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To contain disease outbreaks, health officials rely on people’s trust

To contain disease outbreaks, health officials rely on people’s trust


Lack of trust in Chinese officials may hamper coronavirus containment efforts

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Xinhua/Xiao Yijiu via Getty Images

As the coronavirus outbreak continues to spread, the Chinese government and health officials around the world are counting on an intangible factor to help them contain the virus: trust.

“I think of it as the ‘because I said so’ theory of governance,’ says Rob Blair, assistant professor of political science and international and public affairs at Brown University. To prevent the spread of disease, governments ask people to comply with public health recommendations that might seem onerous, like avoiding contact with certain people, isolating themselves, or changing travel plans. Even authoritarian governments can’t control every single person’s actions — much less control millions of people across a broad area. For those measures to work, the authorities need people to trust that their solutions will keep the population safe.

But trust can break down for a number of reasons, which China and other global governments have to account for. If one crisis is handled poorly, there will likely be less trust during the next one. Not only that, but the spread of misinformation can have real-time impacts on what people believe. That erosion can weaken public health response.

“Ultimately, in moments of crisis, public health crises and others, governments have to rely on a baseline level of citizen trust in order to organize an effective response to that crisis,” Blair says.

“In moments of crisis, public health crises and others, governments have to rely on a baseline level of citizen trust”

The consequences of a lack of public trust were clear during the 2014–2015 outbreak of Ebola in West Africa. In Liberia, people who did not trust the government were less likely to follow recommendations around ways to prevent the disease, and they were less likely to support policies that would slow the spread of the virus. It wasn’t that they didn’t understand how the virus was passed from person to person, says Blair, who conducted research on the outbreak. They just didn’t trust that the government could do anything to stop it. After over a decade of civil war in the 1990s, trust in the Liberian government is still low.

People have long memories of major public health events, Blair says. “In West Africa, during the Ebola crisis, people distrusted government not because they were uninformed, but because in the past, the government had done things that weren’t trustworthy,” he says.

Many people living in China have good reasons to feel the same way: during the SARS outbreak in 2002 and 2003, the Chinese government mislead public health officials and attempted to conceal the extent of the problem. While the World Health Organization has said that Chinese officials are being more transparent during this outbreak, people living through it are less confident that their government is telling them the whole story. Many are expressing their anger on social media. Scrutiny of the government intensified last week when some evidence from the ongoing research into the new virus suggested that it may have emerged earlier than the Chinese government said. That could be because of understandable confusion early in an outbreak, but the legacy of SARS leaves some experts concerned that it could be due to Chinese officials misleading people.

Blair says that there may also be less compliance with public health practices in China if trust is that low, just as there was in Liberia. “One of the core challenges they face is trust, especially when they have to overcome the legacy of crises not being well-handled,” he says.

Misinformation, which is common during these types of events, can also affect trust in governments. In Liberia, for example, rumors spread that the government had manufactured the Ebola crisis to get more foreign aid. Conspiracy theories — that have no basis in reality — are circulating around the new coronavirus, like that Bill Gates created the coronavirus. Those types of rumors can reveal and exacerbate distrust. “People are willing to believe these sorts of conspiracy theories if they think the government is not trustworthy, fundamentally. And if you hear enough of them and start to believe them, you might conclude the government is not trustworthy,” Blair says.

“People are willing to believe these sorts of conspiracy theories if they think the government is not trustworthy.”

People may also turn to conspiracy theories if they’re not getting information from official sources, which can fuel that cycle, says Allan McCoy, an assistant professor of sociology at SUNY Plattsburgh. “They rely on what they can find.” In China, where censorship restricts the amount of information published in state-run news outlets, people turn to social media where misinformation proliferates.

In the US, the Centers for Disease Control and Prevention (CDC) is updating its website with case numbers and providing regular briefings and statements to journalists and the public. The CDC has fairly high levels of trust from the public — particularly compared to political bodies like the Senate — which is a good sign for coronavirus control efforts. The first two patients who had confirmed cases of coronavirus in the US went to their doctors at the first sign of illness and cooperated fully. While those are isolated incidents, they show the benefits of some baseline level of trust. “That sort of action is exactly what you’re looking for,” Blair says. “In a crisis, people have to do things that make them uncomfortable.”

The real test will come, though, if there is more widespread transmission of the coronavirus in the US or if officials put more restrictive recommendations or policies in place, McCoy says. “You’ll see a greater sense of crisis, and see what people’s cooperation level is then,” he says. “What will the government do, and how willing will people be to go along with it?”