Trust is a key reason for the wide variance in how countries have fared during the COVID-19 pandemic, determining why some have succeeded in containing the virus while others have failed, according to new research on responses across 23 countries.
The work, supported by Schmidt Futures and the National Science Foundation and carried out by teams at Columbia, Harvard, and Cornell Universities, studied national responses to COVID-19 based on public health, economy, and politics.
It organizes countries into three categories: control, consensus, and chaos. The researchers call the United States the leading example of high levels of polarization, decentralized decision-making, and distrust in expertise leading to policy chaos. The category also includes Brazil, India, Italy, and the United Kingdom.
To prepare for future pandemics, countries must build trust in public health, government institutions, and expert advice, according to a range of speakers at last week’s Futures Forum on Preparedness. Schmidt Futures, which co-hosted the event, announced that it is launching a new challenge to source the best ideas from around the world for developing trust in public health interventions. This request for proposals is likely just the beginning as funders explore how to learn from the pandemic and build trust moving forward.
In April of last year, as the scientific community began to coalesce on a set of best practices to stop the spread of COVID-19, Schmidt Futures saw a unique role for itself.
“It wasn’t that the science advice was wrong, it was that trust would be a huge factor in whether people choose to follow public health guidance,” Christopher Kirchhoff, a senior fellow at the organization, told Devex.
“People may not trust public health officials or political leaders, but they trust their neighbors.”— Jim Kim, former president, World Bank
Schmidt Futures decided to support a group of researchers around the world to conduct studies on ways public trust, leadership, and political culture impacted COVID-19 responses in different contexts.
In societies where trust in government is low, there tends to be greater reliance on front-line health workers to disseminate accurate information, wrote the authors of the study on five African countries.
“Most of the citizens don’t actually trust the state to the extent that they should ideally,” said Wilmot James, a senior research scholar at the Institute for Social and Economic Research and Policy at Columbia University, and the lead investigator of the study comparing COVID-19 responses on the African continent. “The people they trust are community health workers and nurses who are embedded in communities, who take care of people, and have a history of interaction at a real human level.”
Researchers warn that those who are reluctant might be able to influence those on the fence.
James called on the audience at the event to focus on understanding who people trust, warning that trust in institutions can be undermined when the police and military overstep their roles, as was the case in several African countries.
The research challenges several pieces of conventional wisdom, such as the notion that politics takes a backseat to policy in an emergency, said Dr. Stephen Hilgartner, professor of Science and Technology Studies at Cornell University.
“In polarized societies, emergencies amplify the preexisting social conflicts in economic and political systems,” he said.
Another fallacy Hilgartner highlighted is the idea that distrust in public health advice is due to scientific illiteracy.
During health crises, such as the COVID-19 pandemic, the public health system wields enormous influence over the way people live their lives, with mandates ranging from testing to restrictions of movement to vaccines, but there are models for how trust can be earned.
“People may not trust public health officials or political leaders, but they trust their neighbors,” former World Bank President Jim Kim said at the event.
Kim shared insights from his work with the global health care nonprofit Partners in Health, which he co-founded. While the organization has typically focused its work in low- and middle-income countries, it is now working with the state of Massachusetts, where it is headquartered, on COVID-19 response. Kim emphasized the important role of public health workers, saying this should be one of the growing professions moving forward, as part of the health system that is required for testing, contact tracing, and vaccination.
“What are the things we can invest in that will build solidarity as opposed to breaking it down?” Kim said. “I think it’s an opportunity.”
Trust is relational, meaning it’s interpersonal or between people and institutions, and the strength of those relationships depends on a variety of factors, said Dr. Sheila Jasanoff, a professor of Science and Technology Studies at the Harvard Kennedy School, and one of the lead investigators of the comparative study.
“What is the nature of the communication? How frequent is it? Who is doing the talking? To whom? Are there people who are being excluded?” she said.
During public health emergencies, society delegates knowledge authority to experts, Jasanoff said.
They issue guidance on best practices, including the many personal sacrifices people are being asked to make to protect themselves and their fellow citizens from COVID-19. But Jasanoff said that while citizens must trust expertise, experts and the institutions they represent must also be trustworthy.
“One of the problems with the high end scientific and technological community is a kind of arrogance of power and authority,” she told Devex.
Jasanoff criticized the view that “close scientific knowledge helped by experts is the thing that needs to be communicated more broadly to people who would benefit from having that knowledge.”
“It is not unidirectional, or one way, communication, but rather bidirectional or multidirectional communication, which helps to build trust,” she said.
Schmidt Futures is partnering with the Social Science Research Council and National Academy of Medicine on its request for proposals, and will support pilots of new approaches to build trust in a variety of contexts.
Several experts at the event, including Saad Omer, director of the Yale Institute for Global Health, noted that there is already a body of knowledge on how to build trust, and the key now is “to scale that up.”