Social cohesion predicts COVID-19 vaccination intentions and uptake

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How does social cohesion influence COVID-19 vaccination behavior?

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How does social cohesion influence COVID-19 vaccination behavior?

Image courtesy of interviewee. March 28, 2025

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Actually, if I can go even broader, I think the question

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that is pertinent to ask looking into the future is

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how do we increase vaccination uptake during any pandemic?

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Whenever the next one comes, how can we be ready for it?

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And the way I like to think about vaccination uptake is,

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in two ways, right?

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So the first one is that it's an individual behavior

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that I do because I wanna protect myself.

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So if I take the vaccine, I am less likely to get sick.

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Or if I get sick, it's gonna be much milder.

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So I'm really trying to protect myself.

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My motivation is individual.

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And then the other way to think about this is,

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about vaccination, is

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that even though it is an individual behavior,

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I am motivated because I wanna protect my group.

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I wanna protect those that are around me.

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I wanna protect those that are important to me.

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And so here we are,

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even though it is an individual behavior, it has

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what we call group motives or collective motives.

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And it also has collective consequences

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because we know that when a high proportion

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of the population takes the vaccine, that means

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that everyone is much more protected, right?

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So this is what we call a herd immunity.

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So what's interesting here is

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that we're shifting the question

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because we're no longer asking what makes

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individuals more likely to be motivated to take a vaccine,

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or rather asking what kind of groups

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motivate people to take the vaccine.

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How can we make groups?

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How can we create societies in which people are more likely

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to take that vaccine?

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And this is where social cohesion came in,

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and social cohesion can be thought of as the glue

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that connects people in the same group together.

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So this glue has two key ingredients.

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The first one is, the quality

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of the relationships in that group.

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So if I trust people in that group,

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if I like people in that group.

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And then the other one is the extent to which

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that group is important to me, to how I think about myself.

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And when we put these two ingredients together,

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we get social cohesion.

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And what my, my collaborators

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and I wanted to, see more about to, to understand

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was how social cohesion was gonna predict vaccinations,

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intentions and uptake, during the Covid pandemic.

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So what we did is that we conducted two studies.

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The first one, we had a representative sample

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of Australians, and they answered our questionnaire twice.

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So the first time was in March, 2020,

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so May, sorry, 2020.

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And this was basically,

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if you can put yourself back in Covid when it was all

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happening, you know, early 2020, that's when there was a lot

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of lockdowns and everything was happening.

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So we asked people,

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how cohesive do you perceive Australia to be?

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Do you feel like Australians are a cohesive group

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or are they breaking apart?

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And then four months later, in October, September, October,

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we ask them, how willing are you take?

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Are you, how willing are you

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to take the vaccine whenever it is available?

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And what we found in this first study is

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that those initial levels of social cohesion

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predicted greater intentions to take the COVID-19 vaccine

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four months later.

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What we did in a second study is

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that we asked people in 2022 to tell us their, what their,

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how, how cohesive they felt Australia to be.

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And then we also looked at

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how many vaccines they had taken at that point.

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So how many COVID-19 jab they've taken.

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And we found that people

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who had stronger social cohesion were more likely

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to have a greater uptake of COVID-19 vaccines.

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Uh, and, and this was the case when you could have up

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to four vaccines.

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Uh, and what's really important here to consider is

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that social cohesion predicted vaccination intention

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and vaccination uptake.

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Above and beyond many of these classic

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important demographic variables like age

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and sex, it went beyond things like COVID-19 anxiety

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and even beyond certain psychological concepts like social

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dominance orientation, for example, I briefly mentioned

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that there's two ingredients to the glue of social cohesion.

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Um, so it's the quality of the social relationships

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that exist within the group.

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And the other one is how important

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or how self relevant the group is to you.

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And there's multiple ways of measuring this,

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but we focused on three well supported dimensions.

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The first one is the positive social relationships

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that existed within the community.

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So we asked people how, how,

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how much do you trust fellow Australians?

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How positive are the relationships

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with these fellow Australians?

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So that's the first one. The second one is social

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identification, which is the extent to which

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I think my group, this group is important for

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how I see myself, how I behave.

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And then the third one is trust

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or confidence in government as the institutions that are,

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legitimizing and enforcing the decisions of that group.

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So that was our, three prone approach

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to social cohesion.

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And they, together, they capture both the quantity,

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the quality of social relationships, as well as,

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how important the group is to the self.

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And as for how to measure this in diverse populations,

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when we are asking the questions of, diversity per se,

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the first thing to note is that to, to ask these questions,

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you need to have a working relationship

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with these different populations.

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If you don't have a working relationship,

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if there's no trust,

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then they're not gonna answer the questions truthfully.

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So the first thing to establish is trust.

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And then, the, the way to measure it would be in terms

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of using questionnaires or surveys.

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You can also use interviews.

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Uh, I would caution against anything

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that would be deemed objective measures of social cohesion,

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because we're talking here about the quality of relations

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and how important the group is to the self.

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And we can only answer that subjectively.

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Uh, there might be objective proxies,

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but they don't really get to what we are really thinking

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of in terms of social cohesion.

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One of the things that I was talking about is

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that vaccination can be seen as,

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there's two motives, right?

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There's the individual motives

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and individual factors that come in

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to predict vaccination intentions.

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And then there's also the,

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the collective ones, the group ones.

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So what makes us more likely to get vaccinated?

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And I think that any, any good,

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vaccination program is gonna take into account both

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of these take into account that, you know,

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we are complex beings, we have individual

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and collective motives.

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There's two things though that I would like to point out.

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Uh, the first one is

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that when we conducted our research in these two studies,

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we controlled for a bunch of demographic variables.

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We controlled for health related variables.

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We controlled even for some individual differences in there.

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And what we found was that first social cohesion emerged

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above all the other demographic variables.

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So it was a significant,

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a consistently significant predictor

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above and beyond everything else.

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And second, that the other individual differences

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either were non-significant,

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or if they were significant, they weren't necessarily

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as important of social cohesion.

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So what this tells me is that if I need

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to put my money somewhere, either in social cohesion

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or on other individual variables,

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my money would be better spent on strengthening social

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cohesion and making sure that's well set up.

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And then if need be,

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I would move towards the individual factors.

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So that would be my way of thinking about it.

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And the other thing to notice

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that when the demographic variables are significant in this

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relationship, when, for example, we know that age is an,

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was a very important predictor of vaccination uptake.

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It's not because people have a specific age,

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Is because it's an entire social

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and group context behind it.

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We were telling older people that they were at risk

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and we're telling younger people to stop being so risky

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and to stop being so irresponsible.

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So even though it's a simple demographic characteristic,

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it actually has a lot of group processes and potential.

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So social cohesion implications

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behind these demographic variable.

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So the first strategy that every policy maker

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and every government should be aware

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of is assessing social cohesion.

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Like you need to know how your population is cohesive,

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how cohesive it is, and how much you need to put effort

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and work into it to strengthen that cohesion.

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If you do not know what your baseline level is,

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then you don't know what resources are available when

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another crisis concept.

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So the first strategy that's really important is assessment.

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And then afterwards you can make a decision.

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So if you find that the community has actually low social

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cohesion, you need to start building that up right away.

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And we saw that in the first study, right?

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We saw that in that first study, that

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social cohesion at time,

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one predicted vaccination intention

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intentions later in time.

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So that means that that resource that you build

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and that you have early in a pandemic

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can actually have very important protective factors.

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Protective, yeah, can be protective

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to the community later on.

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So you wanna make sure it's strong to begin with.

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If you find that in your community, you need

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to work on social cohesion,

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that means social cohesions just is not just a matter

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of getting people together, it's a matter

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of public health policy.

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It's a prevention and it's a protection for future events.

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If in fact, you find

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that social cohesion is actually strong in your community

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and you can actually leverage it in times of crisis,

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there's a few things that you can do.

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The first thing is work with local members,

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local leaders of the community.

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And this, they don't necessarily need to be,

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elected there.

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There's leaders in all kinds of areas,

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and there's leaders in all kinds of different,

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places.

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You don't have to be elected to be a leader.

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So make sure you recognize

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and you strengthen community leaders.

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And then make sure that in your offering, your,

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you are telling and you're showing that community

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that they matter, that they're important.

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And of course, make sure that you're employing any kind

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of policy, any kind of strategy

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that favors positive relationships within that community.

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You wanna make sure that these people get along

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and more importantly, that they think of each other already,

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so that when there's another pandemic,

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they're gonna be thinking,

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how can I protect those that are around?

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In summary, social cohesion is often looked at

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as something that, as a social resource.

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Uh, and sometimes it's taken out of context as something,

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that politicians can exploit

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or something that is associated with the number

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of immigrants in a community.

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Uh, but what we are looking at, what we're showing here is

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that in fact, social cohesion first is, subjective

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feeling that people have.

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It's, it's an impression.

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It's how they relate to this group.

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And this can't be measured objectively.

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It has to be asked to our communities.

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And second, that it has clear implications

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for public policy

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and public health, that if you wanna be ready

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for whatever happens for

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whenever the next pandemic strikes, you need

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to start building that social cohesion before that happens.

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And it's like any relationship, any relationship

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that is worth having takes a lot of time, takes a lot

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of effort, so you cannot expect it

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to build it from one day to another.

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So what I would encourage anyone watching

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and po policy makers and public health policies

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and such, is to think about how we can start assessing

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social cohesion or communities today, and strengthening for

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whenever the next pandemic strikes.

Quick Answers

00:00:00 - Actually, if I can go even broader, I think the question that is pertinent to ask looking into the future is how do we increase vaccination uptake during any pandemic? Whenever the next one comes, how can we be ready for it? And the way I like to think about vaccination uptake is, in two ways, right? So the first one is that it's an individual behavior that I do because I wanna protect myself.

00:00:36 - Or if I get sick, it's gonna be much milder. So I'm really trying to protect myself. My motivation is individual. And then the other way to think about this is, about vaccination, is that even though it is an individual behavior, I am motivated because I wanna protect my group. I wanna protect those that are around me. I wanna protect those that are important to me. And so here we are,

00:01:06 - what we call group motives or collective motives. And it also has collective consequences because we know that when a high proportion of the population takes the vaccine, that means that everyone is much more protected, right? So this is what we call a herd immunity. So what's interesting here is that we're shifting the question because we're no longer asking what makes

00:01:37 - or rather asking what kind of groups motivate people to take the vaccine. How can we make groups? How can we create societies in which people are more likely to take that vaccine? And this is where social cohesion came in, and social cohesion can be thought of as the glue that connects people in the same group together. So this glue has two key ingredients. The first one is, the quality

00:02:07 - So if I trust people in that group, if I like people in that group. And then the other one is the extent to which that group is important to me, to how I think about myself. And when we put these two ingredients together, we get social cohesion. And what my, my collaborators and I wanted to, see more about to, to understand was how social cohesion was gonna predict vaccinations,

00:02:42 - So what we did is that we conducted two studies. The first one, we had a representative sample of Australians, and they answered our questionnaire twice. So the first time was in March, 2020, so May, sorry, 2020. And this was basically, if you can put yourself back in Covid when it was all happening, you know, early 2020, that's when there was a lot

00:03:10 - So we asked people, how cohesive do you perceive Australia to be? Do you feel like Australians are a cohesive group or are they breaking apart? And then four months later, in October, September, October, we ask them, how willing are you take? Are you, how willing are you to take the vaccine whenever it is available? And what we found in this first study is that those initial levels of social cohesion predicted greater intentions to take the COVID-19 vaccine

00:03:43 - What we did in a second study is that we asked people in 2022 to tell us their, what their, how, how cohesive they felt Australia to be. And then we also looked at how many vaccines they had taken at that point. So how many COVID-19 jab they've taken. And we found that people who had stronger social cohesion were more likely to have a greater uptake of COVID-19 vaccines.

00:04:14 - to four vaccines. and what's really important here to consider is that social cohesion predicted vaccination intention and vaccination uptake. Above and beyond many of these classic important demographic variables like age and sex, it went beyond things like COVID-19 anxiety and even beyond certain psychological concepts like social dominance orientation, for example, I briefly mentioned

00:04:46 - so it's the quality of the social relationships that exist within the group. And the other one is how important or how self relevant the group is to you. And there's multiple ways of measuring this, but we focused on three well supported dimensions. The first one is the positive social relationships that existed within the community. So we asked people how, how,

00:05:16 - How positive are the relationships with these fellow Australians? So that's the first one. The second one is social identification, which is the extent to which I think my group, this group is important for how I see myself, how I behave. And then the third one is trust or confidence in government as the institutions that are, legitimizing and enforcing the decisions of that group. So that was our, three prone approach

00:05:47 - And they, together, they capture both the quantity, the quality of social relationships, as well as, how important the group is to the self. And as for how to measure this in diverse populations, when we are asking the questions of, diversity per se, the first thing to note is that to, to ask these questions, you need to have a working relationship with these different populations. If you don't have a working relationship, if there's no trust,

00:06:19 - So the first thing to establish is trust. And then, the, the way to measure it would be in terms of using questionnaires or surveys. You can also use interviews. I would caution against anything that would be deemed objective measures of social cohesion, because we're talking here about the quality of relations and how important the group is to the self. And we can only answer that subjectively. there might be objective proxies,

00:06:52 - of in terms of social cohesion. One of the things that I was talking about is that vaccination can be seen as, there's two motives, right? There's the individual motives and individual factors that come in to predict vaccination intentions. And then there's also the, the collective ones, the group ones. So what makes us more likely to get vaccinated? And I think that any, any good,

00:07:23 - of these take into account that, you know, we are complex beings, we have individual and collective motives. There's two things though that I would like to point out. the first one is that when we conducted our research in these two studies, we controlled for a bunch of demographic variables. We controlled for health related variables. We controlled even for some individual differences in there. And what we found was that first social cohesion emerged

00:07:56 - So it was a significant, a consistently significant predictor above and beyond everything else. And second, that the other individual differences either were non-significant, or if they were significant, they weren't necessarily as important of social cohesion. So what this tells me is that if I need to put my money somewhere, either in social cohesion or on other individual variables,

00:08:28 - cohesion and making sure that's well set up. And then if need be, I would move towards the individual factors. So that would be my way of thinking about it. And the other thing to notice that when the demographic variables are significant in this relationship, when, for example, we know that age is an, was a very important predictor of vaccination uptake. It's not because people have a specific age, Is because it's an entire social

00:08:59 - We were telling older people that they were at risk and we're telling younger people to stop being so risky and to stop being so irresponsible. So even though it's a simple demographic characteristic, it actually has a lot of group processes and potential. So social cohesion implications behind these demographic variable. So the first strategy that every policy maker and every government should be aware of is assessing social cohesion.

00:09:33 - how cohesive it is, and how much you need to put effort and work into it to strengthen that cohesion. If you do not know what your baseline level is, then you don't know what resources are available when another crisis concept. So the first strategy that's really important is assessment. And then afterwards you can make a decision. So if you find that the community has actually low social cohesion, you need to start building that up right away.

00:10:04 - We saw that in that first study, that social cohesion at time, one predicted vaccination intention intentions later in time. So that means that that resource that you build and that you have early in a pandemic can actually have very important protective factors. Protective, yeah, can be protective to the community later on. So you wanna make sure it's strong to begin with. If you find that in your community, you need

00:10:34 - that means social cohesions just is not just a matter of getting people together, it's a matter of public health policy. It's a prevention and it's a protection for future events. If in fact, you find that social cohesion is actually strong in your community and you can actually leverage it in times of crisis, there's a few things that you can do. The first thing is work with local members, local leaders of the community.

00:11:09 - elected there. There's leaders in all kinds of areas, and there's leaders in all kinds of different, places. You don't have to be elected to be a leader. So make sure you recognize and you strengthen community leaders. And then make sure that in your offering, your, you are telling and you're showing that community that they matter, that they're important. And of course, make sure that you're employing any kind

00:11:39 - that favors positive relationships within that community. You wanna make sure that these people get along and more importantly, that they think of each other already, so that when there's another pandemic, they're gonna be thinking, how can I protect those that are around? In summary, social cohesion is often looked at as something that, as a social resource. and sometimes it's taken out of context as something,

00:12:11 - or something that is associated with the number of immigrants in a community. but what we are looking at, what we're showing here is that in fact, social cohesion first is, subjective feeling that people have. It's, it's an impression. It's how they relate to this group. And this can't be measured objectively. It has to be asked to our communities.

00:12:43 - for public policy and public health, that if you wanna be ready for whatever happens for whenever the next pandemic strikes, you need to start building that social cohesion before that happens. And it's like any relationship, any relationship that is worth having takes a lot of time, takes a lot of effort, so you cannot expect it to build it from one day to another. So what I would encourage anyone watching

00:13:24 - and such, is to think about how we can start assessing social cohesion or communities today, and strengthening for whenever the next pandemic strikes.

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