Why have some countries fared better in handling the pandemic than others? A growing pile of evidence points to trust — in the government and in our fellow citizens — as a significant predictor of a country’s ability to act cooperatively and reduce the spread of the virus.
Most recently, a study published in the Lancet, a premier medical journal, pulled together vast amounts of data from 177 countries from January 2020 to September 2021, and found that trust in government and other citizens stood out as a predictor of a country’s performance against the spread of infections. By contrast, a host of other features of societies that many might consider critical factors like health care capacity did not appear to play a role in mitigating the spread of Covid.
“We found no links between Covid outcomes and democracy, populism, government effectiveness, universal health care, pandemic preparedness metrics, economic inequality or trust in science,” Thomas Bollyky, a senior fellow for global health at the Council on Foreign Relations and one of the study’s authors, told The Washington Post.
Relentlessly demanding that people “believe the science” is not going to do the trick.
It’s a striking finding, and goes some way toward explaining why the U.S. — an affluent democracy with high quality health care and superior preparation for a catastrophic biological event — has fared very poorly compared to so much of the rest of the world in containing spread and minimizing mortality rates. As we’ve seen in often horrifying detail, having the best technology, like world-class vaccines, means little if people don’t trust the institutions recommending it. In the U.S., trust is near historic lows after decades of decline and is relatively low compared to other high income countries, according to the Post.
Liberals should take particular note of that last factor listed by Bollyky — trust in science. As we reflect on lessons and potential strategies for generating better cooperation against the pandemic, relentlessly demanding that people “believe the science” is not going to do the trick. The bigger problem is that we don’t believe in each other.
According to the Post’s report on the Lancet study, trust in the government and in others is “strongly associated” with a decline in mobility — i.e., social distancing — and vaccination rates. Having a public that reliably takes cues from public health officials on how to reduce the spread of the virus through guidance on issues like masking up, limiting exposure and getting jabbed has proven central to fighting the dangers posed by the virus in countries around the world. Bollyky says that the fact that Vietnam has among the highest levels of trust in government in the world helps explain why its pandemic response outstripped that of many far richer and better-equipped nations. (Lest anyone argue that high trust merely masks what is really fear of an autocratic government, the study estimates that if people around the world displayed the same level of high trust that Danes do in their government and each other, 40 percent fewer people might've been infected with the virus globally.)
This study is not some kind of wild outlier. Public health experts have spoken extensively about the critical importance of trust in institutions throughout the pandemic — and often expressed concern about the Centers for Disease Control and Prevention’s poor reputation as a communicator. In a December op-ed in The New York Times, a doctor treating patients in the Bronx and a sociologist who assists international institutions with vaccinations in developing countries explained that five years of administering surveys, focus groups and interviews have led them to the conclusion that vaccine hesitancy can be traced to an erosion in the social contract. “We’ve found that people who reject vaccines are not necessarily less scientifically literate or less well-informed than those who don’t,” they wrote. “Instead, hesitancy reflects a transformation of our core beliefs about what we owe one another.” They attribute a great deal of that transformation to a global trend of governments cutting social services and delegating them to the private sector, where they're less evenly accessible and class disadvantage breeds suspicion of institutions.
The cost of austerity policy is greater than just cutting off vulnerable people’s access to services — it also narrows people's perception of community, solidarity and citizenship.
As I’ve discussed before, if you look at phenomena like the right’s fixation on Covid cures like ivermectin — which has not been proven to be an effective treatment for Covid — it’s evident that focusing on telling people to trust in science misses the way that people's exposure to science is always tied up in trust in authorities. Few people read scientific studies and judge them based on their merits, because they wouldn't be able to understand them. Rather, they trust experts and authority figures who interpret studies and recommend actions based on their findings.
The core issue with the crowds that were drawn to ivermectin wasn’t hostility to science per se as much as hostility to the government and skepticism of the consensus of the medical establishment. One sign of this is the fact that so many of them searched for seemingly scientific guidance from outsider "experts," often recommended through political in-groups. And indeed, a lot of ivermectin misinformation has been cloaked in pseudoscience or retracted scientific articles, and even recommended by groups of rogue doctors (who have fringe beliefs and corrupt financial incentives and often no relevant speciality, but are doctors). It's never a bad idea to teach people how to distinguish between legitimate science and junk science, but a lot of the people shunning Covid guidance are checking out at the level of not even wanting to hear what a mainstream authority figure has to say. Additionally, an increasingly robust and nihilistic right-wing media ecosystem is exploiting and exacerbating that tendency.
Laying out how to solve our trust crisis — which has huge implications for everything from our political life to levels of violence in our society — is beyond the scope of this column. But here are a couple starters: The Lancet study calls for “greater investment in risk communication and community engagement strategies.” The researchers writing in the Times call for universal programs of the kind we saw during the Great Society to help recultivate the public’s faith in government and the notion that “individual flourishing is bound up in collective well-being.” In other words, build out more robust and universal social services that combat inequality, and communicate effectively with the public. These are not quick fixes, but they're necessary ones.