In Nature Medicine in April 2024 researchers explore perspectives on COVID-19 and routine immunisation alongside trust in pandemic information sources across 23 countries to understand public health needs. The authors find that “vaccine hesitancy and trust challenges remain” and call for “targeted, culturally sensitive health communication strategies”. This research is the latest in a series of studies conducted annually since 2020 by a team at the City University of New York Graduate School of Public Health and Health Policy (CUNY SPH).
Pandemic times
The authors comment on the “expeditious” development of vaccines against SARS-CoV-2 during the COVID-19 pandemic, suggesting that this accelerated process combined with “limited availability” to present “serious challenges” in the equitable distribution of vaccines. Furthermore, “vaccine-related misinformation and mistrust of the science behind vaccine safety” compounded these problems. Considering the issues of vaccine hesitancy, pandemic fatigue, and vaccine fatigue (the ‘inertia or inaction toward vaccine information or instruction due to perceived burden and burnout”), the authors identify continued challenges to vaccine uptake.
Although COVID-19 has been “deprioritised as a substantial public health threat” since 2023, cases and hospitalisations continue. Thus, vaccine hesitancy poses a “substantial” threat to both booster dose receptivity and routine immunisation as “spillover effects” lead to a reemergence in diseases that were “nearly in hand”.
The study
The latest research is the fourth in a series of annual global surveys across 23 countries: Brazil, Canada, China, Ecuador, France, Germany, Ghana, India, Italy, Kenya, Mexico, Nigeria, Peru, Poland, Russia, Singapore, South Africa, South Korea, Spain, Sweden, Türkiye, the United Kingdom, and the United States. The authors report perspectives from the general public on COVID-19 and routine immunisation in 2023, trust in pandemic information sources, and collective preparedness to address possible future pandemics.
Evidence from the study
Some key elements of the study include:
- An increase in the reported uptake of at least one COVID-19 vaccine dose to 87.8% in 2023. This compares with 36.9% in 2021 and 70.4% in 2022.
- COVID-19 vaccine booster acceptance among vaccinated respondents decreased from 87.9% in 2022 to 71.6% in 2023, a decline that was “most profound” in HICs.
- Perspectives on willingness to get vaccinated against diseases other than COVID-19 suggest that 60.8% of respondents may be more and 23.1% less willing to get vaccinated in 2023 after their experience during the pandemic.
The authors recognise that the pandemic caused “widespread disruptions” to routine immunisation services globally. One consequence is that, as noted above, 23.1% of respondents are “less likely” to accept vaccines for diseases other than COVID-19
“Experience from the diversion of healthcare resources during the pandemic, along with lockdown measures and concerns about infection, highlights the need for resilient primary care systems, especially in maintaining access to crucial prevention interventions, such as routine childhood and adult vaccination.”
Further challenges include supply chain disruptions, which “underscore the importance of strengthening immunisation systems and services”
“Moreover, the extension of COVID-19 vaccine scepticism to other vaccines, including among parents who make vaccination decisions for their children, signals a crucial need for ongoing efforts in vaccine education and trust building.”
The paper emphasises the need for strategies to “fortify healthcare systems” and “ensure the continuity of routine immunisation and COVID-19 vaccination campaigns to improve vaccine confidence”. Survey responses on trust in information or guidance sources revealed “generally high levels of trust”. However, all 11 studied sources “averaged less than seven points on a ten-point scale”.
- “My doctor or nurse” ranked 6.9
- “My family and friends” ranked 6.4
- WHO ranked 6.5
- US CDC ranked 6.4
- Social media platforms ranked 5.0
- Religious leaders ranked 5.0
These sources did see variability across countries; for example, “religious leaders” were ranked lower in Sweden and Germany but higher in Nigeria and India.
- Trust in health authorities that recommended COVID-19 vaccination was higher (65.4%) than trust in governments’ management of the pandemic (56.4%)
- Trust in health authorities was 66.8% in MICs and 63.9% in HICs, compared to trust in government (60.7% in MICs and 51.7% in HICs)
- Perceived trust in science after COVID-19 vaccine development decreased for 13.9% of respondents
- Perceived trust in the pharmaceutical industry after COVID-19 vaccine development decreased for 18.7% of respondents
- Trust in the science behind available COVID-19 vaccines was reported by 71.6% of respondents
“The unprecedented speed of development, the novel application of mRNA technology, and the proliferation of misinformation, particularly on social media, raised concerns among some about the thoroughness of testing and long-term safety of COVID-19 vaccines and contributed to increase scepticism regarding science generally.”
Public health communication has been “further complicated” by factors like prepandemic “vaccine-related controversies” and mistrust in pharmaceutical companies, governments, and health institutions. Perspectives on future pandemic preparedness paint a “mixed picture” of confidence and trust.
- 74.9% of respondents are confident that society collectively will manage the next health crisis better than the COVID-19 pandemic – but only 63.3% reported trusting a hypothetical WHO recommendation to vaccinate if this was announced
- 26.6% of respondents in Russia and 25.5% in the US express low trust in WHO as a reliable source of information to announce a new pandemic threat
- 51.5% of respondents in Ghana, 51.3% in India, and 49.2% in Kenya, report a high level of confidence in our collective ability to better manage the next potential health crisis
- 30.2% of respondents in France and 28.9% in Poland are “not at all confident” in this collective ability
The authors highlight that “country-specific approaches” will be required to generate trust in collective scientific and health communities. An interesting consideration is the relationship between trust in scientists and trust in governments; this is weaker in Brazil and the US than in France, where populations “view them as more closely aligned”.
Disinformation continues to “drive resistance” to vaccination, as a “vocal minority” engage with “inaccurate and disproven claims”. Therefore, communication campaigns should “focus on delivering clear, accurate, and culturally sensitive information to specific communities” through appropriate information channels and trusted sources.
“It is important to acknowledge that individuals often show a preference for information that aligns with their existing beliefs and perceive such information as more credible.”
Implications for health policy
A key lesson from the results of the study is that each context is different and demands a “culturally and contextually relevant” strategy. Accurate information should be communicated in a “timely” manner. The results of the study highlight the “increasingly urgent necessity for sustained vaccine education and trust-building efforts”.
“Health system preparedness for future outbreaks and global health threats should include improving vaccine accessibility and vaccine demand through effective, culturally and contextually relevant public communication strategies, and innovative use of digital and social media in health education employing infodemic countermeasures.”
Professor of Global Health at CUNY SPH, Dr Jeffrey V. Lazarus, coordinated the study and identified “major obstacles” in the “repercussions of pandemic disruptions”, the consequences of “inequitable and slow global vaccine distribution” and the “prevalence of misinformation and mistrust”. Professor Lazarus highlights that there is an “urgent need” to get people “caught up” on immunisations and “ready to face the next pandemic”.
Senior author and dean of CUNY SPH is Dr Aymen El-Mohandes, who is concerned by the “public health statistics” that show “many older people and others who are at higher risk of severe disease and death” have not accepted variant-adapted boosters. However, there is potential to recover trust and progress.
“We still see a general openness to immunisation that we must build on to boost vaccine confidence, including acceptance of new generations of COVID-19 vaccines and boosters. We must design targeted messages from trusted communicators to encourage vaccine uptake.”
Public health communication strategies and trust in vaccines and vaccinators are key themes that continue to feature on agendas for The World Vaccine Congress, so if you want to join these discussions do get your tickets for the Congress in Barcelona this October, and don’t forget to subscribe to our weekly newsletters here.
