Trust in government institutions and influenza vaccine acceptance among U.S. adults.

Abstract

Seasonal influenza remains a persistent public health burden in the United States despite effective vaccines. Adult vaccination coverage consistently falls below national targets, suggesting that factors beyond access and individual risk perception influence uptake. Within the social and political context of vaccine decision-making, trust in government institutions is a key determinant of vaccination behavior. This study examined the association between trust in government institutions and influenza vaccine acceptance and intent among U.S. adults. We conducted a nationally representative cross-sectional survey of 1166 U.S. adults in May 2025, corresponding to the 2024-2025 influenza season. Vaccine acceptance and intent were defined as having received an influenza vaccine in the past eight months or intention to receive it in the next four months. Overall, 55% of participants reported influenza vaccine acceptance. Higher composite trust in government institutions was associated with increased odds of vaccine acceptance (aOR = 1.4, 95% CI:1.2-1.7, p < 0.001). Older age, higher income, and higher education were also associated with acceptance. In institution-specific models, trust in the Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA), and state and local health departments was associated with greater vaccine acceptance, whereas trust in the Department of Health and Human Services (HHS) and U.S. Presidentwas not significantly associated. Trust in government institutions was independently associated with influenza vaccine acceptance. Improving coverage requires strategies beyond access and information, including strengthening institutional and political trust through vaccine safety, transparency, credible communication, and accountability in policy and practice.