Previous studies of vaccine hesitancy in the context of COVID-19 have reported mixed results in terms of the role played by political and institutional trust. This study addresses this ambiguity with a global analysis of the relationship between trust and vaccine hesitancy, disentangling the effects of generalized trust orientations, trust in specific institutions and conspiracy mentality. It first draws upon a cross-national survey of 113 countries to demonstrate that trust in government is a predictor of vaccine hesitancy across global regions. It further draws on original surveys fielded in seven countries (France, Germany, Spain, Argentina, Croatia, Brazil, India), which deploy a diverse range of measures, to disentangle the individual-level predictors of vaccine hesitancy. Our findings confirm the robust effects of trust in government across countries, but when including other trust measures in the same models, the most robust effects are those of trust in health institutions and conspiracy mentality. Weaker associations are observed for right-wing ideology and online political engagement, while the consumption of traditional media tends to predict the willingness of individuals to be vaccinated.