Public health and public trust: Survey evidence from the Ebola Virus Disease epidemic in Liberia

Abstract

Trust in government has long been viewed as an important determinant of citizens' compliance with public health policies, especially in times of crisis. Yet evidence on this relationship remains scarce, particularly in the developing world. We use results from a representative survey conducted during the 2014-15 Ebola Virus Disease (EVD) epidemic in Monrovia, Liberia to assess the relationship between trust in government and compliance with EVD control interventions. We find that respondents who expressed low trust in government were much less likely to take precautions against EVD in their homes, or to abide by government-mandated social distancing mechanisms designed to contain the spread of the virus. They were also much less likely to support potentially contentious control policies, such as "safe burial" of EVD-infected bodies. Contrary to stereotypes, we find no evidence that respondents who distrusted government were any more or less likely to understand EVD's symptoms and transmission pathways. While only correlational, these results suggest that respondents who refused to comply may have done so not because they failed to understand how EVD is transmitted, but rather because they did not trust the capacity or integrity of government institutions to recommend precautions and implement policies to slow EVD's spread. We also find that respondents who experienced hardships during the epidemic expressed less trust in government than those who did not, suggesting the possibility of a vicious cycle between distrust, non-compliance, hardships and further distrust. Finally, we find that respondents who trusted international non-governmental organizations (INGOs) were no more or less likely to support or comply with EVD control policies, suggesting that while INGOs can contribute in indispensable ways to crisis response, they cannot substitute for government institutions in the eyes of citizens. We conclude by discussing the implications of our findings for future public health crises.

Using social and behavioural science to support COVID-19 pandemic response

“…Trust in institutions and governments also may play an important role. For example, trust in the Liberian government was correlated with decisions to abide by mandated social distancing policies 195 and using clinics for care during the Ebola outbreak 196 . Trust was also related to decisions to adopt preventive measures such as Ebola vaccinations in the Democratic Republic of Congo 197 .…”

COVID-19 in Latin America: Novel transmission dynamics for a global pandemic?

“…But will LAC citizens comply? Public distrust of government is significantly higher in LAC than in the first countries to experience COVID-19 spread out of China (Fig 1), and this distrust has been shown to erode compliance with public health societal restrictions [21]. Collectively, the interactions between climate, WASH conditions, and other socioeconomic factors suggest that the impacts of COVID-19 in LAC will be more extreme than even that experienced by Western Europe and the United States.…”

The Politics of Disease Epidemics: a Comparative Analysis of the SARS, Zika, and Ebola Outbreaks

“…Jones (2014) criticizes this Bculturalist epidemiology^(pg. 1) that overlooks the wider global forces that promote the spread of Ebola, instead exoticizing Liberian culture to attribute responsibility (Blair et al 2017). For example, traditional burial practices and the consumption of bush meat were identified as key etiological factors to the Ebola epidemic .…”