Discourses of Distrust: How Lack of Trust in the US Health-Care System Shaped COVID-19 Vaccine Hesitancy

This artible 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 ma- jority 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 insti- tutional 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 insti- tutional Histrust. The data reveal a complex landscape of beliefs and perceptions, illustrating widespread hesitancy and ambivalence among parutipants.