Mistrust in public health institutions is a stronger predictor of vaccine hesitancy and uptake than Trust in Trump

Association of National Identity and Trust in Government with COVID-19 Vaccination and Brand Choice in Taiwan

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.

Explaining Political Differences in Attitudes to Vaccines in France: Partisan Cues, Disenchantment with Politics, and Political Sophistication

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 representative 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 on the far left, parties on the far right, and green parties are more vaccine hesitant. The authors found a small effect of partisan cues and a much stronger effect of trust. More importantly, they show that the more politically sophisticated are less vaccine hesitant and that the nonpartisan are the biggest and most vaccine hesitant group.

CONCLUSIONS

The literature on vaccine attitudes has focused on the case of the United States, but turning attention toward countries where disenchantment with politics is more marked helps researchers better understand the different ways trust, partisanship, and political sophistication can affect attitudes to vaccines.

Exploring vaccine hesitancy in digital public discourse: From tribal polarization to socio-economic disparities

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.

Re-Routing Persuasion: How Conversion Messages Boost Attitudes and Reduce Resistance Among Holdouts Unvaccinated for COVID-19

This study examined the persuasive effects of two-sided refutational conversion messages compared to one-sided advocacy messages in increasing pro-COVID-19 vaccination attitudes and reducing resistance to getting vaccinated among U.S. adults who self-reported as unvaccinated. Results showed that main effects of conversion messages led to significantly higher attitudes but failed to directly reduce resistance toward vaccination. Predicted mediation effects between conversion messages and the dependent variables were found for homophily but were not supported for argument strength. Significant group differences were detected between participants who self-reported as high or low in vaccine hesitancy, for structural equation models that significantly and indirectly led to decreased resistance. Findings show the potential for two-sided conversion messages to be used by public health message designers to affect pro-health outcomes. Implications and limitations of these results and future directions are discussed.

Trust in government, social media and willingness to vaccinate

Vaccine hesitancy is considered one of the biggest global health threats. The prevalence of false information about vaccines on social media amplifies this challenge, making it more urgent. This study examines the relationship between social media use, trust in information sources, beliefs about vaccination rates, and willingness to adopt vaccines using data gathered in late 2023 from 975 respondents in South Africa. Our results suggest that people who rely on social media as their primary news source are more hesitant to get vaccinated for themselves and their children. Trust, which includes various sources including confidence in the government, is positively linked to vaccination decisions. Trust is especially important when it comes to less traditional vaccines such as COVID-19 and flu vaccines for both adults and children. We also note gender differences, with South African men showing more reluctance to get vaccinated as adults. Additionally, there is a negative correlation between social media use and the willingness of males to get vaccinated, but this relationship is not evident among females. Our research highlights the need for targeted interventions aimed at improving vaccine uptake, taking into account the links with information sources about vaccination and government trust.

Watchful, skeptics, and system distrusters: Characteristics associated with different types of COVID-19 vaccine hesitancy among U.S. working-age adults

COVID-19 vaccine hesitancy is complex, with adults identifying various reasons for not getting vaccinated. Using data from the 2022 National Wellbeing Survey on 7612 U.S. adults aged 18-64, we identified how age, race/ethnicity, sex, marital status, education, income, employment status, partisanship, and metropolitan status are associated with COVID-19 vaccination status and three non-mutually exclusive types of vaccine hesitancy: 1) watchful, concerned about vaccine side effects and efficacy; 2) skeptics, distrust the vaccine, and 3) system distrusters, distrust government. A third of respondents overall (N = 2643) had not received at least one dose at the time of the survey. Among respondents who were not vaccinated, 67 % are classified as watchful, 53 % are skeptics, and 32 % are system distrusters. Results from logistic regression show that concerns about side effects and safety (watchfulness) appear to be major drivers for not getting vaccinated among females and among non-Hispanic Black and unmarried adults, whereas skepticism and distrust appear to be more important barriers among ages 25-44. All three types of hesitancy appear to be important contributors to lower vaccination uptake among low-income, low-education, and unemployed adults, and among individuals who voted for Donald Trump in the 2020 election (with skepticism and distrust being most endorsed by this group). Findings suggest that universal messaging and intervention strategies are unlikely to be effective in reducing vaccine hesitancy. Different messages, messengers, and tactics must be used with different groups.

Effects of non-pharmaceutical interventions on COVID-19 transmission: rapid review of evidence from Italy, the United States, the United Kingdom, and China

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.

The impact of coronavirus disease 2019 (COVID-19) pandemic experiences on attitudes towards vaccinations: on the social, cultural and political determinants of preferred vaccination organization models in Poland

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).

Fostering Trust in Public Health Messaging: Tailoring Communication for Rural Parents

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.

Trust in the Food and Drug Administration: A National Survey Study

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.

COVID-19 vaccine hesitancy prevalence in Mexico: A systematic review and metanalysis

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.

COVID-19 Vaccine Hesitancy and Associated Oral Cholera Vaccine Hesitancy in a Cholera-Endemic Country: A Community-Based Cross-Sectional Study in the Democratic Republic of Congo

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.

Identifying trusted local sources and predicting behavior change pathways according to COVID-19 vaccination status: Results of a 2022 statewide survey of Alaskan adults

BACKGROUND

Low rates of COVID-19 vaccination remain a substantial public health challenge. Despite early successes, vaccinations of Alaskans trail the US average, drawing attention to the need for better-designed and targeted vaccine confidence interventions. Our objective was to assess levels of community trust and theory-driven predictors of vaccination status to inform the design of future programs.

METHODS

We conducted a cross-sectional, telephone-based survey of 940 Alaskan adults between May and June 2022. Data were collected on vaccination status (including initial vaccination and receipt of booster shots), trust in local community members, demographic characteristics, and thematic questions designed using the Capability, Opportunity, Motivation - Behavior (COM-B) model to examine possible predictors (barriers/facilitators) of vaccination status.

FINDINGS

Among those who are not fully vaccinated and boosted, we observe significantly lower trust placed in many immediate community members, especially health workers (e.g., doctors, nurses, specialty care physicians, health administrators). Firefighters and emergency medical technicians enjoy the most community trust, followed by medical professionals. Among those who received only a primary vaccine series, we find that perceptions of whether close friends are vaccinated, a sense of professional responsibility, and age were the strongest predictors vaccination status. Among the unvaccinated, we find significant predictive power from the same variables, as well as perceptions of whether family members are vaccinated, perceived risks from non-vaccination and whether vaccination is a healthy choice.

CONCLUSIONS

These findings will help inform the design and targeting of future vaccine promotion interventions to adult populations in Alaska. Interventions that leverage reflective motivation and social opportunity domains of the COM-B framework may be most effective. Local community members including firefighters and emergency medical technicians, as well as medical professionals may be perceived as the most trustworthy and influential messengers among those who are not fully vaccinated and boosted.

Vaccine Hesitancy and Public Mistrust during Pandemic Decline: Findings from 2021 and 2023 Cross-Sectional Surveys in Northern Italy

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.

The mRNA vaccine, a swift warhead against a moving infectious disease target

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.

Quantitative Synthesis of Factors Associated with COVID-19 Vaccine Acceptance and Vaccine Hesitancy in 185 Countries

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 3081,766 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 different World 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.

Who gets COVID-19 booster vaccination? Trust in public health institutions and promotion strategies post-pandemic in the Republic of Korea

INTRODUCTION

It is increasingly recognized that regular boosters will be necessary for the continued management of the COVID-19 pandemic. While vaccine hesitancy in the context of the initial COVID-19 vaccinations has been extensively studied, less is known about hesitancy around boosters in the post-pandemic era, where the immediate threat of COVID-19 has diminished.

METHODS

Using 5,584 survey responses from people who had received at least one COVID-19 vaccine dose based on a four-round survey between May and November 2022, we examined various factors that affect booster vaccine uptake and the willingness to take an additional shot. Ordinary least squares regressions were conducted to confirm the statistical significance of the findings.

RESULTS

Nearly 99% of vaccinated respondents reported having had two COVID-19 vaccine doses, while 69% of respondents reported having received a booster shot (three or more vaccine doses) and 48% reported being willing to get another shot. Booster uptake was strongly increased along with the degree of trust in the Korean Disease Control Agency (KDCA) and was also significantly associated with older age, gender, political propensity, and household income-level. When examining willingness to get an additional shot, the predictors were similar to booster vaccine uptake. However, the effect of trust in the KDCA became more salient.

CONCLUSION

The factors associated with booster uptake and willingness to continue to boost are similar to those associated with initial vaccine acceptance in the ROK, namely trust in the public health authority and older age. Despite high initial uptake in the ROK, convincing the public of the continued necessity of routine immunization against COVID-19 may pose challenges in the post-pandemic era.

Trust in public health institutions moderates the effectiveness of COVID-19 vaccine discussion groups on Facebook

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.

Trust and distrust in low-income Michigan residents during the early COVID-19 pandemic: A qualitative study

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.