Information plays a critical role in public health management. The success of the COVID-19 vaccination campaign cannot be uncoupled from the flow of information and public perceptions of source reliability. Before COVID-19, studies indicated that the crux of the vaccination issue may have been trust or distrust in governmental and health institutions [25]. During COVID-19, a 2021 study indicated that increased trust in health experts was an important predictor of receiving a vaccine [26], while a 2022 study suggested that information from regulated sources was associated with individual health choices [27].
The national survey analyzed here sought to examine specific information sources and their association with both vaccination and anti-vaccination beliefs. Information sources vary in the extent to which organizational constraints limit or encourage certain kinds of outputs, as well as the extent to which people view them as reliable. Such sources include both those that tend to be more regulated (e.g., health experts and government sources) and those that are less regulated (social media, religious and community leaders, and journalists). The results here show that information from regulated sources was positively associated with vaccination status while information from less regulated sources was negatively associated. Correspondingly, anti-vaccination sentiments were higher for those who viewed social media and community/religious leaders as reliable. Those who viewed local health experts as reliable were less likely to hold such sentiments. As Harper and colleagues suggest, this may be partially due to the more consistent communication of the threat posed by the virus by health and government experts [28]. The association between information from local health experts and anti-vaccination sentiments is important because it raises the issue of trust. Perhaps a plausible basis for this nexus is the relationship that exists between local experts and their communities.
Respondents who viewed social media, community/religious leaders, and journalists as reliable may have received diverse or even contradictory information, resulting in a lower probability of vaccination and greater anti-vaccination sentiments. Sieber and colleagues suggested that the impact of social media was to reduce the likelihood that people get the COVID-19 vaccine [24]. Indeed, there may be a cascading effect. Once people begin to consume anti-vaccination materials they may seek and find more such content [29]. In a network analysis of 100 million users on Facebook, 4.2% held anti-vaccination views, 6.9% were in favor of vaccination and 74.1% were “undecided” about the topic [30]. Journalism may have a similar effect. Thus, people with distinct political leanings seek out journalists who share their political inclinations exposing people to a narrower range of information through their social media platforms. We note that information from national and local governments was not significantly associated with anti-vaccination sentiments. However, it must be noted that some government officials used social media platforms to communicate the need for COVID-19 measures. It is difficult to measure the impact these officials had on vaccination or vaccine hesitance because different platforms appeal to specific demographics.
While several dimensions were related to vaccination but not anti-vaccination beliefs (education, income, children, and the reliability of local/national government), one interesting finding that emerges from this analysis are sources of inconsistency: factors related to behavior (vaccination) and belief (anti-vaccination) in unexpected ways. At the bivariate level, vaccinated respondents are less likely than those who are unvaccinated to hold any of the five beliefs in our anti-vaccination scale. Our conventional understanding is that behavior and attitudes tend toward consistency[3] [31]. Whether the causal direction is (a) from sentiment to behavior or (b) from behavior to sentiment, we typically expect vaccination to be negatively correlated with anti-vaccination sentiments.
Consistency of the correlates of behavior and belief is implied if those factors positively associated with vaccination are negatively associated with anti-vaccination sentiment. In statistical terms, evidence for consistent predictors of behavior and belief would be coefficients in Models 2 and 4 that are reversed in sign: (a) factors positively associated with vaccination should be negatively associated with anti-vaccination sentiments, while (b) factors negatively associated with vaccination should be positively associated with anti-vaccination sentiments.
Yet, as Table 3 shows, only one positive factor (age) is negatively associated with anti-vaccination sentiment, while only two negative factors (right-leaning politics and conspiracy beliefs) are positively associated with anti-vaccination beliefs. Inconsistency in predictors is common, beginning with race. African Americans were less likely to have had a vaccine, but also less likely to hold anti-vaccine sentiments. This finding supports prior work that found African Americans less willing to vaccinate than other races [3-4]. The literature on vaccine behavior and distrust of the government also shows the reluctance of African Americans to receive vaccines [32-33]. Further, some studies highlight the challenge some minority groups experience accessing vaccines in the nascent stage of the program [34]. However, they are less likely than Whites to hold anti-vaccination sentiments.
Community living and having a positive COVID-19 status also had inconsistent relations with both outcome variables. Those who lived in community settings and had been diagnosed with COVID-19 were more likely than others to have been vaccinated but were also more likely to hold anti-vaccination sentiments. One possible explanation for this is that each of these factors was associated with social network pressures to vaccinate, while at the same time placing individuals in contact with others who had diverse beliefs. Many group living arrangements imposed vaccination mandates as a requirement to remain in these statuses. Hence, people who lived in group settings were more likely to have received a vaccine. Yet at the same time, they may have been in contact with individuals unhappy about such requirements and exposed to anti-vaccination sentiments. Lastly, being diagnosed with COVID-19 was also positively associated with receiving at least one vaccine and holding anti-vaccination sentiments. While the present data does not tell us whether vaccination occurred before or after COVID-19 diagnosis, one possible reason for this association was the belief that having COVID-19 itself is sufficient to acquire antibodies and mandated vaccination increased receptivity to antivaccination beliefs. Future studies should explore the reasons for these inconsistencies.
This analysis has three limitations. First, the study was cross-sectional, such that causal implications remain speculative. Second, the large sample size can produce statistically significant relationships that are not always substantively significant. Finally, data were gathered at the end of 2021 and the findings cannot be generalized to the second half of the pandemic as it evolved over time.
This study attempted to understand the relationships between both sociodemographic factors and COVID-19 information sources with vaccination behavior and anti-vaccination sentiments. Since regulated sources—government and health experts—are associated with increased vaccination and lower anti-vaccination sentiments, agents from these sources need to think carefully about their relationships with social media, community leaders, and journalists if they wish to amplify and mitigate casualties. Local government should also improve the funding of local public health communication in future pandemics.