Historical Violence and Public Health: Institutional Post-Traumatic Stress and Vaccine Acceptance in Romania

Abstract Does historical violence influence contemporary public health decisions? Using data from the Life in Transition Survey IV in Romania, this paper examines how differential exposure to repression during the 1989 Revolution affected COVID-19 vaccine uptake in the long run. By exploiting variation in the number of deaths during the Revolution, as well as exogenous variation in one of the main determinants of this type of violence, the presence of the historical communist Gulag, we find that each additional death is associated with a 3–5% point increase in the probability of vaccination.These results suggest that a legacy of violence paradoxically fosters greater reliance on scientific expertise while undermining trust in political authorities. Specifically, distrust in political institutions, inherited through institutional posttraumatic stress, appears to channel citizens’ trust in scientific authorities, thereby promoting vaccine acceptance. Our findings extend scholarship on the long-term influence of authoritarian legacies and offer new, broader insights into public health compliance in societies with persistent mistrust of state actors.