Associations between trust in public health, vaccine confidence, and COVID-19 vaccination among American adults.

INTRODUCTION

COVID-19 vaccines have reduced severe morbidity and mortality from SARS-CoV-2 infection. However, low vaccine confidence slowed widespread vaccine adoption. This analysis investigated the relationship between individual-level trust in public health authorities, vaccine confidence, and COVID-19 vaccination behavior/intentions among Americans from 2020 to 2022. Additionally, we explored the role of vaccination behavioral environments on individual behaviors and intentions.

METHODS

We utilized data from three nationally representative panel surveys conducted at critical junctures of the COVID-19 pandemic in 2020-2022 that measured trust in federal public health authorities, vaccine confidence, and COVID-19 vaccination behavior/intention. Regression analysis was performed to understand our relationships of interest. External county COVID-19 vaccine coverage data was used to examine the potential modifying effect of local vaccine coverage on these relationships.

RESULTS

Across all years, individuals with low trust in the CDC had significantly higher odds of low vaccine confidence. The relationship strength doubled over time post-vaccine approval. Previous influenza vaccination modified this relationship. Among those with low vaccine confidence, the adjusted odds of being unvaccinated and refusing to vaccinate versus vaccinated was more than double that of being unvaccinated and intending to vaccinate. The differences in the vaccine confidence and vaccination behavior relationship remained consistent in high and low vaccine coverage counties.

CONCLUSION

Trust in the CDC and past influenza vaccination both have a strong relationship with vaccine confidence, which is strongly associated with COVID-19 vaccination. Explorations of new and evolving ways to build public trust are essential for public health responses, routine immunization, and vaccines for future emerging pathogens. Efforts to promote and incentivize routine, seasonal immunization may shape individuals' vaccine confidence and prime future vaccination behavior of different vaccine types.