Since their discovery more than 300 years ago, vaccines have been shown to be effective in curtailing the spread of diseases with a positive impact on human health and longevity [1]. With the troublesome success of SARS-CoV-2 and its variants at spreading the coronavirus disease 2019 (COVID-19), scientists have worked tirelessly at producing cutting-edge vaccines that are safe and that will reduce the high death rates recorded in different parts of world. As of 10th of July 2021, about 11 COVID-19 vaccines have been recommended by the World Health Organization including Pfizer/BioNTech, Moderna, Janssen, and Oxford/AstraZeneca [2]. Many of these vaccines have been proven to have durable effect in mitigating the risk of hospitalization and mortality; albeit with a waning efficacy as a result of immunity decline and occurrence of the delta variant [3].

Many nations have experienced high vaccine hesitancy rates despite the effectiveness of COVID-19 vaccines. For example, among Turkish respondents, it was reported that more than 65% showed reluctance in taking COVID-19 vaccines and especially those vaccines coming from foreign countries [4]. In a longitudinal survey of attitude towards vaccinations among 10 countries consisting of 8 European nations, South Africa and Australia, it was reported that only two countries (Belgium and Netherlands) showed positive attitudes over time [5]. In another survey of African countries, a 40% hesitancy rate was documented with 79% bothered about the unforeseen negative effects of vaccination [6]. However, a lower hesitancy rate of 20% was reported in one survey carried out among 15 African countries by the Africa Centers for Disease Control and Prevention [7]. This figure coincides with an 81% acceptance rate obtained in Nigeria [8]. Yet, some studies have reported hesitancy rates as high as 60–80% in other Nigerian samples [9,10,11].

In the 3Cs model of vaccine hesitancy, refusal or delay in vaccines’ acceptance despite their availability is determined by the 3Cs: confidence, complacency, and convenience [12]. Confidence refers to trust in the efficacy of vaccines together with their safety, the structure that offers them, and the interest of the policymakers who decide on the necessity of the vaccines. Complacency means the perception that the impact of the disease to be vaccinated against is low, and thus, vaccination is not considered as essential for prevention. Convenience indicates the extent of the availability, accessibility, and affordability of vaccines [13]. More important in the model is the role of confidence or trust in government and policymakers who make decisions about the relevance of vaccines to the populace. This was demonstrated by Trent et al. [14] where high trust in government promoted the willingness to receive COVOD-19 vaccines in some selected cities in Australia. Similar outcomes have been observed in Ethiopia [15], Ghana [16], and Belgium [17].

Although there is evidence linking trust in government and COVID-19 vaccination acceptance, we do not empirically know the mechanism underlying this association. The current study contributes to existing knowledge by proposing that trust in government influences rates of acceptance of COVID-19 vaccination via shaping of the citizen’s attitudes towards COVID-19 vaccines (ATCV). ATCV can be in the form of concerns that the vaccination program centers on commercial profiteering, anxiety about the unforeseen effect of the vaccine in the future, mistrust regarding the vaccine efficacy, and more preference for natural immunity rather than getting vaccinated [18].

The connections among trust in government, ATCV, and acceptance of COVID-19 vaccination are supported by the fairness model of trust which posits that perceptions of corruption and unfairness on the part of the government in the distribution of wealth and resources provoke negative attitudes of citizens towards governmental institutions, policies, and health programs [19, 20]. Given the possible unfavorable dispositions towards the government and its health institutions from the lack of public trust, citizens may cultivate negative attitudes towards the COVID-19 vaccination program together with the system that delivers it. Once negative ATCV is developed, there are higher odds that individuals will display high hesitant behavior based on the strong connection between attitudes and behavior as opined by the Theory of Reasoned Action [21].

Building on the possible associations among trust in government, ATCV, and COVID-19 vaccination acceptance, the following are hypothesized:

1.

High levels of mistrust in government will significantly associate with low levels of COVID-19 vaccination acceptance.

2.

High levels of mistrust in government will significantly associate with negative ATCV.

3.

Negative ATCV will significantly associate with low levels of COVID-19 vaccination acceptance.

4.

The relationship between trust in government and COVID-19 vaccination acceptance will be significantly accounted for by negative ATCV.

The outcomes of the study will provide significant contributions to the existing models of vaccination hesitancy which will be useful for implementers of public awareness programs geared towards promoting COVID-19 vaccination acceptance.