Pandemic fatigue and vaccine hesitancy continue to affect global public health, new 23-country study finds

While it found that global uptake of at least one COVID-19 vaccine dose was robust, a new survey published in Nature Medicine revealed mixed signals about the current acceptance of vaccines generally, especially COVID-19 boosters.

The new survey of 23,000 respondents from 23 countries representing more than 60% of the world's population is the fourth in a series of studies led annually since 2020 by a team from the City University of New York Graduate School of Public Health and Health Policy (CUNY SPH).

"The repercussions of pandemic disruptions in health care services, the effects of the inequitable and slow global vaccine distribution, and the prevalence of misinformation and mistrust in health authorities continue to be felt," says Jeffrey V. Lazarus, Professor of Global Health at CUNY SPH, head of the Health Systems Research Group at Barcelona Institute for Global Health, and coordinator of the study.

"They represent major obstacles for health practitioners struggling to meet the urgent need to get people caught up on routine immunizations and ready to face the next pandemic."

Reported global uptake of at least one COVID-19 vaccine dose rose last year to 87.8%, as compared to 36.9% in 2021 and 70.4% in 2022. However, the intent to get a COVID-19 booster (71.6%) was lower compared to 2022 (87.9%).

"The SARS-CoV-2 virus continues to circulate and mutate," says Ayman El-Mohandes, senior author and dean of CUNY SPH. "Variant-adapted boosters are available, but public health statistics show that many older people and others who are at higher risk of severe disease and death have not accepted them."

In addition, documented spillover effects on routine immunization raise the threat of the re-emergence of other childhood and adult vaccine-preventable diseases. While just more than three respondents in five (60.8%) said that their experience with COVID-19 made them more willing to get vaccinated against other diseases other than COVID-19, almost a quarter (23.1%) reported greater reluctance to do so.

"While we are concerned about the evident fallout of the pandemic on large numbers of people, we still see a general openness to immunization that we must build on to boost vaccine confidence, including acceptance of new generations of COVID-19 vaccines and boosters," says El-Mohandes. "We must design targeted messages from trusted communicators to encourage vaccine uptake."

Survey responses on trust in sources that provide information or guidance on pandemic interventions revealed somewhat higher levels of trust in those close to or well recognized by the individual, although all 11 studied sources averaged less than 7 on a 10-point scale. The most trusted sources were "my doctor or nurse" and the World Health Organization, averaging 6.9 and 6.5, respectively.

The report also noted interesting variations in trusted sources across different countries. For example, "religious leaders" ranked 3.16 in Sweden and 3.19 in Germany but 6.57 in Nigeria and 6.72 in India, whereas "my doctor or nurse" ranked 4.95 in Russia and 7.70 in Kenya.

General trust in health authorities was reported by 65.4% of respondents, while general trust in government was 56.4%. A decrease in trust in science was reported by 13.9%, and 18.7% reported less trust in the pharmaceutical industry compared to prior surveys.

"These findings emphasize that vaccine hesitancy and trust in health and science remain complex challenges and underscore the need for targeted, culturally sensitive health communication messages and outreach strategies going forward," Lazarus states.