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Mistrust in public health institutions is a stronger predictor of vaccine hesitancy and uptake than Trust in Trump
Abstract
Study goal
This study examines the sources of COVID-19 vaccine hesitancy and refusal in Americans by decomposing different forms of government trust/mistrust including trust in Trump and mistrust in public health institutions.
Methods
Using linear panel regression models with data from 5,446 US adults (37,761 responses) from the Understanding America Survey, the likelihoods of vaccine hesitancy, uptake, and trust in various information sources were examined.
Results and conclusion
We find that the likelihoods of hesitancy and having negative perceptions of COVID-19 vaccines were consistently much higher among PHI mistrusters, showing even a stronger hesitancy than Trump trusters. This tendency has persisted over time, resulting in only 49% of PHI mistrusters having been vaccinated in the most recent survey wave. However, a large portion of PHI mistrusters still trusted physicians, family, and friends. These findings suggest that mistrust in PHIs is a salient predictor of vaccine hesitancy and reduced uptake on its own, which is compounded by trust in Trump.
... Studies examining public trust in government agencies have tended to bear this prediction out, finding the public to be more favorable toward public agencies than politicians or elected officials. [28][29][30] The perceived insulation of public agencies and scientists from the incentive structures of electoral politics has potential implications for compliance with desired public health measures. Studies during COVID-19 find varying results for the effects of trust on compliance with desired public health actions depending on the actor/institutions. ...
... In doing so, public health leaders may have drawn too heavily on what Bennett refers to as "epistemic trust" as the basis for compliance. 28 Bennett defines epistemic trust as the expectation that interpersonally communicated information is true and relevant, and that communicators intend it to be so. 34 In public policy, epistemic trust refers to forming beliefs on the basis of the testimony of scientists and scientific communities without need for additional proof. ...
... While this group may be the most problematic from the perspective of ensuring compliance, extreme distrusters, like vaccine refusers, do not appear to be a large share of the population. 28 Addressing distrusters may therefore benefit from more targeted approaches to reframe scientific debates or controversies through intervening upon common disinformation mediums. ...
Trust in government has emerged as one of the strongest predictors of national performance in fighting COVID-19. This commentary aims to take stock of the vast literature on trust and compliance with public health measures that has emerged during the pandemic to synthesize policy-relevant recommendations about: 1) How to conceptualize trust; 2) Whether trust is always deserved; and 3) How governments can earn (appropriate levels of) trust. Based on a critical reading of the literature, we develop a framework that conceptualizes trust as falling along a continuum ranging from extreme distrust to blind trust with the ideal point— “informed” or “basic” trust—falling in the mid-point of the continuum. We illustrate the continuum with examples and provide recommendations regarding how governments can build more nuanced disease responses that account for individuals and sub-groups at different rungs on the continuum while (re)building trust. We conclude that trust-building is a long-term project that must continue in non-crisis times.
... (Lane, MacDonald, Marti, & Dumolard, 2018 452 pentingnya vaksinasi, serta faktor agama, budaya, jenis kelamin dan isu sosio-ekonomi terkait vaksinasi. (Choi, & Fox, 2022). ...
... Sikap raguragu atau tidak yakin terhadap vaksin menjadi salah satu faktor yang akan memengaruhi cakupan vaksinasi di suatu daerah. Keraguan terhadap vaksin yang tinggi akan menyebabkan cakupan vaksinasi di suatu daerah rendah, sehingga perlu diidentifikasikan apakah terdapat keraguan masyarakat terhadap vaksin jika cakupan vaksinasi di suatu daerah rendah (Choi, & Fox, 2022). ...
Background: Measles and rubella (German measles) are diseases that can be prevented by vaccination (PD3I). Both of these diseases are acute diseases caused by viruses whose complications can cause death, especially in groups of children under five who do not receive vaccinations. Vaccination coverage for children, both basic and advanced vaccinations, has decreased in the post-Covid-19 era. Vaccination at the global level shows a decline in basic vaccination coverage from 86% (2019) to 83% (2020). Purpose: To review determinant factors influencing measles, and rubella vaccine hesitancy among parents. Method: Literature review using PRISMA guidelines with database sources coming from Sciencedirect, Pubmed, and Google Scholar published in 2019-2023. The keywords used are “vaccine hesitancy” and “determinants”. Results: The factors causing hesitancy in measles-rubella vaccination in various regions are quite complex and varied. Time barriers, distance in accessing health services, the influence of religious, cultural factors, local government support, and the influence of anti-vaccination issues through various communication media are contextual factors that need to be questioned. Individual or group/community factors that influence vaccine hesitancy include knowledge, perception of the risks and benefits of vaccines, beliefs and attitudes towards vaccination. Other factors that also influence acceptance and refusal of vaccination are support from health workers, cost barriers, and vaccine availability. Conclusion: The determining factors for doubts about measles-rubella vaccination are caused by 3 factors, namely contextual, individual, group/community influences, and the influence of specific issues regarding vaccination. Keywords: Determinant Factors; Measles-Rubella; Vaccine Hesitancy. Pendahuluan: Penyakit campak (measles) dan rubella (german measles) merupakan penyakit yang dapat dicegah dengan vaksinasi (PD3I). Kedua penyakit ini merupakan penyakit akut disebabkan oleh virus yang komplikasinya dapat menyebabkan kematian, terutama pada kelompok balita yang tidak mendapat vaksinasi. Cakupan vaksinasi pada anak, baik vaksinasi dasar maupun lanjutan era post Covid-19 mengalami penurunan. Pemberian vaksin di tingkat global menunjukkan adanya penurunan cakupan vaksinasi dasar dari 86% (2019) menjadi 83% (2020). Tujuan: Untuk meninjau faktor-faktor penentu yang memengaruhi keraguan orang tua terhadap pemberian vaksin campak dan rubella pada anaknya. Metode: Literature review menggunakan panduan PRISMA dengan sumber database berasal dari Sciencedirect, Pubmed, dan Google scholar terbitan pada 2019-2023. Kata kunci yang digunakan yakni “vaccine hesitancy” dan “determinants”. Hasil: Faktor penyebab keraguan vaksinasi campak-rubella di berbagai daerah cukup kompleks dan bervariasi. Hambatan waktu, jarak dalam mengakses pelayanan kesehatan, pengaruh faktor agama, budaya, dukungan pemerintah setempat, dan pengaruh isu anti vaksin melalui berbagai media komunikasi merupakan faktor kontekstual keraguan. Faktor individu atau kelompok/masyarakat yang memengaruhi keraguan vaksin meliputi, pengetahuan, persepsi resiko-keuntungan vaksin, keyakinan, dan sikap terhadap vaksinasi. Faktor lainnya yang juga memengaruhi penerimaan dan penolakan vaksinasi adalah adanya dukungan petugas kesehatan, hambatan biaya, dan ketersediaan vaksin. Simpulan: Faktor determinan keraguan vaksinasi campak-rubella disebabkan oleh 3 faktor, yaitu kontekstual, pengaruh individu, kelompok/masyarakat, dan pengaruh isu spesifik dari vaksinasi. Kata Kunci: Faktor Determinan; Campak-Rubella; Keraguan Vaksinasi.
... 29,32 Recent work conducted in Europe and even in the USA suggests that partisan identities are less important to vaccination than often stated, especially compared to trust in public authorities, disengagement with politics, and rejection of politicians altogether. 29,32,[54][55][56][57] How might we explain these failings to include context and to recognize and account for global diversity and complexity? One answer may lie in the publication formats and norms of many medical and interdisciplinary journals. ...
... For example, the study of political identities has interrogated the link between structural variables (income, level of education, confidence in the health authorities) and changes in the public stances taken by party representatives. 31,54,55,62,63 Other work looks at national differences in perceptions of vaccination as a norm, and how this affects one's propensity to think of vaccine hesitancy as a transgression or deviance. 27 Finally, many pandemic studies uncovered changes in the profile of hesitant people, or differences in profiles between countries, showing that the same factors can play out differently depending on geographical and temporal contexts. ...
The pandemic dramatically accelerated research on vaccine attitudes and uptake, a field which mobilizes researchers from the social sciences and humanities as well as biomedical and public health disciplines. The field has the potential to contribute much more, but the growth in research and the deeper connections between disciplines brings challenges as well as opportunities. This perspective article assesses the recent development of the field, exploring progress whilst emphasizing that not enough attention has been paid to national and local contexts. This lack of contextual attention limits the progress of research and hinders our capacity to learn from the COVID-19 crisis. We suggest three concrete responses: building and recognizing new publishing formats for reporting and synthesizing studies at a country level; establishing country-level interdisciplinary networks to connect research and praxis; and strengthening international comparative survey work by enhancing the focus on local contextual factors.
... This concern created hesitancy for SARS-CoV-2 mRNA vaccine even among well educated people having scientific background. However, as the safety of mRNA vaccine was proven and the benefits became evident, the mRNA vaccine uptake gradually increased [112] (ii) Lack of trust: Lack of trust in government or public health authorities, or mistrust of pharmaceutical companies that produce vaccines, is the another important factor that adds to vaccine hesitancy. A recent survey revealed that broader mistrust in public health institutions is a stronger and more consistent predictor of vaccine hesitancy [112]. ...
... However, as the safety of mRNA vaccine was proven and the benefits became evident, the mRNA vaccine uptake gradually increased [112] (ii) Lack of trust: Lack of trust in government or public health authorities, or mistrust of pharmaceutical companies that produce vaccines, is the another important factor that adds to vaccine hesitancy. A recent survey revealed that broader mistrust in public health institutions is a stronger and more consistent predictor of vaccine hesitancy [112]. (iii) Religious or cultural beliefs: Some people have religious or cultural beliefs that are in conflict with vaccination. ...
Introduction
The rapid development of mRNA vaccines against SARS-CoV-2 has revolutionized vaccinology, offering hope for swift responses to emerging infectious diseases. Initially met with skepticism, mRNA vaccines have proven effective and safe, reducing vaccine hesitancy amid the evolving COVID-19 pandemic. The COVID-19 pandemic has demonstrated that the time required to modify mRNA vaccines to counter new mutant strains is significantly shorter than the time it takes for pathogens to mutate and generate new variants that can thrive in vaccinated populations. This highlights the notion that mRNA vaccine technology appears to be outpacing viruses in the ongoing evolutionary race.
Areas covered
This review article offers valuable insights into several crucial aspects of mRNA vaccine development and deployment, including the fundamentals of mRNA vaccine design and synthesis, the utilization of delivery systems, considerations regarding vaccine safety, the longevity of the immune response, strategies for modifying the original mRNA vaccine to address emerging mutant strains, as well as addressing vaccine hesitancy and potential approaches to mitigate reluctance.
Expert opinion
Challenges such as stability, storage, manufacturing complexities, production capacity, allergic reactions, long-term effects, accessibility, and misinformation must be addressed. Despite these hurdles, mRNA vaccine technology holds promise for revolutionizing future vaccination strategies.
... Mistrust of government institutions, public health institutions, scientists, and vaccines have been identified as playing a role in discouraging people from taking the COVID-19 vaccine. This study and others confirmed that political mistrust and mistrust in vaccines, scientists, and public health institutions continued to play a role in increasing COVID-19 vaccine hesitancy [97,103,[168][169][170][171][172][173][174][175]. Politicization of vaccines for political gains has been recorded and well exploited. ...
... This is due to the inherent nature of science itself, which has to do with the uncertainty of the field and the fact that questioning existing findings is part of the research process [168,[176][177][178]. There is, therefore, a need to depoliticize outreach programs by involving health officials that have proven record of being apolitical [168], as well as the use of physicians as most families turn to trusted physicians that have once attended to them successfully [170]. ...
Mass vaccination against COVID-19 is the best method to ensure herd immunity in order to curb the effect of the pandemic on the global economy. It is therefore important to assess the determinants of COVID-19 vaccine acceptance and hesitancy on a global scale. Factors were recorded from cross-sectional studies analyzed with t-Test, ANOVA, correlation, and meta-regression analyses
and synthesized to identify global trends in order to inform policy. We registered the protocol (ID: CRD42022350418) and used standard Cochrane methods and PRISMA guidelines to collect and synthesize cross-sectional articles published between January 2020 and August 2023. A total of 67 articles with 576 studies from 185 countries involving 3,081,766 participants were included in this synthesis. Global COVID-19 vaccine acceptance was 65.27% (95% CI; 62.72–67.84%), while global
vaccine hesitancy stood at 32.1% (95% CI; 29.05–35.17%). One-Way ANOVA showed that there was no significant difference in the percentage Gross Domestic Product spent on vaccine procurement across the World Bank income levels (p < 0.187). There was a significant difference of vaccine acceptance (p < 0.001) and vaccine hesitancy (p < 0.005) across the differentWorld Bank Income levels. World Bank income level had a strong influence on COVID-19 vaccine acceptance (p < 0.0004) and hesitancy (p < 0.003) but percentage Gross Domestic Product spent on vaccine procurement did not. There was no correlation between percentage Gross Domestic Product spent on vaccine procurement and COVID-19 vaccine acceptance (r = −0.11, p < 0.164) or vaccine hesitancy (r = −0.09, p < 0.234).
Meta-regression analysis showed that living in an urban setting (OR = 4.83, 95% CI; 0.67–212.8), rural setting (OR = 2.53, 95% CI; 0.29–119.33), older (OR = 1.98, 95% CI; 0.99–4.07), higher education (OR = 1.76, 95% CI; 0.85–3.81), and being a low income earner (OR = 2.85, 95% CI; 0.45–30.63) increased the odds of high COVID-19 vaccine acceptance. Factors that increased the odds of high COVID-19 vaccine hesitancy were no influenza vaccine (OR = 33.06, 95% CI; 5.03–1395.01), mistrust
for vaccines (OR = 3.91, 95% CI; 1.92–8.24), complacency (OR = 2.86, 95% CI; 1.02–8.83), pregnancy (OR = 2.3, 95% CI; 0.12–141.76), taking traditional herbs (OR = 2.15, 95% CI; 0.52–10.42), being female (OR = 1.53, 95% CI; 0.78–3.01), and safety concerns (OR = 1.29, 95% CI; 0.67–2.51). We proposed a number of recommendations to increase vaccine acceptance and ensure global herd immunity
against COVID-19.
... Though regarded as a behavioral phenomenon that is specific to both vaccine and the context in which the vaccine is applied, scholars have identified three common categories of determinants that give rise to more or less vaccine hesitancy: confidence (or trust in a vaccine's safety and efficacy, in the health care system of delivery, and in policy-makers); complacency (or low perceived risks and regard to vaccination as a preventative measure); and convenience (or availability, accessibility, affordability and willingness to pay for, and ability to comprehend language and health literacy of a vaccine) (McDonald et al., 2015). In the context of COVID-19, prior research indicates that trust in the government may predict vaccine hesitancy, and Choi and Fox (2022) argue that since the U.S. government helped with the development and distribution of the COVID-19 vaccine, hesitancy to get vaccinated was consequently high. In the case of the COVID-19 vaccine, Choi and Fox (2022) also found significant relationships between mistrust in public health institutions and vaccine hesitancy. ...
... In the context of COVID-19, prior research indicates that trust in the government may predict vaccine hesitancy, and Choi and Fox (2022) argue that since the U.S. government helped with the development and distribution of the COVID-19 vaccine, hesitancy to get vaccinated was consequently high. In the case of the COVID-19 vaccine, Choi and Fox (2022) also found significant relationships between mistrust in public health institutions and vaccine hesitancy. Findings also showed that respondents held higher trust in their physicians, family, and friends. ...
... Public trust is considered an informal mechanism that alleviates the psychological burden of accepting vaccines while improving the credibility of public health information from government bodies and experts [14,15]. Studies during the COVID-19 pandemic generally found trust in public health institutions as one of the strongest factors of vaccine confidence and uptake in various contexts [16][17][18][19][20], among others, including party identification, religious beliefs, risk perception, occupation, race, gender, age, and educational attainment [16,[21][22][23][24][25][26][27]. When the immediate threat of COVID-19 becomes less visible, the health authority's message emphasizing the importance of routine vaccinations is an essential means to draw the attention of those who are complacent to booster shots. ...
... The factors influencing the Korean public's decisions to receive booster shots and their willingness to continue with vaccinations were largely consistent with those that determined initial acceptance of the vaccine. Respondents' trust in the KDCA was a salient predictor of getting three or more doses among vaccinated people when controlling for other covariates, resonating with earlier studies that identified trust in public health institutions as the most salient predictor of COVID-19 vaccination among others [17][18][19]. The predictors of the willingness to get an additional shot were largely similar, however, the willingness was significantly higher among those who had already received booster vaccine doses. ...
... 31 Vaccine hesitancy has been found to be related to a general distrust of government, distrust in medicine, and distrust in pharmaceutical companies. 32 With the growing trend of vaccine hesitancy and refusal, parents are finding ways to legally avoid required vaccinations, using loopholes or easy verification for religious and philosophical exemptions. While all fifty U.S. states and Washington D.C. require MMR vaccine for school entry, some states allow for various exemptions based on religion or philosophy. ...
... Some commenters also questioned the government's ability to independently verify vaccine safety, particularly for HPV and COVID-19 vaccines, suggesting a broader mistrust of government programs. 29,[35][36][37] The rapid development of COVID-19 vaccines was similarly questioned, consistent with trends observed globally. 38,39 This highlights the need for local researchers to conduct independent safety assessments and for the government to invest in research infrastructure; ensuring scientific efforts are locally proven and results communicated effectively to the public to build confidence in the health and scientific systems. ...
Objectives
Vaccine hesitancy remains a critical challenge to public health in Zambia and globally, necessitating a deeper understanding of the factors influencing this phenomenon. The study analyzed user-generated Facebook comments from January 2021 to December 2023 to understand the factors influencing vaccine hesitancy in Zambia.
Methods
This study employed a qualitative case study design, focusing on the official Facebook page of the Ministry of Health in Zambia. A purposeful sampling technique was used, collecting comments that discussed vaccine hesitancy related to polio, human papilloma virus (HPV), and coronavirus disease 2019 (COVID-19) vaccines.
Results
The analysis revealed that men contributed 77.5% of comments followed by women with 22.5%. The majority of comments (82.5%) pertained to COVID-19 vaccines, followed by polio (14.1%) and HPV (3.4%). Notably, women expressed greater hesitancy toward polio vaccines (60%) compared to COVID-19 (19.9%) and HPV (12.5%). Thematic analysis highlighted significant hesitancy against vaccines shaped by vaccine safety and efficacy concerns, frequent calls for vaccination particularly against polio, conspiracy theories, distrust in health authorities, and poor communication from health authorities. Other drivers of vaccine hesitancy were reliance on spiritual beliefs, herbal remedies and natural immunity, and the pervasive spread of misinformation.
Conclusion
These findings underscore the barriers to vaccine acceptance, emphasizing the critical need for transparent communication and community engagement. To improve vaccine uptake, public health strategies must address community-specific concerns, foster trust, and enhance the effectiveness of health communication efforts.
... In 2019, the Wellcome Global Monitor 2018 (Wellcome, 2018) reported that a) high-income regions -with the highest level of education -such as the USA and Western Europe, had lower trust in vaccine safety and efficacy than low-income regions, and b) people who had recently sought scientific information were less likely to strongly or somewhat agree that vaccines are safe compared to people who did not engage with seeking scientific information. Consequently, a potential issue with identifying the failure to instill belief in compulsory educational settings as the cause of something as serious as vaccine hesitancy, is that it may divert from other wellreported causes such as the growing mistrust in public health institutions by both the public (Choi & Fox, 2022) and health professionals themselves (Ahmad et al., 2022;Verger et al., 2022). It is not our opinion that such trust can be restored by forcing belief-change in learners whatever their age may be. ...
For the past five decades, the majority of science education has adhered to a pedagogical philosophy which contends that issues in the acquisition and expression of target scientific narratives by learners stem from the existence of “incorrect beliefs” called misconceptions. According to this philosophy, misconceptions must be identified, possibly as early as in childhood, and eradicated with specific interventions to allow the proper scientific knowledge to be acquired. Despite much effort cataloging misconceptions and their associated interventions in different disciplines and sub-branches of these disciplines, misconceptions get still regularly diagnosed in a wide academic population ranging from school pupils to teachers in training, and even experts. In addition to this potential lack of efficacy, the present article puts forward three lines of argument making the case against the adoption of a science pedagogy based on a belief-change strategy in learners. The suggested lines of argument rely on ethical, epistemic, and professional considerations. It is then argued that adopting a pedagogical philosophy based on representational pluralism, in opposition to holding a single “true” scientific story, can both address the three points of concern aforementioned, but also allow learners to bypass misconceptions when making judgements based on their scientific knowledge. Possible applications in physics education are presented.
... Skepticism about the safety and benefits of vaccines is linked to low trust in institutions [1,2]. Vaccine hesitancy, along with climate change denial, is part of a larger trend of mistrust in scientific expertise and a decline in trust in public institutions [3][4][5][6]. To combat the "infodemic" the World Health Organization (WHO) has worked with major social media platforms to redirect internet users to reliable websites when searching for information related to COVID-19 [7]. ...
This study analyzed online public discourse on Twitter (later rebranded as X) during the COVID-19 pandemic to understand key factors associated with vaccine hesitancy by employing deep-learning techniques. Text classification analysis reveals a significant association between attitudes toward vaccination and the unique socio-economic characteristics of US states, such as education, race, income or voting behavior. However, our results indicate that attributing vaccine hesitancy solely to a single social factor is not appropriate. Furthermore, the topic modeling of online discourse identifies two distinct sets of justifications for vaccine hesitancy. The first set pertains to political concerns, including constitutional rights and conspiracy theories. The second pertains to medical concerns about vaccine safety and efficacy. However, vaccine-hesitant social media users pragmatically use broad categories of justification for their beliefs. This behavior may suggest that vaccine hesitancy is influenced by political beliefs, unconscious emotions, and gut-level instinct. Our findings have further implications for the critical role of trust in public institutions in shaping attitudes toward vaccination and the need for tailored communication strategies to restore faith in marginalized communities.
... Details around NPI implementation, including how quickly the measures are put into place and their degree of stringency, are key pieces of information that would be highly relevant to modelers and to decision-makers considering these NPI measures. In addition, how well the public adheres to the NPIs once they are implemented varies enormously depending on the local context, and societal trust in institutions is a strong predictor of adherence to public health recommendations (73)(74)(75). Yet, these details are mostly missing from the existing evidence base and contribute to both the mathematical uncertainty around the effectiveness estimates as well as policymaker uncertainty about how to interpret these data. Two notable exceptions are a study of mostly middle-to-high-income European countries that found that wealth and demographic structure explain country-level variation in "NPI effects" (defined as relative change in avoided new infections) (76) and the one study in our sample of 61 that estimated different reductions in the specific COVID-19 transmission parameters of interest by NPI stringency. ...
Background
Prior to the development of COVID-19 vaccines, policymakers instituted various non-pharmaceutical interventions (NPIs) to limit transmission. Prior studies have attempted to examine the extent to which these NPIs achieved their goals of containment, suppression, or mitigation of disease transmission. Existing evidence syntheses have found that numerous factors limit comparability across studies, and the evidence on NPI effectiveness during COVID-19 pandemic remains sparse and inconsistent. This study documents the magnitude and variation in NPI effectiveness in reducing COVID-19 transmission (i.e., reduction in effective reproduction rate [Reff] and daily contact rate) in Italy, the United States, the United Kingdom, and China.
Methods
Our rapid review and narrative synthesis of existing research identified 126 studies meeting our screening criteria. We selected four contexts with >5 articles to facilitate a meaningful synthesis. This step yielded an analytic sample of 61 articles that used data from China, Italy, the United Kingdom, and the United States.
Results
We found wide variation and substantial uncertainty around the effectiveness of NPIs at reducing disease transmission. Studies of a single intervention or NPIs that are the least stringent had estimated Reff reductions in the 10–50% range; those that examined so-called “lockdowns” were associated with greater Reff reductions that ranged from 40 to 90%, with many in the 70–80% range. While many studies reported on multiple NPIs, only six of the 61 studies explicitly used the framing of “stringency” or “mild versus strict” or “tiers” of NPIs, concepts that are highly relevant for decisionmakers.
Conclusion
Existing evidence suggests that NPIs reduce COVID-19 transmission by 40 to 90 percent. This paper documents the extent of the variation in NPI effectiveness estimates and highlights challenges presented by a lack of standardization in modeling approaches. Further research on NPI effectiveness at different stringency levels is needed to inform policy responses to future pandemics.
... This is an important issue because the level of trust in public health institutions has a significant impact on vaccination practices. In the United States, hesitancy and negative perceptions of COVID-19 vaccines affected trust in public health institutions [56]. Supporters of the view that private health centres offering paid services should be responsible for vaccinations constituted a distinct minority (4%). ...
Background
The article describes attitudes towards vaccinations in Poland in relation to issues such as voluntary versus compulsory vaccinations, the method of financing vaccinations, the method of organizing and carrying out vaccinations, the cognitive and educational aspect of vaccines (how to obtain knowledge about vaccines) and the preferred model of work and research on new vaccines. Taking into account these issues, the authors have created four ideal models of preferred vaccination policies: (a) the market model; (b) the state model; (c) the vaccine hesitancy model; and (d) the civic–social model. This perspective makes it possible to better understand and learn about the various motives behind the attitudes of anti-vaccination movements, as well as to notice cracks and divisions among vaccination supporters and their attitudes towards the financing and organization of vaccinations.
Methods
The study was carried out using the CATI method on a representative random-quota sample of Polish society of 1000 people aged 18 and over. The study took age, sex, education and the size of the place of residence into account.
Additionally, in the Socio-demographic factors influencing attitudes towards vaccination practices in Poland section, we used the chi-squared test and regression analysis of factors influencing vaccination practices in Poland. PASW Statistics 18 (a version of SPSS) software was used for statistical analysis. Significant correlations were demonstrated at a significance level of 0.05% Pearson.
Results
This article has shown that attitudes towards vaccinations are embedded in broader divisions and orientations related to the vision of the social order: the role of the state, the organization of healthcare and payments for vaccinations and medical services, as well as preferred ways of knowledge production in society and work on new vaccines. The political sympathies and the age of the respondents were the most important variables influencing vaccination behaviour. The education of the respondents was less important.
Conclusions
A few years after the peak of the pandemic, the scope of anti-vaccination attitudes in Polish society ranges from 20% of the population (dogmatic anti-vaxxers) to 30% (vaccine hesitancy occurring depending on attitudes towards vaccinations).
... Nicholls and Yitbarek, 2022). Lower trust in scientists and belief in misinformation have been associated with COVID-19 vaccine hesitancy in the USA (Stoler et al., 2022), where specific mistrust in public health institutions has also been found to predict vaccine hesitancy (Choi and Fox, 2022). Lack of trust in institutions (including the church, government, the justice system and the EU) is also related to vaccine hesitancy in Italy (Cordella et al., 2023). ...
... Public mistrust predates the COVID-19 pandemic and was further ampli ed with the rapidity of the COVID-19 immunization rollout in Canada. Public mistrust within health institutions is deeply rooted in anti-Black violence, racism, experimentation observed among African, Caribbean and Black Canadians (ACB) and other racial groups and a strong predictor for vaccine hesitancy (VH) [1,2]. VH is a common term that is currently used in the literature to capture the varying reasons for low uptake of COVID-19 vaccine among various populations. ...
Background
The COVID-19 pandemic had a significant global impact predominantly among Africans, Caribbean and Black (ACB) Canadians. ACB people experienced higher infection and recovery rates, greater health risks, and access to care. Public mistrust, due to anti-Black racism and historical trauma contributed to low vaccine uptake among ACB populations. Our study examined multi-level and intersectional issues impacting vaccine uptake and acceptance in Ottawa. This paper will focus on the themes of agency and community resilience.
Methods
A mixed methods research (MMR) approach guided this study using the socio-ecological model (SEM), intersectionality lens, and community-based participatory research principles to generate the qualitative results. The sample included 49 ACB participants involved in focus group discussions (FGDs). The sample population included service providers (20), social workers (15), doctors (3), and nurses (3) and others (8) who were predominantly Black African (70%), mostly female (80%), age range was 35–44 (33%) with high school diplomas (40%). Data were recorded digitally, transcribed verbatim, analyzed inductively. Data analysis methods were thematic analysis including inductive coding using NVivo software and rigor methods were member-checking and external audits. Ethical approval retrieved from affiliated institutions and measures taken to ensure trustworthiness of data.
Results
Our data showed rebuilding public trust is possible by bridging knowledge gaps on vaccine information, increasing service providers’ cultural competence capacity, and providing governance/leadership opportunities for ACB communities.
Conclusion
Restoring public trust will require dismantling racism by prioritizing ACB community’ needs, proactive and accessible culturally appropriate messages, and opportunities to develop policies to improve health outcomes.
... Hence, the study further aligns with existing literature on the detrimental effects of public distrust in health institutions and government on vaccine hesitancy, exacerbated during the COVID-19 pandemic by the rapid spread of misinformation and conspiracy theories [28][29][30][31][32]. The emergence of an 'infodemic'-an overload of both accurate and false information-has been identified as a significant barrier to trust in health services, potentially explaining the observed association between vaccine hesitancy and religious acceptance of vaccination [25,[33][34][35]. ...
COVID-19 vaccine hesitancy and its enablers would shape community uptake of non-covid vaccines such as oral cholera vaccine (OCV) in the post-COVID-19 era. This study assessed the impact of COVID-19 vaccine hesitancy and its drivers on OCV hesitancy in a cholera endemic region of the Democratic Republic of Congo. We conducted a community-based survey in Bukavu. The survey included characteristics, intention to take OCV and COVID-19, reasons for COVID-19 hesitancy, and thinking and feeling about COVID-19 vaccines. Poisson regression analyses were performed. Of the 1708 respondents, 84.66% and 77.57% were hesitant to OCV alone and to both OCV and COVID-19, respectively. Hesitancy to COVID-19 vaccines rose OCV hesitancy by 12% (crude Prevalence Ratio, [cPR]=1.12, 95%CI[1.03-1.21]). Independent predictors of OCV hesitancy were living in semi-urban area (adjusted Prevalence Ratio [aPR]=1.10, 95%CI[1.03-1.12]), religious refusal of vaccines (aPR=1.06, 95%CI[1.02-1.12]), concerns about vaccine safety (aPR=1.05, 95%CI[1.01-1.11]) and adverse effects (aPR=1.06, 95%CI[1.01-1.12]), as well as poor knowledge (aPR=1.07, 95%CI[1.01-1.14]). Conversely, the belief about COVID-19 vaccine effectiveness reduced OCV hesitancy (aPR=0.76, 95%CI[0.62-0.93]). COVID-19 vaccine hesitancy and its drivers exhibiting a significant domino effect on OCV uptake. Addressing vaccine hesitancy through community-based health literacy interventions would likely improve the introduction of novel non-COVID-19 vaccines in post-COVID-19 era.
... Hence, the study further aligns with existing literature on the detrimental effects of public distrust in health institutions and government on vaccine hesitancy, exacerbated during the COVID-19 pandemic by the rapid spread of misinformation and conspiracy theories [32][33][34][35][36]. The emergence of an 'infodemic'-an overload of both accurate and false information-has been identified as a significant barrier to trust in health services, potentially explaining the observed association between vaccine hesitancy and religious acceptance of vaccination [37][38][39][40]. ...
COVID-19 vaccine hesitancy and its enablers shape community uptake of non-covid vaccines such as the oral cholera vaccine (OCV) in the post-COVID-19 era. This study assessed the impact of COVID-19 vaccine hesitancy and its drivers on OCV hesitancy in a cholera-endemic region of the Democratic Republic of Congo. We conducted a community-based survey in Bukavu. The survey included demographics, intention to take OCV and COVID-19 vaccines, reasons for COVID-19 hesitancy, and thoughts and feelings about COVID-19 vaccines. Poisson regression analyses were performed. Of the 1708 respondents, 84.66% and 77.57% were hesitant to OCV alone and to both OCV and COVID-19, respectively. Hesitancy to COVID-19 vaccines rose OCV hesitancy by 12% (crude prevalence ratio, [cPR] = 1.12, 95%CI [1.03–1.21]). Independent predictors of OCV hesitancy were living in a semi-urban area (adjusted prevalence ratio [aPR] = 1.10, 95%CI [1.03–1.12]), religious refusal of vaccines (aPR = 1.06, 95%CI [1.02–1.12]), concerns about vaccine safety (aPR = 1.05, 95%CI [1.01–1.11]) and adverse effects (aPR = 1.06, 95%CI [1.01–1.12]), as well as poor vaccine literacy (aPR = 1.07, 95%CI [1.01–1.14]). Interestingly, the belief in COVID-19 vaccine effectiveness reduced OCV hesitancy by 24% (aPR = 0.76, 95%CI [0.62–0.93]). COVID-19 vaccine hesitancy and its drivers exhibited a significant domino effect on OCV uptake. Addressing vaccine hesitancy through community-based health literacy and trust-building interventions would likely improve the introduction of novel non-COVID-19 vaccines in the post-COVID-19 era.
... [15,42] Horizontal community engagement strategiescollaboration fostering an equal exchange of ideas, resources, and support among all members of a communitywill likely result in more successful and equitable vaccination campaigns, [43] without undermining future mass vaccination efforts. Low trust in government is a consistent predictor of VH. [15,44] While media strategies targeted at reducing VH may not be effective, [43] it is reasonable to emphasize the importance of succinct, consistent, and honest governmental communication about vaccines particularly regarding safety and effectiveness. The role of social media is increasingly being recognized to have a major role in attitudes towards vaccination. ...
Background
Vaccine hesitancy (VH) is a recognized threat to public health that undermines efforts to mitigate disease burden. This study aims to gather available evidence regarding COVID-19 VH in Mexico, estimate the prevalence of VH, and its determinants to inform policymaking in this country.
Methods
Following PRISMA guidelines, a systematic review of the MEDLINE literature, articles that estimated the prevalence of COVID-19 VH in Mexico were included in the analysis to obtain a pooled estimate. We used a binomial-normal model for meta-analysis of proportions (i.e., generalized linear mixed model) to perform the metanalysis. We then performed a narrative review of COVID-19 VH in Mexican subpopulations.
Results
Seven studies met inclusion criteria. We estimated a pooled prevalence of COVID-19 VH of 16 % (95 % CI: 11–23 %) in Mexico. We found an association between VH and demographic characteristics, intrinsic vaccine factors, and beliefs. Subgroup analyses from specific studies suggested that patients with clinical conditions such as breast cancer or rheumatologic diseases had a higher prevalence of VH.
Conclusions
VH is a highly complex and dynamic phenomenon in Mexico. Characterizing and understanding COVID-19 vaccine hesitancy in the Mexican population helps target future policy interventions to mitigate the spread and impact of infectious diseases. The implications of VH differ among groups that may be at higher risk of severe disease, underscoring the importance of prompt research among these groups as well as targeted interventions to address VH.
... perceptions regarding vaccine safety and efficacy, influenced by global vaccine politics and local trust in different vaccine brands [44]. This skepticism in Taiwan towards the AstraZeneca vaccine illustrates how vaccine reception can be influenced by factors beyond scientific evidence, including psychological characteristics and public distrust [45][46][47]. It also highlights the challenges public health policymakers face in managing vaccine rollout strategies amid varying degrees of public trust and skepticism [48][49][50]. ...
In Taiwan, hesitancy regarding COVID-19 vaccination centered more on the choice of vaccine brand than on the decision to vaccinate. However, there is limited research exploring the factors influencing COVID-19 vaccine brand preferences from a sociopolitical perspective. Thus, we aimed to examine how Taiwanese national identity and trust in government influence vaccination status and vaccine brand choice, using longitudinal data from 2020, 2021, and 2023. This study utilized data from the Taiwan Panel Study of Family Dynamics 2020 survey, and combined it with data from two self-administered surveys conducted in 2021 and 2023. We focused on four vaccines commonly administered in Taiwan: AstraZeneca, Moderna, Pfizer-BioNTech, and the domestically-developed Medigen. Using Poisson regression models with robust standard errors, we assessed the effects of national identity and trust in government on the choice of COVID-19 vaccine brand. By analyzing data from 2361 participants, we found that national identity and trust in government were associated with the likelihood of COVID-19 vaccination, the number of vaccine doses received, and the brand of vaccine taken. Those who identified themselves as Taiwanese were more inclined to receive the Medigen and AstraZeneca vaccines, but less willing to receive Pfizer-BioNTech vaccine. Those who trusted the government were more likely to prefer and receive the Medigen vaccine. Conversely, those who didn’t trust the government were less likely to prefer Medigen and AstraZeneca vaccines, but were willing to receive Pfizer-BioNTech vaccine. Vaccine brand preferences and uptake in Taiwan were affected by individuals’ national identity and their trust in government. This highlights the critical role of sociopolitical factors in shaping public health strategies.
... and religious leaders in vaccine uptake, corroborating literature that stresses their effectiveness in building trust and promoting health interventions over political or medical authorities [26,27]. Hence, the study further aligns with existing literature on the detrimental effects of public distrust in health institutions and government on vaccine hesitancy, exacerbated during the COVID-19 pandemic by the rapid spread of misinformation and conspiracy theories [28][29][30][31][32]. The emergence of an ʹinfodemicʹ-an overload of both accurate and false information-has been identified as a significant barrier to trust in health services, potentially explaining the observed association between vaccine hesitancy and religious acceptance of vaccination [25,[33][34][35]. ...
Vaccine hesitancy is one of the greatest health issues worldwide. The recent coronavirus disease 2019 (COVID-19) pandemic was marked by substantial levels of vaccine hesitancy, especially in low- and middle-income countries. COVID-19 vaccine hesitancy and its enablers would shape community uptake of non-covid vaccines such as oral cholera vaccine (OCV) in the post-covid era. This study assessed the impact of COVID-19 vaccine hesitancy and its drivers on OCV hesitancy in the Democratic Republic of Congo (DRC). We conducted a community cross-sectional survey from 1st to 31st March 2022 in Bukavu, South-Kivu, eastern DRC. The survey included characteristics, intention to take OCV and COVID-19 when available, reasons for COVID-19 hesitancy, and thinking and feeling about COVID-19 vaccines. Poisson regression analyses were performed. Of the 1708 respondents, median age 38 years (interquartile range, 26-54), 54.34% males, 84.66% and 77.57% were hesitant to take OCV alone or both OCV and COVID-19, respectively. Being hesitant to COVID-19 increased by 12% the likelihood of being hesitant to OCV (crude prevalence ratio, [cPR]=1.12, 95%CI[1.03-1.21]). Independent sociodemographic predictors of OCV hesitancy were living in semi-urban areas (adjusted PR[aPR]=1.10, 95%CI[1.03-1.12]) and religious acceptance of vaccines (aPR=1.06, 95%CI[1.02-1.12]). Further, concern about safety (aPR=1.05, 95%CI[1.01-1.11]), effects (aPR=1.06, 95%CI[1.01-1.12]), and poor knowledge (aPR=1.07, 95%CI[1.01-1.14]). COVID-19 vaccines significantly increased the likelihood of OCV hesitancy, whereas thinking that COVID-19 could be prevented by vaccination reduced the odds of hesitancy by about 24% (aPR=0.76, 95%CI[0.62-0.93]). In this cholera endemic region, we found a high rate of OCV with COVID-19 vaccine hesitancy and its drivers exhibiting a significant domino effect on the uptake of OCV. Addressing COVID-19 vaccine hesitancy and misinformation through community-based health literacy interventions would likely improve the introduction of novel non-COVID-19 vaccines in COVID-19 endemic era.
... A sentiment of trust, in its various forms-including trust in government, the healthcare system, and healthcare providers-has been identified as a significant factor contributing to vaccine hesitancy in the U.S. and worldwide [58][59][60]. The relationship between such sentiment and vaccine acceptance is similarly present among Black and African American individuals in the U.S., with an additional layer of complexity arising from a historical backdrop of unethical practices in the medical field and contemporary experiences of discrimination affecting this population's sentiments of trust in the system and providers in charge of vaccination. ...
Despite the crucial role the COVID-19 vaccine played in curbing the pandemic, a significant portion of Black and African American individuals expressed hesitancy toward being vaccinated. This review aimed to identify the determinants of COVID-19 vaccine hesitancy among Black and African American individuals in the U.S. The literature search was conducted in December 2022 according to the PRISMA criteria focusing on empirical studies. Data extraction methods, critical appraisal, and secondary thematic analysis were conducted on both quantitative and qualitative studies. Sixteen quantitative studies identified the key factors associated with vaccine hesitancy, such as confidence in vaccine effectiveness, safety, and trust in the healthcare system. Fourteen qualitative studies revealed major themes of mistrust, fear, and information needs, including historical mistrust, concerns about the vaccine development process, and contemporary institutional mistrust. The synthesis of quantitative and qualitative findings derived from this review provides a nuanced understanding of the determinants of vaccine hesitancy in Black and African American communities in the U.S., offering a foundation for the development of evidence-based interventions. Mistrust in the healthcare system, fear, and informational gaps on vaccine safety and effectiveness were identified as significant barriers to vaccination, demanding targeted interventions.
... The logistic regression analysis from the study indicated the critical finding of a significant role of trust in institutions, which consistently emerged as an increasing predictor of agreement with the national vaccination plan for both 2021 and 2023. This underscores the importance of public trust in health authorities and policies [56][57][58]. Building and sustaining this trust is crucial for successful vaccination campaigns as it directly influences individuals' willingness to comply with public health recommendations. The significant role of the native language, particularly Italian over German, suggests that health communication and policymaking must be culturally sensitive and linguistically tailored to effectively reach and resonate with diverse communities. ...
This study examines vaccine agreements in South Tyrol, Italy, within distinct socio-cultural and linguistic contexts. Using data from the 2021 and 2023 “COVID-19 Snapshot Monitoring” extended surveys, we assessed changes in attitudes towards COVID-19 and other vaccinations during the second and final years of the pandemic. Multivariate logistic regression analysis was used to examine factors such as trust in institutions, language groups, and the use of complementary and alternative medicine. The representativeness of the study is supported by good participation rates, ensuring a comprehensive view of attitudes towards vaccination in the region. The results show a shift in public agreement with the national vaccination plan to 64% by 2023, from a rate of about 73% agreement in 2021 (p < 0.001). A significant decrease in trust in health authorities and a negative correlation with complementary and alternative medicine consultations were observed. The results highlight the complex nature of vaccine hesitancy in diverse regions such as South Tyrol and underline the need for targeted communication strategies and trust-building initiatives to effectively reduce hesitancy. This study provides critical insights for the formulation of public health strategies in diverse sociocultural settings.
... A sentiment of trust, in its various forms, including trust in government, the healthcare system, and healthcare providers has been identified as a significant factor contributing to vaccine hesitancy in the USA and worldwide [54,55,56]. The relationship between such sentiment and vaccine acceptance is similarly present among Black and African American individuals in the USA, with an additional layer of complexity arising from a historical backdrop of unethical practices in the medical field and contemporary experiences of discrimination affecting this population's sentiments of trust in the system and providers in charge of the vaccination. ...
Despite the crucial role the COVID-19 vaccine played in curbing the pandemic, a significant portion of Black and African American individuals expressed hesitancy in being vaccinated. This review aimed to identify the determinants of COVID-19 vaccine hesitancy among Black and African American individuals in the USA. The literature search was conducted in December 2022 according to the PRISMA criteria focusing on empirical studies. Data extraction methods, critical appraisal, and secondary thematic analysis were conducted on both quantitative and qualitative studies. Sixteen quantitative studies identified key factors associated with vaccine hesitancy such as confidence in vaccine effectiveness, safety, and trust in the healthcare system. 14 qualitative studies revealed major themes of mistrust, fear, and information needs, including historical mistrust, concerns about the vaccine development process, and contemporary institutional mistrust. The synthesis of quantitative and qualitative findings derived from this review provides a nuanced understanding of determinants of vaccine hesitancy in Black and African American communities in the USA, offering a foundation for the development of evidence-based interventions. Mistrust in the healthcare system, fear, and informational gaps on vaccine safety and effectiveness have been identified as significant barriers to vaccination, demanding targeted interventions.
... In a study of 7,554 individuals in Brazil, Storopoli et al. (2020) found that confidence in the ability of social institutions to cope with the pandemic positively influenced people's choice to adopt preventive measures for COVID-19. Similarly, Choi and Fox (2022) found that mistrust of public health institutions was a strong predictor of COVID-19 vaccine hesitancy among U.S. adults. In China, the lack of trust toward vaccine producers was also found to be associated with vaccine hesitancy (Wu et al., 2023). ...
In light of the controversies surrounding COVID-19 vaccines, this study explored vaccine adoption through a theoretical model, focusing on France (n=2001) and South Africa (n=1107). Analysis using structural equation modelling and hierarchical cluster analysis revealed that social influences, personal opinions on vaccines, perceived severity of the pandemic, and perceived benefits of vaccination were primary drivers of adoption in both countries. Belief in conspiracy theories and perceptions of social distancing and stay-at-home measures had no influence on acceptance. Trust significantly influenced adoption intentions only in South Africa. Cluster analysis revealed four distinct opinion groups—“enthusiasts,” “doubters,” “followers,” and “conspirationists”—each preferring different health information sources and technologies, with a common preference for traditional media over social media. These findings have implications for developing targeted health policies, communication, and trust-building strategies.
... 22 Other studies have found that trust in government, social trust, trust in physicians and mistrust of public health institutions and scientists are associated with vaccination intention and rates. 23,24 These findings are consistent with many of the expressions of trust and distrust made by our participants during the early pandemic. ...
Background
Trust and distrust have shaped health behaviour during the COVID‐19 pandemic. Since the start of the pandemic, misinformation and polarization eroded trust across the United States. In states like Michigan, pandemic restrictions led to significant unrest. Michiganders also faced disproportionate morbidity and mortality from COVID‐19 during this period.
Objective
The objective of this qualitative study was to understand the individual experiences of trust in low‐income Michiganders during the early COVID‐19 pandemic.
Participants
Twenty‐four participants at or below 200% of the federal poverty line who resided in Michigan were recruited for this study.
Approach
Interviews were conducted during the winter of 2020 using a formal interview guide that addressed sources of information, perceptions of risk and exposure, protective behaviours and impacts of the pandemic at home, work and in receiving healthcare.
Results
Thematic analysis showed that themes of trust and distrust emerged in multiple facets of our participants' experiences, including in the context of information sources, the behaviours of others, health, financial security, employment and overall safety. Trust and distrust in low‐income communities often stemmed from significant financial and economic vulnerabilities and instability in access to healthcare that was exacerbated in the pandemic. Furthermore, participant trust was shaped by internal (e.g., relationships with others) and external (e.g., source of information, social inequity) factors that influenced their perceptions and experiences during the pandemic.
Conclusion
Trust has played an important role in many aspects of the experiences of low‐income communities during the COVID‐19 pandemic. This is important for clinicians to consider as COVID‐19 becomes endemic, and trust continues to impact patients' approaches to vaccines, testing and treatment options.
Patient or Public Contribution
This study was designed and conducted with the assistance and input of the members of the DECIDERS Steering Committee, a diverse statewide network of community members in Michigan. The DECIDERS team allows community members to have a voice in the design and conduct of health research, and collaborates with researchers to improve health across the state of Michigan.
This study examines changes in the association between social policy performance and trust in government, focusing on the Coronavirus disease 2019 (COVID-19) vaccination policy implemented by Japan’s central government. Data from the Online Panel Survey of Stratification and Social Psychology (SSPW2021-Panel) were analyzed using two-way fixed effects regression models. The quadratic term of the COVID-19 vaccination rate at the prefecture level had statistically significant effects on the evaluation of the central government’s infection control policies and trust in the central government. This implies that the relative deprivation experienced by unvaccinated individuals weakened trust in the central government in the early stage, and the decline in the number of unvaccinated individuals strengthened trust in the central government in the latter stage. Thus, this paper finds that even if a social policy meets people’s demands, its implementation may temporally damage the government’s reputation through relative deprivation.
Background
Democrats are more likely to be vaccinated for COVID-19 than Republicans. It is unknown if political polarization surrounding the COVID-19 vaccine has affected flu vaccine uptake. The purpose of this study is to examine the partisan differences in annual flu vaccine uptake before and after the COVID-19 pandemic.
Methods
This study uses longitudinal panel survey data from the Understanding America Study (UAS), spanning from 2015 to 2024. Using self-reported flu vaccination and partisanship over time, I estimate the odds ratios of flu vaccination for partisan groups before the COVID-19 pandemic, during the pre-vaccination phase of the COVID-19 pandemic, and after the rollout of the COVID-19 vaccine.
Results
In pre-COVID years, the predicted probability of flu vaccination was 0.54 ([0.52,0.56], P < .000) among Republicans and 0.63 ([0.61,0.64], P < .00) among Democrats. After the roll-out of the COVID-19 vaccine, the average flu vaccination probability was 0.44 ([0.43,0.46], P < .00) among Republicans and 0.61 ([0.59,0.62], P < .00) among Democrats.
Conclusions
The COVID-19 pandemic increased the partisan gap in annual flu vaccination. Researchers should continue to investigate if the partisan gap in other types of vaccinations has grown post-COVID. Practitioners may need to tailor their flu vaccine messaging to vaccine-hesitant political demographics.
Study Design
Cross-sectional study of presenter disclosures from the 2022 North American Spine Society (NASS), Scoliosis Research Society (SRS), and Cervical Spine Research Society (CSRS) annual research conferences.
Objective
The current study aimed to evaluate the consistency of financial disclosures for authors presenting at multiple 2022 spine conferences and compared results to those previously reported in 2008.
Summary of Background Data
Transparent reporting of financial relationships between physicians and industry is seen as an important way to limit/address potential bias. Thus, many research conferences require authors to disclose such relationships. Despite these requirements, variability in the financial disclosure reporting for matched speakers at 2008 major spine conferences was previously reported. Since then, the Sunshine Act mandated public financial relationships, potentially furthering attention and leading to improvements in financial disclosures.
Methods
Disclosures of authors presenting at >1 of the three 2022 spine conferences were compiled from conference websites, and discrepancies were determined based on conference disclosure policies. For comparisons where both conferences required disclosure of all relationships, the discrepancy was identified if there was not a match. For comparisons where 1 conference required paper-specific relationships, and the other required all relationships, discrepancy was identified if the first was not a subset of the other. Results were compared with those reported from 2008.
Results
NASS and SRS both required disclosure of all relationships, had 208 overlapping authors, and had 36.5% discrepancies. SRS and CSRS required all and paper-specific disclosures, had 37 overlapping authors, and had 29.7% discrepancies. NASS and CSRS required all and paper-specific disclosures, had 81 overlapping authors, and had 29.6% discrepancies. Overall, the average discrepancy for pairs of conferences in 2008 was 26%, and for 2022 was 32%, indicating a lack of improvement. Compared with 2008, discrepancies decreased more when disclosure requirements were the same for both conferences being considered.
Conclusions
These findings demonstrate that significant variability remains in the reporting of financial conflicts of interest by authors presenting at 3 major spine conferences last year, despite previous scrutiny and the evolution of the Sunshine Act. These discrepancies may reflect the ambiguity caused by different disclosure policies and further attention is needed for this topic.
Context: Policy feedback research has demonstrated that a highly tangible policy that shapes public attitudes through direct and day-to-day experiences often reshapes public opinion, with the effect of generating supportive or skeptical constituencies that determine the sustainability of future programs. This paper examines the impact of mass vaccination efforts on attitudes towards vaccines in a context of high vaccine hesitancy in the U.S.
Methods: We analyzed 73,092 survey responses from 9,229 participants in the longitudinal data from the Understanding America Study project, covering December 2020 to July 2023. Using two-way fixed-effects ordinary least squares regression and ordinal logistic regression, we estimated the changes in attitudes towards vaccines, including trust in vaccine manufacturing and approval processes, following COVID-19 vaccinations.
Findings: COVID-19 vaccination was associated with improved perceptions of vaccine effectiveness and social benefits and reduced mistrust in vaccine-related processes. However, it did not significantly alleviate concerns regarding vaccine side effects and illness. The strongest effects were observed among respondents initially hesitant but who eventually vaccinated.
Conclusions: The experience of COVID-19 vaccination generally improved attitudes and confidence in COVID-19 vaccines among the U.S. public, particularly among vaccine-hesitant people. These effects could have positive impacts on future immunization programs by mitigating vaccine hesitancy.
This chapter addresses one lesson (among many) from the COVIZ-19 pandemic: trust and public communication of science-based evidence are crucial in the management of public health crises. It is a lesson all countries need to grasp to equip themselves with the governance tools required to prevent, as far as possible, the escalation of future infectious disease outbreaks into pandemics. The analysis is based on the community informed concept and illustrated by comparative cross-national empirical evidence--available up to 31 Dec 2023--on the governance of the COVID-19 pandemic. The data are from 20 countries selected from the full score range of the World Bank's Worldwide Governance Indicators. The key findings from this study are: (1) A public health crisis cannot be managed successfully by a country's health authorities alone, irrespective of the quality and sophistication of its health care services. (2) The health authorities need to work together as partners with the at-risk population in the design and implementation of an effective preventive and containment strategy. (3) The at-risk population is most likely to consent to cooperate in the implementation of a preventive and containment strategy if they trust the information from the health authorities; if they are kept well-informed about the authorities' prevention and containment strategy and its progress; if they are offered incentives to cooperate; and if they are invited to participate by contributing their knowledge and voluntary assistance when needed. (4) The at-risk population's trust in the health authorities cannot be instilled overnight. Countries where segments of the population have low or no trust in their government are more likely to dismiss, resist or oppose the implementation of a strict pandemic prevention and control strategy, particularly regulations perceived as intrusive (for example facemask wearing, restricted physical distance, quarantine, and vaccination).
Geographical residence predicts health and well-being. Population health, life expectancy, and mortality are partially the outcome of the characteristics of one’s social policy context. Yet how do such links occur? We extend focus from health outcomes to health behaviors and from a policy context to a broader political context. Using 20 waves of the Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System between 1993 and 2021 in combination with the Correlates of State Policy Project, we find that right-leaning political contexts—both policies and public attitudes—are predictive of riskier health behaviors. Counterfactual simulations show that these associations are due less to states becoming more different over time but rather, with political contexts increasing in their predictiveness over time. Results from this study broaden the pathways linking local politics to health and identify a key antecedent, health behaviors, that helps explain political context’s influence on health.
Purpose
As pandemic-related mistrust of public health recommendations in rural communities may compound gaps in pediatric immunizations, our team explored parents’ perceptions of trustworthiness in messaging.
Design
Qualitative study using 4 virtual focus groups.
Setting
Rural Wisconsin.
Participants
Participants (n = 25) were parents or guardians of children recruited through our contacts with community-based organizations serving rural communities.
Methods
Researchers used task-oriented elicitation techniques to initiate discussion on the trustworthiness of messengers and messages providing health recommendations. Participants were asked to (1) review existing public health messaging on a range of topics and from a range of sponsors; and (2) rank a list of potential messengers in terms of trustworthiness (eg, local health department, Centers for Disease Control). Discussions were recorded, and audio files transcribed, to facilitate a team-based, thematic analysis.
Results
Competency in medical knowledge and parenting experience contributed to estimations of trustworthiness. Participants also responded well to messages and messengers that were able to project recognition of their children’s uniqueness and their experience as parents. Participants distrusted messengers who were seen as biased or “one-sided” in their perspectives.
Conclusions
For successful health promotion for rural-living parents, messengers must be recognized as “competent” to provide pediatric health advice and to avoid blanket recommendations that may undermine parents’ experience and feelings of being “understood” and affect perceptions of trustworthiness.
Context: The role of political identities in determining attitudes to vaccines has attracted a lot of attention in the last decade. Explanations have tended to focus on the influence of party representatives on their sympathizers (partisan cues).
Methods: Four representatives samples of the French adult population completed online questionnaires between July 2021 and May 2022 (N = 9,177). Bivariate and multivariate analyses were performed to test whether partisan differences in attitudes to vaccines are best explained by partisan cues or by parties' differences in propensity to attract people who distrust the actors involved in vaccination policies.
Findings: People who feel close to parties at the far left, the far right and to green parties are more vaccine hesitant. We found a small evidence for the effect of partisan cues and a much stronger effect of trust. But more importantly, we show that the more politically sophisticated are less vaccine hesitant and that the non-partisan are the biggest and most vaccine-hesitant group.
Conclusions: The literature has focused on the case of the USA but turning the attention towards countries where disenchantment with politics is more marked helps better understand the different ways trust, partisanship and political sophistication can affect attitudes to vaccines.
Building trust in public health agencies like the US Food and Drug Administration (FDA) has become a key government priority. Understanding the roots of FDA mistrust is important if the agency is to develop targeted messaging and reforms aimed at building confidence in the agency. We conducted a survey of 2,021 respondents in the US probing attitudes toward the FDA. The primary outcome was FDA trust, defined as the mean score that each respondent assigned to the FDA across four prespecified axes: (1) competence and effectiveness; (2) commitment to acting in the best interests of the American public; (3) abiding by the rules and regulations set forth by policy or law; and (4) expertise in health, science, and medicine. On multivariable ordinal logistic regression, FDA mistrust was associated with female gender (odds ratio [OR] = 0.74, 95% confidence interval [CI] 0.62–0.88), rural community (OR 0.85, 95% CI 0.75–0.96), conservative political views (OR 0.77, 95% CI 0.74–0.81), worse self‐reported health (OR 0.89, 95% CI 0.80–0.98), lower satisfaction with health care received (OR 0.63, 95% CI 0.56–0.71), less attention to health and science news (OR 0.72, 95% CI 0.64–0.80), and not having children under the age of 18 (OR 0.72, 95% CI 0.60–0.86). These findings underscore the challenges faced by US political leaders in convincing a heterogeneous American public to trust the FDA. The FDA should develop and deploy targeted outreach strategies to populations with lower levels of trust and strengthen internal processes that minimize biases and ensure sound decision‐making.
Health literacy and awareness, trust in healthcare workers and healthcare system are im-portant factors in health-related decision-making. The aim of the study was to assess health awareness and the level of trust in health profession-als, to identify prevailing opinions and preferences in health services, and to define possible links between these parameters and demographic indicators among a sample of adults.
The primary focus of this paper is to investigate the influence of science literacy, particularly health literacy, on vaccine-specific conspiracy beliefs, within the broader context of vaccine hesitancy. The authors tested deficit (scientific literacy shapes science attitudes) and contextual models (contextual variables exert direct influence and influence the connection between literacy and science attitudes) in a survey research study ( N = 729) in Croatia. The analytical approach included structural equation modeling with vaccination conspiracy beliefs as the outcome variable and health literacy, religiosity, and political identification as predictors. The results showed that lower health literacy and higher religiosity were related to higher vaccination conspiracy beliefs, which was not the case for political identification. In addition, the moderating effect of religiosity on the relationship between health literacy and conspiracy beliefs was confirmed. In contrast, the moderating effect of political identification was not confirmed, thus partially confirming the stronger version of the contextual model. The authors comparatively discuss the results by evoking specific socio-political characteristics of Croatian society as well as the reactions of political and religious organizations to the COVID-19 pandemic.
Background:
Distrust and partisan identity are theorized to undermine health communications. We examined the role of these factors on the efficacy of discussion groups intended to promote vaccine uptake.
Method:
We analyzed survey data from unvaccinated Facebook users (N = 371) living in the US between January and April 2022. Participants were randomly assigned to Facebook discussion groups (intervention) or referred to Facebook's COVID-19 Information Center (control). We used Analysis of Covariance to test if the intervention was more effective at changing vaccination intentions and beliefs compared to the control in subgroups based on participants' partisan identity, political views, and information trust views.
Results:
We found a significant interaction between the intervention and trust in public health institutions (PHIs) for improving intentions to vaccinate (P = .04), intentions to encourage others to vaccinate (P = .03), and vaccine confidence beliefs (P = .01). Among participants who trusted PHIs, those in the intervention had higher posttest intentions to vaccinate (P = .008) and intentions to encourage others to vaccinate (P = .002) compared to the control. Among non-conservatives, participants in the intervention had higher posttest intentions to vaccinate (P = .048). The intervention was more effective at improving intentions to encourage others to vaccinate within the subgroups of Republicans (P = .03), conservatives (P = .02), and participants who distrusted government (P = .02).
Conclusions:
Facebook discussion groups were more effective for people who trusted PHIs and non-conservatives. Health communicators may need to segment health messaging and develop strategies around trust views.
Health literacy and awareness, trust in healthcare workers and healthcare system are im-portant factors in health-related decision-making. The aim of the study was to assess health awareness and the level of trust in health profession-als, to identify prevailing opinions and preferences in health services, and to define possible links between these parameters and demographic indicators among a sample of adults.
L’influence des identités et croyances politiques sur les attitudes à l’égard d’une grande diversité d’aspects de l’épidémie de Covid-19 a été soulignée dès les débuts de cette crise. Dans cet article, nous dressons un bilan de ce que les enquêtes par questionnaire réalisées au cours de l’épidémie nous disent de la relation entre vaccination et politisation. Nous souhaitons également faire un état des lieux des débats internationaux sur l’influence des identités politiques sur les attitudes à l’égard de la santé, la médecine et la science plus généralement. Les approches ancrées en psychologie cognitive et sociale dominent cette littérature. À partir du cas français, nous montrerons les apports, mais aussi les limites de ces approches. Nous proposerons certaines pistes d’articulation entre cette littérature et la sociologie française des rapports ordinaires à la politique. Ces pistes permettent de mieux comprendre la place que peuvent avoir les rapports ordinaires à la politique dans les rapports à la santé.
Background
The COVID-19 era has been characterized by the politicization of health-related topics. This is especially concerning given evidence that politicized discussion of vaccination may contribute to vaccine hesitancy. No research, however, has examined the content and politicization of legislator communication with the public about vaccination during the COVID-19 era.
Objective
The aim of this study was to examine vaccine-related tweets produced by state and federal legislators during the COVID-19 era to (1) describe the content of vaccine-related tweets; (2) examine the differences in vaccine-related tweet content between Democrats and Republicans; and (3) quantify (and describe trends over time in) partisan differences in vaccine-related communication.
Methods
We abstracted all vaccine-related tweets produced by state and federal legislators between February 01, 2020, and December 11, 2020. We used latent Dirichlet allocation to define the tweet topics and used descriptive statistics to describe differences by party in the use of topics and changes in political polarization over time.
ResultsWe included 14,519 tweets generated by 1463 state legislators and 521 federal legislators. Republicans were more likely to use words (eg, “record time,” “launched,” and “innovation”) and topics (eg, Operation Warp Speed success) that were focused on the successful development of a SARS-CoV-2 vaccine. Democrats used a broader range of words (eg, “anti-vaxxers,” “flu,” and “free”) and topics (eg, vaccine prioritization, influenza, and antivaxxers) that were more aligned with public health messaging related to the vaccine. Polarization increased over most of the study period.
Conclusions
Republican and Democratic legislators used different language in their Twitter conversations about vaccination during the COVID-19 era, leading to increased political polarization of vaccine-related tweets. These communication patterns have the potential to contribute to vaccine hesitancy.
As the novel coronavirus (COVID-19) continues to spread, vaccine hesitancy increasingly threats public health worldwide. Health information from traditional, online and social media may influence vaccine hesitancy. The purpose of this study was to explore the influence of exposure to COVID-19 information from various media on vaccine hesitancy, as well as the mediating roles of public trust in government and vaccine confidence. With a sample of 438 online participants (mean age = 30.69 years) responding to an anonymous questionnaire, the study tested a mediation model using bias-corrected bootstrap. The results indicated that exposure to COVID-19 information from online news media and traditional media can reduce vaccine hesitancy indirectly. Whereas a positive and indirect relationship between COVID-19 information exposure on social media and vaccine hesitancy was revealed. Trust in government and vaccine confidence were found to be salient mediators between exposure to COVID-19 information from various media and vaccine hesitancy. Findings from this study offer implications for strategies to address vaccine hesitancy. ARTICLE HISTORY
COVID-19 vaccine hesitancy threatens pandemic control efforts. We evaluated vaccine hesitancy in the US by employment status and occupation category during the COVID-19 vaccine rollout. US adults 18-64 years completed an online COVID-19 survey 3,179,174 times from January 6-May 19, 2021. Data was aggregated by month. Survey weights matched the sample to the US population age, gender, and state profile. Weighted percentages and 95% confidence intervals (CI) were calculated. Changes in vaccine hesitancy from January-May varied widely by employment status (e.g., -7.8% [95%CI, -8.2--7.5] among those working outside the home, a 26.6% decrease; -13.3% [95%CI, -13.7--13.0] among those not working for pay, a 44.9% decrease), and occupation category (e.g., -15.9% [95%CI, -17.7--14.2] in production, a 39.3% decrease; -1.4% [95%CI, -3.8--1.0] in construction/extraction, a 3.0% decrease). April 20-May 19, 2021, vaccine hesitancy ranged from 7.3% (95%CI, 6.7-7.8) in computer/mathematical professions to 45.2% (95%CI, 43.2-46.8) in construction/extraction. Hesitancy was 9.0% (95%CI, 8.6-9.3) among educators and 14.5% (95%CI, 14.0-15.0) among healthcare practitioners/technicians. While the prevalence of reasons for hesitancy differed by occupation, over half of employed hesitant participants reported concern about side effects (51.7%) and not trusting COVID-19 vaccines (51.3%), whereas only 15.0%) didn't like vaccines in general. Over a third didn't believe they needed the vaccine, didn't trust the government, and/or were waiting to see if it was safe. In this massive national survey of adults 18-64 years, vaccine hesitancy varied widely by occupation. Reasons for hesitancy indicate messaging about safety and addressing trust are paramount.
The long-term success of New Zealand’s Covid-19 elimination plan and the re-opening of fortress New Zealand rests on high population uptake of the Covid-19 vaccine. Understanding factors that contribute to vaccine hesitancy – and potential inequities in access and uptake – are consequently essential for the efficacy of the national immunisation programme which began rolling out to the general population in July 2021. Prior research on the New Zealand context has documented socio-demographic disparities in Covid-19 vaccine hesitancy (Horizon Research, 2020; Prickett, Habibi and Atatoa Carr, 2021; Thaker, 2021). However, little research has been undertaken to examine how psychosocial elements – such as people’s trust in institutions – might be associated with people’s vaccine intent and cast some light on the reasons underpinning their intent.
Leveraging nationally representative survey data on 443,680 respondents from January to March 2021, this study examines the temporal, spatial, and sociodemographic variations in COVID-19 vaccine hesitancy in the U.S. Findings reveal multidimensional determinants of vaccination intentions involving confidence, complacency, and circumspection factors. Using descriptive analyses and multilevel mixed-effects regression models, we find persistent partisan divide across states and significant racial disparities, with Blacks more likely to develop vaccine hesitancy due to confidence and circumspection than Whites. Vaccine hesitancy among Blacks declines dramatically across time but varies little across states, indicating new directions to effectively address inequalities in vaccination. Results also show nuanced gender differences, with women more likely to develop hesitancy due to circumspection and men more likely to have hesitancy due to complacency. Moreover, we find important intersection between race, gender, and education that calls for efforts to adequately address the concerns of the most vulnerable and disadvantaged groups.
Background:
There is widespread hesitancy towards COVID-19 vaccines in the United States, United Kingdom, and Australia.
Objective:
To identify predictors of willingness to vaccinate against COVID-19 in five cities with varying COVID-19 incidence in the US, UK, and Australia.
Design:
Online, cross-sectional survey of adults from Dynata's research panel in July-September 2020.
Participants, setting:
Adults aged 18 and over in Sydney, Melbourne, London, New York City, or Phoenix.
Main outcomes and measures:
Willingness to receive a COVID-19 vaccine; reason for vaccine intention.
Statistical methods:
To identify predictors of intention to receive a COVID-19 vaccine, we used Poisson regression with robust error estimation to produce prevalence ratios.
Results:
The proportion willing to receive a COVID-19 vaccine was 70% in London, 71% NYC, 72% in Sydney, 76% in Phoenix, and 78% in Melbourne. Age was the only sociodemographic characteristic that predicted willingness to receive a COVID-19 vaccine in all five cities. In Sydney and Melbourne, participants with high confidence in their current government had greater willingness to receive the vaccine (PR = 1.24; 95% CI = 1.07-1.44 and PR = 1.38; 95% CI = 1.74-1.62), while participants with high confidence in their current government in NYC and Phoenix were less likely to be willing to receive the vaccine (PR = 0.78; 95% CI = 0.72-0.85 and PR = 0.85; 95% CI = 0.76-0.96).
Limitations:
Consumer panels can be subject to bias and may not be representative of the general population.
Conclusions:
Success for COVID-19 vaccination programs requires high levels of vaccine acceptance. Our data suggests more than 25% of adults may not be willing to receive a COVID-19 vaccine, but many of them were not explicitly anti-vaccination and thus may become more willing to vaccinate over time. Among the three countries surveyed, there appears to be cultural differences, political influences, and differing experiences with COVID-19 that may affect willingness to receive a COVID-19 vaccine.
Does emphasizing the pandemic as a partisan issue polarize factual beliefs, attitudes, and behavioral intentions concerning the SARS-CoV-2/COVID-19 pandemic? To answer this question, we conducted a preregistered survey experiment with a “questions as treatment” design in late March 2020 with 1587 U.S. respondents recruited via Prime Panel. Respondents were randomly assigned to answer several questions about then-president Donald J. Trump and the coronavirus (including receiving an information cue by evaluating one of Trump’s tweets) either at the beginning of the survey (treated condition) or at the end of the survey (control condition). Receiving these questions at the beginning of the survey had no direct effect on COVID-19 factual beliefs, attitudes, and behavioral intentions.
As COVID-19 vaccines are rolled out across the world, there are growing concerns about the roles that trust, belief in conspiracy theories, and spread of misinformation through social media play in impacting vaccine hesitancy. We use a nationally representative survey of 1476 adults in the UK between 12 and 18 December 2020, along with 5 focus groups conducted during the same period. Trust is a core predictor, with distrust in vaccines in general and mistrust in government raising vaccine hesitancy. Trust in health institutions and experts and perceived personal threat are vital, with focus groups revealing that COVID-19 vaccine hesitancy is driven by a misunderstanding of herd immunity as providing protection, fear of rapid vaccine development and side effects, and beliefs that the virus is man-made and used for population control. In particular, those who obtain information from relatively unregulated social media sources—such as YouTube—that have recommendations tailored by watch history, and who hold general conspiratorial beliefs, are less willing to be vaccinated. Since an increasing number of individuals use social media for gathering health information, interventions require action from governments, health officials, and social media companies. More attention needs to be devoted to helping people understand their own risks, unpacking complex concepts, and filling knowledge voids.
COVID-19 vaccines were approved for use in the general American public by late 2020 and early 2021. Media reports started highlighting COVID-19 vaccination hesitancy in racial and ethnic minorities. However, little is known about the extent of COVID-19 vaccination hesitancy in racial and ethnic minorities and whether there are unique sociodemographic and cognitive correlates associated with vaccine hesitancy. Thus, the purpose of this study was to review all nationwide studies on COVID-19 vaccine hesitancy among African-Americans and Hispanics (the largest minority groups in the U.S.). A comprehensive review of the published literature was conducted to search for national studies and a final pool of 13 studies (n=107,841 participants) was included in this review. The overall pooled prevalence rate of COVID-19 vaccination hesitancy for adult Americans across all studies was 26.3% (95%Ci=17.3-36.4). In contrast, the overall pooled prevalence rate of COVID-19 vaccination hesitancy for African-Americans was 41.6% (95%Ci=34.4-48.9) and for Hispanics, it was 30.2% (95%Ci=23.2-37.7). The major predictors of vaccine hesitancy in African-Americans and Hispanics were: sociodemographic characteristics (e.g., age, gender, income, education, and household size); medical mistrust and history of racial discrimination; exposure to myths and misinformation, perceived risk of getting infected with COVID-19; beliefs about vaccines and past vaccine compliance, and concerns about the safety, efficacy, and side effects from the COVID-19 vaccines. Given the high COVID-19 vaccine hesitancy rates in racial/ethnic minorities and the unique factors associated with vaccine hesitancy in African-Americans and Hispanics, several clinic-based and community-oriented practice recommendations have been included in this article.
Anti-intellectualism (the generalized distrust of experts and intellectuals) is an important concept in explaining the public’s engagement with advice from scientists and experts. We ask whether it has shaped the mass public’s response to coronavirus disease 2019 (COVID-19). We provide evidence of a consistent connection between anti-intellectualism and COVID-19 risk perceptions, social distancing, mask usage, misperceptions and information acquisition using a representative survey of 27,615 Canadians conducted from March to July 2020. We exploit a panel component of our design (N = 4,910) to strongly link anti-intellectualism and within-respondent change in mask usage. Finally, we provide experimental evidence of anti-intellectualism’s importance in information search behaviour with two conjoint studies (N ~ 2,500) that show that preferences for COVID-19 news and COVID-19 information from experts dissipate among respondents with higher levels of anti-intellectual sentiment. Anti-intellectualism poses a fundamental challenge in maintaining and increasing public compliance with expert-guided COVID-19 health directives.
Background
COVID-19 has had a devastating impact and efforts are being made to speed up vaccinations. The growing problem of vaccine hesitancy may affect the uptake of COVID-19 vaccine. We examined the individual, communication and social determinants associated with vaccines uptake.
Methods
Data come from a nationwide online probability-based panel of 1012 representative adults in the United States and the survey was conducted before the vaccines were available. People under the federal poverty level and racial and ethnic minorities were oversampled. Our outcome variables of interest were likelihood of vaccinating self and likelihood of vaccinating people under one’s care (such as children) measuring behavioral intentions. Independent variables included perceptions of risk, exposure to different media for COVID-19 news, political party identification, confidence in scientists and social determinants of health. Logistic regression analysis was used to ascertain the effects of independent variables on the two outcome variables.
Results
The results indicated that 68 and 65% agreed to get the vaccine for themselves and people under their care, respectively. Risk perceptions (severity of and susceptibility to COVID-19) were significantly associated with vaccine uptake. People who relied on “conservative” news outlets, Republicans, and who had low confidence in scientists are least likely to vaccinate self or children. Non-Hispanic Blacks and those with least schooling were also less likely to receive vaccine for themselves or people in their care.
Conclusions
Our study identified race/ethnicity, risk perceptions, exposure to different media for COVID-19 news, party identification and confidence in scientists as factors that would be affecting COVID-19 vaccine uptake. The good news is that these are addressable through strategic public health communications, but a lot of work remains to be done with some urgency.
Beyond the complex logistical task of prioritizing, distributing and safely storing millions of doses of COVID-19 vaccines, state and local governments must simultaneously devise and carry out transparent plans that center equity and overcome the barriers to vaccination facing minority communities. Using insights gleaned from four focus groups conducted with health care and social service professionals serving minority communities in New York State as well as from existing research on vaccination, our results emphasize that vaccine hesitancy and access barriers—particularly within minority communities—pose significant hurdles to achieving widespread uptake of COVID-19 vaccines. Overcoming barriers requires community-engaged campaigns that acknowledge and address the historical injustices and on-going inequities that drive distrust within communities of color, emphasize understandable and culturally appropriate messages that directly address people's concerns about vaccine safety and access, and tap existing community infrastructure to make full use of trusted voices to deliver timely and accurate information about vaccines. Given emerging data and changing conditions, campaigns must also be self-reflective and adaptive, assessing progress and outcomes and reevaluating strategies as needed. However, above all, primary goals should remain focused on transparency, equity and building trust.
Objective
To study the U.S. public’s health behaviors, attitudes, and policy opinions about COVID-19 in the earliest weeks of the national health crisis (March 20–23, 2020).
Method
We designed and fielded an original representative survey of 3,000 American adults between March 20–23, 2020 to collect data on a battery of 38 health-related behaviors, government policy preferences on COVID-19 response and worries about the pandemic. We test for partisan differences COVID-19 related policy attitudes and behaviors, measured in three different ways: party affiliation, intended 2020 Presidential vote, and self-placed ideological positioning. Our multivariate approach adjusts for a wide range of individual demographic and geographic characteristics that might confound the relationship between partisanship and health behaviors, attitudes, and preferences.
Results
We find that partisanship—measured as party identification, support for President Trump, or left-right ideological positioning—explains differences in Americans across a wide range of health behaviors and policy preferences. We find no consistent evidence that controlling for individual news consumption, the local policy environment, and local pandemic-related deaths erases the observed partisan differences in health behaviors, beliefs, and attitudes. In further analyses, we use a LASSO regression approach to select predictors, and find that a partisanship indicator is the most commonly selected predictor across the 38 dependent variables that we study.
Conclusion
Our analysis of individual self-reported behavior, attitudes, and policy preferences in response to COVID-19 reveals that partisanship played a central role in shaping individual responses in the earliest months of the COVID-19 pandemic. These results indicate that partisan differences in responding to a national public health emergency were entrenched from the earliest days of the pandemic.
Despite calls for political consensus, there is growing evidence that the public response to the COVID-19 pandemic has been politicized in the US. We examined the extent to which this polarization exists among the US public across two national studies. In a representative US sample (N = 699, March 2020) we find that liberals (compared to conservatives) perceive higher risk, place less trust in politicians to handle the pandemic, are more trusting of medical experts such as the WHO, and are more critical of the government response. We replicate these results in a second, pre-registered study (N = 1000; April 2020), and find that results are similar when considering partisanship, rather than political ideology. In both studies we also find evidence that political polarization extends beyond attitudes, with liberals consistently reporting engaging in a significantly greater number of health protective behaviors (e.g., wearing face masks) than conservatives. We discuss the possible drivers of polarization on COVID-19 attitudes and behaviors, and reiterate the need for fostering bipartisan consensus to effectively address and manage the COVID-19 pandemic.
It is critical to develop tailored strategies to increase acceptability of the COVID-19 vaccine and decrease hesitancy. Hence, this study aims to assess and identify factors associated with COVID-19 vaccine hesitancy in Portugal. We used data from a community-based survey, “COVID-19 Barometer: Social Opinion”, which includes data regarding intention to take COVID-19 vaccines, health status, and risk perception in Portugal from September 2020 to January 2021. We used multinomial regression to identify factors associated with intention to delay or refuse to take COVID-19 vaccines. COVID-19 vaccine hesitancy in Portugal was high: 56% would wait and 9% refuse. Several factors were associated with both refusal and delay: being younger, loss of income during the pandemic, no intention of taking the flu vaccine, low confidence in the COVID-19 vaccine and the health service response during the pandemic, worse perception of government measures, perception of the information provided as inconsistent and contradictory, and answering the questionnaire before the release of information regarding the safety and efficacy of COVID-19 vaccines. It is crucial to build confidence in the COVID-19 vaccine as its perceived safety and efficacy were strongly associated with intention to take the vaccine. Governments and health authorities should improve communication and increase trust.
This study reports a comprehensive empirical investigation of the nature and correlates of anti-mask attitudes during the COVID-19 pandemic. Accumulating evidence underscores the importance of facemasks, as worn by the general public, in limiting the spread of infection. Accordingly, mask wearing has become increasingly mandatory in public places such as stores and on public transit. Although the public has been generally adherent to mask wearing, a small but vocal group of individuals refuse to wear masks. Anti-mask protest rallies have occurred in many places throughout the world, sometimes erupting violently. Few empirical studies have examined the relationship between anti-mask attitudes and mask non-adherence and little is known about how such attitudes relate to one another or other factors (e.g., non-adherence to social distancing, anti-vaccination attitudes). To investigate these issues, the present study surveyed 2,078 adults from the US and Canada. Consistent with other surveys, we found that most (84%) people wore masks because of COVID-19. The 16% who did not wear masks scored higher on most measures of negative attitudes towards masks. Network analyses indicated that negative attitudes about masks formed an intercorrelated network, with the central nodes in the network being (a) beliefs that masks are ineffective in preventing COVID-19, and (b) psychological reactance (PR; i.e., an aversion to being forced to wear masks). These central nodes served as links, connecting the network of anti-masks attitudes to negative attitudes toward SARSCoV2 vaccination, beliefs that the threat of COVID-19 has been exaggerated, disregard for social distancing, and political conservatism. Findings regarding PR are important because, theoretically, PR is likely to strengthen other anti-masks attitudes (e.g., beliefs that masks are ineffective) because people with strong PR react with anger and counter-arguments when their beliefs are challenged, thereby leading to a strengthening of their anti-mask beliefs. Implications for improving mask adherence are discussed.
A significant portion of the U.S. population may experience vaccine hesitancy of a new COVID-19 vaccine, which poses dangers to both the individual and their community, since exposure to a contagious disease places the person at risk, and individuals are far more likely to spread the disease to others if they do not get vaccinated. Many individuals are doubtful, and without the healthcare community, speaking with one voice has led to distrust. Experience from the influenza vaccines have shown vaccine acceptance has not been optimal, and this new vaccine, even though it is not approved, is already showing layperson skepticism compounded by political influences.
How do individuals form new health beliefs and act in the context of unprecedented uncertainty? Drawing on a unique data set of registered California voters collected a month into stay-at-home orders that allows for an individual-level analysis, we examine the impact of political worldviews on trust in public health institutions and beliefs about the threat of COVID-19, effective methods for preventing the disease, and leaving home during the pandemic. Although all measures of political worldviews are strongly associated with trust in public health institutions and perceptions of threat, beliefs about effective prevention measures, and behavior, we find that Trump approval is particularly associated with COVID-19 risk perception and beliefs, beyond political party affiliation or life circumstances that shape exposure to COVID-19. We discuss the theoretical implications of these findings for understanding how political worldviews bear on embodied practices and shape the relationship between beliefs and action in unsettled times.
Several coronavirus disease 2019 (COVID-19) vaccines are currently in human trials. In June 2020, we surveyed 13,426 people in 19 countries to determine potential acceptance rates and factors influencing acceptance of a COVID-19 vaccine. Of these, 71.5% of participants reported that they would be very or somewhat likely to take a COVID-19 vaccine, and 61.4% reported that they would accept their employer’s recommendation to do so. Differences in acceptance rates ranged from almost 90% (in China) to less than 55% (in Russia). Respondents reporting higher levels of trust in information from government sources were more likely to accept a vaccine and take their employer’s advice to do so.
Europe is increasingly described as the region in the world with the least confidence in vaccination, and particularly in the safety of vaccines. The aim of this systematic literature review was to gather and summarise all peer-reviewed and grey literature published about determinants of Human Papillomavirus (HPV) vaccine hesitancy in Europe. Ten thematic categories were identified across the 103 articles which were included in the review. Participants from European studies most commonly reported issues with the quantity and quality of information available about HPV vaccination; followed by concerns about potential side effects of the vaccine; and mistrust of health authorities, healthcare workers, and new vaccines. Comparative analyses indicated that confidence determinants differed by country and population groups. This evidence supports the need to develop context-specific interventions to improve confidence in HPV vaccination and design community engagement strategies aiming to build public trust.
This paper presents the basic political science consensus on parties and their impact on policy, then turns to focus on the impact of the populist radical right (PRR) parties on policy, what PRR parties have done to implement their views and whether they make a difference. Three effects on policy were established: 1) they de-emphasize the issue, preferring to focus on migration, crime and security rather than health and welfare and 2) they prefer to pursue exclusionary policies. 3) it is not clear whether they increase or decrease benefits for the ‘‘native’’ populations they claim to represent. In short PRR parties make a difference whether to migrants or conservative governments, this party group matters.
In a Policy Forum, Peter Hotez and colleagues discuss vaccination exemptions in US states and possible consequences for infectious disease outbreaks.
This article provides an overview of the Understanding America Study (UAS), a nationally representative Internet panel of approximately 6,000 adult respondents that is administered by the University of Southern California. The UAS, which began in 2014, represents one of the richest sources of panel data available in the United States. It includes over 50 survey modules on topics such as retirement planning, economic well-being, and psychological constructs. This article reviews the UAS methodology; describes how external researchers may commission UAS surveys and incorporate their own survey questions and randomized controlled trials; highlights selected publicly available data from UAS surveys on cognition, personality, financial literacy and behaviors, political views, and other topics; and discusses opportunities for external parties to work with UAS administrators in developing new surveys and future lines of research.
Recently, Americans have become increasingly likely to hold anti-intellectual attitudes (i.e., negative affect toward scientists and other experts). However, few have investigated the political implications of anti-intellectualism, and much empirical uncertainty surrounds whether or not these attitudes can be mitigated. Drawing on cross-sectional General Social Survey (GSS) data and a national election panel in 2016, I find that anti-intellectualism is associated with not only the rejection of policy-relevant matters of scientific consensus but support for political movements (e.g., “Brexit”) and politicians (e.g., George Wallace, Donald Trump) who are skeptical of experts. Critically, though, I show that these effects can be mitigated. Verbal intelligence plays a strong role in mitigating anti-intellectual sympathies, compared with previously studied potential mitigators. I conclude by discussing how scholars might build on this research to study the political consequences of anti-intellectualism in the future.
Vaccine acceptance depends on public trust and confidence in the safety and efficacy of vaccines and immunization, the health system, healthcare professionals and the wider vaccine research community. This systematic review analyses the current breadth and depth of vaccine research literature that explicitly refers to the concept of trust within their stated aims or research questions. After duplicates were removed, 19,643 articles were screened by title and abstract. Of these 2,779 were screened by full text, 35 of which were included in the final analysis. These studies examined a range of trust relationships as they pertain to vaccination, including trust in healthcare professionals, the health system, the government, and friends and family members. Three studies examined generalized trust. Findings indicated that trust is often referred to implicitly (19/35), rather than explicitly examined in the context of a formal definition or discussion of the existing literature on trust in a health context. Within the quantitative research analysed, trust was commonly measured with a single-item measure (9/25). Only two studies used validated multi-item measures of trust. Three studies examined changes in trust, either following an intervention or over the course of a pandemic. The findings of this review indicate a disconnect between the current vaccine hesitancy research and the wider health-related trust literature, a dearth in research on trust in low and middle-income settings, a need for studies on how trust levels change over time and investigations on how resilience to trust-eroding information can be built into a trustworthy health system.
We compare sources of Donald Trump’s appeal in the 2016 US presidential campaign to the appeal of right-populists from Australia, Canada, New Zealand and the UK. We compare the appeal of right-populist to center-right candidates in each case (as measured with feeling thermometers) and test hypotheses about how the appeal of right-populists differs from that of center-right candidates. Standard predictors of affect toward right-of-center candidates were generally less relevant as a basis of affect toward right-populist candidates. This comparative perspective demonstrates that Trump’s appeal was based on racial resentment, anti-immigration sentiments and anxiety. Affect toward Trump and other right-populists from these Anglo-democracies fits patterns previously observed in Europe, a pattern that appears to be world-wide.
In light of the increasing refusal of some parents to vaccinate children, public health strategies have focused on increasing knowledge and awareness based on a “knowledge-deficit” approach. However, decisions about vaccination are based on more than mere knowledge of risks, costs, and benefits. Individual decision making about vaccinating involves many other factors including those related to emotion, culture, religion, and socio-political context. In this paper, we use a nationally representative internet survey in the U.S. to investigate socio-political characteristics to assess attitudes about vaccination. In particular, we consider how political ideology and trust affect opinions about vaccinations for flu, pertussis, and measles. Our findings demonstrate that ideology has a direct effect on vaccine attitudes. In particular, conservative respondents are less likely to express pro-vaccination beliefs than other individuals. Furthermore, ideology also has an indirect effect on immunization propensity. The ideology variable predicts an indicator capturing trust in government medical experts, which in turn helps to explain individual-level variation with regards to attitudes about vaccine choice.
Background
Missing data may seriously compromise inferences from randomised clinical trials, especially if missing data are not handled appropriately. The potential bias due to missing data depends on the mechanism causing the data to be missing, and the analytical methods applied to amend the missingness. Therefore, the analysis of trial data with missing values requires careful planning and attention.
Methods
The authors had several meetings and discussions considering optimal ways of handling missing data to minimise the bias potential. We also searched PubMed (key words: missing data; randomi*; statistical analysis) and reference lists of known studies for papers (theoretical papers; empirical studies; simulation studies; etc.) on how to deal with missing data when analysing randomised clinical trials.
Results
Handling missing data is an important, yet difficult and complex task when analysing results of randomised clinical trials. We consider how to optimise the handling of missing data during the planning stage of a randomised clinical trial and recommend analytical approaches which may prevent bias caused by unavoidable missing data. We consider the strengths and limitations of using of best-worst and worst-best sensitivity analyses, multiple imputation, and full information maximum likelihood. We also present practical flowcharts on how to deal with missing data and an overview of the steps that always need to be considered during the analysis stage of a trial.
Conclusions
We present a practical guide and flowcharts describing when and how multiple imputation should be used to handle missing data in randomised clinical.
Electronic supplementary material
The online version of this article (10.1186/s12874-017-0442-1) contains supplementary material, which is available to authorized users.
Trust in government agencies plays a key role in advancing these organizations' agendas, influencing behaviors, and effectively implementing policies. However, few studies have examined the extent to which individuals are aware of and trust the leading United States agencies devoted to protecting the public’s health. Using two national samples of adolescents (N = 1,125) and adults (N = 5,014), we examined demographic factors, with a focus on vulnerable groups, as correlates of awareness of and trust in the Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA), and the federal government. From nine different weighted and adjusted logistic regression models, we found high levels of awareness of the existence of the FDA and CDC (ranging from 55.7% for adolescents’ awareness of the CDC to 94.3% for adults’ awareness of the FDA) and moderate levels of trust (ranging from a low of 41.8% for adults’ trust in the federal government and a high of 78.8% for adolescents’ trust of the FDA). In the adolescent and adult samples, awareness was higher among non-Hispanic Blacks and respondents with low numeracy. With respect to trust, few consistent demographic differences emerged. Our findings provide novel insights regarding awareness and trust in the federal government and specific United States public health agencies. Our findings suggest groups to whom these agencies may want to selectively communicate to enhance trust and thus facilitate their communication and regulatory agendas.
Objective
Why are Americans COVID-19 vaccine hesitant? We test social science hypotheses for vaccine hesitancy, focusing on partisanship, trust in institutions, and social-demographic characteristics of registered voters.
Methods
We use survey data from a representative sample of American registered voters collected in November 2020 to study vaccine hesitancy, and the reasons for vaccine hesitancy, at a point in time before the vaccine was available and hence show underlying responses based on beliefs and not on clinical trial data. We use multivariate logistic regression models to test hypotheses on vaccine hesitancy.
Results
We find that consistently similar groups of people tend to be vaccine hesitant. Specifically, black voters, those between the ages of 45 and 64, female voters, voters without college degrees, voters not worried about the spread of COVID-19, and voters who are concerned about government and the CDC's handling of the COVID-19 pandemic, were vaccine hesitant. We also provide intriguing results showing the nuanced reasons that the vaccine hesitant provide.
Conclusions
Our analysis allows us to establish important baseline information from a social science perspective on vaccine hesitancy at a crucial time, right before COVID-19 vaccines were beginning to be made available to adult Americans. What emerges from our analysis is a nuanced perspective on vaccine hesitancy in the United States, from this important point in the history of the COVID-19 pandemic.
Objective
Vaccine hesitancy remains a significant public health challenge, and one that is socially patterned. This study examined whether the vaccine hesitancy effects of identifying as female, race–ethnicity, the number of children, educational attainment, and political conservatism were mediated by governmental conspiracy beliefs.
Methods
Linear mediation models controlling for potential confounders were employed to analyze data from a national survey of adults (2019 Chapman University Survey of American Fears; n = 1,209).
Results
Effects on vaccine hesitancy were significant and negative for educational attainment, and significant and positive for the other focal predictors. Governmental conspiracy beliefs significantly mediated each of these effects; the percent mediated was largest for Hispanic identity (79 percent), followed by female identification (69 percent), educational attainment (69 percent), number of children (55 percent), black identification (34 percent), and political conservatism (30 percent).
Conclusion
This study underscores the importance of nonvaccine-related conspiracy beliefs for future interventions aimed at reducing sociodemographic disparities in vaccine hesitancy.
Media critics frequently complain about the tendency of reporters to cover political news using partisan conflict or partisan game frames, which describe policy disagreement as sites of partisan conflict where the parties can score “wins” or “losses.” Such frames, thought to decrease trust and increase partisan polarization, may be particularly dangerous when used in the coverage of public health crises such as the COVID-19 pandemic. We report a survey experiment where 2,455 respondents were assigned to read coverage of the pandemic that was framed in non-partisan terms, in terms of partisan conflict, or as a game where one party was winning and the other losing. Contrary to expectations, we find no effect of these frames across a broad range of opinions about and actions related to the pandemic, with the exception of a small negative effect of partisan game-framed coverage on the desire to consume news about the pandemic. These results suggest that partisan framing may not have negative effects during a public health crisis or, alternately, that such effects are difficult to detect in real-time using traditional survey experiments.
Halting the spread of the coronavirus will require a high-level counteroffensive against new destructive forces. Halting the spread of the coronavirus will require a high-level counteroffensive against new destructive forces.
This article engages the contemporary crises of health, the economy, and democracy in the United States during the era of Trump and the COVID-19 pandemic. The author begins with a discussion of the COVID-19 pandemic and Trump's chaotic and inept responses. The author follows with a discussion of Trump and authoritarian populism, arguing that Trump's floundering fortunes in the context of a hotly contested 2020 presidential campaign triggered his chaotic and contradictory responses to the COVID-19 pandemic, producing a crisis of democracy.
The US response to coronavirus disease 2019 (COVID-19) has been plagued with politics driving public health and messaging. As a result, COVID-19 vaccine roll out is occurring in an environment ill-equipped to achieve broad acceptance of the vaccine. Addressing Public concerns unlocks the potential for high vaccine coverage; this is best achieved when science and values, not politics, informs public health. A multifaceted and thorough engagement and communication plan responsive to the concerns and values of different groups must be swiftly yet carefully implemented in a coordinated manner by federal, state, and local governments. Effective communication will require rapid and rigorous science to promptly differentiate between adverse events following immunization which are causally related versus simply coincidental. Health care providers, in particular, will need support to process the otherwise potentially overwhelming amount of relevant information and effectively integrate it into discussions with their patients to support their decision-making. An equitable COVID-19 immunization program could substantively reduce the disproportionate risks associated with this pandemic. [Editor's Note: This Fast Track Ahead Of Print article is the accepted version of the peer-reviewed manuscript. The final edited version will appear in an upcoming issue of Health Affairs.].
The US president’s actions have exacerbated the pandemic that has killed more than 200,000 people in the United States, rolled back environmental and public-health regulations and undermined science and scientific institutions. Some of the harm could be permanent. The US president’s actions have exacerbated the pandemic that has killed more than 200,000 people in the United States, rolled back environmental and public-health regulations and undermined science and scientific institutions. Some of the harm could be permanent.
As Covid-19 spreads across the world, governments turn a hopeful eye towards research and development of a vaccine against this new disease. But it is one thing to make a vaccine available, and it is quite another to convince the public to take the shot, as the precedent of the 2009 H1N1 influenza illustrated. In this paper, we present the results of four online surveys conducted in April 2020 in representative samples of the French population 18 years of age and over (N = 5018). These surveys were conducted during a period when the French population was on lockdown and the daily number of deaths attributed to the virus reached its peak. We found that if a vaccine against the new coronavirus became available, almost a quarter of respondents would not use it. We also found that attitudes to this vaccine were correlated significantly with political partisanship and engagement with the political system. Attitudes towards this future vaccine did not follow the traditional mapping of political attitudes along a Left-Right axis. The rift seems to be between people who feel close to governing parties (Centre, Left and Right) on the one hand, and, on the other, people who feel close to Far-Left and Far-Right parties as well as people who do not feel close to any party. We draw on the French sociological literature on ordinary attitudes to politics to discuss our results as well as the cultural pathways via which political beliefs can affect perceptions of vaccines during the COVID-19 pandemic.
The last five years has seen a sharp rise in anti-science rhetoric in the United States, especially from the political far right, mostly focused on vaccines and, of late, anti-COVID-19 prevention approaches. Vaccine coverage has declined in more than 100 US counties leading to measles outbreaks in 2019, while in 2020 the US became the epicenter of the COVID-19 pandemic. Now the anti-science movement in America has begun to globalize, with new and unexpected associations with extremist groups and the potential for tragic consequences in terms of global public health. A new anti-science triumvirate has emerged, comprised of far right groups in the US and Germany, and amplified by Russian media.
Vaccine confidence depends on trust in vaccines as products and trust in the system that produces them. In the US, this system consists of a complex network connecting pharmaceutical companies, government agencies, and the healthcare system. We explore narratives from White and African American adults describing their trust in these institutions, with a focus on influenza vaccine. Our data were collected between 2012 and 2014 as part of a mixed-methods investigation of racial disparities in influenza immunization. We interviewed 119 adults, primarily in Maryland and Washington, DC, in three stages utilizing semi-structured interviews (12), focus groups (9, n = 91), and in-depth interviews (16). Analysis was guided by grounded theory. Trust in institutions emerged as a significant theme, with marked differences by race. In 2018, we contextualized these findings within the growing scholarship on trust and vaccines. Most participants distrusted pharmaceutical companies, which were viewed to be motivated by profit. Trust in government varied. Whites described implicit trust of federal institutions but questioned their competency. African Americans were less trusting of the government and were more likely to doubt its motives. Trust in institutions may be fragile, and once damaged, may take considerable time and effort to repair.
High rates of nonmedical exemptions (NMEs) from required childhood vaccinations have contributed to outbreaks of vaccine-preventable diseases, such as measles and pertussis. Understanding the parental decision to obtain an NME could help health professionals and public health programs improve vaccination rates in areas with high vaccine refusal. Using a 2002–2003 multi-state survey of parents of school age children ( n = 2445), this study found that parental distrust of the government and of healthcare providers is a significant factor related to a number of vaccine-related beliefs and behaviors. The odds that parents who distrust the government have seen a complementary/alternative medicine (CAM) provider were 2.11 times greater than those of parents who trust the government (70.1% vs 52.6%; OR, 2.11; 95% CI, 1.59–2.84; P < 0.01). Parents who distrust the government had increased odds of trusting vaccine information from CAM providers compared to trusting parents (57.9% vs 46.3%; OR, 1.53; 95% CI, 1.16–2.01; P < 0.01). Parents who distrust the government also had increased odds of distrusting vaccine information acquired at their healthcare providers’ offices (12.6% vs 4.7%; OR, 2.64; 95% CI, 1.64–4.24; P < 0.01). Distrustful parents had increased odds of thinking government sources of information about vaccines were unreliable, categorizing the CDC, the Food and Drug Administration (FDA), or local and state health departments as poor or very poor sources (distrust government vs trust government: 25.2% vs 11.7%; OR, 2.39; 95% CI, 1.70–3.36; P < 0.01; distrust healthcare providers vs trust healthcare providers: 24.4% vs 11.4%; OR, 2.44; 95% CI, 1.75–3.38; P < 0.01). These findings indicate that distrustful parent populations may need to be reached through modalities outside of traditional government and healthcare provider communications. Research into new and more effective techniques for delivering pro-vaccine messages is warranted.
Vaccine hesitancy reflects concerns about the decision to vaccinate oneself or one's children. There is a broad range of factors contributing to vaccine hesitancy, including the compulsory nature of vaccines, their coincidental temporal relationships to adverse health outcomes, unfamiliarity with vaccine-preventable diseases, and lack of trust in corporations and public health agencies. Although vaccination is a norm in the U.S. and the majority of parents vaccinate their children, many do so amid concerns. The proportion of parents claiming non-medical exemptions to school immunization requirements has been increasing over the past decade. Vaccine refusal has been associated with outbreaks of invasive Haemophilus influenzae type b disease, varicella, pneumococcal disease, measles, and pertussis, resulting in the unnecessary suffering of young children and waste of limited public health resources. Vaccine hesitancy is an extremely important issue that needs to be addressed because effective control of vaccine-preventable diseases generally requires indefinite maintenance of extremely high rates of timely vaccination. The multifactorial and complex causes of vaccine hesitancy require a broad range of approaches on the individual, provider, health system, and national levels. These include standardized measurement tools to quantify and locate clustering of vaccine hesitancy and better understand issues of trust; rapid, independent, and transparent review of an enhanced and appropriately funded vaccine safety system; adequate reimbursement for vaccine risk communication in doctors' offices; and individually tailored messages for parents who have vaccine concerns, especially first-time pregnant women. The potential of vaccines to prevent illness and save lives has never been greater. Yet, that potential is directly dependent on parental acceptance of vaccines, which requires confidence in vaccines, healthcare providers who recommend and administer vaccines, and the systems to make sure vaccines are safe.
Copyright © 2015 by American Journal of Preventive Medicine and Elsevier Ltd. Published by Elsevier Inc. All rights reserved.