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Vials of COVID-19 vaccine. Photo credit: Screen shot, Reuters

Trust in governments and health care workers hit lows around the world even before the pandemic, influencing attitudes on vaccines, according to a study released this week.

The research, based on data from 2018, predates the coronavirus pandemic, draws on surveys of more than 149,000 people in 144 countries.

“Trust is essential for effective health care delivery and health policy implementation,” said Dr. Corrina Moucheraud, a professor of health policy at the UCLA Fielding School of Public Health and the lead author of the study.

The August edition of the journal Health Affairs features the study.

The findings are a sober reminder of the need for effective public health communications, especially as the world faces the COVID-19 crisis, which has taken more than 4.1 million lives, Moucheraud said.

“What we’ve learned through this research is that trust in government may be critical for trust in health messages, and for feeling that vaccines are important, effective and safe – but only one-quarter of respondents globally meet this bar,” she said. “And fewer than half of respondents globally said that they trust doctors and nurses a lot.”

The findings are based on analysis of responses to the 2018 Wellcome Global Monitor survey, the most recent and comprehensive – across regions and income levels – worldwide assessment of opinions of health and medical topics.

“People’s trust in these institutions – governments and health care professionals – was correlated with trust in health or medical advice from them, and with more positive attitudes toward vaccines,” said Huiying Guo, a Fielding School doctoral student and co-author of the study. “Vaccine attitudes also varied substantially worldwide, with safety being the most common concern.”

Researchers found less than one-third of respondents expressed trust in health advice from their governments. Less than half of respondents trusted doctors and nurses or felt positive about vaccines.

There were significant differences by region.

Positive attitudes toward vaccines – feeling that they are safe, effective, and important – varied widely, with more than 70% of South Asian respondents strongly agreeing with these sentiments.

Fewer than 40% of European or East Asian respondents, though, strongly agreed with these sentiments.

In some regions, East Asia, Europe, and North America, respondents were particularly unlikely to strongly agree that vaccines were safe.

Positive vaccine attitudes were about 39% more common among those who trust the government and 59% more common among those who trust health advice from the government.

Those who trust doctors and nurses, as well as those who trust health advice from medical workers such as doctors and nurses, were also more likely to report positive vaccine attitudes.

Although the survey predates the SARS-CoV-2 outbreak, researchers found elements that may be relevant to the current pandemic. Trust in government was positively associated with rural residence and negatively associated with educational attainment, and was highest among those who were older.

The researchers also identified gender differences. Women expressed greater trust in medical advice from the government and from medical workers, compared with men.

The analysts deemed three findings especially relevant to policy-making:

  • In settings where trust in governments is especially low, public officials might not be the best messenger to deliver crucial public health information;
  • Family physicians may be more effective at communicating health advice and vaccine messages, rather than local or national public health officials, and
  • Understanding the sources of vaccine attitudes is essential to boosting vaccination rates.

“Policy makers should understand that the public may have varying levels of trust in different institutions and actors,” said co-author Dr. James Macinko, also with UCLA’s Fielding School.

“Although much attention is paid to crafting public health messages, it may be equally important, especially during a pandemic, to identify appropriate, trusted messengers to deliver those messages more effectively to different target populations.”