy in the public could facilitate anti-vaccine policy-making that gives more weight to religious freedom in the public space at the expense of public health....As the roll out of COVID-19 vaccines and booster shots raises questions regarding vaccinate mandates and religious reservations,...[this study's] findings can help inform the discussion."