Does Political Instability Lower Trust in Vaccines?

A pillar of the COVID-19 mitigation exit strategy has been an emphasis on vaccination as the path to herd immunity. But in a divisive time where public trust in public health is frayed, uptake has become a major concern for SARS-CoV-2 vaccine rollout plans.

New research published in The Lancet may provide insight; the work maps recent trends in vaccine confidence around the world. Data were collected between 2015-2019 from 149 countries.

Authors of the study expressed concern that areas of political instability would see particularly high increases in vaccine skepticism. Several findings stood out in the results, which were gathered from over 284,000 adults.

• Vaccine confidence in Europe remains low compared to other regions and ranges from 19% (Lithuania) to 66% (Finland) of people in December 2019 strongly agreeing that vaccines are safe.
• There are signs that public trust in vaccine safety is increasing in the EU, particularly in Finland, France, Italy, and Ireland — as well as in the UK.
• In contrast, in six countries globally significant increases were noted in the proportion of survey respondents strongly disagreeing vaccines are safe: Azerbaijan (2% of those surveyed strongly disagreeing vaccines are safe in 2015 rising to 17% in 2019), Afghanistan (2%—3%), Indonesia (1%–3%), Nigeria (1%–2%), Pakistan (2%–4%), and Serbia (4%–7%)—mirroring trends in political instability and religious extremism.
• With COVID-19 vaccine hope, authors say regularly assessing public attitudes and rapid response to declining confidence must be top priority to give the best chance to ensure uptake of new life-saving vaccines.

While parts of Europe are seeing public trust increase, several countries experiencing instability and extremism are seeing a rise in hesitancy.

“It is vital with new and emerging disease threats such as the COVID-19 pandemic, that we regularly monitor public attitudes to quickly identify countries and groups with declining confidence, so we can help guide where we need to build trust to optimise uptake of new life-saving vaccines”, said study author Heidi Larson, PhD, professor at the London School of Hygiene & Tropical Medicine.

A total of 290 nationally representative surveys were incorporated into the study, with modeling used to estimate trends in public thought.

The authors estimate that confidence in the importance, safety, and efficacy of vaccines dropped in Afghanistan, Indonesia, Pakistan, the Philippines, and South Korea.

The team also found significant increases in respondents strongly disagreeing that vaccines are safe in Afghanistan, Azerbaijan, Indonesia, Nigeria, Pakistan, and Serbia.

On the other hand, confidence has improved between 2018 and 2019 in EU member states such as Finland, France, Ireland, and Italy.

Interestingly, it was not safety that was the strongest association with uptake.

“Confidence in the importance of vaccines (rather than in their safety or effectiveness) had the strongest univariate association with vaccine uptake compared with other determinants considered,” authors wrote.

The findings also indicated that members of minority religious groups tended to have lower probabilities of uptake.

"To our knowledge, this is the largest study of global vaccine confidence to date, allowing for crosscountry comparisons and changes over time. Our findings highlight the importance of regular monitoring to detect emerging trends to prompt interventions to build and sustain vaccine confidence," the team concluded.