Skip to main content
Log in

Association of National Identity and Trust in Government with COVID-19 Vaccination and Brand Choice in Taiwan

  • Original Paper
  • Published:
Journal of Community Health Aims and scope Submit manuscript

Abstract

In Taiwan, hesitancy regarding COVID-19 vaccination centered more on the choice of vaccine brand than on the decision to vaccinate. However, there is limited research exploring the factors influencing COVID-19 vaccine brand preferences from a sociopolitical perspective. Thus, we aimed to examine how Taiwanese national identity and trust in government influence vaccination status and vaccine brand choice, using longitudinal data from 2020, 2021, and 2023. This study utilized data from the Taiwan Panel Study of Family Dynamics 2020 survey, and combined it with data from two self-administered surveys conducted in 2021 and 2023. We focused on four vaccines commonly administered in Taiwan: AstraZeneca, Moderna, Pfizer-BioNTech, and the domestically-developed Medigen. Using Poisson regression models with robust standard errors, we assessed the effects of national identity and trust in government on the choice of COVID-19 vaccine brand. By analyzing data from 2361 participants, we found that national identity and trust in government were associated with the likelihood of COVID-19 vaccination, the number of vaccine doses received, and the brand of vaccine taken. Those who identified themselves as Taiwanese were more inclined to receive the Medigen and AstraZeneca vaccines, but less willing to receive Pfizer-BioNTech vaccine. Those who trusted the government were more likely to prefer and receive the Medigen vaccine. Conversely, those who didn’t trust the government were less likely to prefer Medigen and AstraZeneca vaccines, but were willing to receive Pfizer-BioNTech vaccine. Vaccine brand preferences and uptake in Taiwan were affected by individuals’ national identity and their trust in government. This highlights the critical role of sociopolitical factors in shaping public health strategies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Steinbrook, R. (2021). Lessons from the success of COVID-19 control in Taiwan. JAMA Internal Medicine, 181, 922. https://doi.org/10.1001/jamainternmed.2021.1625

    Article  CAS  PubMed  Google Scholar 

  2. Summers, J., Cheng, H.-Y., Lin, H.-H., Barnard, L. T., Kvalsvig, A., Wilson, N., & Baker, M. G. (2020). Potential lessons from the Taiwan and New Zealand health responses to the COVID-19 pandemic. The Lancet Regional Health—Western Pacific. https://doi.org/10.1016/j.lanwpc.2020.100044

    Article  PubMed  PubMed Central  Google Scholar 

  3. Wang, C. J., Ng, C. Y., & Brook, R. H. (2020). Response to COVID-19 in Taiwan: Big data analytics, new technology, and proactive testing. JAMA, 323, 1341–1342. https://doi.org/10.1001/jama.2020.3151

    Article  CAS  PubMed  Google Scholar 

  4. Yen, M.-Y., Yen, Y.-F., Chen, S.-Y., Lee, T.-I., Huang, K.-H., Chan, T.-C., Tung, T.-H., Hsu, L.-Y., Chiu, T.-Y., Hsueh, P.-R., & King, C.-C. (2021). Learning from the past: Taiwan’s responses to COVID-19 versus SARS. International Journal of Infectious Diseases, 110, 469–478. https://doi.org/10.1016/j.ijid.2021.06.002

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Fernández-Villaverde, J., & Jones, C. I. (2020). Macroeconomic outcomes and COVID-19: A progress report. National Bureau of Economic Research.

    Book  Google Scholar 

  6. Dyer, O. (2021). Covid-19: Variants are spreading in countries with low vaccination rates. BMJ, 373, n1359. https://doi.org/10.1136/bmj.n1359

    Article  PubMed  Google Scholar 

  7. Wu, C.-H., Chou, Y.-C., Lin, F.-H., Hsieh, C.-J., Wu, D.-C., Peng, C.-K., & Yu, C.-P. (2021). Epidemiological features of domestic and imported cases with COVID-19 between January 2020 and March 2021 in Taiwan. Medicine, 100, e27360. https://doi.org/10.1097/MD.0000000000027360

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Sheng, W.-H., Hsieh, S.-M., & Chang, S.-C. (2023). Achievements of COVID-19 vaccination programs: Taiwanese perspective. Journal of the Formosan Medical Association. https://doi.org/10.1016/j.jfma.2023.04.017

    Article  PubMed  PubMed Central  Google Scholar 

  9. Lee, Y.-C., & Wu, W.-L. (2023). Key drivers of COVID-19 vaccine hesitancy: A perspective of collectivism. Healthcare, 11, 176. https://doi.org/10.3390/healthcare11020176

    Article  PubMed  PubMed Central  Google Scholar 

  10. Guan, C.-Y., Tsai, S.-H., Fan, J.-S., Lin, Y.-K., & Kao, C.-C. (2022). Middle-age Asian male with cerebral venous thrombosis after COVID-19 AstraZeneca vaccination. American Journal of Emergency Medicine, 51, 427. https://doi.org/10.1016/j.ajem.2021.07.011

    Article  Google Scholar 

  11. Li, S.-Y., Chen, H.-H., Liu, P.-Y., Shi, Z.-Y., Lin, Y.-H., Tsai, C.-A., & Lin, S.-P. (2022). Case report of acute encephalitis following the AstraZeneca COVID-19 vaccine. International Journal of Rheumatic Diseases, 25, 950–956. https://doi.org/10.1111/1756-185X.14372

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Latkin, C. A., Dayton, L., Yi, G., Konstantopoulos, A., & Boodram, B. (2021). Trust in a COVID-19 vaccine in the US: A social-ecological perspective. Social Sciences & Medicine, 270, 113684. https://doi.org/10.1016/j.socscimed.2021.113684

    Article  Google Scholar 

  13. Yuan, Y., Yeo, S. Y., & Lee, K. S. (2024). Different roles of interpersonal trust and institutional trust in motivating older adults to receive COVID-19 vaccines in Singapore. Social Science and Medicine, 340, 116475. https://doi.org/10.1016/j.socscimed.2023.116475

    Article  PubMed  Google Scholar 

  14. Silver, A. (2021). Why Taiwan approved its own vaccine before phase III trials. BMJ, 374, n2104. https://doi.org/10.1136/bmj.n2104

    Article  PubMed  Google Scholar 

  15. Lin, A.M.-W., & Wu, C. (2023). Party identification, ambivalence, and the issue of vaccine procurement in Taiwan. Journal of Asian and African Studies, 58, 232–248. https://doi.org/10.1177/00219096221137675

    Article  Google Scholar 

  16. Schaffer DeRoo, S., Pudalov, N. J., & Fu, L. Y. (2020). Planning for a COVID-19 vaccination program. JAMA, 323, 2458–2459. https://doi.org/10.1001/jama.2020.8711

    Article  CAS  PubMed  Google Scholar 

  17. Goldenberg, M. J. (2021). Vaccine hesitancy: Public trust, expertise, and the war on science. University of Pittsburgh Press.

    Book  Google Scholar 

  18. Chiang, C.-F., Kuo, J., & Liu, J.-T. (2022). Cueing quality: Unpacking country-of-origin effects on intentions to vaccinate against COVID-19 in Taiwan. Social Science and Medicine, 314, 115403. https://doi.org/10.1016/j.socscimed.2022.115403

    Article  PubMed  Google Scholar 

  19. Gotanda, H., Miyawaki, A., Tabuchi, T., & Tsugawa, Y. (2021). Association between trust in government and practice of preventive measures during the COVID-19 pandemic in Japan. Journal of General Internal Medicine, 36, 3471–3477. https://doi.org/10.1007/s11606-021-06959-3

    Article  PubMed  PubMed Central  Google Scholar 

  20. Pak, A., McBryde, E., & Adegboye, O. A. (2021). Does high public trust amplify compliance with stringent COVID-19 government health guidelines? A multi-country analysis using data from 102,627 individuals. Risk Management and Healthcare Policy, 14, 293–302. https://doi.org/10.2147/RMHP.S278774

    Article  PubMed  PubMed Central  Google Scholar 

  21. Shanka, M. S., & Menebo, M. M. (2022). When and how trust in government leads to compliance with COVID-19 precautionary measures. Journal of Business Research, 139, 1275–1283. https://doi.org/10.1016/j.jbusres.2021.10.036

    Article  PubMed  Google Scholar 

  22. Van Bavel, J. J., Cichocka, A., Capraro, V., Sjåstad, H., Nezlek, J. B., Pavlović, T., Alfano, M., Gelfand, M. J., Azevedo, F., Birtel, M. D., Cislak, A., Lockwood, P. L., Ross, R. M., Abts, K., Agadullina, E., Aruta, J. J. B., Besharati, S. N., Bor, A., Choma, B. L., … Boggio, P. S. (2022). National identity predicts public health support during a global pandemic. Nature Communications, 13, 517. https://doi.org/10.1038/s41467-021-27668-9

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Barceló, J., Sheen, G.C.-H., Tung, H. H., & Wu, W.-C. (2022). Vaccine nationalism among the public: A cross-country experimental evidence of own-country bias towards COVID-19 vaccination. Social Science and Medicine, 310, 115278. https://doi.org/10.1016/j.socscimed.2022.115278

    Article  PubMed  Google Scholar 

  24. Trent, M., Seale, H., Chughtai, A. A., Salmon, D., & MacIntyre, C. R. (2022). Trust in government, intention to vaccinate and COVID-19 vaccine hesitancy: A comparative survey of five large cities in the United States, United Kingdom, and Australia. Vaccine, 40, 2498–2505. https://doi.org/10.1016/j.vaccine.2021.06.048

    Article  CAS  PubMed  Google Scholar 

  25. Van Oost, P., Yzerbyt, V., Schmitz, M., Vansteenkiste, M., Luminet, O., Morbée, S., Van Den Bergh, O., Waterschoot, J., & Klein, O. (2022). The relation between conspiracism, government trust, and COVID-19 vaccination intentions: The key role of motivation. Social Science and Medicine, 301, 114926. https://doi.org/10.1016/j.socscimed.2022.114926

    Article  PubMed  Google Scholar 

  26. Chang, M. (2003). On the origins and transformation of Taiwanese national identity. In P. R. Katz & M. A. Rubinstein (Eds.), Religion and the formation of Taiwanese identities (pp. 23–58). Palgrave Macmillan. https://doi.org/10.1057/9781403981738_2

    Chapter  Google Scholar 

  27. Liao, D.-C., Chen, B., & Huang, C. (2013). The decline of “Chinese Identity” in Taiwan?! An analysis of survey data from 1992 to 2012. East Asia, 30, 273–290. https://doi.org/10.1007/s12140-013-9198-3

    Article  Google Scholar 

  28. Wang, A.H.-E., Yeh, Y.-Y., Wu, C. K. S., & Chen, F.-Y. (2023). Why does taiwan identity decline? Journal of Asian and African Studies. https://doi.org/10.1177/00219096231168068

    Article  PubMed  PubMed Central  Google Scholar 

  29. Ong, A. K. S., Prasetyo, Y. T., Lagura, F. C., Ramos, R. N., Salazar, J. M. L., Sigua, K. M., Villas, J. A., Chuenyindee, T., Nadlifatin, R., Persada, S. F., & Thana, K. (2022). Young adult preference analysis on the attributes of COVID-19 vaccine in the Philippines: A conjoint analysis approach. Public Health Practice, 4, 100300. https://doi.org/10.1016/j.puhip.2022.100300

    Article  Google Scholar 

  30. Lin, C.-Y., Fan, C.-W., Ahorsu, D. K., Lin, Y. C., Weng, H.-C., & Griffiths, M. D. (2022). Associations between vaccination and quality of life among Taiwan general population: A comparison between COVID-19 vaccines and flu vaccines. Human Vaccines & Immunotherapeutics, 18, 2079344. https://doi.org/10.1080/21645515.2022.2079344

    Article  CAS  Google Scholar 

  31. Wang, C.-W., de Jong, E. P., Faure, J. A., Ellington, J. L., Chen, C.-H.S., & Chan, C.-C. (2022). A matter of trust: A qualitative comparison of the determinants of COVID-19 vaccine hesitancy in Taiwan, the United States, the Netherlands, and Haiti. Human Vaccines & Immunotherapeutics, 18, 2050121. https://doi.org/10.1080/21645515.2022.2050121

    Article  CAS  Google Scholar 

  32. Lee, H.-W., Leng, C.-H., & Chan, T.-C. (2022). Determinants of personal vaccination hesitancy before and after the mid-2021 COVID-19 outbreak in Taiwan. PLoS ONE, 17, e0270349. https://doi.org/10.1371/journal.pone.0270349

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Lo, S.-Y., Li, S.-C.S., & Wu, T.-Y. (2021). Exploring psychological factors for COVID-19 vaccination intention in Taiwan. Vaccines, 9, 764. https://doi.org/10.3390/vaccines9070764

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Viskupič, F., Wiltse, D. L., & Meyer, B. A. (2022). Trust in physicians and trust in government predict COVID-19 vaccine uptake. Social Science Quarterly, 103, 509–520. https://doi.org/10.1111/ssqu.13147

    Article  PubMed  PubMed Central  Google Scholar 

  35. Ho, K., Clarke, H. D., Chen, L.-K., & Weng, D.L.-C. (2013). Valence politics and electoral choice in a new democracy: The case of Taiwan. Elect. Stud. Economics and Elections: Effects Deep and Wide, 32, 476–481. https://doi.org/10.1016/j.electstud.2013.05.012

    Article  Google Scholar 

  36. Zou, G. (2004). A modified poisson regression approach to prospective studies with binary data. American Journal of Epidemiology, 159, 702–706.

    Article  PubMed  Google Scholar 

  37. Council on Foreign Relations. (2021). Taiwan Confronts A Serious Vaccine Shortage. Retrieved October 12, 2023, from https://www.cfr.org/blog/taiwan-confronts-serious-vaccine-shortage

  38. BBC News. (2021). Covid: Taiwan rolls out homegrown vaccine amid criticism. BBC News. Retrieved October 12, 2023, from https://www.bbc.com/news/world-asia-58301573

  39. Reuters. (2021a). BioNTech COVID-19 vaccines coming to Taiwan, Chinese agent says. Reuters. Retrieved October 12, 2023, from https://www.reuters.com/world/asia-pacific/tsmc-says-it-is-process-signing-deal-biontech-covid-19-vaccines-2021-07-11/

  40. Reuters. (2021b). Taiwan says China blocked deal with BioNTech for COVID-19 shots. Reuters. Retrieved October 12, 2023, from https://www.reuters.com/world/china/taiwan-says-china-blocked-deal-with-biontech-covid-19-shots-2021-05-26/

  41. Breakwell, G. M., Camilo, C., Jaspal, R., & Lima, M. L. (2022). Influences of nationality and national identification on perceived dangerousness of COVID-19 variants and perceived effectiveness of COVID-19 vaccines: A study of UK and Portuguese samples. Journal of Social and Political Psychology, 10, 106–122. https://doi.org/10.5964/jspp.7425

    Article  Google Scholar 

  42. Fumagalli, E., Krick, C. B., Dolmatzian, M. B., Del Negro, J. E., & Navajas, J. (2023). Partisanship predicts COVID-19 vaccine brand preference: The case of Argentina. Humanities and Social Sciences Communications, 10, 1–10. https://doi.org/10.1057/s41599-023-02067-1

    Article  Google Scholar 

  43. Taiwan News. (2021). Japan to donate 1 million more doses of AstraZeneca vaccine to Taiwan. Retrieved October 12, 2023, from https://www.taiwannews.com.tw/en/news/4232242

  44. The Diplomat. (2021). Taiwan receives vaccine donation from Japan as outbreak continues. Retrieved October 12, 2023, from https://thediplomat.com/2021/06/taiwan-receives-vaccine-donation-from-japan-as-outbreak-continues/

  45. Choi, Y., & Fox, A. M. (2022). Mistrust in public health institutions is a stronger predictor of vaccine hesitancy and uptake than Trust in Trump. Social Science and Medicine, 314, 115440. https://doi.org/10.1016/j.socscimed.2022.115440

    Article  PubMed  Google Scholar 

  46. Marchlewska, M., Hamer, K., Baran, M., Górska, P., & Kaniasty, K. (2022). COVID-19: Why do people refuse vaccination? The role of social identities and conspiracy beliefs: evidence from nationwide samples of polish adults. Vaccines, 10, 268. https://doi.org/10.3390/vaccines10020268

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Nurmi, J., & Jaakola, J. (2023). Losing trust: Processes of vaccine hesitancy in parents’ narratives. Social Science and Medicine, 331, 116064. https://doi.org/10.1016/j.socscimed.2023.116064

    Article  PubMed  Google Scholar 

  48. Daly, M., Jones, A., & Robinson, E. (2021). Public trust and willingness to vaccinate against COVID-19 in the US from October 14, 2020, to March 29, 2021. JAMA, 325, 2397–2399. https://doi.org/10.1001/jama.2021.8246

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Seddig, D., Maskileyson, D., Davidov, E., Ajzen, I., & Schmidt, P. (2022). Correlates of COVID-19 vaccination intentions: Attitudes, institutional trust, fear, conspiracy beliefs, and vaccine skepticism. Social Science and Medicine, 302, 114981. https://doi.org/10.1016/j.socscimed.2022.114981

    Article  PubMed  Google Scholar 

  50. Tan, M., Straughan, P. T., & Cheong, G. (2022). Information trust and COVID-19 vaccine hesitancy amongst middle-aged and older adults in Singapore: A latent class analysis Approach. Social Science and Medicine, 296, 114767. https://doi.org/10.1016/j.socscimed.2022.114767

    Article  PubMed  Google Scholar 

Download references

Funding

There is no specific funding source for this study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Chun-Tung Kuo.

Ethics declarations

Competing interests

The authors declare no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kuo, CT., Yu, RR. Association of National Identity and Trust in Government with COVID-19 Vaccination and Brand Choice in Taiwan. J Community Health (2024). https://doi.org/10.1007/s10900-024-01347-4

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s10900-024-01347-4

Keywords

Navigation