Science, healthcare system, and government effectiveness perception and COVID-19 vaccination acceptance and hesitancy in a global sample: an analytical cross-sectional analysis

BACKGROUND: Determinants of COVID-19 vaccine acceptance are complex; how perceptions of the effectiveness of science, healthcare and government impact personal COVID-19 vaccine acceptance is unclear, despite all three domains providing critical roles in development, funding and provision, and distribution of COVID-19 vaccine. OBJECTIVE: To estimate impact of perception of science, healthcare systems, and government along with sociodemographic, psychosocial, and cultural characteristics on vaccine acceptance. DESIGN: We conducted a global nested analytical cross-sectional study of how the perceptions of healthcare, government and science systems have impacted COVID-19 on vaccine acceptance. SETTING: Global Facebook, Instagram and Amazon Mechanical Turk (mTurk) users from 173 countries. PARTICIPANTS: 7411 people aged 18 years or over, and able to read English, Spanish, Italian, or French. MEASUREMENTS: We used Χ(2) analysis and logistic regression-derived adjusted Odds Ratios (aORs) and 95% CIs to evaluate the relationship between effectiveness perceptions and vaccine acceptance controlling for other factors. We used natural language processing and thematic analysis to analyse the role of vaccine-related narratives in open-ended explanations of effectiveness. RESULTS: After controlling for confounding, attitude toward science was a strong predictor of vaccine acceptance, more so than other attitudes, demographic, psychosocial or COVID-19-related variables (aOR: 2.1; 95% CI: 1.8 to 2.5). The rationale for science effectiveness was dominated by vaccine narratives, which were uncommon in other domains. LIMITATIONS: This study did not include participants from countries where Facebook and Amazon mTurk are not available, and vaccine acceptance reflected intention rather than actual behaviour. CONCLUSIONS: As our findings show, vaccine-related issues dominate public perception of science’s impact around COVID-19, and this perception of science relates strongly to the decision to obtain vaccination once available.