Spoiler alert: No one is.

With vaccine authorizations hitting the 5-12 year-old age group soon, we’ll see an uptick in the overall vaccination rate in the US, but of course there remain tens of millions people who are eligible for the vaccine who remain unvaccinated. This is a problem. According to a Kaiser study, 90,000 COVID deaths since June 2021 would have been prevented by vaccination.

But the rhetoric surrounding why people choose not to get vaccinated tends to focus on the perception of harm. The narrative quickly settles on the idea that people who don’t get vaccinated think the risks of the vaccine are way higher than they actually are. And of course, plenty of good faith and bad faith debate occurs on social media surrounding those risks.

But that’s a bit one-sided. A new article, appearing in PLOS One shows us what is, I think, an equally plausible reason some people choose not to get vaccinated. It’s not that they overestimate the risk of vaccination, they underestimate the risk of COVID. Or, as the authors put it, they feel invincible.

Invincibility is actually a relatively well-studied phenomenon in the psychological literature. It has various definitions, but it basically refers to an individual, false belief that one will be successful in any endeavor, regardless of risk. Invincibility promotes risky behaviors, including taking less precautions when driving or having sex. Maybe people don’t choose to get vaccinated because they feel invincible to coronavirus.

A feeling of invincibility is quite personal, you might even call it ego-centric. But we don’t only get vaccinated to protect ourselves, but to protect our community. How does a societies stance on collectivism interplay with the individual feeling of invincibility to lead to choices about vaccination?

To answer the questions, the researchers conducted a survey that spanned 51 countries and nearly 300,000 individuals. Of note, the survey was conducted from July to November of 2020 – so no vaccines had actually been released yet. To get at the sense of invincibility they asked “How serious would it be if you became infected with COVID-19”?  They also asked about intention to get vaccinated, and about how important it is to take actions to prevent the spread of COVID-19 in your community.

Let’s focus on willingness to get vaccinated. Topline results are no surprise – those who felt invincible – that an infection would be “not at all serious” were much more likely to state they weren’t going to be vaccinated. In fact, it appears that a feeling of invincibility was the single most significant predictor of not getting vaccinated – beating out age, sex, and level of education.

Feeling invincible to COVID-19 was also linked to feeling that pro-social behaviors like mask-wearing and social distancing weren’t important, which makes sense I suppose. If you don’t think COVID can hurt you, you might also think it can’t hurt others.

That said, in countries with more of a collectivist culture, the effect of feeling invincible was strongly mitigated. As you can see here, as the collectivism score of a country increases, the vaccine intention, even among those who feel invincible, also increases. 

This suggests a potential path forward, the authors write. Perhaps in the less collectivist countries like the US, an appeal to community would move the needle, even among those who feel they would handle the virus just fine.

President Biden has been hitting the pro-social themes in multiple speeches, probably for just this reason.

Of course, sometimes it’s the message, and sometimes it’s the messenger.

Look, there are plenty of people out there who feel like COVID-19 won’t affect them very much. Many of them are right. But some of them are very wrong. And right now, we have no good way to figure out in advance who is who. And that’s the problem with feeling invincible, right? In the end, the real end, the ultimate end, none of us are.

A version of this commentary first appeared on medscape.com.