A 2026 literature review presentation examining the role of trust as a determinant of vaccine uptake, with a focus on conflict-affected settings and polio eradication.

The presentation synthesizes evidence across six thematic areas. It opens with the rationale for focusing on trust — positioning it as the foundation of effective health investment, with the World Economic Forum ranking declining trust among the most severe global risks. It then conceptualizes trust through three core ingredients consistently identified across disciplines: competence, integrity, and benevolence, with public health extending these to include fairness, confidentiality, communication, and system-level reliability. The evidence section shows that trust is the strongest predictor of vaccine uptake globally — Edelman's Trust Barometer found a 21-percentage-point gap in vaccination coverage between high- and low-trust populations across 28 countries — and that doctors and nurses are the most trusted messengers (84–92%), while governments rank last. On measurement, the review notes that 93% of trust instruments were developed in high-income countries, highlighting the need for locally adapted tools that account for dimensions such as dignity, caste, and historical grievance. In conflict settings, the presentation finds that displacement, politicization of healthcare, and colonial legacies systematically erode institutional trust, while gatekeepers — religious leaders, community volunteers, traditional authorities — can either bridge or deepen that divide depending on their neutrality and community standing. The polio-specific section identifies the trust challenge in eradication: refusals driven by misconceptions, fear of hidden motives, geopolitical context (67% of polio cases occur in conflict settings), and caregiver frustration at the contrast between intensive polio campaigns and absent basic services. India's SMNet program is presented as a model of trust-led success, reducing refusals below 1% and raising immunization coverage above 80% through local mobilizers, religious leader partnerships, and consistent household engagement.

Best used for: trust-building theory and evidence base, vaccine hesitancy in conflict and FCV settings, messenger strategy and influencer engagement, programme design grounded in behavioral science.