"We Just Have to Trust the People in White Lab Coats": Analyzing Distrust in Vaccine Hesitant Comments on the HHS Nondiscrimination in Health Programs and Activities Proposed Rule

Vaccine attitudes provide a valuable site for analyzing trust relations on both interpersonal and institutional levels. This study is a content analysis of public comments submitted from August through October 2022 in response to a proposed rule issued by the U.S. Department of Health and Human Services, which sought to strengthen non-discrimination protections in healthcare programs. Specifically, it examines the role of distrust in shaping and reinforcing vaccine hesitant beliefs, experiences, and healthcare decisions. The five themes identified in the study illustrate a breakdown in trust in pharmaceutical companies, government actors, and healthcare providers, reflecting broader social patterns. In the Roots of Rejection theme, commenters describe the concerns about vaccine technology that lead them to vaccine hesitant beliefs. The theme Encounters in Medicine demonstrates how interactions with healthcare workers impact commenters' vaccine-related beliefs and medical decision-making. The Science and Truth theme illuminates a tendency among commenters to position themselves as being in search of the "real" truth and "real" science. The Freedom and Tyranny theme shows how commenters' vaccine stances are often tied up with their identity as Americans. The final theme, Social Consequences, discusses the issues vaccine-hesitant individuals interpersonally and/or encounter outside of healthcare that reinforce their beliefs about vaccines. These results reveal a need for further studies to address ways to mitigate both interpersonal and institutional-level distrust when considering interventions for vaccine hesitancy.