Influence of COVID-19 on Trust in Routine Immunization, Health Information Sources and Pandemic Preparedness in 23 Countries in 2023

"Heightened vaccine hesitancy relative to COVID-19, pandemic fatigue and concerted disinformation campaigns have strong implications for plans to prevent or manage future pandemics, as well as a degree of spillover effect on our collective ability to control other vaccine-preventable diseases..."

Even after COVID-19 was deprioritised as a substantial public health threat, vaccine hesitancy, pandemic fatigue, and vaccine fatigue continued to present challenges to vaccine uptake in 2023. This fourth study in a series of annual global surveys across 23 countries (see Related Summaries, below) reports perspectives of adults in the general public on COVID-19 and routine immunisation in late 2023, trust in pandemic information sources, and collective preparedness to address any possible future pandemic. It also compares COVID-19 vaccine acceptance in 2023 to that in previous years to promote a better understanding of the current and future challenges public health authorities may face in encouraging vaccine uptake.

Conducted in October 2023, this study employed random stratified sampling in a 23-panel cross-sectional design. There were 23,000 participants, 1,000 from each country, the populations of which collectively represent nearly 60% of the world's population. The countries surveyed were 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 reported uptake of at least one COVID-19 vaccine dose rose to 87.8% in 2023 across the 23 countries, as compared with 36.9% in 2021. However, the participants reported a lower intent to get a COVID-19 booster vaccine in 2023 (71.6%), compared with 2022 (87.9%). A total of 60.8% expressed being more willing to get vaccinated for diseases other than COVID-19 as a result of their experience during the pandemic, while 23.1% reported being less willing. Per the researchers, "the extension of COVID-19 vaccine skepticism 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."

Trust in 11 selected sources of vaccine information each averaged less than 7 on a 10-point scale, with one's own doctor or nurse and the World Health Organization (WHO) averaging a 6.9 and 6.5, respectively. A decrease in perceived trust in science as a result of COVID-19 vaccine development was reported by 13.9% of respondents, and a decrease in perceived trust in the pharmaceutical industry as a result of COVID-19 vaccine development was reported by 18.7% 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 increased skepticism regarding science generally....Moreover, factors such as prepandemic vaccine-related controversies and mistrust in pharmaceutical companies, governments and health institutions, sometimes the result of cultural beliefs or past negative experiences, have further complicated public health communication."

As reported here, perspectives on future pandemic preparedness reveal a mixed picture of confidence and trust among global populations. Approximately three-quarters (74.9%) of respondents are confident that society collectively will manage the next health crisis better than the COVID-19 pandemic, yet only 63.3% reported trusting a hypothetical WHO recommendation to vaccinate if such a crisis was announced. "Trust in the collective scientific and health communities to respond effectively to pandemic threats will require country-specific approaches that consider relevant sociocultural factors....Ongoing global efforts to prepare for future global health threats promote a comprehensive 'vaccines plus' approach that incorporates social and behavioral preventive measures alongside rigorous testing and treatment..."

Strategies to deal with disinformation aiming to influence public opinion and the vulnerability of certain people to conspiracy theories that drive resistance to vaccination "should focus on delivering clear, accurate and culturally sensitive information to specific communities through their preferred information channels and via trusted sources and on exposing the motivation of those behind disinformation."

In conclusion: "This study reveals that a substantial proportion of individuals express resistance to vaccination and that concerns about COVID-19 vaccination appear to have spilled over to affect other vaccine-preventable diseases. This underscores the increasingly urgent necessity for sustained vaccine education and trust-building efforts. Moreover,...there remains a notable lack of trust and potential adherence to the recommendations of public health authorities. 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."