Join or die: How deontological moral intuitions complicate cooperation amid the COVID-19 pandemic

Abstract

Tackling COVID-19 requires universal collective action: everyone must play their part to reduce the spread of the virus and quell the pandemic. Yet, some people obstinately refuse to cooperate, irrespective of the consequences for themselves and others. In this note, I illustrate a key element of human psychology that hampers cooperation amid the pandemic: deontological moral intuitions. Deontological morality prescribes that moral taboos must be followed no matter the consequences. This means that people who consider Covid vaccines a moral taboo are prepared to suffer virtually any consequence rather than take the vaccine. I discuss the evolutionary basis of deontological intuitions, their implications for cooperation, and consider possible solutions. In conclusion, although not always harmful, deontological moral intuitions against Covid measures -and vaccines in particular- are a major obstacle that stands in the way of successful collective action during the pandemic.

Keywords

COVID-19 pandemic morality deontology cooperation vaccines

Nel caro ricordo di Mario Mignone, un grande italiano a cui devo eterna gratitudine.

In loving memory of Mario Mignone, a great Italian to whom I owe eternal gratitude.

Introduction

“I’d rather die than take the vaccine.”

A (later deceased) COVID-19 patient of Dr Matthew Trunsky, Troy, Michigan

‘Join, or die’ admonished Benjamin Franklin as he called upon all members of the Thirteen Colonies to come together in the Union and set free from British rule. Over 250 years later, Franklin's words still sound extremely current amid repeated calls by the international medical community to prioritize collective action over personal interests in the fight against the COVID-19 pandemic (Harring et al., 2021). Against an increasingly transmissible disease, everyone is called to take steps to avoid more deaths, which have amounted to about seven million in the first three years of the pandemic (Roser et al., 2020). The very nature of the virus implies that widespread cooperation is needed to quell the pandemic. And yet, a sizeable minority of humans refuses to cooperate, literally preferring to die (or have others die) rather than comply with prescriptions (Murphy et al., 2021; Ruiz and Bell, 2021).

Why will some people just never cooperate, regardless of the consequences that defection in the war on COVID-19 entails? In this note, I illustrate how a prominent feature of human psychology – deontological moral intuitions – complicates the battle against the fiercest enemy that mankind has seen since the Spanish flu of 1918–1920. Specifically, I argue that due to deontological moral stances about COVID-19, measures that require willful cooperation – such as getting vaccinated – are unlikely to be met with universal compliance.

A pandemic requiring collective action

Throughout the pandemic, joining the fight against COVID-19 has meant taking different actions: complying with border closures, shelter-in-place orders, lockdowns, and social distancing measures; wearing a face mask; submitting to contact-tracing methods via phone-tracking technology; getting inoculated with a pioneering vaccine; and accepting discrimination by vaccination status, to name a few prominent ones. These wartime measures, while different, have an important feature in common: they require virtually everyone to follow them in order to be effective.

The early successes of lockdowns in China, which were carried out with draconian rigor in a collectivistic country ruled by dictatorship, are a case in point. Lockdowns were remarkably effective in China (Leung et al., 2020; Wang et al., 2020), where cooperation was inflexibly enforced rather than simply demanded. However, there is mounting evidence that lockdowns failed to reduce deaths in democracies, where cooperation is far from universal (see e.g., evidence from New Zealand: Gibson, 2022). And even in China, lockdowns proved to be ineffective in the long run: three years after the start of the pandemic, the spread of the virus and death toll reached dramatic proportions when China reopened its borders to the world and relaxed its internal measures against COVID-19 (Dyer, 2023).

The success of vaccination in ending the pandemic is similarly predicated on everyone getting the shot. For instance, a study in the Fall of 2021 showed that the rise in COVID-19 cases around the world is unrelated to the percentage of vaccinated individuals in the week before (Subramanian and Kumar, 2021). Rather than indicating vaccine ineffectiveness, the study illustrates that vaccines are unable to stop the pandemic unless everyone is covered by vaccination. (Even then, further measures that require collective cooperation may need to be taken.) However, two years after a vaccine became widely available, the world was still very far from attaining universal COVID-19 vaccination: in Africa, only about 45% of the population was fully vaccinated while in the United States, the figure hovered around 68% (Roser et al., 2020).

Emerging research on the effectiveness of face masks (Lindsley et al., 2021) and smartphone contact-tracing technology (Hernández-Orallo et al., 2020) reached parallel conclusions: universal adoption is needed for these measures to be efficacious. And yet, in these cases too, adoption is far from universal. Efforts to encourage people to wear a mask can increase mask usage (Goldberg et al., 2020), but they are insufficient to ensure that everyone complies. For instance, the Understanding Coronavirus in America study found that in December 2020, half of Americans who reported being in close proximity with people outside of their household admitted that they did not wear a mask (Key, 2021). Furthermore, even in countries where wearing a mask is compulsory, people still wear a mask incorrectly. For example, amid the COVID-19 pandemic, a study found that only one in 12 Singaporeans wore an N95 mask correctly (Yeung et al., 2020). Moreover, in Singapore, contact tracing via Bluetooth technology was mandatory to go about one's daily life normally, and yet in May 2021 – about one year after the technology was rolled out – 8% of Singaporeans were not participating in the contact-tracing program, and 1100 people even deregistered from it (Baharudin, 2021).

To be sure, in the global fight against infectious diseases, eradication is the exception rather than the norm. To date, only smallpox has been fully eradicated (Hinman, 1999), and global vaccination efforts required strong international institutions and support (Barrett, 2003). However, COVID-19 is arguably different and perhaps unique due to the politicization of the responses to the pandemic. Politicization became worse after vaccines using pioneering technology became available within just one year since the disease was discovered. Most notably, a sizeable minority of people – especially in the United States – fiercely resist vaccination appealing to political reasons, thus striking a fatal blow to universal cooperation against COVID-19.

Political tribalism and responses to the COVID-19 pandemic

The responses to the COVID-19 pandemic have been fraught with divisions since the very beginning. For instance, in the first months of 2020, once it became clear that a deadly virus was prevalent in Wuhan and the Hubei province of China, a hefty debate emerged about whether to curb travel from China, which would deprive millions of basic freedom of movement. Failure to act would likely accelerate the spread of the virus worldwide. There is evidence that travel bans against China did slow down the spread of the virus in the early stages of the pandemic (Adekunle et al., 2020; Grépin et al., 2021). Yet, while European governments were rolling out travel curbs, these measures were widely criticized as being racist and an expression of right-wing ideology.

In counter-response to travel bans, numerous pundits and politicians called for intercultural solidarity through initiatives such as “Hug a Chinese” (Criscuolo, 2020) or invitations to keep going about business as usual to underscore city pride (e.g., the Milan mayor's campaign, “Milan does not stop”) (Bajaj et al., 2021). Similar reactions occurred in the United States, where then-candidate Joe Biden dubbed President Trump's Covid-related travel bans as “hysteria, xenophobia, and fear-mongering”, pointing at how “a wall will not stop the coronavirus” and the curbs were actually “designed to make it harder for black and brown people to immigrate into the United States.” Meanwhile, a year later, the Biden presidency reinstated the same travel curbs that the previous president had removed on the last day of office, and reinstated them once more in the wake of the Omicron variant of the virus just weeks after lifting them (Miller, 2021).

The initial cacophony of discord in response to the impending pandemic was a harbinger of the tribal divisions and the rampant climate of moral condemnation that would rip societies apart during the rest of the pandemic. Instead of interrogating themselves on whether travel curbs were a sensible measure to buy time against an unknown but highly contagious and deadly virus, many citizens followed their tribal instincts regarding politics and judged measures based on who implemented them. For instance, in Western Europe, support for COVID-19 policies was mainly driven by voting for the incumbent party in the last election (Jørgensen et al., 2021). Of course, if citizens had judged the measures based on their merit, there should be no correlation between voting for the incumbent and supporting the measures. Yet, this pattern is consistent with tribalistic divisions between partisans (Huddy, 2018; Mason and Wronski, 2018).

The politicization of the pandemic response in early 2020 was temporarily subsided by the overwhelming pandemic wave that hit first Italy in March 2020, and the rest of Europe and the Northeastern United States soon after. Amid unprecedented lockdowns and primeval fears about the novel pathogen, citizens across all sides of the political spectrum mostly rallied around their incumbent government. In Western Europe, citizens interviewed during the lockdown of April 2020 indicated more trust in the government, greater satisfaction with democracy, and a higher intention to vote for the incumbent compared to those who were interviewed before the lockdowns (Bol et al., 2021). Remarkably, fear and anxiety over the unknown prevailed over partisan divisions, if only for a short time.

However, once the virus retreated during summertime in the Northern hemisphere, partisan tribalism once again drove citizens’ response to the pandemic. For example, in the United States, partisanship at the county level was correlated with compliance with state lockdown orders (Camobreco and He, 2021). In the meantime, a new fundamental fault line had emerged, based on trust in science and health officials: for example, in the United Kingdom, there is evidence that citizens who distrust science were less likely to follow the guidelines for prevention and mitigation (Maher et al., 2020).

Divisions only became worse when new vaccines using cutting-edge mRNA technology became available in December 2020 (Mahase, 2020). A sizeable minority of people around the world – e.g., one in four in France (Troiano and Nardi, 2021) – simply refused to get vaccinated (Dror et al., 2020). Common reasons for vaccine hesitancy include blanket skepticism toward vaccines, safety concerns due to the speed with which the vaccines were discovered, beliefs that COVID-19 is a hoax, doubts about vaccine efficacy, convictions of being already immune to the virus, and doubts about the origin of the vaccine (Machingaidze and Wiysonge, 2021; Troiano and Nardi, 2021). In addition to ancestral fears for the new vaccines that are common all over the world, in the United States, the vaccination campaign has also been hampered due to issues of partisanship and race.

Partisanship

In the United States, since Covid vaccines only became widely available during the Biden presidency, many Republicans – particularly in the South and in the West of the United States – have boycotted the vaccine rollout and refused to get vaccinated. To be sure, anti-vaccination propaganda is not a Republican prerogative per se: former President Donald Trump endorsed vaccines. Yet, at a rally in Alabama in 2021, he was booed by his supporters for encouraging vaccinations, indicating that the former president is misaligned with the Republican base (Smith, 2021). There is abundant evidence that Republicans are less likely to get vaccinated (Kreps and Kriner, 2021; Ruiz and Bell, 2021), in part due to the consumption of anti-vaccine propaganda on Republican-leaning media such as Fox News (Allington et al., 2021) and conspiracy theories spread through social media (Romer and Jamieson, 2020).

Race

Race is another key factor that contributes to vaccine hesitancy in the United States, especially in the least affluent states. For instance, a study conducted in Arkansas in August 2020 reported that half of African-Americans had no intention of getting vaccinated (Willis et al., 2021). Several subsequent studies reported a similar pattern (Callaghan et al., 2021; Khubchandani et al., 2021). Besides socio-economic reasons, there are unique motivations behind the prevalence of vaccine hesitancy among African-Americans and racial minorities more generally. Namely, a widespread skepticism toward government medical interventions that dates back to infamous incidents such as the Tuskegee Syphilis Study, which ended in the 1970s. In the Tuskegee Study, hundreds of Black syphilis patients were enrolled in an unethical clinical trial unbeknownst to them and denied treatment, with the result that a large number of them died. The scars of Tuskegee have been long-lasting and still impact vaccine hesitancy among Black communities today (Bajaj and Stanford, 2021; Warren et al., 2020), in the United States and beyond (Kadambari and Vanderslott, 2021). Thus, as a result of prolonged racial discrimination, data show that beliefs in government conspiracies and refusal to get vaccinated against COVID-19 have become an inherent part of racial group identity, especially among Black and Hispanic communities (Stroope et al., 2021).

Together, the combined effects of political tribalism and ancestral fears over vaccines create a bedrock of hard-core defectors in the collective fight against COVID-19. Even so, the striking numbers of the pandemic, which disproportionately hits the unvaccinated, as center for disease control director Dr Rochelle Walensky remarked (Anthes and Petri, 2021), invite the question of why this persistent refusal to cooperate still stands in the face of disastrous consequences. Importantly, refusal to cooperate not only contributes to mankind's defeat in the battle against COVID-19, but also implies that the noncooperators are the prime casualties. Why do people not change their minds about vaccines and preventative measures in the face of mounting evidence that their defection backfires (Redlawsk et al., 2010)? Deontological moral intuitions offer a clue.

Moral obstinacy regarding COVID-19 measures

The pandemic response has been fraught with divisions since the beginning, except for in moments of direst fear. Especially as new tools have become available, restrictions have eased, and the response has become more fragmented, divisions have crystalized and people have sorted into groups, such as the ‘distancers’ and the ‘non-distancers’, the vaccinated and the ‘anti-vaxxers’, and so on. The rift is even deeper when these differences compound existing cleavages, such as partisanship and race. The result is the moralization of the pandemic, with both sides engaging in moral condemnation (Prosser et al., 2020): the actions of the other side are considered not just incorrect or harmful, but morally wrong.

The distinctive element of moral condemnation amid the pandemic is that it defies considerations about costs and benefits. On one side, anti-vaxxers condemn vaccination regardless of how many lives it saves; on the other side, lockdowners seem willing to accept a tremendous degree of human suffering caused by restrictions to prevent the spread of COVID-19 (Graso et al., 2021). In sum, the signature of moral condemnation amid the pandemic is deontological moral reasoning, which is inflexible to costs and benefits. Thus, loathing and condemnation across group lines occur due to the violation of moral imperatives rather than for the pursuit of choices that cause greater harm (consequentialist morality). On the side of deontological moral reasoning against COVID-19, vaccine hesitancy is a case in point.

Covid vaccine hesitancy and deontological moral intuitions

At one extreme, anti-vaxxers hold the view that one should never get vaccinated against COVID-19, no matter what the consequences are, taking a deontological stance (Kant, 1797). On the other side, there is the view that vaccines are worth taking when the aggregate benefits outweigh the costs, taking a consequentialist stance such as utilitarianism (Bentham, 1996[1789]). The field of moral psychology finds that for many moral rules, such as prohibitions against killing or stealing, people have conflicting deontological and consequentialist tendencies (reviewed in Haidt, 2012).

Psychologists have found that moral judgments have a distinct deontological character, alongside and often in conflict with consequentialist motives for the greater good (DeScioli and Kurzban, 2009, 2013; Greene, 2013; Haidt, 2012; Mikhail, 2007; Tetlock, 2003). Following moral philosophy, a deontological judgment focuses on the category and nature of the action rather than its consequences (Kant, 1797). Hence, deontological judgments require strict observance of moral taboos and prohibitions, and they resist the kinds of cost-benefit considerations that factor into other kinds of (non-moral) decisions such as matters of economics or personal safety. In a large literature with hundreds of experiments, researchers find that participants often judge that breaking moral rules is wrong and deserving of punishment, even when breaking the rules achieves better consequences. For example, in the famous trolley problem, most participants (∼75%) typically say that it is morally wrong to push one person into death in front of a trolley to save five people on the rail tracks (Mikhail, 2007), condemning an action that would save four lives.

Deontological moral intuitions have shaped the public's response to political events long before COVID-19. A common theme in this research is the intransigence toward compromise with others on any issue that becomes moralized (Dehghani et al., 2010; Del Ponte and DeScioli, 2022; Delton et al., 2020; Ginges et al., 2007; Ryan, 2014, 2017, 2019; Skitka and Bauman, 2008). For instance, previous work found that people who considered Social Security benefits a moral issue resisted compromises on the issue and were even willing to punish politicians who were in favor of compromise (Ryan, 2017). Moreover, people with strong moral convictions about a political issue were more likely to ignore new information about it and dismiss arguments based on costs and benefits (Ryan, 2019).

Another line of research has examined deontological judgment in the context of conflict resolution. One study asked Palestinian and Israeli participants what deals they would accept to resolve issues surrounding the Israeli-Palestinian conflict (Ginges et al., 2007). Participants who viewed an issue as a matter of moral absolutes reacted to a potential compromise with outrage, and even more so when additional perks were added to try to persuade them. Similarly, Iranian respondents who considered their nuclear program as an absolute moral right met monetary offers to change their minds with more anger (Dehghani et al., 2010). In yet two more studies, American participants judged that a government must repay its international debt even if the consequences of repayment are as much as 20 times worse than defaulting (Del Ponte and DeScioli, 2022). People who hold deontological stances about the response to COVID-19 are similarly irremovable in their convictions (Prosser et al., 2020).

The reason for the persistent moral obstinacy that is typical of fights over COVID-19 lies in the evolutionary roots of deontological moral judgment. Moral judgment is an evolved ability that allows people to take sides in a conflict (DeScioli and Kurzban, 2009, 2013). The set of evolved algorithms that underlie moral intuitions allow people to choose allies when conflict bursts out within or between groups fraught with complex coalitions and power structures. Thus, people create moral codes to address conflicts, signal loyalties, and solve coordination problems. Moral codes are certainly not the only way humans tackle these tasks. For instance, the choice of driving on the left or the right side of the road is usually not the object of a moral debate, and yet this coordination problem is solved daily by billions of drivers around the globe. Even so, the use of moral codes has proven a successful strategy to solve strategic interactions: following a moral imperative regardless of the consequences helps groups stick together. For example, food prohibitions (Counihan and Van Esterik, 1997) or sexual taboos (Lear and Cantarella, 2009; Zeitzen, 2008) serve the function of distinguishing the ingroup from the outgroup and maintaining ingroup loyalty and cohesiveness.

Despite the stickiness of deontological intuitions, even obstinate convictions can still be susceptible to cost-benefit calculations that are typical of consequentialist morality. However, consequentialist considerations are unlikely to prevail as long as adhering to a deontological moral code is necessary for remaining loyal to the group amid a conflict. For example, as long as people believe that refusing to get vaccinated defines their racial, political, or religious identity (Stroope et al., 2021), efforts to convince them are unlikely to prove successful. It is no coincidence that appeals in favor of vaccination by Dr Fauci – an independent medical expert – encountered a muted response among Republicans (Bokemper et al., 2021).

Deontological intuitions and collective action against COVID-19

The sobering implication of deontological intuitions about the response to COVID-19 seems that mankind faces a collective action requiring universal engagement, and yet a sizeable minority of humans will simply not cooperate, never mind the costs. However, two solutions stand out to convince defectors to join forces against the invisible enemy.

Appealing to a superordinate identity. Much of the vaccine hesitancy and general non-compliance with Covid measures in societies such as the United States has to do with intergroup conflict within these societies (e.g., racial minorities vs. the government; conservatives vs. liberals; the religious vs. the non-religious). However, people hold multiple identities at the same time that peacefully coexist (Sen, 2007). Thus, appealing to a superordinate identity such as national identity (Gaertner et al., 1999) may induce people to take action to defend the status of their nation (Huddy and Del Ponte, 2019). For example, emphasizing how the United States’ lagging vaccination rates are making it lose its reputation as the most advanced country in the world may motivate unvaccinated nationalists to get inoculated.

Assuaging fears over the safety of vaccines. As new vaccines become available and more data are gathered on existing ones, fears over the safety of vaccines can be gradually assuaged. Deontological reasons advanced for refusing to take the vaccine (for example, religious reasons) may in part be the rationalization of personal fears. Thus, over time, the share of people who are firmly opposed to vaccinations may decrease, leaving only a bedrock of hard-core deontologists to refuse the shot.

How deontological intuitions can be useful amid COVID-19

Deontological intuitions against Covid measures are a major obstacle in the pandemic fight. Yet, they are not entirely pernicious. As I discussed earlier, there is evidence that people have also been holding deontological intuitions in favor of Covid measures. While moralizing these measures helps discipline others to uphold the same high standards, a deontological stance in favor of Covid measures can backfire and lead to catastrophic consequences, too, such as ignoring the cost of human suffering brought by COVID-19 measures (Graso et al., 2021), which is starting to emerge in its dizzying severity (e.g., Miles et al., 2021; Pietrobelli et al., 2020; Rossi et al., 2020). Two years after the beginning of the pandemic, a consensus has been growing that the zero-Covid strategy of lockdowns advocated by many experts (e.g., Scherbina, 2021) and inflexibly practiced in much of East Asia and Australasia (Lau et al., 2020) has carried substantial unintended consequences and, ultimately, proved largely unadvisable going forward (Tambyah, 2021). Even so, and despite the wide availability of vaccines, hard-core lockdowners and Covid-fanatics still advocate new restrictions and generalized lockdowns, treating COVID-19 as a taboo to be avoided at all costs.

In this context, deontological intuitions against Covid measures help rebalance the public conversation and focus the public's attention on vulnerable minorities hit by Covid measures, or the need to rigorously scrutinize the clinical and ethical issues that inevitably emerge in the development of any new drug. Moreover, they raise the scrutiny of measures that undoubtedly infringe on individual freedom, compressing individual rights in favor of a, sometimes ill-defined, public interest (Spadaro, 2020). These contributions are especially valuable as COVID-19 becomes endemic, and some governments may be tempted to keep restrictions indefinitely even without any scientific evidence in their support. Importantly, moral considerations purely based on consequentialist reasoning -the pursuit of the greatest good for the greatest number of people- would not protect vulnerable minorities and basic freedoms against the infringements posed by wartime measures.

Conclusion

If – as it seems – the fight against COVID-19 truly requires universal collective action to succeed in eradicating the virus, endemicity and the failure of collective action seem likely outcomes. Deontological moral intuitions about Covid responses stand in the way of universal vaccination, especially in countries such as the United States where political polarization is rampant (Iyengar et al., 2019). Recall that deontological judgment is insensitive to the welfare consequences for the people involved, since it emphasizes moral obligations apart from their consequences. This means that deontological judgment can pose a threat to public welfare whenever moral prohibitions come into conflict with the common good. The fact that vaccination remains taboo for many in the United States and elsewhere indicates that no amount of death and despair might move them to change their mind.

Amid new, deadly virus variants and a prolonged pandemic, the appeal of vaccine mandates and other enforced restrictions may grow among governments around the world. Faced with the choice to comply or be ineligible to work (or worse), many will likely get vaccinated (Mello et al., 2022). However, governments will have to carefully consider the unintended consequences of alienating a sizeable portion of the electorate (Bardosh et al., 2022), which will see the move as the ultimate infringement of their sacred values (Tetlock, 2003). Over time, acquiescence with the political status quo may settle in (Passarelli and Del Ponte, 2020), and people may just get used to living under increased restrictions, accepting the new policy (similar to the changes in the airline industry after the 9/11 attacks). Yet, even then, balancing the need for widespread cooperation and preserving individual freedom will remain a delicate challenge for democracies.

Irrespective of whether vaccine mandates and other restrictions become widespread, overcoming moral obstinacy about vaccination is a difficult but necessary task that societies should undertake. A better understanding of deontological moral reasoning about COVID-19 measures is an important step to improve cooperation in fighting the pandemic within each society. Since tackling COVID-19 is a matter of collective action, this undertaking is as urgent as ever.

Footnotes

Acknowledgments

I wish to thank the Center for Italian Studies at Stony Brook University as well as Benjamin Carter, Peter DeScioli, Pradeep Krishnan, and Luigi Troiani for helpful feedback on this project.

ORCID iD

Alessandro Del Ponte

References

Adekunle

Meehan

Rojas-Alvarez

, et al. (2020) Delaying the COVID-19 epidemic in Australia: Evaluating the effectiveness of international travel bans. Australian and New Zealand Journal of Public Health 44(4): 257–259.

Allington

McAndrew

Moxham-Hall

, et al. (2021) Media usage predicts intention to be vaccinated against SARS-CoV-2 in the US and the UK. Vaccine 39(18): 2595–2603.

Anthes

Petri

(2021) C.D.C. Director Warns of a ‘Pandemic of the Unvaccinated’ . https://www.nytimes.com/2021/07/16/health/covid-delta-cdc-walensky.html (accessed 7 April 2023).

Baharudin

(2021, May 11) More than 1,100 users have deregistered from TraceTogether: Vivian. The Straits Times. https://www.straitstimes.com/singapore/more-than-1100-users-have-deregistered-from-tracetogether-vivian (accessed 7 April 7 2023).

Bajaj

Khandelwal

Budhwar

(2021) COVID-19 pandemic and the impact of cross-cultural differences on crisis management: A conceptual model of transcultural crisis management. International Journal of Cross Cultural Management 21(3): 569–601.

Bajaj

Stanford

(2021) Beyond Tuskegee—vaccine distrust and everyday racism. New England Journal of Medicine 384(5): e12.

Bardosh

De Figueiredo

Gur-Arie

, et al. (2022) The unintended consequences of COVID-19 vaccine policy: Why mandates, passports and restrictions may cause more harm than good. BMJ Global Health 7(5): e008684.

Barrett

(2003) Global disease eradication. Journal of the European Economic Association 1(2–3): 591–600.

Bentham

(1996[1789]) The collected works of Jeremy Bentham: An introduction to the principles of morals and legislation. Oxford, UK: Clarendon Press.

10.

Bokemper

Huber

Gerber

, et al. (2021) Timing of COVID-19 vaccine approval and endorsement by public figures. Vaccine 39(5): 825–829.

11.

Bol

Giani

Blais

, et al. (2021) The effect of COVID-19 lockdowns on political support: Some good news for democracy? European Journal of Political Research 60(2): 497–505.

12.

Callaghan

Moghtaderi

Lueck

, et al. (2021) Correlates and disparities of intention to vaccinate against COVID-19. Social Science & Medicine 272: 113638.

13.

Camobreco

(2021) The party-line pandemic: A closer look at the partisan response to COVID-19. PS: Political Science & Politics 55(1), 13–21.

14.

Counihan

Van Esterik

(1997) Food and culture. A Reader, New York, NY: Routledge.

15.

Criscuolo

(2020, February 2) Abbraccia un cinese, spopola l’hashtag anti razzismo dopo i primi casi di Coronavirus in Italia . https://www.newsly.it/abbraccia-un-cinese/ (accessed 7 April 2023).

16.

Dehghani

Atran

Iliev

, et al. (2010) Sacred values and conflict over Iran’s nuclear program. Judgment and Decision Making 5(7): 540.

17.

Del Ponte

DeScioli

(2022) Pay your debts: Moral dilemmas of international debt. Political Behavior 44(4): 1657–1680.

18.

Delton

DeScioli

Ryan

(2020) Moral obstinacy in political negotiations. Political Psychology 41(1): 3–20.

19.

DeScioli

Kurzban

(2009) Mysteries of morality. Cognition 112(2): 281–299.

20.

DeScioli

Kurzban

(2013) A solution to the mysteries of morality. Psychological Bulletin 139(2): 477.

21.

Dror

Eisenbach

Taiber

, et al. (2020) Vaccine hesitancy: The next challenge in the fight against COVID-19. European Journal of Epidemiology 35(8): 775–779.

22.

Dyer

(2023) COVID-19: China stops counting cases as models predict a million or more deaths. BMJ 380: 2.

23.

Gaertner

Dovidio

Nier

, et al. (1999) Across cultural divides: The value of a superordinate identity. In Prentice D. and Miller D (eds) Cultural divides: Understanding and overcoming group conflict. New York. Russell Sage Foundation, 173–212.

24.

Gibson

(2022) Government mandated lockdowns do not reduce COVID-19 deaths: Implications for evaluating the stringent New Zealand response. New Zealand Economic Papers 56(1), 17-28.

25.

Ginges

Atran

Medin

, et al. (2007) Sacred bounds on rational resolution of violent political conflict. Proceedings of the National Academy of Sciences 104(18): 7357–7360.

26.

Goldberg

Gustafson

Maibach

, et al. (2020) Mask-wearing increased after a government recommendation: A natural experiment in the US during the COVID-19 pandemic. Frontiers in Communication 5: 44.

27.

Graso

Chen

Reynolds

(2021) Moralization of COVID-19 health response: Asymmetry in tolerance for human costs. Journal of Experimental Social Psychology 93: 104084.

28.

Greene

(2013) Moral Tribes: Emotion, Reason, and the Gap Between Us and Them. New York, NY: Penguin.

29.

Grépin

T-L

Liu

, et al. (2021) Evidence of the effectiveness of travel-related measures during the early phase of the COVID-19 pandemic: A rapid systematic review. BMJ Global Health 6(3): e004537.

30.

Haidt

(2012) The Righteous Mind: Why Good People are Divided by Politics and Religion. New York, NY: Pantheon Books.

31.

Harring

Jagers

Löfgren

(2021) COVID-19: Large-scale collective action, government intervention, and the importance of trust. World Development 138: 105236.

32.

Hernández-Orallo

Manzoni

Calafate

, et al. (2020) Evaluating how smartphone contact tracing technology can reduce the spread of infectious diseases: The case of COVID-19. Ieee Access 8: 99083–99097.

33.

Hinman

(1999) Eradication of vaccine-preventable diseases. Annual Review of Public Health 20(1): 211–229.

34.

Huddy

(2018) The group foundations of democratic political behavior. Critical Review 30(1–2): 71–86.

35.

Huddy

Del Ponte

(2019) National identity, pride, and chauvinism–their origins and consequences for globalization attitudes. In: Gustavsson G and Miller D (eds) Liberal Nationalism and Its Critics. Oxford: Oxford University Press, pp. 38–58.

36.

Iyengar

Lelkes

Levendusky

, et al. (2019) The origins and consequences of affective polarization in the United States. Annual Review of Political Science 22: 129–146.

37.

Jørgensen

Bor

Lindholt

, et al. (2021) Public support for government responses against COVID-19: Assessing levels and predictors in eight western democracies during 2020. West European Politics 44(5-6): 1129–1158.

38.

Kadambari

Vanderslott

(2021) Lessons about COVID-19 vaccine hesitancy among minority ethnic people in the UK. The Lancet Infectious Diseases 21(9): 1204–1206.

39.

Kant

(1797) Kant: The Metaphysics of Morals. Cambridge: Cambridge University Press.

40.

Key J (2021) Half of US adults don’t wear masks when in close contact with non-household members. USC Dornsife. https://dornsife.usc.edu/news/stories/3388/half-of-u-s-adults-dont-wear-masks-when-in-close-contact-with-no/ (accessed 7 April 2023).

41.

Khubchandani

Sharma

Price

, et al. (2021) COVID-19 vaccination hesitancy in the United States: A rapid national assessment. Journal of Community Health 46(2): 270–277.

42.

Kreps

Kriner

(2021) Factors influencing COVID-19 vaccine acceptance across subgroups in the United States: Evidence from a conjoint experiment. Vaccine 39(24), 3250–3258.

43.

Lau

Khosrawipour

Kocbach

, et al. (2020) The positive impact of lockdown in Wuhan on containing the COVID-19 outbreak in China. Journal of Travel Medicine 27(3): 1–7.

44.

Lear

Cantarella

(2009) Images of Ancient Greek Pederasty: Boys were their gods. New York: Routledge.

45.

Leung

Liu

, et al. (2020) First-wave COVID-19 transmissibility and severity in China outside hubei after control measures, and second-wave scenario planning: A modelling impact assessment. The Lancet 395(10233): 1382–1393.

46.

Lindsley

Beezhold

Coyle

, et al. (2021) Efficacy of universal masking for source control and personal protection from simulated cough and exhaled aerosols in a room. Journal of Occupational and Environmental Hygiene 18(8): 409–422.

47.

Machingaidze

Wiysonge

(2021) Understanding COVID-19 vaccine hesitancy. Nature Medicine 27(8): 1338–1339.

48.

Mahase

(2020) COVID-19: Pfizer and BioNTech submit vaccine for US authorisation . BMJ 371: m4552.

49.

Maher

MacCarron

Quayle

(2020) Mapping public health responses with attitude networks: The emergence of opinion-based groups in the UK’s early COVID-19 response phase. British Journal of Social Psychology 59(3): 641–652.

50.

Mason

Wronski

(2018) One tribe to bind them all: How our social group attachments strengthen partisanship. Political Psychology 39: 257–277.

51.

Mello

Opel

Benjamin

, et al. (2022) Effectiveness of vaccination mandates in improving uptake of COVID-19 vaccines in the USA. The Lancet 400(10351): 535–538.

52.

Mikhail

(2007) Universal moral grammar: Theory, evidence and the future. Trends in Cognitive Sciences 11(4): 143–152.

53.

Miles

Stedman

Heald

(2021) Stay at home, protect the national health service, save lives”: A cost benefit analysis of the lockdown in the United Kingdom. International Journal of Clinical Practice 75(3): e13674.

54.

Miller

(2021, November 26) Flashback: Biden suggested Trump’s coronavirus travel ban was “xenophobic.” Fox News. https://www.foxnews.com/politics/flashback-biden-suggested-trumps-coronavirus-travel-ban-xenophobic.amp (accessed 7 April 2023).

55.

Murphy

Vallières

Bentall

, et al. (2021) Psychological characteristics associated with COVID-19 vaccine hesitancy and resistance in Ireland and the United Kingdom. Nature Communications 12(1): 1–15.

56.

Passarelli

Del Ponte

(2020) Prospect theory, loss aversion, and political behavior. In: Oxford Research Encyclopedia of Politics. Oxford: Oxford University Press. https://doi.org/10.1093/acrefore/9780190228637.013.947

57.

Pietrobelli

Pecoraro

Ferruzzi

, et al. (2020) Effects of COVID-19 lockdown on lifestyle behaviors in children with obesity living in Verona, Italy: A longitudinal study. Obesity 28(8): 1382–1385.

58.

Prosser

Judge

Bolderdijk

, et al. (2020) Distancers’ and ‘non-distancers’? The potential social psychological impact of moralizing COVID-19 mitigating practices on sustained behaviour change. British Journal of Social Psychology 59(3): 653–662.

59.

Redlawsk

Civettini

Emmerson

(2010) The affective tipping point: Do motivated reasoners ever “get it”? Political Psychology 31(4): 563–593.

60.

Romer

Jamieson

(2020) Conspiracy theories as barriers to controlling the spread of COVID-19 in the US. Social Science & Medicine 263: 113356.

61.

Roser

Ritchie

Ortiz-Ospina

, et al. (2020) Coronavirus pandemic (COVID-19). Our World in Data. https://ourworldindata.org/coronavirus (accessed 7 April 2023).

62.

Rossi

Socci

Talevi

, et al. (2020) COVID-19 pandemic and lockdown measures impact on mental health among the general population in Italy. Frontiers in Psychiatry 11: 790.

63.

Ruiz

Bell

(2021) Predictors of intention to vaccinate against COVID-19: Results of a nationwide survey. Vaccine 39(7): 1080–1086.

64.

Ryan

(2014) Reconsidering moral issues in politics. The Journal of Politics 76(2): 380–397.

65.

Ryan

(2017) No compromise: Political consequences of moralized attitudes. American Journal of Political Science 61(2): 409–423.

66.

Ryan

(2019) Actions versus consequences in political arguments: Insights from moral psychology. The Journal of Politics 81(2): 426–440.

67.

Scherbina

(2021) Assessing the optimality of a COVID lockdown in the United States. Economics of Disasters and Climate Change 5(2): 177–201.

68.

Sen

(2007) Identity and Violence: The Illusion of Destiny. New Delhi: Penguin Books India.

69.

Skitka

Bauman

(2008) Moral conviction and political engagement. Political Psychology 29(1): 29–54.

70.

Smith

(2021, August 22) Trump booed at Alabama rally after telling supporters to get vaccinated . https://www.nbcnews.com/politics/donald-trump/trump-booed-alabama-rally-after-telling-supporters-get-vaccinated-n1277404 (accessed 7 April 2023).

71.

Spadaro

(2020) COVID-19: Testing the limits of human rights. European Journal of Risk Regulation 11(2): 317–325.

72.

Stroope

Kroeger

Williams

, et al. (2021) Sociodemographic correlates of vaccine hesitancy in the United States and the mediating role of beliefs about governmental conspiracies. Social Science Quarterly 102(6), 2472–2481.

73.

Subramanian

Kumar

(2021) Increases in COVID-19 are unrelated to levels of vaccination across 68 countries and 2947 counties in the United States. European Journal of Epidemiology: 36(12), 1237-1240.

74.

Tambyah

(2021) Strategies to flatten the curve: Current evidence and practical pitfalls. International Journal of Antimicrobial Agents 58: 21002260.

75.

Tetlock

(2003) Thinking the unthinkable: Sacred values and taboo cognitions. Trends in Cognitive Sciences 7(7): 320–324.

76.

Troiano

Nardi

(2021) Vaccine hesitancy in the era of COVID-19. Public Health. 194, 245–251.

77.

Wang

Gao

Wang

, et al. (2020) Epidemiology of 2019 novel coronavirus in Jiangsu province, China after wartime control measures: A population-level retrospective study. Travel Medicine and Infectious Disease 35: 101654.

78.

Warren

Forrow

Hodge Sr

, et al. (2020) Trustworthiness before trust—COVID-19 vaccine trials and the black community. New England Journal of Medicine 383(22): e121.

79.

Willis

Andersen

Bryant-Moore

, et al. (2021) COVID-19 vaccine hesitancy: Race/ethnicity, trust, and fear. Clinical and Translational Science 14(6): 2200–2207.

80.

Yeung

Fong

, et al. (2020) Assessment of proficiency of N95 mask donning among the general public in Singapore. JAMA Network Open 3(5): e209670–e209670.

81.

Zeitzen

(2008) Polygamy: A Cross-Cultural Analysis. Oxford: Berg.