Trust As Important as Mandates in Changing Minds About Vaccines


Attitudes change over time but people need convincing.

uilding trust may be just as important as government mandates in convincing patients of the importance of vaccines, according to a new study.

Researchers analyzed COVID-19 vaccine opposition and how people changed their attitudes during the first three waves of the global pandemic, according to a news release.1

When shots were voluntary, 3.3% of people consistently opposed vaccines. If vaccines were required, resistance grew to 16.5%, said the study2 by Santa Fe Institute researchers Katrin Schmelz, PhD, and Samuel Bowles, PhD, published in the Proceedings of the National Academy of Sciences.

They analyzed three surveys of 2,018 people in Germany from April 2020 to May 2021. The authors said they were not aware of comparable panels of people in other countries, but other studies suggested commonalities with populations in Europe and North America.Over time, many respondents switched from anti-vaccination to pro, even if vaccination was mandated, the news release said. Their attitudes changed when they “had become more convinced of the vaccines’ effectiveness, more trusting in public institutions, and less concerned that a mandate would compromise their freedom.”

Demographic factors like age, gender, and educational levels were irrelevant to who switched.

“What matters is how people think and what they believe. So, to increase and sustain vaccination rates, change people’s beliefs, and build trust,” Schmelz said in the news release. “People have to feel that the guidance they’re getting from the government makes sense and is reliable. And it’s key to get the word out that the vaccines really work.”

For future policy, the researchers acknowledged vaccine mandates could undermine trust in government, but still may be needed, the news release said.

“Looking beyond Covid, we might have to take on board that some of the standard tools of public policy — mandates — will backfire if they are experienced as a limit on a person’s freedom rather than a necessity for expanding the freedom of all to lead a more normal life in pandemic times,” Bowles said.

Yet, mandates could contribute to sustaining trust in public institutions, particularly if a still-worse variant emerges in the COVID-19 pandemic.

“Failing to adopt aggressive policies against the pandemic when it is surging is not a way to win trust from the majority who are already vaccinated,” Bowles said.

Lessons from the COVID-19 pandemic may apply to other societal challenges when changes to personal behavior and social interactions are critical to success of public policy, the researchers said.

They gave examples such as climate change, tolerating ethnic diversity or racial and gender equality.

When mandates are used, resistance will be lower if people affected are convinced of the severity of the problem and of the effectiveness of new mandates.

This article originally appeared on Medical Economics.


  1. Changing beliefs is critical to sustaining high levels of vaccination. News release. Santa Fe Institute. March 22, 2022. Accessed March 29, 2022.
  2. Schmelz K, Bowels S. Opposition to voluntary and mandated COVID-19 vaccination as a dynamic process: Evidence and policy implications of changing beliefs. Proc Natl Acad Sci U S A. 2022;119(13):e2118721119. doi:10.1073/pnas.22118721119
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