Our results showed that people judged the unvaccinated (vs vaccinated) individuals as more responsible and blameworthy for overwhelming the healthcare system, jeopardising public health efforts and prolonging the pandemic. Importantly, these judgements emerged even for characters who, according to scientific evidence available at the time, were at exceedingly low risk of hospitalisations and who had recovered from a prior infection when vaccines became available (study 1). We also found these effects when the low-risk unvaccinated-recovered character was contrasted against a counterpart who was vaccinated more than 6 months ago (study 2). On average, the participants’ ratings for the vaccinated characters fell in the lower range, while ratings of the unvaccinated characters fell within the middle range of the scapegoating scale (ie, suggesting moderate levels of blame). Finally, we observed that liberals were more likely than conservatives to blame the unvaccinated (vs vaccinated) characters.

Recall that what makes blame assignment a form of scapegoating (vs a justified response to a social threat) is that it is driven by fear or based on unfounded or inaccurate facts.10 11 13 63 64 We provide evidence that the scapegoating of the unvaccinated was not grounded in available empirical facts, but a miscalibration of risk. Our evidence for this is that while participants recognised that the elderly and people with severe comorbidities were at higher risk of hospitalisations or deaths (vs low-risk characters), they consistently overestimated the risks of C19, especially for the unvaccinated people who are not in a known high-risk group. These inaccurate risk estimates comport with results from representative sample-based studies available at the time.17 18 55 The final contributing factor to misperceptions, and another indication of scapegoating, was the failure to consider the protective effects of prior infection, which were known according to the evidence available at the time of our data collection.40 43

Implications for medical ethics, science communications and ideological divisions

Humans often react to threats by applying generalisations driven by a miscalibration of risks, selective information retrieval or the unwillingness to update beliefs based on new information.14 56 Our data provide evidence that these processes led some people to use a single piece of information—vaccination status—as a heuristic for making judgements about the culpability of individuals, regardless of whether or not they are statistically at risk of needing care, pose a grave threat to others, have recovered from the virus and whether the vaccinated individuals have not been boosted for many months. These overgeneralisations and the resulting scapegoating are not without social and ethical implications.

One social consequence is that scapegoating can subject people to ostracism, discrimination and, in extreme cases, even violence and persecution.10 11 13 63 64 While we did not seek to document these consequences in our studies, scapegoating risks reinforcing public attitudes that may be based as a justification for discrimination. For instance, multiple policies were implemented in the USA to pressure individuals to get vaccinated, including employer mandates and vaccine passports. Although widely supported,49 these policies did not consider the protective effects of prior infection or the age-based risk distribution of severe disease outcomes. There is some evidence that they generated adverse societal consequences, such as reactance, and increased vaccine scepticism and social polarisation,6 among others. Therefore, because the C19 pandemic showed how the public’s understanding of health information could impact social cohesion, we strongly recommend that the medical community considers the downstream and negative impacts of presumptively well-intentioned guidelines.

Second, scapegoating implies that the blame is either undeserved or disproportional. Thus, we encourage public health researchers, practitioners and science communicators to consider the implications of relying primarily on fear-based approaches to mitigating the harms caused by C19.65 For example, if 35% of US adults believed that at least half of C19 infections require hospitalisation,18 it suggests a significant health communication failure. A result is that it can lead people to turn against and blame each other when doing so is not justified by available facts, which may not have been adequately presented to the public. We submit that a relevant ethical question that public health officials should debate is whether it is morally obligatory for them to correct misinformation regardless of whether it overestimates or underestimates of C19 risk.

Third, our findings also show the impact of citizens’ political ideology on scapegoating. We did not test the sources of liberals’ greater likelihood to scapegoat the unvaccinated individuals, but we encourage further investigation of whether media exposure could be a contributing factor. Just as conservative media and politicians are culpable for misinformation leading people to underestimate certain C19 risks,66 67 it is possible that liberal outlets introduced misinformation in the opposite direction. For instance, Rachel Maddow of MSNBC, an outlet with a decidedly liberal audience,68 noted in March 2021: ‘Now we know that the vaccines work well enough that the virus stops with every vaccinated person.’69 However, this claim was not possible to make at that time,70 nor was it true. The original clinical trials did not test for effectiveness on transmission.71 Early evidence, and reasonable deduction from the research in vaccinology and virology, suggested that the vaccines would not fully stop transmission.

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