Taiwan has a history of battling pandemics. From the bubonic plague in the Japanese colonial era to the initial severe acute respiratory syndrome (SARS) outbreak in the 2000s, Taiwan’s central location has made it vulnerable to imported diseases. Despite a strong National Health Insurance scheme and generally high levels of governmental trust, the Taiwanese government struggled during the COVID-19 pandemic with vaccination: their locally developed vaccine, Medigen, was a target of foreign disinformation and local misinformation—likely due to its late and rapid development—while their efforts to procure foreign vaccines were stymied. Beyond this, the population engaged in strategic vaccine shopping, at least in part due to both disinformation and misinformation, creating further challenges for the government and the medical system. Despite these setbacks, the island has reached a 91.7% vaccination rate as of April 2024, although the rate of booster uptake is in decline. While the government succeeded during the pandemic in regular communication and investment in local scientists for vaccine development, it lacked targeted media campaigns surrounding vaccination and was unclear about vaccine rollouts when they started. Concerns about vaccine safety remained unaddressed, and non-Mandarin-speakers were largely left out of governmental communication. Policy recommendations include (1) investing in social science research before the next pandemic, (2) ensuring that information presented is both simple and available in multiple languages, (3) enforcing medical transparency in government communication, and (4) making use of credible third-party communicators to reduce perceived political bias in vaccine messaging.
In Japan, the public health system has evolved since World War II into a sophisticated framework offering comprehensive health services, including vaccination, supported by a universal health insurance system. This evolution has significantly contributed to Japan’s status among the nations with the highest longevity and health standards worldwide. However, vaccine hesitancy in Japan presents a complex challenge, influenced by historical, cultural, demographic, psychological, and economic factors. Despite a history of vaccination contributing to public health improvements, incidents of vaccine-related adverse effects and public mistrust toward public health authorities have occasionally led to hesitancy. This hesitancy was notably highlighted during the COVID-19 pandemic, despite the government’s efforts to promote vaccination through various policies and programs aimed at preventing and managing infectious diseases. The pandemic has underscored the importance of addressing vaccine hesitancy through a multifaceted approach, considering the intricate interplay of misinformation, societal values, and the media environment. Misinformation and distrust in vaccines have been propagated through a diverse array of media channels, posing significant public health challenges. Studies have indicated a correlation between social media use and vaccine hesitancy, highlighting the role of digital and media literacy in combating misinformation. The Japanese government’s vaccine communication strategies during the pandemic, emphasizing transparency, consistency, and engagement, have been critical in addressing hesitancy and misinformation. Lessons learned underscore the importance of targeted communication strategies, prioritizing evidence-based policies, and enhancing digital and media literacy to navigate future public health crises effectively. These strategies, while specific to Japan, offer valuable insights for global public health policy formulation and crisis management, advocating for an integrated approach to fostering trust and addressing vaccine hesitancy amidst the challenges posed by misinformation and the evolving media landscape.
Vietnam’s experience with vaccine hesitancy during the COVID-19 pandemic highlights a complex interplay of historical trust in vaccination, rapid policy responses, the emergence of highly transmissible variants, and the pervasive impact of misinformation. Historically, Vietnam has demonstrated robust public health responses, exemplified by its successful handling of previous infectious diseases and high routine immunization coverage rates. The country’s healthcare system has been significantly strengthened following the 1986 “Doi Moi” socioeconomic reforms, which paved the way for improvements in healthcare access and infrastructure. Despite these advances, the COVID-19 pandemic presented unique challenges. Initially, Vietnam experienced low levels of vaccine hesitancy, thanks to a well-established trust in vaccines stemming from the successful implementation of the National Expanded Program on Immunization established in 1981, resulting in a sharp decrease in vaccine-preventable diseases. However, the COVID-19 pandemic saw a rise in skepticism, driven by misinformation and disinformation, particularly through widespread internet and social media use. During this period, nearly 79% of the population was online, with a significant majority actively engaging on social media platforms, where misinformation thrived. The government’s response was multipronged, involving stringent legal and punitive measures against misinformation, partnership with tech companies to flag false information, and extensive public education campaigns. These efforts were conducted across various media, emphasizing the safety and efficacy of vaccines through trusted public figures and healthcare professionals. Nevertheless, challenges persisted during high-stress periods, such as the Delta variant outbreak, when public trust wavered due to perceived lapses in transparency and communication. This summary underscores the necessity of continuous public education, robust data transparency, and the leveraging of digital platforms to counteract misinformation effectively, ensuring public trust and compliance with health policies during health crises.
The COVID-19 pandemic magnified many governance challenges that predated the health crisis. From the necessity of swift responses against an unknown virus to the development of economic relief packages for supporting affected families and businesses, governments were confronted with amplified challenges to health, economic, and social resilience. Promoting vaccination, a long-standing challenge, became a critical testing ground during the COVID-19 pandemic, revealing the dynamics of how health information—both true and false—spreads and how the media landscape can shape health behavior.
Misinformation and disinformation reduce people’s confidence in vaccines. Recent experiences from the Asia-Pacific region in vaccine rollout have also highlighted the importance of cultural values, personal privacy, and communication in the design and implementation of public health policy. As this health emergency wanes and future crises loom on the horizon, the issue of vaccine hesitancy becomes increasingly crucial, amplified by the ever-expanding array of information and media channels. How can governments understand public attitudes toward vaccines and leverage communication strategies to protect population health? With distinctive cultural, political, and social systems, Asia-Pacific societies can offer compelling lessons for the world in navigating misinformation and disinformation to promote public health.
To this effect, CAPRI has been developing the first two reports in this series on Japan and Taiwan, which both have unique cultural, historical, and political contexts but could offer insights and best practices for the region.
Taiwan spent 2020 and the first months of 2021 largely free of COVID-19, thanks to strict border controls and nonpharmaceutical measures that eliminated community spread of the disease. In May 2021, local cases began to increase, and the government implemented tighter restrictions on movement and social life. At this time, only limited numbers of the AstraZeneca vaccine were available in Taiwan, and demand for them increased rapidly, creating an environment of uncertainty in which misinformation and disinformation could thrive.
Throughout the pandemic, both Taiwan’s government and civil society dedicated considerable attention to reducing the spread of misinformation and disinformation related to COVID-19. From May 20 to July 27, 2021, the Central Epidemic Command Center held an additional press conference every morning to address misconceptions about the pandemic and vaccines. Furthermore, Taiwan’s Ministry of Health and Welfare and Centers for Disease Control established clarification sections on their websites to help the public verify the accuracy of claims about COVID-19 and the vaccines. Taiwan’s government has also partnered with social media platforms, such as Google, Facebook, and LINE, to combat COVID-19 misinformation.
Taiwan’s civil society boasts robust fact-checking organizations, including the Taiwan FactCheck Center, Cofacts, and MyGoPen, which have worked closely with the government. In February 2020, Taiwan enacted the “Special Act on COVID-19 Prevention, Relief, and Restoration,” which included a provision penalizing the dissemination of rumors or misinformation about COVID-19. However, determining what constitutes a rumor or misinformation is not clear cut.
Although factors such as age, gender, level of trust in the government, and education level affect vaccine hesitancy in Taiwan, the information landscape during the pandemic contributed to people’s attitudes toward the COVID-19 vaccines, especially when their supplies were limited. The discussions on COVID-19 vaccines were politicized based on speculations that Mainland Chinese agents were spreading misinformation online and perceptions that Taiwan’s government was promoting its domestically developed vaccine prematurely. Given this experience during the pandemic and the robust ecosystem of civil society organizations researching misinformation, Taiwan can establish best practices for health literacy education and science communication to prepare for future health emergencies.
Vaccine hesitancy in Japan before the COVID-19 pandemic is well documented due to its unique history with various vaccines, in which misinformation plays a role. For example, early in the development of vaccines for polio and cholera, contaminated doses and improper administration resulted in people contracting the diseases, contributing to a persistent belief that vaccines can give people the diseases they protect against. In addition, extensive media coverage of adverse effects in young women who received the human papillomavirus (HPV) vaccine led to widespread wariness of adverse effects. Although the reports were based on anecdotal evidence that was later debunked, the HPV vaccination rate in Japan remains low. In both cases, misinformation about vaccines was based on true events, highlighting that collective memories are difficult to overcome.
Despite this history, vaccine hesitancy has decreased in Japan over time, including during the COVID-19 pandemic. Although a substantial portion of Japan’s population did not initially plan to get a COVID-19 vaccine, by May 2023, approximately 83% had received at least two doses, comparable to other high-income Asian countries. People who changed their minds to get vaccinated tended to perceive the benefits of vaccination, recognize the safety of the COVID-19 vaccines and the actual risks of the adverse effects, and acknowledge that vaccination is effective in preventing viral spread. In Japan’s cultural and political context, while government messaging and scientific communication have effectively encouraged COVID-19 vaccination, social connections and forging a social norm of vaccination have been key to increasing vaccine uptake in hesitant groups.
Misinformation remains a major concern, not least because of the role of social media in the information landscape. Studies in Japan have found that the more people use social media as a primary source of COVID-19 information, the more likely they are to be vaccine hesitant. In fact, the use of social media as a primary information source has been linked to people who originally intended to get vaccinated becoming more hesitant. Japan’s government has taken steps to combat this misinformation, including providing accurate information on its own websites, encouraging citizens to consult their doctors about vaccination, and debunking false claims that vaccinations are linked to infertility. Going forward, the effectiveness of these interventions in the Japanese context can be evaluated to identify best practices for other societies.
