When taking action means accepting responsibility: Omission bias predicts parents' reluctance to vaccinate due to greater anticipated culpability for negative side effects

• Published date: 01 December 2021
• Author: Gary D. Sherman,Beth Vallen,Stacey R. Finkelstein,Paul M. Connell,Wendy Attaya Boland,Kristen Feemster
• Date: 01 December 2021
• DOI: http://doi.org/10.1111/joca.12401

RESEARCH ARTICLE

When taking action means accepting

responsibility: Omission bias predicts parents'

reluctance to vaccinate due to greater

anticipated culpability for negative side effects

Gary D. Sherman

1

| Beth Vallen

2

| Stacey R. Finkelstein

1

|

Paul M. Connell

1

| Wendy Attaya Boland

3

| Kristen Feemster

4,5

1

The College of Business, Stony Brook

University, Stony Brook, New York, USA

2

Villanova Business School, Villanova

University, Villanova, Pennsylvania, USA

3

The Kogod School of Business,

American University, Washington,

District of Columbia, USA

4

Division of Infectious Diseases,

Perelman School of Medicine at the

University of Pennsylvania, Philadelphia,

Pennsylvania, USA

5

Vaccine Education Center, The

Children's Hospital of Philadelphia,

Philadelphia, Pennsylvania, USA

Correspondence

Wendy Attaya Boland, Department of

Marketing at the Kogod School of

Business, American University,

Washington, DC 20016, USA.

Email: boland@american.edu

Abstract

Omission bias is the tendency to consider harm from

inaction preferable to equivalent harm from action. In

this work, we explored how individual differences in

omission bias shape parental vaccine-related decisions.

Parents with a stronger omission bias showed greater

negative emotional response to physician vaccine pol-

icy, placed lower trust in medical providers, and

assigned a lower priority on vaccination. We observed

this pattern of results even among parents who priori-

tize vaccination. Heightened anticipation of moral cul-

pability for action (e.g., a child experiences vaccine side

effects) and a diminished anticipation of moral culpa-

bility for possible harms of not acting (e.g., a child con-

tracts a vaccine-preventable disease) accounted for the

effects we observed. These results suggest that parents'

reluctance to vaccinate their children stems—in part—

from the heightened perceived moral culpability that

comes with taking action (versus not taking action).

KEYWORDS

culpability, omission bias, vaccination

Received: 30 July 2020 Revised: 1 July 2021 Accepted: 7 July 2021

DOI: 10.1111/joca.12401

© 2021 American Council on Consumer Interests.

1660 J Consum Aff. 2021;55:1660–1681.wileyonlinelibrary.com/journal/joca

1|INTRODUCTION

Though children have been vaccinated against diseases that impact life and livelihood for cen-

turies, the conversation surrounding vaccine prioritization is as relevant today as it was in the

late 1700s when the basic tenets of inoculation were developed in response to the smallpox

virus. Although the science behind vaccines has evolved significantly—from building immunity

by injecting material from one person's cowpox sore into an uninfected person to modern tech-

nologies such as mRNA used in some COVID-19 vaccines—the decision is still complex for

many parents. Indeed, parents might experience conflicting thoughts, emotions, and percep-

tions of culpability for perceived negative outcomes related to vaccinating or not vaccinating.

These psychological experiences have the potential to shape judgments about healthcare pro-

viders and the service experience.

In this research, we explored how one such bias—omission bias—impacts parental

responses to physician vaccination policy. Omission bias is the tendency to prefer harm from

inaction (e.g., deciding to not vaccinate and therefore not acting) over equivalent harm

from action (e.g., choosing to vaccinate and therefore acting via pursuing vaccination; Baron &

Ritov, 1994). That is, if something negative is going to happen, a person who shows the omis-

sion bias would prefer that it occur as a result of doing nothing (i.e., an error of omission) as

opposed to doing something (i.e., an error of commission). Omission bias can lead individuals

to avoid behaviors with potential negative outcomes even when inaction carries equivalent or

greater risk.

While prior research has shown that the preference for inaction that characterizes omission

bias is present in individuals who delay or refuse vaccinations (Asch et al., 1994; Connolly &

Reb, 2003; Ritov & Baron, 1990), the process by which omission bias drives decisions to delay

or refuse vaccines is less clear. We extend work in this important area by exploring whether

moral psychology—namely, anticipated culpability for potential harm—helps explain why indi-

viduals prone to omission bias might be hesitant to vaccinate their children despite recognizing

the value of vaccines. In doing so, we shed light on a mechanism underlying negative responses

to preventative healthcare in the context of vaccination.

Additionally, our work sheds light on the manner in which anticipated culpability for harm

due to vaccinating drives negative responses to physician vaccine policy, which in turn results

in (a) reduced provider trust, (b) decreased general trust in doctors, and (c) diminished vaccina-

tion priority. Importantly, our results hold even for parents who report prioritizing vaccination,

suggesting that omission bias and associated anticipated culpability for action may be a driver

of vaccine hesitancy—defined here as the refusal or delay of vaccines when vaccine services are

available—and not merely a bias exhibited by parents with strong anti-vaccination sentiments.

Vaccine priority is an important outcome: 87% of pediatricians noted encountering parents who

questioned vaccinating on schedule and such hesitancy is implicated in the spread of vaccine-

preventable disease (Dubé et al., 2013; Hough-Telford et al., 2016; Kennedy et al., 2011).

In addition, our findings have implications for policymakers, public health advocates, health

care providers, patients, and others that seek to benefit the interests of consumers in the mar-

ketplace. As policymakers grapple with understanding the roots of vaccine hesitancy and offer-

ing public health solutions, it is important to not only consider intuitive or obvious drivers of

hesitancy (such as the consumption of misinformation distributed via social media or other

means), but also psychological drivers of hesitancy that can profoundly impact vaccine accep-

tance. Consistent with previous research, our findings support the idea that vaccine hesitancy is

complex and is influenced by many factors. Thus, a one-size-fits-all policy is likely to have a

SHERMAN ET AL.1661