The Institutional Origins of Vaccines Distrust: Evidence from Former-Soviet Countries

"These results suggest that roots of vaccine scepticism lie in a wider distrust in public and state institutions resulting from the exposure to Soviet communism."

Previous research documents that exposure to Soviet communism is found to be relevant for the formation of preferences and detrimental to various forms of trust (e.g., in public institutions). Global differences in vaccination trust suggest a similar picture. The channels through which institutions can affect individual health-related beliefs and behaviours include trust in the effectiveness of vaccines. This paper examines the exposure to Soviet communism and its repercussions for vaccine skepticism.

In providing background, the researchers note that exposure to Soviet communism is related to the reaction to historical events (mass vaccinations during Soviet times), weak trust in government and health system, the extent of adoption of egalitarian values, and suspicion of large business organisations (such as big pharma). Related to the latter: Vaccines are mostly developed in Western Europe, which might not always be appreciated in some Eastern European countries.

The paper uses pre-pandemic data on trust in general in vaccines' safety and efficiency from the Wellcome Global Monitor (WGM) dataset (2018 survey), which included a representative sample of adults from 122 countries with information on attitudes towards science and health challenges.

The data shown in Figure 1 in the paper depict vaccine sceptisicm - specifically, trust in vaccines' efficiency and safety at a country level. Geographical regions formerly belonging to or aligned with the Soviet Union stand out from the rest of the world. The trust in vaccination in these regions seems to be the lowest in the world, despite the fact that individuals in vast majority agree with the statements that vaccines are safe and efficient. Figure 3 documents that exposure to Soviet communism is associated with increased vaccine scepticism. Controlling for year of birth, gender, country of residence, and time trends specific to the country of residence, the study finds that individuals ever exposed to Soviet communism report lower by 2% on average trust in vaccines efficiency measured on 5-point scale. The decrease due to exposure to communism is the same (2%) for the trust in vaccines safety. The effect size is positively correlated with the length of the exposure to communism.

One potential factor that might explain why exposure to Soviet communism is associated with low trust in vaccines is the negative effect of communism on trust in institutions documented in different studies, which might mediate the negative association between exposure to communism and low vaccination rates in some communist countries. The researchers examine the feasibility of the trust hypothesis, reporting the results in Figure 4. In short, individuals who lived under Soviet communism are significantly less likely to trust in health advice given by their governments and by medical doctors in their country. Furthermore, the results confirm that exposure to communism is associated with reduced generalised interpersonal trust and confidence in government. The reduction of government trust is twice as large as the reduction of interpersonal trust for individuals with any exposure to Soviet communism, indicating particular importance of state institutions.

The researchers examined a number of alternative set of control variables (e.g., various types of Soviet communism implementations, rural or urban living, children or not, individual religiosity, and educational attainment) and found the results robust to model specifications.

Thus, the research shows that exposure to socio-political regimes can negatively affect trust in vaccines, which is explained by weak trust in both government and medical advice from doctors as well as in people from the neighbourhood. One lesson that emerges from this evidence is that compulsory vaccinations might backfire, as they might remind individuals of their Soviet legacies and they have been found to crowd out voluntary commitment to vaccinate. In contrast, actions undertaken by international independent bodies, as well as the way in which governmental vaccination programmes are implemented by local authorities or even non-profit organisations, can reduce the government distrust that can exacerbate vaccine scepticism. Hence, in promoting vaccination in Eastern Europe, one strategy is to attract other types of stakeholders that are perceived as more trustworthy than the state and local elites.