When Lack of Trust in the Government and in Scientists Reinforces Social Inequalities in Vaccination Against COVID-19

Abstract

ObjectiveTo assess whether lack of trust in the government and scientists reinforces social and racial inequalities in vaccination practices.DesignA follow-up of the EpiCov random population-based cohort survey.SettingIn July 2021, in France.ParticipantsEighty-thousand nine hundred and seventy-one participants aged 18 years and more.Main Outcome MeasuresAdjusted odds ratios of COVID-19 vaccination status (received at least one dose/ intends to get vaccinated/ does not know whether to get vaccinated/refuses vaccination) were assessed using multinomial regressions to test associations with social and trust factors and to study how these two factors interacted with each other.ResultsIn all, 72.2% were vaccinated at the time of the survey. The population of unvaccinated people was younger, less educated, had lower incomes, and more often belonged to racially minoritized groups, as compared to vaccinated people. Lack of trust in the government and scientists to curb the spread of the epidemic were the factors most associated with refusing to be vaccinated: OR = 8.86 (7.13 to 11.00) for the government and OR = 9.07 (7.71 to 10.07) for scientists, compared to vaccinated people. Lack of trust was more prevalent among the poorest which consequently reinforced social inequalities in vaccination. The poorest 10% who did not trust the government reached an OR of 16.2 (11.9 to 22.0) for refusing to be vaccinated compared to the richest 10% who did.ConclusionThere is a need to develop depoliticised outreach programmes targeted at the most socially disadvantaged groups, and to design vaccination strategies conceived with people from different social and racial backgrounds to enable them to make fully informed choices.

The French Covid-19 vaccination policy did not solve vaccination inequities: a nationwide study on 64.5 million people

“…These accessibility issues may also explain the association we find between lower vaccination rates and living in a district with a high proportion of immigrants, which may for instance reveal language barriers. These associations of lower vaccination rates with more poverty and with higher proportions of immigrants in the district of residence are compatible with the results of a survey conducted in July 2021 in France 16 on close to 81 000 participants, which indicated that unvaccinated respondents were more likely to have lower income and more likely to belong to ethnic minorities than vaccinated respondents.…”

“…For instance, the effect of mistrust in the government on vaccination refusal was shown to be even stronger among individuals from lower social classes than from higher social classes. 16 Finally, our data do not inform directly on the reasons for non-vaccination—e.g. whether it is hesitancy, refusal, or accessibility issues, which is why our approach is complementary to qualitative surveys.…”

“… 7 , 15 A survey conducted in July 2021 in France confirmed that trust in the government and trust in scientists were associated to higher odds to be vaccinated. 16 Votes for Mr Asselineau—which represented a minority of cast votes in 2017 in France (< overall)—can be interpreted as a marker of mistrust in the government (or more generally, against the establishment): this candidate for instance proposed that France exits the European Union, leave the Euro zone and reinstall the Franc currency; he was a proponent of hydroxychloroquin and ivermectin during the Covid-19 pandemic, and publicly expressed doubts about the safety of available Covid-19 vaccines. 17 The association of higher proportion of votes for Mr Asselineau with lower vaccination rates can be seen as a marker of a lack of confidence for the government.…”

Trust in and Use of COVID-19 Information Sources Differs by Health Literacy among College Students

“…The second possible explanation as to why people with low health literacy neither trust nor use health professionals and health authorities for COVID-19 information is that individuals with low health literacy have low trust in scientists, especially during the COVID-19 pandemic [ 29 , 30 ]. For example, people with low health literacy tend to not embrace the COVID-19 vaccine, due to a lack of trust in the government and scientists that stems from the uncertain attitudes towards possible herd immunity, the complexity of the scientific and political discourse surrounding COVID-19 vaccines, as well as questions about the vaccination effectiveness as new variants keep evolving [ 29 ]. Additionally, official rules and recommendations for preventive measures (e.g., mask mandates) based on scientific findings and clinical trials keep changing, because of the evolving knowledge about how this virus is behaving [ 30 ], which leads to negative feelings, such as being overwhelmed, confused, upset, and scared [ 8 ].…”

“…When applying the teach-back technique, health care providers ask their patients to repeat, in their own words, what they have been told, using a caring tone of voice and attitude to create a “shame-free” environment for patients [ 35 ]. Third, collaborating closely with community organizations and social workers to create health messages with no political interference is another effective strategy for government agencies to utilize, in order to build trust in the public [ 29 , 36 ]. Another strategy for government agencies to maintain public trust is to ensure clear information and unambiguous health instructions related to COVID-19 that represent government transparency and effective communication [ 37 ].…”