Understanding Vaccine Hesitancy in the Context of COVID-19: The Role of Trust and Confidence in a Seventeen-Country Survey

Abstract

Objectives: An effective vaccine to SARS-CoV-2 cannot be successfully deployed if a significant number of people worldwide are unwilling to accept it. We investigated the relationship between trust in scientists and medical professionals and perceptions of vaccine safety and effectiveness. We also build on past studies by exploring the relationship between confidence in global health organizations and vaccine hesitancy. Methods: We conducted an online survey in seventeen countries/territories across five world regions between May -June 2020. We assessed the relationship between COVID19 vaccine hesitancy, confidence in public health organizations, and trust in key experts and leaders. Results: Our findings strongly suggest that confidence in the World Health Organization combined with trust in domestic scientists and healthcare professionals is a strong driver of vaccine acceptance across multiple countries/territories. Conclusion: We find that hesitancy is widespread, and uptake would be insufficient to achieve herd immunity. There is widespread confidence in how public health organizations have responded to the current pandemic and this is related to vaccine acceptance. Our results also highlight the important role of trust in health care providers and scientists in reducing COVID19 vaccine hesitancy.

Keywords: COVID-19; global health; public health; trust; vaccine hesistancy.

FIGURE 1

Vaccine hesitancy by country (left to right–highest to lowest). Note: This figure summarizes individual responses (yes, maybe, no), by country, to the following question: “If a vaccine for COVID-19 was made available to you at no cost, would you get it?” The countries are arranged from highest to lowest percentage of respondents reporting either “maybe” or “no”. Sample size by country: Russia = 446; Ukraine = 1068; Hong Kong = 574; Poland = 1081; Thailand = 1082; Sweden = 1052; Germany = 1050; Turkey = 1099; United States = 1155; Taiwan = 749; Canada = 1074; Singapore = 538; Indonesia = 1080; China = 1138; Philippines = 1096; Malaysia = 944; Vietnam = 1014. COVID19 Studying International Coping and Compliance Survey, 2020.

FIGURE 2A

Measures of confidence, representative countries. Note: This figure depicts the distribution of confidence (none at all, not very much, some confidence, a lot of confidence) across respondents, by country, in the World Health Organization, National Health Ministry, and Local Health department, respectively. This figure also provides information on vaccine hesitancy across differing levels of trust and confidence. To measure vaccine hesitancy, we asked individuals to respond (yes, maybe, or no) to the following question: “If a vaccine for COVID-19 was made available to you at no cost, would you get it?” We picked the three countries above to illustrate the distribution of confidence measures in countries with high (Ukraine, 64%), medium (United States, 45%), and low (Vietnam, 27%) vaccine hesitancy, respectively. COVID19 Studying International Coping and Compliance Survey, 2020.

FIGURE 2B

Measures of trust, representative countries. Note: This figure depicts the distribution of trust (do not trust at all, do not trust very much, trust somewhat, trust completely) across respondents, by country, in medical practitioners, in scientists, political leaders, and religious leaders, respectively. This figure also provides information on vaccine hesitancy across differing levels of trust and confidence. To measure vaccine hesitancy, we asked individuals to respond (yes, maybe, or no) to the following question: “If a vaccine for COVID-19 was made available to you at no cost, would you get it?” We picked the three countries above to illustrate the distribution of confidence measures in countries with high (Ukraine, 64%), medium (United States, 45%), and low (Vietnam, 27%) vaccine hesitancy, respectively. COVID19 Studying International Coping and Compliance Survey, 2020.

FIGURE 3

Multivariable modeling of confidence, trust, and vaccine hesitancy. Note: Results from estimating the relationship between confidence and trust measures and vaccine hesitancy using ordinal logistic regression. This multivariable model also includes age, education, socioeconomic status, gender, and country-fixed effects. Age and gender were self-reported by the respondent. Socioeconomic status was determined by self-reported measures of financial well-being. COVID19 Studying International Coping and Compliance Survey, 2020.