How Lack of Trust in the U.S. Health-Care System Shaped COVID-19 Vaccine Hesitancy
This article explores the relationships between the American health-care system, trust in institutions, and decision-making processes that have affected COVID-19 vaccine uptake. Findings are based on an analysis of a nationally representative sample of 137 individuals who participated in semi-structured qualitative interviews during the rollout of the first publicly available vaccine in the first quarter of 2021. The vast majority of respondents reported negative experiences with American health care that predated the pandemic, which generated distrust in medical institutions, including hospitals, private health insurance corporations, the pharmaceutical industry, and related government institutions. The article considers the impact of institutional distrust on attitudes about vaccine uptake. Responses fell along a spectrum from vaccine refusal to vaccine acceptance. Sentiment across categories revealed a high degree of hesitancy framed in terms of institutional distrust. The data reveal a complex landscape of beliefs and perceptions, illustrating widespread hesitancy and ambivalence among participants.
The article appears in Part I of the peer-reviewed, open-access Russell Sage Foundation double issue “Building an Open Qualitative Science,” which demonstrates how shared qualitative data can deepen the study of crises and social conditions that are difficult to capture through conventional surveys alone.
The American Voices Project is a national qualitative study led by researchers at Stanford and Princeton. It is a nationally representative research initiative that documents everyday life in the United States through in-depth qualitative interviews. For this article, the project provided nationally representative interviews conducted during the initial public rollout of the COVID-19 vaccine.
Casselman-Hontalas, Amy, Dominique Adams-Santos, and Celeste Watkins-Hayes. 2024. “Discourses of Distrust: How Lack of Trust in the U.S. Health-Care System Shaped COVID-19 Vaccine Hesitancy.” RSF: The Russell Sage Foundation Journal of the Social Sciences 10(4): 154–72.