Why Data Reveal Covid Has Proven Less Deadly In Locales Where There Is Trust

Data reveal that in nations, regions and among political or ideologically-driven demographics, where there is greater trust in government and/or fellow citizens, there are lower numbers of Covid infections. 

The reason appears to be that where there is trust, there is greater adherence to prudent Covid precautions like masking, social distancing and vaccination. The alternative lesson is that attempts to undermine public policies through disinformation which advocate such life-saving behaviors result in higher infections, hospitalizations and deaths. All of which suggests that engendering trust is an essential element in effective public health policy. JL

Thomas Bollyky and colleagues report in the Wall Street Journal:

Trust in one’s government and fellow citizens, as measured in leading surveys, correlates with better pandemic outcomes. Trust of both types is also associated with higher vaccination rates and greater compliance with social distancing rules. If citizens of every nation trusted their government as much as the Danish do, there would have been 13% fewer coronavirus infections globally. If the same were true the same were true for interpersonal trust, the reduction would be 40%, or 440 million fewer infections

Most Americans don’t think twice about flying on planes, calling the fire department, consuming domestically produced medicines or driving on busy city streets. All of these activities require us to depend for our safety on the judgment and expertise of others, including government officials and experts.

And yet, during the Covid-19 pandemic, many Americans have been reluctant to rely on such authorities to guide their decisions on mask-wearing, vaccination and other protective behaviors.

On its face, this lack of trust seems hard to square with the routine leaps of faith that make everyday life possible. But the leap required in a pandemic is more active: Ordinarily, no one tries to convince us to fly, drive or call the fire department. In a pandemic the government seeks to persuade citizens to take measures to protect themselves and one another.

The global distribution of reported Covid-19 cases and deaths hasn’t followed the pattern of other infectious diseases.

Especially in free societies, whether a country succeeds or fails in mobilizing public trust—between its citizens and their government but also among citizens themselves—may help to explain its success or failure in limiting infections and death from Covid-19.

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Even as the pandemic enters its third year, many experts and commentators consider Covid-19 an “epidemiological mystery” because the global distribution of reported cases and deaths hasn’t followed the pattern of other infectious diseases. With HIV, malaria and seasonal influenza, poor nations suffer most due to their limited health resources. With Covid-19, many wealthy countries have been particularly hard hit.

Deaths from the pandemic have varied dramatically, even among nations in close geographical proximity: Bulgaria, Namibia and Bolivia have fatality rates more than twice as high as their respective neighbors, Turkey, Angola and Colombia. The United States and United Kingdom—nations that experts believed were among the best prepared to mitigate a pandemic—haven't been nearly as successful in doing so as Vietnam, El Salvador and Burkina Faso, which scored low on assessments of pandemic preparedness and healthcare capacity prior to this crisis.

Commentators have suggested many societal or political characteristics to explain Covid-19 success stories. Women leaders, a lack of populism, greater income equality, universal healthcare, trust in science—these may all be desirable, but there is no empirical evidence that any of them increased a nation’s odds of containing the deadly virus. Some democracies struggled against Covid-19, but so have many autocracies, including Iran, Russia and Venezuela.

If the citizens of every country trusted one another as much as South Koreans do, there might have been 40% fewer Covid-19 infections globally.

Within this crowded picture, the one factor that stands out in making a difference is trust. In a study just released in the medical journal The Lancet, we assess the international disparities in Covid-19 outcomes and the factors that might explain them, based on the best available estimates of the number of infections and fatalities in 177 nations and territories. Trust in one’s government and fellow citizens, as measured in leading surveys, correlates with better pandemic outcomes overall.

One reason for our finding may be that trust of both types is also associated with higher vaccination rates and greater compliance with social distancing rules. Many studies have linked these practices to better Covid-19 outcomes. Studies of the 2009 H1N1 influenza pandemic also associated trust in government with greater adoption of recommended behaviors, such as handwashing, social distancing and vaccination.

The effect of trust in this pandemic has been large. If citizens of every nation trusted their government as much as the Danish do theirs (Denmark is in roughly the 75th percentile of countries), we estimate that there would have been 13% fewer coronavirus infections globally. If the same were true the same were true for interpersonal trust (South Korea is at the 75th percentile on this measure), the reduction would be even larger: 40%, or 440 million fewer infections over the 21-month period assessed in the study.

Clearly, not every country is Denmark or South Korea. Nordic and East Asian countries tend to have high government trust levels, while South American and most postcommunist nations have among the lowest. Low interpersonal trust is correlated with income inequality and government corruption, suggesting that those who are economically and socially disadvantaged are less inclined to trust others.

In 1997, two out of three Americans expressed confidence in other people. Now that number has slipped to four out of 10.

The U.S. is anomalous. In most nations, reported levels of government and interpersonal trust fluctuate year to year around stable averages. Trust in the U.S. has plummeted from its heights in 1964, when nearly four out of five Americans reported that the federal government would do the right thing almost always or most of the time.

After the Vietnam War and the social upheaval of the 1970s, America’s trust in its government precipitously declined. It fell further still after the 2008 financial crisis. Today, fewer Americans say that they can trust the government to do what is right than in the Watergate scandal’s aftermath. In 1997, two out of three Americans expressed confidence in other people. Now that number has slipped to four out of 10.

Americans’ confidence in their government is partisan. More than a third of Democrats report trusting the current government, up from 12% during the final year of the Trump administration. Those numbers are reversed for Republicans, for whom trust in government has fallen to 9%, down from 28% last year. At this point in the pandemic, Americans are more confident in their physicians and front-line health workers than in the Centers for Disease Control and Prevention. Trust in state governors has fallen the most.

As far back as 2006, the CDC understood the danger that low trust could pose to public health.

Fortunately, governments can work to foster trust, even in a crisis: by providing accurate, timely information about the pandemic, for example, and by clearly communicating relevant risks and vulnerabilities. Tailoring the messenger to the target community helps too.

In 2014, Guinea, Liberia and Sierra Leone struggled to contain an Ebola epidemic. Conspiracy theories, resistance to vaccine trials and resentment toward government mandates undermined their efforts. With no cure in sight, some people opted for poisonous miracle remedies that local leaders and witch doctors promoted.

To rebuild social solidarity and public trust in government, local government ministries and international organizations came up with community-specific strategies. In Liberia, they trained community youth leaders, pastors and imams to check households daily for infected patients. Anthropologists collaborated with locals to develop safe burial practices that respected cultural traditions. In Sierra Leone, the World Health Organization worked with community liaisons to increase acceptance of the Ebola vaccine trials.

If the comparison to postconflict, impoverished countries seems perverse, note that reported levels of government trust are higher in those West African nations than in the U.S.

As far back as 2006, the CDC understood the danger that low trust could pose to public health. That year’s government strategy document on dealing with an influenza pandemic admonished that “the need for timely, accurate, credible and consistent information that is tailored to specific audiences cannot be overstated.” U.S. officials have struggled to maintain this standard in the current pandemic for many reasons, including an evolving understanding of a mysterious virus, the need to coordinate a patchwork of state and federal public health authorities, and some individual missteps along the way.

There is reason for optimism. Fully 84% of Americans report believing that the level of confidence Americans have in the federal government can be improved. An even higher percentage say the same is possible when it comes to the trust Americans have in each other.

Maybe this pandemic can be a catalyst for our government’s earning and nurturing that confidence. Covid-19 has shown that our future safety depends on it.