How do you persuade reluctant or skeptical people to get vaccinated against a deadly pandemic — or any potentially dangerous illness? That question has long bedeviled public health officials. In 2019, just a year before the coronavirus struck, the World Health Organization declared “vaccine hesitancy,” its term for that reluctance, one of the top 10 global health threats. Vaccines can’t help the world achieve global herd immunity against the coronavirus or any infectious disease if a significant number of people won’t accept the shot.
To better understand this reluctance, we undertook a recently published multicountry study — and found people who have more confidence in the World Health Organization (WHO) and who trust scientists and their country’s health-care professionals are the most likely to say yes to the injections. Many public health efforts focus on educating citizens about vaccine safety. Our work suggests it might be more important to invest in building trust.
Making the vaccine available globally is not enough
Even before an effective vaccine against the coronavirus was announced, many people worried wealthy countries might horde stocks for their own citizens. That’s why three global groups created the COVID-19 Vaccines Global Access Facility (COVAX). With a goal of vaccinating 20 percent of the world’s population by year end, COVAX has already delivered more than 65 million vaccine doses to 120 countries, and has recently purchased 200 million additional doses.
But according to a recent Gallup poll, 1.3 billion adults are unwilling to get the shot. That’s especially true in areas of the world already suspicious of vaccines before the coronavirus pandemic, including Eastern Europe. But even in some well-off countries such as Germany and Japan, citizens are more reluctant than anticipated.
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When facing such reluctance, public health authorities often focus on relieving citizens’ concerns about vaccines’ safety and side effects, assuming those worries are the main source of the problem. That might be true: People may not understand how vaccines work, whether emergency authorization and production left enough time to test thoroughly for safety, or how herd immunity works. Meanwhile, social media and often partisan news sources deliver conflicting information.
That’s why trust matters, research suggests. When people lack the expertise to assess different risks or decide how to reduce risk, or when they’re uncertain about the facts — as has been true during this pandemic — they turn to whomever they trust most for guidance.
How we did our research
So who are the most trusted people and organizations about the coronavirus and vaccination?
To find out, we worked as part of a University of Michigan research team to conduct a survey across five world regions: North America (Canada, the United States); Europe/Eurasia (Germany, Poland, Russia, Sweden, Ukraine); East Asia (China, Hong Kong, Taiwan); Southeast Asia (Indonesia, Malaysia, Philippines, Singapore, Thailand, Vietnam); and the Middle East (Turkey). We intentionally included countries and territories that varied in important ways, including in economic development, dominant cultures, regime type and government pandemic approach.
We used the Qualtrics online survey platform, which enabled us to reach a total of 17,158 people, distributed in a way that accounted for the relative size of each country or territory, and included quotas for gender and age to ensure more nationally representative samples. The survey was translated into each country’s local languages. We fielded the survey early in the pandemic, from May 21 to June 24, 2020.
Each respondent answered questions designed to assess the relationship between their personal hesitations about a (then-theoretical) coronavirus vaccine, confidence in local and global public health organizations, and trust in several key domestic experts and leaders.
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Much as Gallup found, in our survey, more than 50 percent of our respondents in Eurasia/Eastern Europe were reluctant or refused to be vaccinated; from 45 to 50 percent felt the same in Western Europe and the U.S.; and in East and Southeast Asia this was flipped, with people in most countries — ranging from 56.2 percent in Taiwan to 72.6 percent in Vietnam — saying they would get vaccinated.
While we ran these surveys many months before vaccines were approved and available, the hesitation we found has been consistent with actual willingness to be vaccinated once those arrived. For instance, 52.3 percent of Thai citizens told us they’d hesitate or refuse to be vaccinated; and in fact, as of this writing, only about 40 percent of the most at-risk people in Thailand have signed up for the shot.
Two factors stood out among those willing to be vaccinated: Trusting scientists and health-care professionals, and feeling confidence in the WHO. Survey respondents who said they were highly confident in the WHO were almost a third as likely to say they would be reluctant or refuse to get vaccinated than those who said they had no confidence in the WHO. For example, in Poland and Turkey, 80 percent of citizens who expressed confidence in the WHO were willing to be vaccinated, compared with 47 and 55 percent of the total sample in each country.
We also asked respondents whether they trusted their religious leaders and whether they trusted politicians; those who trusted religious leaders were less likely to say they would get vaccinated, while trust in politicians didn’t predict either vaccine willingness or its lack.
All this held even considering factors such as gender, age, education, risk perception and socioeconomic status. What’s more, the results were consistent across all the countries we surveyed. That suggests that even in highly diverse countries, with a great deal of cultural and political variety, trusting scientists, health-care professionals and public health institutions predicts vaccine willingness.
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Building trust may increase vaccine willingness
As experts know, no one approach will persuade everyone everywhere to get vaccinated. At current vaccination rates, global public health authorities estimate the world will reach herd immunity against the coronavirus sometime between 2023 and 2024. Our findings suggest the best place to start boosting vaccination rates might involve building citizens’ trust and confidence in the people and institutions involved in science and health-care.
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Pauline Jones is a professor in the department of political science at the University of Michigan.
Laura Rozek (@laurarozek) is an associate professor in the School of Public Health at the University of Michigan.