Vaccine hesitancy and respect for public health measures: Citizens' trust in politicians and public servants across national, subnational and municipal levels of government.

ABSTRACT

Research shows that citizens' trust in government is associated with lower vaccine hesitancy and an increased willingness to follow public health measures. Thus far, however, the population health literature has largely conceptualized "government" as a unitary actor. This article furthers our understanding of this relationship by examining two important features of modern governance that have largely gone unexamined (1) that governing involves popularly elected politicians and appointed bureaucrats; and (2), that governing often comprises many levels of government within the same country. Analyzing survey data from Canada with various multivariate regression models, this article finds that the relationship political trust has with vaccine hesitancy and intention to follow for public health measures is more complex than presently recognized. Specifically, a larger change in citizens' public health behaviors is associated with trust in public health officials than with trust in government, and of particular importance is trust in national public health authorities, despite the fact that public health measures in Canada are largely the jurisdiction of subnational governments. The implications of these findings for population health research and policymakers are discussed.