Research shows that vaccine skepticism appeals to people who already distrust authority. Solutions proposed during the COVID-19 pandemic may be amplifying the problem rather than solving it.
Which population is least likely to accept a COVID-19 vaccine? Russians. According to a February 2021 survey conducted in Russia, just 30 percent of people said they were willing to receive the country's Sputnik V vaccine, citing concerns about insufficient testing and possible side effects. 
Safety concerns about the vaccine aren't unreasonable.  But the bigger problem, I suspect, is that citizens of the former communist superpower don't trust their own leaders, as even Kremlin-friendly polling agency data has confirmed. Living under a totalitarian regime for the better part of a century is probably to blame for this.
But it appears that Russia may not be the only country with trust issues. There's a strong case to be made that vaccine rejection is in large part fueled by distrust of governments. When this factor is considered alongside other common explanations for vaccine skepticism, the problem becomes much easier to explain—and perhaps easier to solve.
Religious and political “misinformation”
Without a doubt, the proliferation of anti-vaccine content on social media and in the press discourages immunization. Multiple studies have confirmed it. But what motivates people to promulgate these ideas and others to embrace them? Ideological commitments are the obvious answer; people believe many strange things to justify their political and religious views. But these two factors by themselves don't have as much explanatory power as they're often assigned.
Anti-science advocacy is one of the few truly bipartisan pastimes. It's striking that postmodernists and rock-ribbed conservatives who agree on little can nonetheless come together to oppose modern cancer treatments, vaccines, and GMOs. We'll revisit this odd coalition below, but the point for now is that there isn't a single political party or ideology that can be wholly blamed for the spread of vaccine skepticism, though, of course, many still believe there is.
RealClearScience editor Ross Pomeroy helpfully elaborated on this point in a recent article:
COVID-19 vaccines have become politicized, and we are all to blame. Right-wing media downplayed the severity of the disease and hyperbolized government interventions. Left-wing media blared panic-inducing reports which convinced 41% of Democrats that the COVID hospitalization rate is greater than 50% (it's actually closer to 5%). YouTube provocateurs incorrectly claimed the available vaccines are harmful. Twitter mobs shamed people for not wearing masks outdoors, even though there's little evidence it's necessary.
What about religion? Some anti-vaccine advocates tie their campaigning to a deeper religious cause. But as one 2016 study noted, “there are few religious groups, except for Christian Scientists, whose official religious texts explicitly reject immunization.” Citing a 2013 review of the evidence on religious belief and vaccine skepticism, the authors added
that most vaccine reluctance and refusal, sometimes attributed to religious beliefs, is more related to vaccine safety or other personal beliefs that are shared across a social network within a religious congregation.
Distrust of government
Perhaps the sentiment that bonds anti-vaccine vaccine skeptics with disparate religious and political affiliations is their mutual distrust of government. I discussed this phenomenon in a recent article criticizing COVID vaccine mandates in the US. But there's additional evidence worth considering. A 2014 study, for instance, found that exposure to anti-vaccine commentary tended to amplify British parents' existing feelings of powerlessness, disillusionment, and mistrust in authorities:
Research has demonstrated that powerlessness is associated with beliefs in conspiracy theories ,  and also that feelings of political powerlessness mediate the relationship between exposure to conspiracy theories and voting intentions . It is therefore possible that beliefs in anti-vaccine conspiracy theories, and exposure to such theories, increase feelings of powerlessness about the ability to change health outcomes, which subsequently reduce vaccination intentions.
Dismantle the anti-vaxx industry?
The media clearly recognizes the link between vaccine hesitancy and skepticism of policymakers—“a mounting, ever-growing distrust of the government at large,” to use NBC's phrasing—but then suggests that we simply force people to get their shots.  If they object, we'll ban them from social media. The prominent science journal Nature argued last month that
Tech companies have failed to act [take down anti-vaccine content] because their business model relies upon keeping users on their platforms scrolling through content interspersed with advertising, regardless of that content’s impact on society. Their failure to act should be punished with tough government regulation.
If the goal is to foster compliance among people who are already skeptical of authority, I can think of no worse prescription. Silencing users with anti-vaccine views plays into their martyr complex, handing them an effective recruiting tool. Moreover, enterprising activists find ways around bans, most commonly by having their followers post content and setting up new websites that have yet to be flagged by social media platforms.
These companies could clamp down even harder. But the game of whack-a-mole then continues until the internet becomes a tightly regulated library run by government-approved librarians. That's a real proposal, by the way, from the Harvard Kennedy School’s Shorenstein Center on Media, Politics and Public Policy.
The ultimate problem comes down to a psychological concept known as reactance, which describes a person's tendency to do the opposite of what they're told to do. Previous research has investigated the reactance‐arousing effects of public health policies. For example, anti-drinking campaigns on college campuses that emphasize how much students drink actually increased alcohol consumption among the heaviest drinkers. In contrast, campaigns that students perceived as less threatening to their autonomy yielded better results.
Same thing with immunization. Forcing people to get particular vaccines may decrease their willingness to get other shots that aren't mandated. According to a 2015 study conducted in Germany:
[I]f individuals feel constricted, i.e. because they have a negative attitude towards vaccination and did not intrinsically intend to vaccinate, they will reassert their freedom of choice by refusing vaccination on the next possible occasion. Thus, paradoxically, the introduction of partial compulsory vaccination can backfire especially there where it is needed most: among people who have a negative attitude towards vaccination.
Is there a solution?
The Nature commentary suggested two practical solutions that can help rebuild the skeptic's confidence in vaccines:
Physicians and scientists can “inoculate” people against the central claims of any anti-vaccine content—“COVID-19 isn’t dangerous; vaccines are dangerous; you can’t trust doctors or scientists.” Nature's example was joining local Facebook groups and fielding questions about the shots.
“Share good information about vaccines from trusted sources.” In other words, counter nonsense with facts.
These strategies work; research shows that correcting false claims online changes how social media users think about important public health issues like vaccination. But the more important point is that these strategies nicely end-run whatever existing feelings of powerlessness and distrust in their leaders people may harbor.
The takeaway: if you want to change minds, work with people where they are; don't force them to give up their autonomy.
 Hat tip to ACSH reader Tyler Bergen for alerting me to the vaccine uptake situation in Russia.
 European regulators are still reviewing Sputnik V, and Brazil only days ago rejected imports of the shot, citing a “lack of consistent and reliable data." The Russian government has released questionable COVID mortality statistics, too.
 Increasing political partisanship in science probably contributes to mistrust of government, as does contradictory and confusing public health information from politicians.