Institutional trust and vaccination delay as key metrics for vaccination rollout success

Cyrus Lap Kwan Leung; Kin-Kit Li; Arthur Tang; Wilson Wai San Tam; Samuel Yeung Shan Wong; Wan In Wei; Kin On Kwok

doi:10.1038/s43856-026-01597-4

Institutional trust and vaccination delay as key metrics for vaccination rollout success

Cyrus Lap Kwan Leung
, Kin-Kit Li
, Arthur Tang
, Wilson Wai San Tam
, Samuel Yeung Shan Wong
, Wan In Wei^*
, Kin On Kwok^*

^*Corresponding author for this work

Department of Social and Behavioural Sciences

Research output: Journal Publications and Reviews › RGC 21 - Publication in refereed journal › peer-review

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Abstract

Background Timely vaccination effectively reduced COVID-19 hospitalizations and mortality, yet vaccination hesitancy undermined this benefit. Understanding the factors contributing to hesitancy is critical for improving future pandemic control by identifying barriers to timely vaccination. This paper operationalizes hesitancy in terms of vaccine delay—a key public health metric that reflects changing vaccination policies and infection status, factors that can alter individuals’ eligibility, and real-world complexities like infections.
Method Using longitudinal data from the earliest stage of the pandemic in Hong Kong, we examined how institutional trust and the 5C constructs (confidence, complacency, constraints, calculation, and collective responsibility) influenced both vaccination intention and timing.
Results Our results show that only 34.89% and 42.97% of vaccinated participants received their first and third doses within 100 days of eligibility, respectively, despite rising uptake prior to government mandates. Confidence and vaccination intention are key predictors of delay, and higher institutional trust boosts both confidence and collective responsibility, thereby enhancing intention and reducing delays.
Conclusions These findings underscore the importance of building institutional trust and public confidence to minimize vaccine delay, particularly among vulnerable populations. Ultimately, incorporating vaccine delay as a key metric into public health strategies can guide more effective interventions and strengthen pandemic preparedness.
© The Author(s) 2026.

Original language	English
Article number	376
Number of pages	8
Journal	Communications Medicine
Volume	6
Online published	29 Apr 2026
DOIs	https://doi.org/10.1038/s43856-026-01597-4
Publication status	Published - 2026

Funding

We would like to acknowledge support from the Health and Medical Research Fund (reference numbers: INF-CUHK-1, 17160302, 18170312, CID-CUHK-A, COVID1903008), General Research Fund (reference numbers: 14112818, 24104920), Wellcome Trust Fund (reference number: 200861/Z/16/Z), Group Research Scheme and Funding Allocation to Faculties by Research Committee and Inbound Mobility Scheme (OAL) of The Chinese University of Hong Kong. A.T. acknowledges the support from the RMIT Vietnam Strategic Innovation Challenge.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

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title = "Institutional trust and vaccination delay as key metrics for vaccination rollout success",

abstract = "Background Timely vaccination effectively reduced COVID-19 hospitalizations and mortality, yet vaccination hesitancy undermined this benefit. Understanding the factors contributing to hesitancy is critical for improving future pandemic control by identifying barriers to timely vaccination. This paper operationalizes hesitancy in terms of vaccine delay—a key public health metric that reflects changing vaccination policies and infection status, factors that can alter individuals{\textquoteright} eligibility, and real-world complexities like infections. Method Using longitudinal data from the earliest stage of the pandemic in Hong Kong, we examined how institutional trust and the 5C constructs (confidence, complacency, constraints, calculation, and collective responsibility) influenced both vaccination intention and timing. Results Our results show that only 34.89\% and 42.97\% of vaccinated participants received their first and third doses within 100 days of eligibility, respectively, despite rising uptake prior to government mandates. Confidence and vaccination intention are key predictors of delay, and higher institutional trust boosts both confidence and collective responsibility, thereby enhancing intention and reducing delays. Conclusions These findings underscore the importance of building institutional trust and public confidence to minimize vaccine delay, particularly among vulnerable populations. Ultimately, incorporating vaccine delay as a key metric into public health strategies can guide more effective interventions and strengthen pandemic preparedness. {\textcopyright} The Author(s) 2026.",

author = "Leung, \{Cyrus Lap Kwan\} and Kin-Kit Li and Arthur Tang and Tam, \{Wilson Wai San\} and Wong, \{Samuel Yeung Shan\} and Wei, \{Wan In\} and Kwok, \{Kin On\}",

year = "2026",

doi = "10.1038/s43856-026-01597-4",

language = "English",

volume = "6",

journal = "Communications Medicine",

issn = "2730-664X",

publisher = "Springer Nature",

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TY - JOUR

T1 - Institutional trust and vaccination delay as key metrics for vaccination rollout success

AU - Leung, Cyrus Lap Kwan

AU - Li, Kin-Kit

AU - Tang, Arthur

AU - Tam, Wilson Wai San

AU - Wong, Samuel Yeung Shan

AU - Wei, Wan In

AU - Kwok, Kin On

PY - 2026

Y1 - 2026

N2 - Background Timely vaccination effectively reduced COVID-19 hospitalizations and mortality, yet vaccination hesitancy undermined this benefit. Understanding the factors contributing to hesitancy is critical for improving future pandemic control by identifying barriers to timely vaccination. This paper operationalizes hesitancy in terms of vaccine delay—a key public health metric that reflects changing vaccination policies and infection status, factors that can alter individuals’ eligibility, and real-world complexities like infections. Method Using longitudinal data from the earliest stage of the pandemic in Hong Kong, we examined how institutional trust and the 5C constructs (confidence, complacency, constraints, calculation, and collective responsibility) influenced both vaccination intention and timing. Results Our results show that only 34.89% and 42.97% of vaccinated participants received their first and third doses within 100 days of eligibility, respectively, despite rising uptake prior to government mandates. Confidence and vaccination intention are key predictors of delay, and higher institutional trust boosts both confidence and collective responsibility, thereby enhancing intention and reducing delays. Conclusions These findings underscore the importance of building institutional trust and public confidence to minimize vaccine delay, particularly among vulnerable populations. Ultimately, incorporating vaccine delay as a key metric into public health strategies can guide more effective interventions and strengthen pandemic preparedness. © The Author(s) 2026.

AB - Background Timely vaccination effectively reduced COVID-19 hospitalizations and mortality, yet vaccination hesitancy undermined this benefit. Understanding the factors contributing to hesitancy is critical for improving future pandemic control by identifying barriers to timely vaccination. This paper operationalizes hesitancy in terms of vaccine delay—a key public health metric that reflects changing vaccination policies and infection status, factors that can alter individuals’ eligibility, and real-world complexities like infections. Method Using longitudinal data from the earliest stage of the pandemic in Hong Kong, we examined how institutional trust and the 5C constructs (confidence, complacency, constraints, calculation, and collective responsibility) influenced both vaccination intention and timing. Results Our results show that only 34.89% and 42.97% of vaccinated participants received their first and third doses within 100 days of eligibility, respectively, despite rising uptake prior to government mandates. Confidence and vaccination intention are key predictors of delay, and higher institutional trust boosts both confidence and collective responsibility, thereby enhancing intention and reducing delays. Conclusions These findings underscore the importance of building institutional trust and public confidence to minimize vaccine delay, particularly among vulnerable populations. Ultimately, incorporating vaccine delay as a key metric into public health strategies can guide more effective interventions and strengthen pandemic preparedness. © The Author(s) 2026.

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UR - https://www.scopus.com/pages/publications/105043720415#tab=impact

U2 - 10.1038/s43856-026-01597-4

DO - 10.1038/s43856-026-01597-4

M3 - RGC 21 - Publication in refereed journal

SN - 2730-664X

VL - 6

JO - Communications Medicine

JF - Communications Medicine

M1 - 376

ER -

Institutional trust and vaccination delay as key metrics for vaccination rollout success

Abstract

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