Dutch Perspectives Toward Governmental Trust, Vaccination, Myths, and Knowledge About Vaccines and COVID-19

As of November 24, 2021, 258 million confirmed COVID-19 cases had been reported worldwide, including 5.2 million COVID-19 related deaths.¹ The race between vaccination and the occurrence of novel variants will ultimately determine the span of the pandemic. The World Health Organization (WHO) listed vaccine hesitancy as one of the top 10 global health threats. Politicization of acceptance of COVID-19 measures was illustrated by a study showing that US Democrats were more likely than Republicans to support regulation to contain SARS-CoV-2.² European studies demonstrated decreased adherence to COVID-19 control measures in countries with low governmental trust.³ Herein, we report the results of a large nationwide survey study conducted in the Netherlands to investigate the association between governmental trust and vaccine confidence and misconceptions about both COVID-19 and vaccines.

In December 2020, we distributed a survey through the largest Dutch national newspaper De Telegraaf. Participants completed a digital survey regarding (1) demographic information, (2) governmental trust on COVID-19 vaccination (adapted from a governmental trust survey during the H1N1 pandemic), (3) vaccine hesitancy, and (4) myths and knowledge about vaccines and COVID-19. Additional information on the formation of the digital survey is found in the eMethods in the Supplement. The responses to the survey were provided using either a 4-point Likert scale (strongly disagree, disagree, agree, or strongly agree) or a 5-point Likert scale (which adds an optional “I don’t know” response), unless indicated otherwise in the Table. Both strongly agree and agree are included in the agree designation. Likewise, strongly disagree and disagree are reported as disagree. “I don’t know” responses are not included in the reported responses. This study was reviewed and waived for official approval by the institutional review board of the Amsterdam UMC, Amsterdam, the Netherlands. Participants were required to provide informed consent, which was obtained digitally. Information on the background of participants, including race, ethnicity, educational level, income, and migrant background, was self-reported. This study followed the American Association for Public Opinion Research (AAPOR) reporting guideline.

Descriptive analysis was used to present the outcome of the survey for the provaccination group and the vaccination-hesitant group. We used SPSS, version 27.0 for Mac (IBM) for statistical analysis.

A total of 24 722 participants completed the survey. The vaccine-hesitant group consisted of 12 640 participants (51.1%), indicating low acceptance for vaccination at the time of the survey (Table). We observed a higher incidence of vaccine hesitancy among respondents with a lower household annual income, migrant background, and lower educational level and among female respondents. The provaccination respondents showed higher confidence in information provided by the government (76.5% vs 9.4%) and were more likely to follow the advice of their physicians (94.1% vs 29.4%), compared with the vaccination-hesitant group. The acceptability of vaccination in the provaccination group was associated with a sense of responsibility toward society (90.9% vs 1.8%) and a heightened sense of protection of family and friends (94.4% vs 5.6%) compared with the vaccination-hesitant group. The vaccination-hesitant respondents were less likely to disagree with the statement “vaccinations could lead to an autism spectrum disorder (14.0% vs 65.7%). The vaccine-hesitant respondents were also less likely to disagree with the statement “The COVID-19 vaccine (an mRNA vaccine) builds into your own DNA, and that is bad for your health” (8.9% vs 66.9% and were less likely to disagree with the statement “Because of information I read on the internet and social media, I would be less likely to be vaccinated against COVID-19” (38.4% vs 88.9%), compared with the provaccination responders.

The findings of this survey study suggest substantial societal polarization surrounding vaccination, based predominantly on governmental distrust and belief in misinformation. Furthermore, societal and family responsibility was an important argument in the decision to get vaccinated among the provaccination respondents, but it was a negligible argument in the vaccination-hesitant group. Designation as Provaccination or Vaccination-Hesitant was self-reported. The question is how to successfully combat vaccination hesitancy. Previous studies showed that susceptibility to COVID-19 misinformation was associated with low trust in science and low numeracy skills, and they suggested public education as a solution.^4,5 We recently demonstrated the effectiveness of debunking vaccination myths in a national campaign.⁶ In total, 18 280 people had died due to a COVID-19 infection as of November 19, 2021. The current 66.5% vaccination rate in the Netherlands compares favorably with the provaccination percentage presented herein. However, a recent surge in COVID-19 cases in areas with low vaccination rates highlights the importance of continuous campaigning for higher vaccination rates.

Major limitations of the study may be the insufficient representation of the Dutch population despite the large sample size and the time frame in which the study was performed, just before the start of the Dutch vaccination campaign. However, the data clearly show polarized views on governmental trust, trust in science, and the level of social responsibility between vaccination-hesitant respondents and provaccination respondents. We strongly recommend more intense public health education efforts to rebuild trust in the government, the scientific community, and the public health impact of vaccines.

Accepted for Publication: October 29, 2021.

Published: December 30, 2021. doi:10.1001/jamanetworkopen.2021.40529

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Yousuf H et al. JAMA Network Open.

Corresponding Author: Leonard Hofstra, MD, PhD, Department of Cardiology, Amsterdam University Medical Center, Netherlands, Location VUMC, De Boelelaan 1117, 1118, Room ZH 5 F 013, 1081 HV Amsterdam, the Netherlands (l.hofstra@amsterdamumc.nl).

Author Contributions: Prof Hofstra had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Yousuf, Van der Linden, van Essen, Gommers, Hofstra.

Acquisition, analysis, or interpretation of data: Yousuf, van Essen, Scherder, Narula, Hofstra.

Drafting of the manuscript: Yousuf, Gommers, Hofstra.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Yousuf, Hofstra.

Obtained funding: Yousuf, van Essen, Hofstra.

Administrative, technical, or material support: Scherder.

Supervision: Yousuf, Van der Linden, Gommers, Hofstra.

Conflict of Interest Disclosures: Mr Yousuf and Prof Hofstra reported receiving grants from the Dutch Ministry of Health, Welfare and Sport during the conduct of the study. No other disclosures were reported.

Funding/Support: This study was funded by the Dutch Ministry of Health, Welfare and Sport.

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.