Governments try shame to boost vaccine use. Does it work?

When French President Emmanuel Macron said last week that his pandemic policy was intentionally to “piss off” the unvaccinated – a small minority of the population whose “civic-mindedness” he also called into question – he knew he was on safe political ground. A wide majority of French voters are also frustrated by those who refuse the COVID-19 vaccine.

But if his goal was to shame those holdouts into rolling up their sleeves, it backfired with René-Charles Fleurisson, who instead went to a demonstration over the weekend demanding that Mr. Macron should be “everybody’s president.”

“It’s either we accept or we refuse, and if we refuse, we’re made to feel outside society,” says Mr. Fleurisson, braving wind and a cold winter drizzle in central Paris. The protest was one of dozens held in France Saturday that drew 100,000 people angry at what they call the increasing harassment of unvaccinated people.

At this point in the pandemic, a sense of global disappointment and uncertainty seems pervasive as COVID-19 case numbers skyrocket – despite the high vaccination rates in many parts of the globe that most national leaders see as essential. Some jurisdictions find themselves back in lockdown as hospitals are once again overburdened.

Where incentives and tighter restrictions have failed to convince everybody to get vaccinated, some leaders and their citizens are funneling their frustration into public blaming. But if shaming can sometimes be a motivating tool, it can also backfire by entrenching people into their own camps – especially at a time when social cohesion is as fragile as it currently appears in many countries.

“When you tell people what to do and you tell them they should feel bad for not doing it because it’s hurting the team, one reaction people sometimes have is, ‘well, I’m not on that team,’” says Gregory Huber, a political science professor at Yale University who co-wrote a report studying the types of messages that influence vaccine takeup.

“They might say, ‘I don’t feel shame. In fact, I feel alienated.’”

Mr. Macron is not alone in employing centuries-old control measures to keep individuals accountable to the larger group. Canadian Prime Minister Justin Trudeau, in a French-language interview during last year’s election campaign that resurfaced last month, called some unvaccinated people “misogynists” and “racists” and wondered aloud whether the country “should tolerate these people.”

British Prime Minister Boris Johnson recently lashed out at people opposed or hesitant about the vaccine spouting “mumbo jumbo” across social media. 

Whether this constitutes shaming – and whether it’s fair given the stakes – is a matter of heated debate. What’s clear is that leaders are taking little risk by publicly dissing unvaccinated people, since they are largely reflecting the dominant mood across social media, in the press, and among the general public.

A Toronto Star editorial this week called for Canadian provincial governments to come down harder on unvaccinated people, arguing that “it is their irresponsibility that is largely to blame for the restraints under which Canadians are currently required to live” and calling out their “demonstrably anti-social behaviour.” 

When Quebec’s premier, Francois Legault, proposed Tuesday that adults who are unvaccinated by choice should pay an extra tax to cover their potential health care costs, approval of the controversial idea spread like a brushfire on social media.

Shaming cuts both ways. Reports abound of moral posturing, of incidents when children have been humiliated because their parents have not allowed them to be vaccinated, of people ridiculed for voicing reservations about vaccine efficacy or safety as the pandemic morphs. In the United States, others cite the questioning of those with sincerely held religious objections. There are also many reports of unvaccinated demonstrators trying to shame or bully vaccinated people – by holding rallies outside hospitals, sending doctors death threats, or stalking the homes of politicians.

It is these fractures in society that may be showing us new limits of shame.

In many places, frustration has coincided with stronger control measures: People need a vaccine passport to participate in public life in Canada and much of Europe. Italy has made vaccination compulsory for people over age 50; and in the Philippines, Rodrigo Duterte has threatened unvaccinated people caught outside their homes with arrest. 

Widening the requirements for vaccination certificates does appear to have increased vaccination rates in some instances, and shame can also work to a degree, says Harris Ali, a sociologist at York University in Canada.

Shaming people into not drinking and driving, or into giving up smoking, has changed norms over time, he says. In the case of a pandemic, where neighbors’ actions may affect others’ well-being, “many would agree the end justifies the means,” he says. In Ontario, where Mr. Ali lives, schools have closed so as to reduce the pressure on hospital intensive care units, which are disproportionately burdened with unvaccinated COVID-19 patients.

In France, Kevin Arceneaux, an expert in political psychology at the CEVIPOF research institute in Paris, says politicians have long used shame to enforce norms. 

“Shame can work in instances where people feel that negative social judgment about them does have an effect on them psychologically. Plenty of people have joined the army and fought in wars they didn’t want to in order to avoid shame,” he says. “I’m sure many people in France have gotten vaccinated because they don’t want others around them to judge them negatively.”

But in today’s siloed society, shame is a far less effective tool, it seems.

Dr. Huber’s study found that shame could only be a successful way of persuading people to get vaccinated when the subjects were embarrassed or judged by family or friends.

Leaders have a harder time invoking the “us” in nationhood now. “In the United States people say ‘don’t tell me what to do in terms of a vaccine. That’s not what it means to be an American,’” Dr. Huber says. “It’s a little different than Winston Churchill standing up during the Blitz and saying, ‘Look, we’re all in this together and we’re working against a common enemy.’ People don’t feel an allegiance to that larger whole,” which is “really what makes shame work,” he adds.

Giovanni Travaglino, who teaches at the University of London, studied shame in three countries ranging from least to most individualistic: South Korea, Italy, and the United States. He says he was surprised to find that shame had equally little effect as a motivator in pandemic behavior across all the countries.

“What instead seemed to be more effective in getting people to comply with government recommendations was this idea that we are all in it together,” he says, “that we should take care of the people around us instead of creating an ‘us versus them.’”

David Colon, author of a book about political propaganda, says earlier French leaders would not have used the divisive language Mr. Macron chose, instead seeing themselves as “the presidents of all French people.” But governments have often scapegoated striking workers, accusing them of holding the country hostage.

“The point is to discredit the adversary,” says Mr. Colon. Once “it was the unions. Now it’s the unvaccinated who are presented as adversaries of society. The government is basically saying they’re not citizens, which is very harsh. It’s a way to unite as many people as possible” around the president.

Vaccine skeptics are not convinced. “This way of shaming people is dangerous because it makes it seem like the government wants us to disappear,” says Nadia, an English teacher at the weekend demonstration in Paris who asked to remain anonymous for fear of reprisals at work. “We’ve seen this with yellow vest protesters, the unemployed, impoverished people. It’s part of Macron’s strategy to avoid addressing the larger issues our country is facing.” 

Rather than ridicule vaccine skeptics, governments hoping to change their minds would do better to try quiet persuasion, argues Stephanie McClure, who leads the Tuscaloosa, Alabama, team for CommuniVax, a national coalition advocating health equality for historically underserved minority communities. She says that her work in the health field suggests that shaming rarely produces long-term behavioral change.

She recalls one woman in her late 30s, a veteran who works in auto manufacturing. Last spring, she – like many of her peers – was adamant that she would not get vaccinated. But she was asked to keep a diary in which she recorded all the messaging on COVID-19 vaccinations that she received.

After talking with her employer and her health care provider, she changed her mind in the summer, having digested information she recorded as “life-changing.” 

“It is about engaging in respectful dialogue” over time, says Dr. McClure. “Not a lecture, not ‘I’m going to convert you.’” But rather, “‘let’s talk about what your concerns are.’”

Dominique Soguel contributed to this article.