he world over, people feel lied to, unheard, and pushed aside. They no longer have any faith in their leaders. They’re lashing out against their governments and health officials, in some cases by rejecting the COVID-19 vaccine.

Populism, a political expression of this mistrust, is correlated with vaccine hesitancy. In a 2019 study, Jonathan Kennedy, a sociologist at Queen Mary University of London, found a significant association between the percentage of people who voted for populist parties within a country and the percent who believe vaccines are not important or effective. Past research has similarly found that populists around the world are more likely to believe in conspiracy theories about issues such as vaccination and global warming. “Vaccine hesitancy and political populism are driven by similar dynamics: a profound distrust in elites and experts,” Kennedy writes. In politics, populism manifests as supporting parties and figures outside the mainstream, like Donald Trump or UKIP. But populism can be expressed differently in other spheres. “In public health, there’s this growing distrust and anger towards doctors, also towards pharmaceutical companies. Medical populism is skepticism that’s uninformed,” Kennedy told me.

Medical literature reveals a strong connection between vaccine hesitancy and distrust of pharmaceutical companies, government officials, and health-care workers, even among health-care workers themselves. Studies and polls from various countries over the past two years show that people who are reluctant to get a COVID-19 vaccine are more likely to vote for politically extreme parties and to distrust the government, and to cite their distrust as a reason for not getting the shot. In a recent German poll, half of the unvaccinated respondents had voted for the far-right populist party, Alternative für Deutschland, in the recent election. Anti-vaccine sentiments are also most common in the populist areas of Austria, France, and Italy.