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Objectives Substantial inequalities in access to healthcare are common in rural and marginalized populations in the Global South, and these inequalities can drive health disparities. Historical mistrust of healthcare institutions can further impact healthcare behaviors, including vaccination. Here, we apply the concept of medical mistrust, which has been widely applied to healthcare decisions in industrialized countries, across a rural–urban spectrum of communities in Namibia, and assess its utility in understanding vaccination decisions. Methods Otjiherero-speaking indigenous communities of Kunene, Namibia, were surveyed to assess medical mistrust. Participants also answered questions about COVID-19 vaccination status, vaccine safety, and interest in a hypothetical malaria vaccine. Bayesian multilevel models were used to compare medical mistrust across communities and its influence on vaccination and vaccine perceptions. Results The level of medical mistrust varied across contexts, with the highest level of mistrust in peri-urban communities. Medical mistrust predicted beliefs about vaccine safety and interest in the malaria vaccine, but not COVID-19 vaccine status, which was largely driven by access to the vaccine. For rural and peri-urban Himba, participants also expressed disinterest in the COVID-19 vaccine and worries about its safety. Conclusion Addressing global health disparities requires understanding how locally contextualized social and ecological experiences shape healthcare and vaccination decisions. Results of this study show fundamental differences in medical mistrust by community, which may be contributing to beliefs about vaccines. Understanding how medical mistrust varies across these contexts, and how it impacts perceptions about vaccination, can inform health communication and public policy in underserved communities.
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Quantifiable Cross-cultural Research on Medical Mistrust is Necessary for Effective and Equitable Vaccination in Low- and Middle-income Countries
Abstract Perceptions of healthcare personnel and institutions substantially impact healthcare behaviors. In the US, minority experiences with racist events like the Tuskegee study, alongside everyday experiences of marginalization and discrimination, drive medical mistrust in populations that are already burdened with health inequalities. However, the concept of medical mistrust is rarely applied outside of industrialized contexts. Histories of colonialism, underfunded healthcare institutions, and the enormous cultural and ethnolinguistic diversity present in low- and middle-income countries (LMICs) make medical mistrust a likely contributor to health behavior in these contexts. In the era of COVID-19 and emergent malaria vaccines, there is an urgent need to mitigate factors leading to medical mistrust, which impedes interest in novel vaccines. Doing so requires substantial investment in research that examines the causes of medical mistrust across diverse communities, develops methodological tools that can effectively measure medical mistrust across diverse cultural and ethno-linguistic contexts, and applies this data to policy and public health messaging. This commentary highlights the role of medical mistrust in vaccination and argues for its utility in addressing vaccine decision-making in LMICs.
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- Award ID(s):
- 2438025
- PAR ID:
- 10552475
- Publisher / Repository:
- Springer Science + Business Media
- Date Published:
- Journal Name:
- Journal of Epidemiology and Global Health
- Volume:
- 14
- Issue:
- 4
- ISSN:
- 2210-6014
- Format(s):
- Medium: X Size: p. 1771-1777
- Size(s):
- p. 1771-1777
- Sponsoring Org:
- National Science Foundation
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