Gradients of Trust in Vaccines

Abstract

Abstract COVID-19 vaccination in Laos has been affected by challenges in reaching the whole population and preexisting mistrust in the health system. Vaccination rates are low among the Hmong, whose healing epistemologies are rooted in animism and Christianity, while most healthcare staff are from the lowland Buddhist majority. However, local notions of immunity and religious practices are not the main factors influencing confidence in vaccines, as these are flexible and pragmatic in incorporating different approaches to curing illness. Instead, the root causes are patterns of mistrust and inequity enacted through Hmong peoples’ experiences with health services. An innovative government-led initiative focusing on trust-building and local ownership through relational community engagement, utilizing existing village, family, ethnic, and religious structures and promoting effective communication and cultural sensitivity led to a rapid increase in vaccine uptake. Trust in vaccines is therefore not an abstract concept but highly relational, and so can be intentionally developed.