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UH Study: Native Hawaiian, Pacific Islander Vaccination Rates Affected by Trust Levels

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A new University of Hawaiʻi at Mānoa study explains vaccine hesitancy among Native Hawaiians and other Pacific Islanders in Hawaiʻi at the start of the COVID-19 pandemic, and researchers say the findings could provide a foundation for communication strategies for other health policies beyond the pandemic.

“The study revealed for the first time an opposing role of trust in vaccine uptake that we were able to quantify,” Ruben Juarez, economics professor at UH-Mānoa’s College of Social Sciences and Hawaiʻi Medical Service Association endowed professor of health economics at the University of Hawaiʻi Economic Research Organization, said in a press release. “The levels of trust individuals expressed were highly dependent on the source of information they relied on to make decisions regarding their health.”

Until last fall, Native Hawaiians and Pacific Islanders remained significantly under-vaccinated compared to other ethnic groups in Hawaiʻi. In collaboration with the Pacific Alliance Against COVID-19, a team of UH-Mānoa researchers surveyed 1,124 Hawaiʻi residents between March and August 2021 during the group’s COVID-19 testing events. Of the respondents, 61.7% self-identified as Native Hawaiian and Pacific Islander.

The research team’s findings, published in June in Vaccines, describe how racial/ethnic differences in trust between sources of COVID information, coupled with the level of consumption of such information, corresponded to divergence in vaccine uptake.


Researchers observed:

  • Respondents exhibiting a higher degree of trust in official sources of COVID information were 20.68% more likely to get vaccinated.
  • Respondents exhibiting a higher degree of trust in unofficial sources were 12.49% less likely to get vaccinated.
  • Trust in unofficial sources, along with consumption of COVID information from such sources, explained vaccine hesitancy, specifically among Native Hawaiians and Pacific Islanders.

Vaccine hesitancy among Native Hawaiians and Pacific Islanders is concerning, since they are at disproportionately higher risk for severe complications and mortality from COVID because of long-standing social inequities associated with higher prevalence of chronic diseases such as obesity and diabetes.

“Results from our study implicate that public health strategies which nurture trust and health science literacy may augment COVID-19 mitigation efforts, an approach we are evaluating with a community and culturally relevant educational program we developed with our school-based partnerships that are coupled with supporting on-site COVID-19 testing,” Alika Maunakea, associated professor at UH-Mānoa’s John A. Burns School of Medicine, said in the press release.


May Okihiro, John A. Burns School of Medicine associate professor and pediatrician at the Waiʻanae Coast Comprehensive Health Center, added that the data provides critical information that health centers can use to develop strategies to address health disparities more systematically.

The survey was part of a UH-Mānoa-Pacific Alliance Against COVID-19 partnership to increase COVID testing capacity and vaccination in underserved communities while collecting meaningful data to address these problems.

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