Political context and COVID-19 vaccine hesitancy in the European Union: populism, government trustworthiness, and policy

Vaccine hesitancy is a significant 21st Century public health challenge, with vaccines being increasingly politicized in public and government discourse and policymaking, particularly since the introduction of COVID-19 vaccines. We evaluate the potential roles of national political and policy context for individuals' COVID-19 vaccine hesitancy across 27 European Union countries at two timepoints of the pandemic-assessing the extent to which national-level populism and government trustworthiness are associated with individuals' COVID-19 vaccination attitudes and receipt (actual or intended)-directly and indirectly via COVID-19-related policies. We analyzed May 2021 and February 2022 Eurobarometer survey data merged with nation-level populist parties' vote share, Transparency International's Corruption Index, the COVID-19 Policy Stringency Index, plus nation- and respondent-level controls. Increased levels of government trustworthiness and COVID-19 policies, but not populism, were each associated with more positive COVID-19 vaccine attitudes (though not substantively) and, respectively, lower odds of anti-vaccine and uncertain (vs. pro-vaccine) COVID-19 vaccination receipt/intentions. These associations were limited to only the May 2021 period that followed government and scientific scrutiny of vaccine safety signals. No evidence indicated that attitudes and receipt/intention were indirectly associated with populism and trustworthiness via COVID-19 policies. Our findings indicate that governments viewed as more trustworthy have citizens more accepting of government-run vaccination programs. These pandemic era analyses corroborate prior pre-COVID-19 research on nation-level evaluations of populism and vaccine acceptance. Our study highlights the value of multilevel approaches and multiple time periods and measures for advancing understanding of how political context may contribute to vaccination decision-making.