Distrust Of Government Research Articles

Navigating the Complex Landscape of COVID-19 Vaccine Hesitancy in Asia: Identifying Key Determinants and Strategies for Improvement

Most LMICs have been slow to receive and distribute vaccines, which are much more available in high-income countries, prompting critiques of global vaccine inequity, which were exacerbated with the distribution of so-called booster shots in high-income countries in the autumn of 2021. Access issues, coupled with vaccine hesitancy, can have catastrophic effects. Vaccination against the novel coronavirus is one of the most effective strategies for combating the global Coronavirus disease (COVID-19) pandemic. However, vaccine hesitancy has emerged as a major obstacle in several regions of the world, including Asia. The COVID-19 pandemic has necessitated the rapid development and distribution of vaccines worldwide. However, vaccine hesitancy, particularly in Asia, poses a significant challenge to achieving herd immunity and controlling the pandemic. This study aims to identify the key determinants of COVID-19 vaccine hesitancy in Asian populations and develop targeted strategies to improve vaccination uptake. A comprehensive review of literature from 2019 to 2020 was conducted, focusing on sociocultural, political, and healthcare system factors that contribute to vaccine hesitancy in the region. Findings reveal that cultural and religious beliefs, misinformation and distrust in government and healthcare systems, and logistical and accessibility issues significantly impact vaccine uptake. To address these challenges, the study proposes strategies such as engaging with community leaders, improving communication, building public trust, and addressing logistical and accessibility barriers. By comprehensively understanding and addressing the determinants of COVID-19 vaccine hesitancy in Asia, the public health community can navigate the complex landscape and facilitate higher vaccination rates, ultimately contributing to the global control of the COVID-19 pandemic. Keywords: COVID-19 vaccine, Vaccine hesitancy, Determinants, Strategies for improvement, Asia

Factors Associated With Coronavirus Disease 2019 Vaccine Uptake Among Pregnant Women and Nonpregnant Women of Reproductive Age in Jamaica.

Despite high rates of coronavirus disease 2019 (COVID-19)-related maternal mortality, Jamaica currently has little data on COVID-19 vaccine uptake among pregnant women. We conducted a cross-sectional, web-based survey of 192 reproductive-aged women in Jamaica from February 1 to 8, 2022. Participants were recruited from a convenience sample of patients, providers, and staff at a teaching hospital. We assessed self-reported COVID-19 vaccination status and COVID-19-related medical mistrust (operationalized as vaccine confidence, government mistrust, and race-based mistrust). We used multivariable modified Poisson regression to test the association between vaccine uptake and pregnancy. Of 192 respondents, 72 (38%) were pregnant. Most (93%) were Black. Vaccine uptake was 35% in pregnant women versus 75% in nonpregnant women. Pregnant women were more likely to cite healthcare providers versus the government as trustworthy sources of COVID-19 vaccine information (65% vs 28%). Pregnancy, low vaccine confidence, and government mistrust were associated with a lower likelihood of COVID-19 vaccination (adjusted prevalence ratio [aPR] = 0.68 [95% confidence interval {CI}, .49-.95], aPR = 0.61 [95% CI, .40-.95], and aPR = 0.68 [95% CI, .52-.89], respectively). Race-based mistrust was not associated with COVID-19 vaccination in the final model. Pregnancy, low vaccine confidence, and government mistrust were associated with a lower likelihood of COVID-19 vaccination among reproductive-aged women in Jamaica. Future studies should evaluate the efficacy of strategies proven to improve maternal vaccination coverage, including standing "opt-out" vaccination orders and collaborative provider and patient-led educational videos tailored for pregnant individuals. Strategies that decouple vaccine messaging from government agencies also warrant evaluation.

COVID-19 Vaccine Refusal and Delay among Adults in Italy: Evidence from the OBVIOUS Project, a National Survey in Italy.

Vaccine hesitancy was defined by the World Health Organization (WHO) in 2019 as a major threat to global health. In Italy, reluctance to receive vaccines is a widespread phenomenon that was amplified during the COVID-19 pandemic by fear and mistrust in government. This study aims to depict different profiles and characteristics of people reluctant to vaccinate, focusing on the drivers of those who are in favor of and those who are opposed to receiving the COVID-19 vaccine. A sample of 10,000 Italian residents was collected. A survey on COVID-19 vaccination behavior and possible determinants of vaccine uptake, delay, and refusal was administered to participants through a computer-assisted web interviewing method. In our sample, 83.2% stated that they were vaccinated as soon as possible ("vaccinators"), 8.0% delayed vaccination ("delayers"), and 6.7% refused to be vaccinated ("no-vaccinators"). In general, the results show that being female, aged between 25 and 64, with an education level less than a high school diploma or above a master's degree, and coming from a rural area were characteristics significantly associated with delaying or refusing COVID-19 vaccination. In addition, it was found that having minimal trust in science and/or government (i.e., 1 or 2 points on a scale from 1 to 10), using alternative medicine as the main source of treatment, and intention to vote for certain parties were characteristics associated with profiles of "delayers" or "no-vaccinators". Finally, the main reported motivation for delaying or not accepting vaccination was fear of vaccine side effects (55.0% among delayers, 55.6% among no-vaccinators). In this study, three main profiles of those who chose to be vaccinated are described. Since those who are in favor of vaccines and those who are not usually cluster in similar sociodemographic categories, we argue that findings from this study might be useful to policy makers when shaping vaccine strategies and choosing policy instruments.

Perceptions of the COVID-19 pandemic: a qualitative study with South African adults

IntroductionIn South Africa, public perceptions of the COVID-19 pandemic and risk mitigation measures remain mixed. To better understand health behaviours in the context of COVID-19, a qualitative study was conducted, which aimed to investigate perceptions relating to the COVID-19 pandemic among the South African adult population.MethodsTwelve online focus groups were conducted across the following age groups: 18–34, 35–54, 55 + years old (total n = 70) in December 2021. Diversity across socioeconomic status, geographical areas, and urban and rural settings was maximised, with an equal representation of men and women. Focus groups were conducted, and audio recorded using an online platform, transcribed verbatim and thematically analysed using MAXQDA.ResultsThere were mixed perceptions around the pandemic, however, the majority of participants appreciated government actions at the onset of the pandemic and as a result government trust was reported to have initially been high. Nevertheless, as the pandemic progressed, challenges relating to government communication around the pandemic, the inconsistent application of preventative measures by government, the use of soldiers to enforce preventative measures, the banning of alcohol and cigarettes, government corruption and the pervasiveness of social media were reported to have eroded government trust, negatively impacting the uptake of preventative measures. Economic and psychological impacts were experienced differently across income groups. Low-income earners, who already had pre-existing economic challenges reported increased psychological and financial strain. While the once cushioned middle class reported an increase in job insecurity accompanied by psychological challenges. High income earners did not report economic challenges but reported being affected psychologically. Though, low-income earners reported an appreciation of the government financial relief afforded to them middle income earners appeared to not have received adequate financial support.ConclusionWith the existing mistrust of government, there is need for government to leverage existing trusted sources in communities to aid in the implementation of preventative measures. These findings support the development of context specific solutions to address challenges faced at different socioeconomic levels.

Pilgrimage, Precarity, and Pandemics

Pilgrimage, Precarity, and Pandemics

Understanding Distrust of thePublic Sector Leading to Covid-19 Dissidence in Indonesia

COVID-19 has drastic social, economic, and health impacts worldwide. However, mixed attitudes and behaviors of individuals towards Covid-19 ranging from the most responsible to the least bothering ones, have been evident over the last two years. Based on these mixed responses, the current study examines the impact of citizens' attitudes to self-isolation and distrust in official statistics on their threat perceptions and resultant COVID-19 dissidence. Quantitative research methodology with the survey technique was applied to collect data from 537 citizens of Jakarta, Indonesia. SmartPLS 3.0 software was used to assess the structural equation modeling and perform the regression analysis for examining the hypothesized relationships. The results revealed a significant impact of citizens' attitudes to self-isolation and distrust on official statistics in creating the COVID-19 dissidence. Likewise, the results showed the mediatory role of threat perceptions in transmitting the citizens' attitude and distrust in government in COVID-19 dissidence. Furthermore, the current study is a valuable addition to the existing body of literature by highlighting the factors that created the rebellious attitudes and behaviors among the citizens of Jakarta, Indonesia, during the crucial times of COVID-19.

How and When Democratic Values Matter: Challenging the Effectiveness-Centric Framework in Program Evaluation

Performance information is overwhelmingly used in program evaluation by both public managers and external stakeholders. In the market-based New Public Management movement, effectiveness is public programs’ major selling point. However, this approach may marginalize the role of democratic values in governance. In the current complex society with anti-government sentiments, we embrace the idea of New Public Service to reiterate the importance of democratic values. Using a conjoint experiment, we compare the effects of effectiveness and democratic values in predicting public program evaluation, conditioned on citizens’ trust in government. Our results show that effectiveness and democratic values contribute similar effects in explaining policy preferences. Distrust in government strengthens the effect of democratic values but reduces the effect of effectiveness. Our findings challenge the prevalent effectiveness-centric framework in public management. We suggest that citizen-state interaction should not rely only on performance merits, but also on inclusiveness and openness values.

Public decisions about COVID-19 vaccines: A UK-based qualitative study.

To explore UK public decisions around whether or not to get COVID-19 vaccines, and the facilitators and barriers behind participants' decisions. This qualitative study consisted of six online focus groups conducted between 15th March and 22nd April 2021. Data were analysed using a framework approach. Focus groups took place via online videoconferencing (Zoom). Participants (n = 29) were a diverse group (by ethnicity, age and gender) UK residents aged 18 years and older. We used the World Health Organization's vaccine hesitancy continuum model to look for, and explore, three main types of decisions related to COVID-19 vaccines: vaccine acceptance, vaccine refusal and vaccine hesitancy (or vaccine delay). Two reasons for vaccine delay were identified: delay due to a perceived need for more information and delay until vaccine was "required" in the future. Nine themes were identified: three main facilitators (Vaccination as a social norm; Vaccination as a necessity; Trust in science) and six main barriers (Preference for "natural immunity"; Concerns over possible side effects; Perceived lack of information; Distrust in government;; Conspiracy theories; "Covid echo chambers") to vaccine uptake. In order to address vaccine uptake and vaccine hesitancy, it is useful to understand the reasons behind people's decisions to accept or refuse an offer of a vaccine, and to listen to them and engage with, rather than dismiss, these reasons. Those working in public health or health communication around vaccines, including COVID-19 vaccines, in and beyond the UK, might benefit from incorporating the facilitators and barriers found in this study.

Mixed-Immigration Status Families During the COVID-19 Pandemic.

To understand how mixed-immigration status families-families with a mixture of people with and without documentation-in the United States (U.S.) fared during the COVID-19 pandemic. Specifically, this study highlights how health inequities were exacerbated during the height of the pandemic due to the implementation of anti-immigration policies such as Public Charge Rule, which stipulates that receiving public benefits is grounds for inadmissibility for immigrants seeking naturalization. In-depth semistructured interviews were conducted over Zoom with 14 members of mixed-status families between February and April 2021. The interviews were audio recorded, transcribed, and analyzed using Atlas.ti. Using grounded theory, we assessed the level of awareness about Public Charge Rule and the health challenges these families faced during the COVID-19 pandemic. Themes that emerged included financial problems, job insecurity, housing insecurity, food insecurity, mental health problems, distrust of government and health officials, and a fear of Public Charge Rule. We present a framework for understanding health inequities for mixed-status families during the COVID-19 pandemic. Public Charge Rule caused fear and confusion for mixed-status families during the COVID-19 pandemic, resulting in individuals not receiving public benefits they urgently needed. This created heightened mental health problems due to job, housing, and food insecurity. We discuss how trust between mixed-status families and the government needs foundational rebuilding. In addition to streamlining the process for these families to apply for legal status, it is important to protect and support mixed-status families through programs and policies during public health emergencies.

Abstract P6-05-22: Multilevel, Multicomponent Intervention to Improve Informed Decision-Making about Clinical Trial Participation among Cancer Patients

Abstract Background: Knowledge gained through cancer clinical trials (CTs) has been proven critical to preventing, diagnosing and treating the disease, and providing the evidence base for clinical practice. Major advances in cancer treatment, which are essential for improving patients’ outcomes, come from investigations of new therapeutic agents in CTs. Despite the large number of available studies and improvements in public awareness about CTs, participation of underrepresented minorities in clinical research has been persistently low, with only 2 to 5% of Latinos and African Americans participating in cancer treatment trials. Barriers to participation are multilevel, complex, and multifactorial, including study design, healthcare system barriers, and patient- and medical team-related factors. Structural inequities, social determinants of health, distrust of government, patient-doctor communication, cultural and language barriers, and lower levels of health literacy have all been cited as common barriers for Latino and African American populations. Purpose: To improve informed decision-making about cancer CT participation among cancer patients and community members through a bilingual multilevel, multi-communication approach, including 1) a randomized controlled educational trial (clinic-based settings), and 2) a community education module (community-based settings). We will assess the impact of the intervention on awareness, attitudes, self-efficacy, and intentions to consider CTs as an appropriate treatment option for cancer and improve CT participation rates. Methods: The clinical setting includes a 2-group, parallel, randomized study with 400 patients from the Mays Cancer Center. The intervention group receives 1) a bilingual educational video on CTs, 2) a low literacy booklet, 3) support from a patient navigator (PN), and 4) an invitation to join our Salud America! network providing online/social media CT information. The control group receives a general fact sheet on CTs. All healthcare providers involved in clinical research will participate in Webinars to raise awareness of implicit bias and the importance of inclusive research. The community-setting intervention features a prospective single-group pre/post design, where participants (400) act as their own controls. They will receive an educational session on CTs provided by a community health educator + a low literacy booklet. Results: Focus groups guided the development of the video script, booklet, and educational materials. The short video features real cancer patients sharing their experience with CTs and how they overcame common barriers. Patient recruitment starts in August 2022. Preliminary results will be presented. Conclusions: Multilevel interventions involving culturally tailored decision aids (i.e., online video, low literacy booklet) in combination with care coordination by a PN can effectively address common barriers influencing patient decision-making regarding CTs, raise awareness, and increase positive attitudes and CT participation among specific groups with low participation in clinical research. Keywords: health equity, clinical trials, Latinos, underrepresented groups Citation Format: Patricia Chalela, Vivian Cortez, Armida Flores, Sandra Sivak, Ysabel Lew, Edgar Munoz, Cliff Despres, Callie Rainosek, Alyssa Gonzalez, Amara Ali, Ruben Mesa, Amelie Ramirez. Multilevel, Multicomponent Intervention to Improve Informed Decision-Making about Clinical Trial Participation among Cancer Patients [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-22.

Stuck: How Vaccine Rumors Start—and Why They Won’t Go Away

Stuck: How Vaccine Rumors Start—and Why They Won’t Go Away

Mistrust in government and COVID-19 vaccination acceptance in Nigeria: investigating the indirect roles of attitudes towards vaccination

BackgroundResearch shows that trust in government is associated with the acceptance of COVID-19 vaccination. However, there is no empirical evidence suggesting the pathway by which this association is formed. This study examines how dimensional attitudes towards vaccination explain the relationship between mistrust in government and COVID-19 vaccination acceptance.MethodsThe study was an online cross-sectional survey involving 1026 adults (of which 58.9% are female) resident in Nigeria with a mean age of 26.09 (±8.46) years. Data were collected using structured questionnaires assessing the level of mistrust in government, dimensional attitudes towards vaccination, and acceptance to be vaccinated for COVID-19. Structural equation modeling was used to analyze data.ResultsResults show that 56.8% of participants mistrust the government, while COVID-19 vaccination acceptance rate was 28.2%. Mistrust in government was significantly associated with low acceptance of COVID-19 vaccination. Furthermore, mistrust in the government was predictive of negative attitudes towards COVID-19 vaccination which include worries about unforeseen future effects of vaccines, mistrust of vaccine benefits (MVB), concerns about commercial profiteering (CCP), and preference for natural immunity. The outcomes of indirect effect analyses indicated that mistrust in government was associated with high mistrust in vaccine benefits (MVB) and increased concerns about commercial profiteering (CCP), which in turn lead to low acceptance of COVID-19 vaccination.ConclusionsMistrust in the government was high and was coupled with low vaccination acceptance. It is important to initiate culturally relevant awareness programs aiming at combating false notions about COVID-19 vaccination such as MVB and CCP arising from mistrust in government.

COVID-19 vaccine hesitancy among Nigerians living with non-communicable diseases: a qualitative study

ObjectivesThe discovery and subsequent manufacture of various types of COVID-19 vaccines were considered a breakthrough in the fight against the COVID-19 pandemic. Initially, limited supplies of COVID-19 vaccines warranted vulnerable...

The Economic Impact of COVID-19 in India and the Effect of Agricultural Farm Laws on Farm Sector Resilience

COVID-19 was recognized as a pandemic in early 2020 which resulted in lockdowns, social distancing and border closures to both goods and people globally. The impacts to the agriculture sector and farmers included instability in markets and farm prices, disruption of supply chains, and impacts to farmers including migrant worker’s health and livelihood. The World Bank considers India to be a lower-middle-income country (LMIC) and disruption of agriculture has profound implications. In India a majority of the population is engaged in the agricultural sector and two-thirds of its household expenditures are for food. Each year the Government of India announces procurement (support) prices for the main agricultural commodities with purchase operations organized through public agencies. Prices, supply chains and farm labour are intricately linked to both income and consumption of farmed crops and vulnerable to disruptions from COVID-19 impacts. We review the situation in India regarding COVID-19’s impacts on farmers, migrant workers and the agricultural sector. And also review the government response and impacts of three introduced farm laws designed to reduce COVID-19 impacts to the agricultural sector. The inter-relationships between farmers, government procurement policy, and agricultural laws are explored. The new farm laws implemented with good intentions resulted in widespread farmer protests, lawsuits, mistrust of government, and greatly affected farmer resilience with unexpected results.

COVID‐19 vaccination in Nigeria: Challenges and recommendations for future vaccination initiatives

AbstractThe COVID‐19 vaccination program is the most extensive vaccination program held in Nigeria to date. As of September 21, 2022, more than 31 million people have been fully vaccinated which made up 15% of the entire population. Following the global COVID‐19 vaccination goal, Nigeria was expected to vaccinate 40% of its population in 2021 and reach the 70% vaccination threshold before the end of 2022. Currently, Nigeria is nowhere near the global vaccination goal due to various challenges encountered by the program. Challenges such as distrust in government, poor cold‐chain management, and poor communication during the onset of the program all contributed to the inability to attain the set goal. With the pledge of Global Alliance for Vaccines and Immunizations to extend the malaria vaccination program to other Sub‐Saharan African countries after the success of the first dose vaccination in Ghana, Kenya, and Malawi and the recent reemergence of monkeypox virus in Africa which also requires vaccination to curtail its spread, it is important that Nigeria, in preparation for these vaccination programs, learn from some of the challenges that the COVID‐19 vaccination program encountered and take actions to ensure greater success in future vaccination programs in the country. This paper aims to give an overview of the COVID‐19 vaccination program in Nigeria, highlight the challenges encountered, and provide recommendations for better future vaccination initiatives in the country.

Political legitimacy and vaccine hesitancy: Disability support workers in Australia

Abstract People with disability are an at-risk group in the COVID-19 pandemic for a range of clinical and socioeconomic reasons. In recognition of this, Australians with disability and those who work with them were prioritized in access to vaccination, but the vaccination targets were not met. In this paper, we analyze qualitative data generated from a survey with 368 disability support workers to identify drivers of COVID-19 vaccination hesitancy and why the implementation of this policy may have experienced challenges. We identify a range of themes within these data but ultimately argue that a major driver of vaccine hesitancy in this group is a mistrust of government and an erosion of employment terms and conditions. Drawing on the policy capacity literature, we argue that the “Achilles’ heel” for the Australian government in this case is the critical policy capacity of political legitimacy. This finding has important implications for where the government needs to increase/build policy capacity, strengthening its efforts and better relating to organizations that can be helpful in terms of developing public health messaging for disability support workers.

Axiology of Russia’s Image in Mass Media Discourse in Coronavirus Pandemic

The current paper addresses the issue of axiological potential of mass media discursive texts generated during the coronavirus outbreak, namely those discussing and debating Russian vaccines. The study draws on discourse analysis and linguoaxiological analysis of media texts, which reveals the main ideological trends of informing the global community about the state of the Russia’s Sputnik V vaccine. The authors have determined that the trends revealed as a result of media discourse analysis concern such phenomena as ‘political agenda’, ‘safety issues’ and ‘compulsion to vaccinate / mistrust of government’. To share these axiologically charged ideas, speakers follow particular verbal practices, i.e., using emotive vocabulary, primarily evaluative word-combinations, axiological notions, metaphors, pejorative vocabulary, discursive markers etc. for manipulating the perception of the covered events. As a result, main constituents for the three key thematic fields are identified, extensively described, and structured through verbal representations of axiological notions. The results illustrate how mass media discourse can be used to investigate axiological notions delivered by the author. Besides, it can provide researchers with an instrument to identify the language means used to create either positive or negative media image.

Lessons in Empowerment: The Civic Potential of Historically Grounded Conversations among Racially Marginalized Youth

Civic education is associated with the development of democratic capacity. However, this concept is measured using a limited battery of metrics (e.g., trust in government) that do not adequately capture the political sentiments of racially marginalized youth. Drawing from conversations with Chicago high school students and their teachers, I argue that democratic capacity should comprise a broader set of attitudes and behaviors, including political empowerment and acts of public voice. In the process, I identify one pedagogical technique associated with the development of empowerment: historically grounded conversations about politics that validate students’ distrust of government. Nationally representative survey data suggests that civic learning experiences of this kind are associated with feelings of political empowerment and that empowerment is associated with multiple forms of political participation, particularly among Black and Latinx youth. Overall, this study provides a path forward for those interested in reimagining civic education in the U.S.

Public beliefs and willingness to accept COVID-19 vaccines among adults in South-Western Nigeria: A cross-sectional study.

Despite the government's and development partners' unmatched efforts to ensure that every eligible person receives vaccinations, there have been concerns about vaccine fear, government mistrust, vaccine hesitancy and rejection expressed by the public, as well as various conspiracy theories involving the COVID-19 vaccines. This study assessed the public beliefs and willingness to accept COVID-19 vaccines and related factors among residents of Ondo State, Nigeria. Using a convenience sample technique, a cross-sectional survey of the adult population was carried out in the months of February and March of 2022. Factors influencing beliefs and willingness to accept COVID-19 vaccines were found by using univariate and multivariate statistical analysis. 306 out of 323 respondents completed the survey and were included in the final analysis. The respondents mean age was 28.16 ± 16.2 years. Although n = 223, 72.9% of respondents reported to have received at least one dose of COVID-19 vaccines, (n = 205) 67.0% believed COVID-19 vaccines to be effective. Among the individuals who had not yet had any COVID-19 vaccinations, 2.6% (n = 8) of respondents were willing to accept the vaccines, whereas 14.1% (n = 43) were unwilling. Respondents' beliefs about the efficacy of COVID-19 vaccines were influenced by their gender, occupation, religion and educational attainment (p < 0.005). The study revealed a good level of positive beliefs about the vaccine, which was mirrored in vaccination history. However, those who had not yet received the vaccine were unwilling to do so, opening the door for more aggressive risk communication to be able to alter the course of events. In addition to addressing additional COVID-19 vaccination myths, we advise policy-makers to develop communication strategies that emphasise the safety of the COVID-19 vaccine. It is advised that all relevant stakeholders be included in government COVID-19 vaccination programmes by sharing timely, transparent information that fosters accountability.

A mixed methods study exploring requests for unproven COVID therapies such as ivermectin and healthcare distrust in the rural South

The COVID-19 pandemic has led to contentious discourse regarding unproven COVID-19 therapies (UCTs),(e.g. ivermectin). Despite recommendations against it, ivermectin remains, in some areas, highly demanded. The goal of this study is to understand patient and provider perspectives about UCTs (e.g., ivermectin) and how responses to requests for UCTs impact healthcare distrust. This mixed methods observational study was conducted in a rural healthcare system in the Southern United States. Adults (n = 26) with a history of COVID-19 or clinicians (n = 8) from the same system were interviewed using questionnaires assessing healthcare distrust and qualitatively interviewed exploring perceptions about UCTs. Patient themes were: 1) Importance of anecdotal stories for decision-making; 2) Use of haphazard approaches to ‘research’; 3) Strong distrust of government and healthcare organizations; 4) Inherent trust in local healthcare; 5) Decision-making as weighing pros/cons; and 6) Feeling a right to try medications. High survey medians indicated high distrust with differences of 8.5 points for those who requested/used ivermectin versus those who did not (p = 0.027). Clinician themes were: 1) Frustration when patients trust social media over clinicians; 2) Acceptance of community beliefs about UCTs; 3) Distrust originating outside of the healthcare system; 4) Feeling torn about prescribing UCTs to build trust; and 5) Variable educational strategies. When clinicians are perceived as aligned with government, this may void patients’ trust of clinicians. Clinicians should leverage trust in local healthcare and distance themselves from distrusted information sources. Ethical questions arise regarding appropriateness of acquiescing to patient requests for ivermectin for building trust.