The Global Health Security Index published a report ranking countries on how prepared they are for a disease outbreak. The US and the UK scored highest. Both countries are ranked among those with the greatest loss of life from Covid. How could this happen?
Trust is a large part of the answer. The US, UK, Spain and Slovenia were found to lack this layer of defence when they looked good on paper in 2019. Our research over the past two years at the Oxford Covid-19 Government Response Tracker shows it in stark terms. On the left, you can see that a higher global health security score is not correlated with fewer deaths during the Pandemic, at least among the countries with a minimum threshold of capacity.
On the right, we can see that the level of trust in a society is a better indicator of how many people will die or survive. Governments and institutions have received a lot of coverage in the past two years, and yet seem to have little effect. It is a measure of how much people think they can trust another person.
This kind of trust has been a vital resource. After two years, we can see how important it is, raising the question of how we might build it up to deal with both Covid and the next Pandemic.
The results from the past two years show that the extraordinary measures we were asked to follow can work to reduce or even eliminate infections, particularly when they are deployed during the beginning of a wave. In high-trust countries, we see that these restrictions work better, and often don't have to be as long.
The countries in the top tier of trust spent 30% less time with a stringency index over 70, meaning living with stay-at- home orders, school and workplace closings, and similar restrictions. Half as many deaths were seen in 2020 and 2021. Society in which people trust each other were able to get more health benefit from looser restrictions.
The effect only holds for trust in people, not governments. We don't see a difference in the stringency of restrictions applied in countries where citizens trust the government compared to countries with low trust in the government.
Many aspects of fighting a Pandemic require collective action and trust in other people is important. The only way to break a chain of infections is if everyone participates. People are more likely to change their behavior if they trust others to do the same. If you expect other people to break the rules, why are you still sitting at home?
In addition, trust may be key for light-touch measures such as contact tracing and self-testing, which are likely to remain key elements of a new normal in many countries. If you test positive, do you try to identify those you put at risk? You are more likely to do so if you trust others to do the same.
This kind of trust matters a lot. We know it is in short supply. Evidence shows that it has fallen over the last two years. The US, Germany, Australia, and South Korea have seen sharp declines in trust levels in the last four years. The research shows that trust in institutions and trust in other people is going down. These trends are bad news for the future.
There is hope. According to the report, trust in co-workers and neighbours is high around the world. The past two years have seen communities come together to help each other, particularly during those uncertain first months. People organised food delivery for elderly neighbours and stood at their windows to cheer and clap in support of health workers. People showed they could trust each other.
Trust is not like a natural resource buried in the ground that some societies are lucky to have and others can't get. Trust can be produced through actions, beliefs, and institutions. It can be built up.
What can be done to increase trust? Scholars have identified several key interventions that can promote trust by looking at changing levels of trust in societies across decades: reduce income inequality, fight misinformation on social media, and trust people by communicating to them with transparency and honesty.
None of these things are easy, none are panaceas, and none depend on governments alone. Government policies can make them better or worse. The research shows that governments should take this seriously. Building trust is just as important as investing in a new vaccine or hospital bed. Long-term investments to build trust will be important as we aim to build a better immune system.
Thomas Hale is an associate professor at the Blavatnik School of Government at the University of Oxford. The data analysis was contributed to by Rodrigo Furst.
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