Health Messaging During an Infodemic: Explaining Opposition to COVID Vaccines in Four Asian Cities

This study used online survey data collected from four Asian cities to reveal how individuals' health beliefs are shaped in a time of trust deficits and changing media environments. We discovered a negative relationship between individuals' competence-based government trust and their anti-vaccine attitudes, thereby underscoring the important role played by trust in risk communication with individuals during public health crises. We further examined environmental impacts that shape anti-vaccine attitudes in different regions and found that the relationship between competence-based government trust and anti-vaccine attitudes varied with respect to the information environment. In regions with lower levels of information accessibility, competence-based government trust was negatively related to perceived misinformation credibility despite the level of information quality and negatively related to anti-vaccine attitudes when the information quality was high. The patterns in regions with higher levels of information accessibility were different. This study highlights the importance of examining environmental influences on the reception of public health messaging. Policy insights for health promotion in diverse political and information environments are provided.