Influence of COVID-19 on trust in routine immunization, health information sources and pandemic preparedness in 23 countries in 2023

Abstract

It is unclear how great a challenge pandemic and vaccine fatigue present to public health. We assessed perspectives on coronavirus disease 2019 (COVID-19) and routine immunization as well as trust in pandemic information sources and future pandemic preparedness in a survey of 23,000 adults in 23 countries in October 2023. The participants reported a lower intent to get a COVID-19 booster vaccine in 2023 (71.6%), compared with 2022 (87.9%). A total of 60.8% expressed being more willing to get vaccinated for diseases other than COVID-19 as a result of their experience during the pandemic, while 23.1% reported being less willing. Trust in 11 selected sources of vaccine information each averaged less than 7 on a 10-point scale with one's own doctor or nurse and the World Health Organization, averaging a 6.9 and 6.5, respectively. Our findings emphasize that vaccine hesitancy and trust challenges remain for public health practitioners, underscoring the need for targeted, culturally sensitive health communication strategies.

Fig. 1. MICs: Brazil, China, Ecuador, Ghana, India, Kenya, Mexico, Nigeria, Peru, Russia, South Africa and Türkiye.

a, COVID-19 vaccine acceptance among 23 countries, HICs and MICs. b, COVID-19 booster vaccine acceptance among 23 countries, HICs and MICs. c, Reported pandemic influence toward routine immunization. Four countries (Ghana, Kenya, Peru and Türkiye) were not included in the 2020 global survey. HICs: Canada, France, Germany, Italy, Poland, Singapore, South Korea, Spain, Sweden, the United Kingdom and the United States. ‘Routine immunization’ referrs to ‘other diseases (for example, flu, measles and viral hepatitis B)’ in the survey item.

Fig. 2. Reported trust in sources of COVID-19 information and reported COVID-19 treatment.

MICs: Brazil, China, Ecuador, Ghana, India, Kenya, Mexico, Nigeria, Peru, Russia, South Africa and Türkiye. Four countries (Ghana, Kenya, Peru and Türkiye) were not included in the 2020 global survey. HICs: Canada, France, Germany, Italy, Poland, Singapore, South Korea, Spain, Sweden, the United Kingdom and the United States.

Extended Data Fig. 1. Reported willingness for routineimmunization, COVID-19 vaccine and booster acceptance and hesitancy in October 2023 by country.

Sample size for each individual country n = 1,000. Middle-Income Countries (MIC): Brazil, China, Ecuador, Ghana, India, Kenya, Mexico, Nigeria, Peru, Russia, South Africa, Turkiye. High-Income Countries (HIC): Canada, France, Germany, Italy, Poland, Singapore, South Korea, Spain, Sweden, United Kingdom, United States. (a)“I am more willing to get vaccinated against other disease (e g, flu, measles,viral hepatitis B)”, (b) COVID-19 vaccine acceptance and hesitancy, October 2023, COVID-19 vaccine acceptance was defined as having received at least one dose of a COVID-19 vaccine. COVID-19 vaccine hesitancy was defined as not having received at least one dose of a COVID-19 vaccine. (c) COVID-19 booster acceptance and hesitancy among vaccinated respondents, October 2023. COVID-19 booster acceptance among vaccinated respondents was defined as willingness to take future recommended boosters (answer options “strongly agree” or “somewhat agree” to question “I will take the recommended COVID-19 booster”. COVID-19 booster hesitancy among vaccinated respondents was defined as having reportedeither “unsure/ no opinion” or “somewhat disagree” or “strongly disagree” to the same question.

Extended Data Fig. 2. Reportedattitudes about future potential pandemic preparedness.

Sample size for each individual country n = 1,000. Middle-Income Countries (MIC): Brazil, China, Ecuador, Ghana, India, Kenya, Mexico, Nigeria, Peru, Russia, South Africa, Turkiye. High-Income Countries (HIC): Canada, France, Germany, Italy, Poland, Singapore, South Korea, Spain, Sweden, United Kingdom, United States. (a) “If the World Health Organization (WHO) announced a new pandemic threat, would you trust thisinformation?”, (b) “If the World Health Organization (WHO) announced a newpandemic threat and advised getting vaccinated, would you?”, (c) “How confidentare you that we will manage the next health crisis better than the COVID-19 pandemic?”, (d) Reported trust in the sources of information about COVID-19 vaccines, (e) Reported trustin the sources of information about COVID-19 vaccines by country.

Extended Data Fig. 3. Trust in science, health authorities, government and pharmaceutical industry.

Sample size for each individual country n = 1,000. Middle- Income Countries (MIC): Brazil, China, Ecuador, Ghana, India, Kenya, Mexico, Nigeria, Peru, Russia, South Africa, Turkiye. High-Income Countries (HIC): Canada, France, Germany, Italy, Poland, Singapore, South Korea, Spain, Sweden, United Kingdom, United States. Survey items: (a) ‘I trust the science behind the COVID-19 vaccines available to me,’ (b) ‘How much do you trust the health authorities that recommended you get a COVID-19 vaccine?,’ (c) ‘How much did you trust your government’s management of the COVID-19 pandemic in your country?,’ (d) ‘Did the development of COVID-19 vaccines affect your trust in science generally?,’ (e) ‘Did the development of the COVID-19 vaccines affect your trust in the pharmaceutical industry?’.