Triad of Trust: Vaccine Decision-Making by Pregnant People During the COVID-19 Pandemic in British Columbia and Ontario.

OBJECTIVES

While challenges surrounding vaccine acceptance in pregnancy have long been prevalent in Canada, the COVID-19 pandemic introduced a new context for perinatal vaccine decision-making. Pregnant people had to weigh concerns about SARS-CoV-2 infection during pregnancy and the introduction of the new messenger RNA vaccines, with less access to in-person perinatal care and social support than usual. This qualitative analysis sought to understand how trust influenced the decision-making of pregnant people during the early COVID-19 pandemic regarding both routine and SARS-CoV-2 vaccinations.

METHODS

This qualitative study, as part of a larger mixed-methods study, analyzed interviews with 73 participants who gave birth in Ontario or British Columbia, Canada, from May 1, 2020, to December 1, 2021, via reflexive thematic analysis.

RESULTS

Three types of trust influenced pandemic vaccination decisions during pregnancy: (1) trust in prenatal care providers, shaped by efforts to alleviate mental load, cultural norms, and perceived transparency; (2) trust in institutions, focused on the government, health care system, and pharmaceutical industry; and (3) trust in networks, encompassing (dis)trust in social media, valuing of lived experiences, and views of vaccination as a reciprocal obligation to the broader community.

CONCLUSIONS

Several dimensions of trust played vital roles in the experiences of pregnant people navigating vaccine decisions amid high uncertainty. Trust in providers comprised both honesty and transparency, with the latter enabling a novel approach to the patient-provider relationship. Avenues for increasing trust include social media content moderation and discussion of original research by prenatal care providers.