Public Trust, Information Sources and Vaccine Willingness Related to the COVID-19 Pandemic in Trinidad and Tobago: An Online Cross-Sectional Survey

"Exploring the factors influencing the risk perceptions and the level of public trust and confidence that exists in populations is important to a country's pandemic response."

The response of populations to public health measures may rely on the degree to which they trust sources of information and institutions. Although the routine immunisation coverage is above 90% for the majority of vaccines in Trinidad and Tobago, the low vaccination rates seen during the 2009 H1N1 pandemic may indicate potential issues with COVID-19 vaccine acceptance. This exploratory study aimed to evaluate public trust in information sources, confidence in institutions, and COVID-19 vaccine willingness in Trinidad and Tobago.

Although patient and public involvement (PPI) in research is uncommon in Trinidad and Tobago, this study incorporated the PPI concept by involving a secondary schoolteacher in the research process. This public representative advised the research team on the data collection method and choice of words used in the survey and information sheets so that it would be easy to understand. The survey instrument, a validated questionnaire developed by the World Health Organization (WHO), was adapted to the local setting and piloted with 20 participants.

The online cross-sectional survey was distributed to members of the population with internet access from November 10 2020 to December 7 2020, approximately ten months after the first case was detected in the country and as preparation for the implementation of COVID-19 vaccination programmes had begun.

Analysis of 615 responses (195 of whom represented healthcare professionals) to the survey revealed that:

• 46.5% of participants thought they were likely to contract COVID-19, while 38.0% considered themselves at high risk of contracting the illness. Approximately 35% felt they would develop severe illness if they did contract COVID-19.
• Health literacy was assessed by asking five questions related to ease of finding and understanding COVID-19-related information. The most common response to the questions was "easy" or "very easy". However, 20.3% of participants thought it was difficult to judge information in the media.
• When asked how often they sought information related to COVID-19, 49.6% said they never/rarely searched for information. The most trusted sources of information included health workers (32.5%) and the Ministry of Health (23.6%).
• Approximately 32.5% of participants believed that it was probably true that "many important things happen which the public are not aware of", and 41.0% felt that it was definitely true that "politicians usually did not tell their true motives for doing things". Increasing levels of trust in the medical sector were associated with decreasing levels of believing misinformation, as well as a greater likelihood of getting tested and sharing names of contacts.
• Overall, 62.8% of participants said they would take a COVID-19 vaccine if available; in the health professionals subgroup, only 61.5% agreed they would do so. ("As this group is uniquely placed to influence vaccine uptake, it is imperative to build vaccine confidence amongst health professionals by addressing their own concerns, understanding what factors influence health professionals' decision to accept and recommend the vaccine.")
• In terms of factors influencing the decision to take a COVID-19 vaccine, whether the vaccine had been in use for a long time with no serious adverse effects was considered extremely important by 44.2% of participants. Regression analyses showed that those who agreed that everyone should adhere to the national immunisation schedule and those who would take the flu vaccine were 2.77 (95% confidence interval (CI) 1.77-4.35) and 4.60 (95% CI 3.11-6.84) times more likely to take the vaccine, respectively.

In order to promote compliance with COVID-19-related public health measures and to encourage vaccine uptake in Trinidad and Tobago, the researchers recommend:

1. That various health professional associations should deliver accurate information to the public, since their opinions are likely to be highly trusted. This strategy may help individuals differentiate misinformation and increase confidence in the vaccines.
2. That the government "engage communities to understand local needs and clearly communicate the reasons for implementing public health measures....As COVID-19 vaccination programmes are initiated in Trinidad and Tobago, self-reported behaviours, public trust and vaccine opinions may change either positively or negatively. Thus, it is important to have continuous campaigns reinforcing credible information on COVID-19 and public health measures."

With regard to future research directions, a separate study could focus on the growing Venezuelan population in Trinidad and Tobago, as migrant groups are especially vulnerable to COVID-19. In addition, details on the mechanism behind vaccine hesitancy in Trinidad and Tobago could be explored in order to support effective vaccination programmes. It would also be useful to conduct qualitative research to provide a deeper understanding of the factors contributing to vaccine willingness.

In conclusion, "the results may provide insights to inform public health interventions in the country such as developing strategies for effective public communication and to support vaccine uptake."