Native Hawaiian, Pacific Islander vaccination rates affected by trust levels, study says

The reasons behind vaccine hesitancy among Native Hawaiians and other Pacific Islanders (NHPIs) in Hawaiʻi at the start of the COVID-19 pandemic are explained in a new University of Hawaiʻi at Mānoa study. Researchers said the findings could provide a foundation for communication strategies for other health policies beyond the pandemic.

Until last fall, NHPIs remained significantly under-vaccinated compared to ethnic groups in Hawaiʻi. A team of University of Hawaiʻi at Mānoa researchers surveyed Hawaiʻi residents between March and August 2021 and their findings, published in Vaccines in June 2022, describes how racial/ethnic differences in trust between sources of COVID-19 information, coupled with the level of consumption of such information, corresponded to divergence in vaccine uptake.

"The study revealed for the first time an opposing role of trust in vaccine uptake that we were able to quantify," said Ruben Juarez, economics professor in UH Mānoa's College of Social Sciences (CSS) and HMSA Endowed Professor of Health Economics at UHERO. "The levels of trust individuals expressed were highly dependent on the source of information they relied on to make decisions regarding their health."

Working in collaboration with the Pacific Alliance Against COVID-19 (PAAC), researchers surveyed 1,124 Hawaiʻi residents during the group's COVID-19 testing events. Of the respondents, 61.7% self-identified as Native Hawaiian and Pacific Islander. Researchers observed that:

• Respondents exhibiting a higher degree of trust in official sources of COVID-19 information were 20.68% more likely to get vaccinated.
• Respondents exhibiting a higher degree of trust in unofficial sources were 12.49% less likely to get vaccinated.
• Trust in unofficial sources, along with consumption of COVID-19 information from such sources, explained vaccine hesitancy, specifically among NHPIs.

These findings are particularly relevant as Indigenous communities across the nation, including NHPIs, have experienced vaccine hesitancy at unprecedented levels due to historically derived sentiments of distrust in government and widespread use of social media as an information source.

In Hawaiʻi, vaccine hesitancy among NHPIs is especially concerning. This population is at disproportionately higher risk for severe complications and mortality from COVID-19 due to long-standing social inequities associated with the higher prevalence of chronic diseases including obesity and diabetes.

"Results from our study implicate that public health strategies which nurture trust and health science literacy may augment COVID-19 mitigation efforts, an approach we are evaluating with a community and culturally relevant educational program we developed with our school-based partnerships that are coupled with supporting on-site COVID-19 testing," said Alika Maunakea, John A. Burns School of Medicine (JABSOM) associate professor.

Added May Okihiro, JABSOM associate professor and pediatrician at the Waiʻanae Coast Comprehensive Health Center, "This data provides critical information for our community of health centers to act on the development of strategies to address health disparities more systematically."

This survey is part of a UH Mānoa-PAAC partnership to increase COVID-19 testing capacity and vaccination in underserved communities, while collecting meaningful data to address these problems systematically.