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1. Global adoption of personal and social mitigation behaviors during COVID-19: The role of trust & confidence

   https://doi.org/10.1371/journal.pone.0256159  

   Jones, Pauline; Menon, Anil; Hicken, Allen; Rozek, Laura S. (September 2021, PLOS ONE)

   Mukherjee, Amitava (Ed.)

   What influences the adoption of SARS-CoV-2 mitigation behaviors–both personal, such as mask wearing and frequent handwashing, and social, such as avoiding large gatherings and physical contact–across countries? Understanding why some individuals are more willing to change their behavior to mitigate the spread of a pandemic will not only help us to address the current SARS-CoV-2 pandemic but also to respond to future ones. Researchers have pointed to a variety of factors that may influence individual adoption of personal and social mitigation behaviors, including social inequality, risk perception, personality traits, and government policies. While not denying the importance of these factors, we argue that the role of trust and confidence has received insufficient attention to date. Our study explores whether there is a difference in the way trust and confidence in particular leaders and organizations affect individual compliance and whether this effect is consistent across different types of mitigation behaviors. Specifically, we utilize an original cross-national survey conducted during the first wave of the SARS-CoV-2 pandemic (May-June 2020) to investigate how trust in scientists, medical professionals, politicians, and religious leaders and confidence in global, national, and local health organizations affects individual compliance in 16 countries/territories across five world regions. Our analyses, which control for the aforementioned factors as well as several others, suggest that trust in politicians and confidence in national health ministries have the most consistent influence on whether individuals adopt both personal and social mitigation behaviors. Across our sample, we find that greater trust in politicians is associated with lower levels of individual compliance with public health directives, whereas greater confidence in the national health ministry is associated with higher levels of individual compliance. Our findings suggest the need to understand trust and confidence as among the most important individual level characteristics driving compliance when developing and delivering messaging about the adoption of mitigation behaviors. The content of the message, it seems, will be most effective when citizens across countries trust its source. Trusted sources, such as politicians and the national health ministry, should thus consider working closely together when determining and communicating recommended health behaviors to avoid contradicting one another. 

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2. Promoting data harmonization to evaluate vaccine hesitancy in LMICs: approach and applications

   https://doi.org/10.1186/s12874-023-02088-z  

   Rego, Ryan T.; Zhukov, Yuri; Reneau, Kyrani A.; Pienta, Amy; Rice, Kristina L.; Brady, Patrick; Siwo, Geoffrey H.; Wachira, Peninah Wanjiku; Abubakar, Amina; Kollman, Ken; et al (December 2023, BMC Medical Research Methodology)

   Abstract BackgroundFactors influencing the health of populations are subjects of interdisciplinary study. However, datasets relevant to public health often lack interdisciplinary breath. It is difficult to combine data on health outcomes with datasets on potentially important contextual factors, like political violence or development, due to incompatible levels of geographic support; differing data formats and structures; differences in sampling procedures and wording; and the stability of temporal trends. We present a computational package to combine spatially misaligned datasets, and provide an illustrative analysis of multi-dimensional factors in health outcomes. MethodsWe rely on a new software toolkit, Sub-National Geospatial Data Archive (SUNGEO), to combine data across disciplinary domains and demonstrate a use case on vaccine hesitancy in Low and Middle-Income Countries (LMICs). We use data from the World Bank’s High Frequency Phone Surveys (HFPS) from Kenya, Indonesia, and Malawi. We curate and combine these surveys with data on political violence, elections, economic development, and other contextual factors, using SUNGEO. We then develop a stochastic model to analyze the integrated data and evaluate 1) the stability of vaccination preferences in all three countries over time, and 2) the association between local contextual factors and vaccination preferences. ResultsIn all three countries, vaccine-acceptance is more persistent than vaccine-hesitancy from round to round: the long-run probability of staying vaccine-acceptant (hesitant) was 0.96 (0.65) in Indonesia, 0.89 (0.21) in Kenya, and 0.76 (0.40) in Malawi. However, vaccine acceptance was significantly less durable in areas exposed to political violence, with percentage point differences (ppd) in vaccine acceptance of -10 (Indonesia), -5 (Kenya), and -64 (Malawi). In Indonesia and Kenya, although not Malawi, vaccine acceptance was also significantly less durable in locations without competitive elections (-19 and -6 ppd, respectively) and in locations with more limited transportation infrastructure (-11 and -8 ppd). ConclusionWith SUNGEO, researchers can combine spatially misaligned and incompatible datasets. As an illustrative example, we find that vaccination hesitancy is correlated with political violence, electoral uncompetitiveness and limited access to public goods, consistent with past results that vaccination hesitancy is associated with government distrust. 

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3. Mediators of Racial Differences in COVID-19 Vaccine Acceptance and Uptake: A Cohort Study in Detroit, MI

   https://doi.org/10.3390/vaccines10010036  

   Wagner, Abram L.; Wileden, Lydia; Shanks, Trina R.; Goold, Susan Door; Morenoff, Jeffrey D.; Sheinfeld Gorin, Sherri N. (January 2022, Vaccines)

   Despite their disparate rates of infection and mortality, many communities of color report high levels of vaccine hesitancy. This paper describes racial differences in COVID-19 vaccine uptake in Detroit, and assesses, using a mediation model, how individuals’ personal experiences with COVID-19 and trust in authorities mediate racial disparities in vaccination acceptance. The Detroit Metro Area Communities Study (DMACS) is a panel survey of a representative sample of Detroit residents. There were 1012 respondents in the October 2020 wave, of which 856 (83%) were followed up in June 2021. We model the impact of race and ethnicity on vaccination uptake using multivariable logistic regression, and report mediation through direct experiences with COVID as well as trust in government and in healthcare providers. Within Detroit, only 58% of Non-Hispanic (NH) Black residents were vaccinated, compared to 82% of Non-Hispanic white Detroiters, 50% of Hispanic Detroiters, and 52% of other racial/ethnic groups. Trust in healthcare providers and experiences with friends and family dying from COVID-19 varied significantly by race/ethnicity. The mediation analysis reveals that 23% of the differences in vaccine uptake by race could be eliminated if NH Black Detroiters were to have levels of trust in healthcare providers similar to those among NH white Detroiters. Our analyses suggest that efforts to improve relationships among healthcare providers and NH Black communities in Detroit are critical to overcoming local COVID-19 vaccine hesitancy. Increased study of and intervention in these communities is critical to building trust and managing widespread health crises. 

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4. Vaccine Hesitancy and Rejection of a Vaccine for the Novel Coronavirus in the United States

   https://doi.org/10.3389/fimmu.2021.558270  

   Shih, Shu-Fang; Wagner, Abram L.; Masters, Nina B.; Prosser, Lisa A.; Lu, Yihan; Zikmund-Fisher, Brian J. (June 2021, Frontiers in Immunology)

   null (Ed.)

   The arrival of the COVID-19 vaccine has been accompanied by increased discussion of vaccine hesitancy. However, it is unclear if there are shared patterns between general vaccine hesitancy and COVID-19 vaccine rejection, or if these are two different concepts. This study characterized rejection of a hypothetical COVID-19 vaccine, and compared patterns of association between general vaccine hesitancy and COVID-19 vaccine rejection. The survey was conducted online March 20-22, 2020. Participants answered questions on vaccine hesitancy and responded if they would accept the vaccine given different safety and effectiveness profiles. We assessed differences in COVID-19 rejection and general vaccine hesitancy through logistic regressions. Among 713 participants, 33.0% were vaccine hesitant, and 18.4% would reject a COVID-19 vaccine. Acceptance varied by effectiveness profile: 10.2% would reject a 95% effective COVID-19 vaccine, but 32.4% would reject a 50% effective vaccine. Those vaccine hesitant were significantly more likely to reject COVID-19 vaccination [odds ratio (OR): 5.56, 95% confidence interval (CI): 3.39, 9.11]. In multivariable logistic regression models, there were similar patterns for vaccine hesitancy and COVID-19 vaccine rejection by gender, race/ethnicity, family income, and political affiliation. But the direction of association flipped by urbanicity (P=0.0146, with rural dwellers less likely to be COVID-19 vaccine rejecters but more likely to be vaccine hesitant in general), and age (P=0.0037, with fewer pronounced differences across age for COVID-19 vaccine rejection, but a gradient of stronger vaccine hesitancy in general among younger ages). During the COVID-19 epidemic’s early phase, patterns of vaccine hesitancy and COVID-19 vaccine rejection were relatively similar. A significant minority would reject a COVID-19 vaccine, especially one with less-than-ideal effectiveness. Preparations for introducing the COVID-19 vaccine should anticipate substantial hesitation and target concerns, especially among younger adults. 

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5. One year later: What role did trust in public officials and the medical profession play in decisions to get a booster and to overcome vaccine hesitancy?

   https://doi.org/10.1016/j.pmedr.2024.102626  

   Silver, Diana; Kim, Yeerae; Piltch-Loeb, Rachael; Abramson, David (February 2024, Preventive Medicine Reports)

   Physicians may have an important role to play in promoting boosters as well as reducing COVID-19 vaccine hesitancy, but the relationship between hesitancy and trust in the medical profession and these behaviors has been underexplored. A representative online panel of 1,967 US adults that included oversamples of minoritized and rural populations were surveyed in April 2021 and June 2022 regarding their booster and vaccine status and intentions, their views of the medical profession, and their levels of trust in their own doctors, and national and state/local officials. Eighty percent of those vaccinated in 2021 had received a booster by 2022, while fewer than half of those initially reluctant to get a vaccine had gotten one by Wave 2 of the survey. Mean factor scores were calculated for response to a validated scale measuring trust in the medical profession. Linear and logistic regression models estimated the relationship between these factors scores and trust in other officials for those vaccinated as well initial hesitaters/refusers in Wave 1, controlling for population factors. Trust in one’s own physician was associated with those vaccinated/eager to be vaccinated getting a booster, while trust in the medical profession was associated with getting a vaccine among those who had previously refused or were hesitant. Trust in other experts was not significantly associated with these behaviors, but wide confidence intervals suggest a need for future research. Innovative strategies, including mobilizing the medical community is needed to address reluctance, uncertainty, and distrust of therapeutic agents in pandemic response. 

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