COVID-19 Vaccine Uptake and Risk Mitigation Behaviors: Understanding the Role of Institutional Trust

Project Summary The COVID-19 pandemic has unfolded against the backdrop of diminished public trust in key social and public health institutions. This erosion of trust is problematic because it undermines individual adherence to key public health recommendations (e.g., vaccination, mask wearing, physical distancing) which are critical to managing the COVID-19 crisis as well as future pandemics. While an emerging sub-stream of literature has begun to unpack the relationship between trust and risk-averting behavior, very little is known about the causal relationship between trust in larger social institutions (e.g., public health agencies, government, the health care agencies and the broader health care system) and individual health behavior for the U.S. The goal of this project is to leverage longitudinal data collected over the course of the COVID-19 pandemic to provide the most robust assessment to date of the relationship between trust and individual adherence to key public health recommendations across space and time. The rationale for this project is that trust is a key determinant of not only effective COVID-19 mitigation but also the mitigation of future disease outbreaks. The objective of this project will be accomplished by three specific aims: (1) Estimate the impact of individual-level trust in social institutions on their vaccine intentions and vaccine uptake. (2) Estimate the impact of individual-level trust in social institutions on their adherence to public health recommendations or non-pharmaceutical interventions (NPIs), including mask wearing, physical distancing, and shelter-in-place orders. (3) Assess how disparities in trust, spatially and across sub-populations (race/ethnicity, educational attainment and socio-economic status, political preference), map onto disparities in compliance with public health guidelines and risk-mitigating efforts. This project is innovative because it (a) leverages a unique longitudinal dataset to provide some of the first causal effects on the link between trust and a variety of risk mitigating behaviors (e.g., vaccination, mask wearing, physical distancing) and (b) utilizes a quasi-experimental design to both quantitatively and qualitatively assess variation in trust across time as opposed to merely relying on static indicators of trust and other key variables. The proposed project is significant because it will (a) uncover the relationship between trust and risk mitigation behaviors, a critical determinant of individual adherence with public health recommendations, (b) help identify pathways for improving public trust in key social and public health institutions, in turn helping policymakers and public health officials to better prepare for future COVID-19 waves and pandemic, and (c) inform the development of recommendations for mitigating the trust-gap between racial, ethnic, and socioeconomic groups.