Proximity to a disease outbreak such as measles was found to have no independent statistical effect on respondent attitudes regarding vaccination; however, individuals with low trust in medical organizations were noticeably less likely to express support for immunizations at increasing distances from a recent outbreak, according to results of a study published in PLoS One.

Using original survey data collected in January and February 2017, researchers sought to ascertain respondents’ attitudes toward vaccination, specifically focusing on measles. The survey contained hypothetical scenarios regarding pursuing measles vaccination if there was no immediate risk of becoming infected vs if there was an actual outbreak of the disease in the community. Responses were ranked from 0 (very unlikely) to 4 (very likely).

Zip codes were used to determine an individual’s distance from the 2 largest measles outbreaks that occurred between January 2016 and January 2017 in Shelby County, Tennessee, and Eloy, Arizona. To ascertain an individual’s level of trust in government medical organizations, survey respondents were also asked how much they trusted medical experts. Subjects ranked their level of trust from 1 (strongly distrust) to 5 (strongly trust).

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Study findings showed that an individual’s proximity to a recent measles outbreak has no independent effect on vaccination attitudes. Respondents who strongly trust and somewhat trust government medical organizations were found to be significantly more likely to have favorable views about vaccination for measles than respondents who do not trust these organizations and tend to be more skeptical about immunizations. Furthermore, low-trust individuals who live farther away from a recent measles outbreak were found to have less favorable views about vaccination as opposed to low-trust individuals who live in close proximity to an outbreak.

“Empirically, we found that proximity to a recent outbreak has no independent statistical effect on respondent attitudes,” the investigators concluded. “However, as expected, there is a significant interactive relationship between proximity and trust. In particular, low-trust respondents become noticeably less likely to express support for immunizations at increasing distance from a recent outbreak.”


Justwan F, Baumgaertner B, Carlisle JE, Carson E, Kizer J. The effect of trust and proximity on vaccine propensity. PLoS One. 2019;14(8):e0220658.