Journal of Behavioral Medicine

, Volume 42, Issue 3, pp 381–391 | Cite as

The willingness to vaccinate increases when vaccination protects others who have low responsibility for not being vaccinated

  • Robert BöhmEmail author
  • Nicolas W. Meier
  • Marina Groß
  • Lars Korn
  • Cornelia Betsch


Vaccination provides direct protection for the vaccinating individual and indirect protection for other, unvaccinated individuals via herd immunity. Still, some people do not get vaccinated—either because they cannot (e.g., due to health conditions) or they don’t want to (e.g., due to vaccine hesitancy). We investigate whether non-vaccinators’ level of responsibility for not being vaccinated affects individuals’ motivation to vaccinate and, thus, to indirectly protect non-vaccinators. In Study 1 (N = 101), the intention to vaccinate increased (Cohen’s d = 0.99) when non-vaccinators were described as willing but unable to get vaccinated (low responsibility) compared to when they were able but unwilling to get vaccinated (high responsibility). Study 2 (N = 297) replicated this finding with regard to vaccination behavior in an interactive vaccination (I-Vax) game (OR = 2.38). Additionally, knowing about non-vaccinators’ low responsibility also increased the willingness to vaccinate compared to when there was no information on non-vaccinators’ level of responsibility. Amplified levels of social welfare concerns in the case of non-vaccinators’ low responsibility mediated the latter effect. This finding informs effective communication strategies for improving the vaccination rates.


Vaccination Prosociality Attribution theory Herd immunity 



This work was supported by the German Research Foundation (DFG) under Grants BO 4466/2-1 to RB and BE 3970/8-1 to CB.

Compliance with ethical standards

Conflict of interest

Robert Böhm, Nicolas W. Meier, Marina Groß, Lars Korn, and Cornelia Betsch declare that they have no conflicts of interest.

Human and animal rights and Informed consent

All procedures performed in studies involving human participants were in accordance with the ethical standards of the German Psychological Association (Deutsche Gesellschaft für Psychologie) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all patients for being included in the study.


  1. Ajzen, I. (2002). Perceived behavioral control, self-efficacy, locus of control, and the theory of planned behavior. Journal of Applied Social Psychology, 32, 665–683.CrossRefGoogle Scholar
  2. Askelson, N. M., Campo, S., Lowe, J. B., Smith, S., Dennis, L. K., & Andsager, J. (2010). Using the theory of planned behavior to predict mothers’ intentions to vaccinate their daughters against HPV. Journal of School Nursing, 26, 194–202.CrossRefGoogle Scholar
  3. Balliet, D., Mulder, L. B., & Van Lange, P. A. M. (2011). Reward, punishment, and cooperation: A meta-analysis. Psychological Bulletin, 137, 594–615.CrossRefGoogle Scholar
  4. Bauch, C. T., & Earn, D. J. D. (2004). Vaccination and the theory of games. Proceedings of the National Academy of Sciences of the United States of America, 101, 13391–13394.CrossRefGoogle Scholar
  5. Betsch, C., & Böhm, R. (2016). Detrimental effects of introducing partial compulsory vaccination: Experimental evidence. European Journal of Public Health, 26, 378–381.CrossRefGoogle Scholar
  6. Betsch, C., Böhm, R., & Chapman, G. B. (2015). Using behavioral insights to increase vaccination policy effectiveness. Policy Insights from the Behavioral and Brain Sciences, 2, 61–73.CrossRefGoogle Scholar
  7. Betsch, C., Böhm, R., & Korn, L. (2013). Inviting free-riders or appealing to prosocial behavior? Game-theoretical reflections on communicating herd immunity in vaccine advocacy. Health Psychology, 32, 978–985.CrossRefGoogle Scholar
  8. Betsch, C., Böhm, R., Korn, L., & Holtmann, C. (2017). On the benefits of explaining herd immunity in vaccine advocacy. Nature Human Behaviour, 1, 0056.CrossRefGoogle Scholar
  9. Betsch, C., Schmid, P., Heinemeier, D. K., Korn, L., Holtmann, C., & Böhm, R. (2018). Beyond confidence: Development of a measure assessing the 5C psychological antecedents of vaccination.
  10. Böhm, R., Betsch, C., & Korn, L. (2016a). Selfish-rational non-vaccination: Experimental evidence from an interactive vaccination game. Journal of Economic Behavior & Organization, 131, 183–195.CrossRefGoogle Scholar
  11. Böhm, R., Betsch, C., Korn, L., & Holtmann, C. (2016b). Exploring and promoting prosocial vaccination: A cross-cultural experiment on vaccination of health care personnel. BioMed Research International, 2016, 6870984.CrossRefGoogle Scholar
  12. Böhm, R., Meier, N. W., Korn, L., & Betsch, C. (2017). Behavioural consequences of vaccination recommendations: An experimental analysis. Health Economics, 26, 66–75.CrossRefGoogle Scholar
  13. Breman, J. G., & Arita, I. (1980). The confirmation and maintenance of smallpox eradication. New England Journal of Medicine, 303, 1263–1273.CrossRefGoogle Scholar
  14. Centers for Disease Control and Prevention (CDC). (2017). Why get a flu vaccine? Retrieved from,
  15. Cohen, J. (1988). Statistical power analysis for the behavioral sciences. Hillsdale, NJ: L. Erlbaum Associates.Google Scholar
  16. Crandall, C., & Biernat, M. (1990). The ideology of anti-fat attitudes. Journal of Applied Social Psychology, 20, 227–243.CrossRefGoogle Scholar
  17. European Centre for Disease Prevention and Control (ECDC). (2015). Immunisation. Information for parents and caregivers. What is community immunity and why is it important? Retrieved from,
  18. Fehr, E., & Gächter, S. (2002). Altruistic punishment in humans. Nature, 415, 137–140.CrossRefGoogle Scholar
  19. Fine, P., Eames, K., & Heymann, D. L. (2011). “Herd immunity”: A rough guide. Clinical Infectious Diseases, 52, 911–916.CrossRefGoogle Scholar
  20. Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York City, NY: Guilford Press.Google Scholar
  21. Li, M., Taylor, E. G., Atkins, K. E., Chapman, G. B., & Galvani, A. P. (2016). Stimulating influenza vaccination via prosocial motives. PLoS ONE, 11, e0159780.CrossRefGoogle Scholar
  22. MacDonald, N. E., & SAGE Working Group on Vaccine Hesitancy. (2015). Vaccine hesitancy: Definition, scope and determinants. Vaccine, 33, 4161–4164.CrossRefGoogle Scholar
  23. Murphy, R. O., Ackermann, K. A., & Handgraaf, M. J. J. (2011). Measuring social value orientation. Judgment and Decision Making, 6, 771–781.Google Scholar
  24. Omer, S. B., Richards, J. L., Ward, M., & Bednarczyk, R. A. (2012). Vaccination policies and rates of exemption from immunization, 2005–2011. New England Journal of Medicine, 367, 1170–1171.CrossRefGoogle Scholar
  25. Oppenheimer, D. M., Meyvis, T., & Davidenko, N. (2009). Instructional manipulation checks: Detecting satisfying to increase statistical power. Journal of Experimental Social Psychology, 45, 867–872.CrossRefGoogle Scholar
  26. Peer, E., Brandimarte, L., Samat, S., & Acquisti, A. (2017). Beyond the turk: Alternative platforms for crowdsourcing behavioral research. Journal of Experimental Social Psychology, 70, 153–163.CrossRefGoogle Scholar
  27. Rodin, M., Price, J., Sanchez, F., & McElligot, S. (1989). Derogation, exclusion, and unfair treatment of persons with social flaws. Personality and Social Psychology Bulletin, 15, 439–451.CrossRefGoogle Scholar
  28. Rubin, L. G., Levin, M. J., Ljungman, P., Davies, E. G., Avery, R., Tomblyn, M., et al. (2014). 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clinical Infectious Diseases, 58, e44–e100.CrossRefGoogle Scholar
  29. Sigmund, K., Hauert, C., & Nowak, M. A. (2001). Reward and punishment. Proceedings of the National Academy of Sciences of the United States of America, 98, 10757–10762.CrossRefGoogle Scholar
  30. Stadlin, S., Bednarczyk, R. A., & Omer, S. B. (2012). Medical exemptions to school immunization requirements in the United States—Association of state policies with medical exemption rates (2004–2011). The Journal of Infectious Diseases, 206, 989–992.CrossRefGoogle Scholar
  31. Vietri, J. T., Li, M., Galvani, A. P., & Chapman, G. B. (2012). Vaccinating to help ourselves and others. Medical Decision Making, 32, 447–458.CrossRefGoogle Scholar
  32. Weiner, B. (1986). An attributional theory of motivation and emotion. New York, NY: Springer.CrossRefGoogle Scholar
  33. Weiner, B. (1993). On sin versus sickness: A theory of perceived responsibility and social motivation. American Psychologist, 48, 957–965.CrossRefGoogle Scholar
  34. Weiner, B., & Kukla, A. (1970). An attributional analysis of achievement motivation. Journal of Personality and Social Psychology, 15, 1–20.CrossRefGoogle Scholar
  35. Weiner, B., Perry, R. P., & Magnusson, J. (1988). An attribution analysis of reactions to stigmas. Journal of Personality and Social Psychology, 55, 738–748.CrossRefGoogle Scholar
  36. WHO. (2017). Childhood immunization. The safest start to life. Retrieved October 29, 2018, from

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.School of Business and EconomicsRWTH Aachen UniversityAachenGermany
  2. 2.Media and Communication ScienceUniversity of ErfurtErfurtGermany
  3. 3.Center for Empirical Research in Economics and Behavioral SciencesUniversity of ErfurtErfurtGermany

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