The role of trust in tackling coronavirus in the world’s most vulnerable communities

Caroline van Koot - Hodges Health

Trust may be one of the most important resources the world must draw on as we grapple with an unprecedented health and economic crisis caused by the coronavirus pandemic. Whilst recorded cases and deaths due to the virus are on the rise across Africa and in many countries in Asia, preventative lockdown and curfew measures are already taking a toll on communities in poverty.

This virus threatens us all, yet the extreme inequalities that define our world mean that low-income countries must confront it while dealing with many other issues. Leaders are forced to take difficult decisions, imposing public health measures which are dependent on the cooperation of their populations. To do so in the face of widespread distrust by citizens towards them makes this a herculean task. Understanding which institutions enjoy people’s trust can help leaders and others responding to this crisis to get public health messages out in ways citizens are more likely to take on board.

Trust has always been important

Trust has been shown to be an important factor in effectively dealing with pandemics and other public emergencies, just as mistrust can reduce adherence to public health interventions. Most recently, research in the Democratic Republic of Congo, which has been grappling with an Ebola outbreak since 2018, indicated that people with low levels of institutional trust were less likely to adopt preventive behaviours and more likely to seek medical help from informal sources. Preliminary indications from this pandemic suggest that countries with the most effective coronavirus measures tend to have higher levels of trust. This echoes more general findings on trust where higher citizen levels of trust in institutions are associated with higher levels of engagement with them.

This suggests that around the world vulnerable communities with little trust in their leaders may be less inclined to adopt coronavirus preventive behaviours.

How trust varies across different contexts

In 2016 and 2017, Oxfam collected data from 14 locations in 11 countries in Africa, Asia and the Middle East where it is implementing projects to strengthen civil society and mobilise citizens to influence policies that affect them. Data was again collected in eight of the same locations (Burundi, Niger, Uganda, occupied Palestinian Territories, Myanmar, Cambodia ) in 2019. This data provided a unique and striking glimpse of the living conditions, attitudes, and behaviour of people living in poverty. It allowed us to look beyond the national statistics and better understand the challenges faced by some of these countries’ most marginalised communities, including the trust they place in different institutions and organisations.

Much of our data on trust bodes ill for the coronavirus response. We found that trust in a number of institutions or groups who currently play a role in enacting and communicating public health measures is low, in some cases critically so.

In Burundi, for instance, trust in the media was at rock bottom, with only 2% of respondents stating they always or often trust the media to do the right thing. The national government was trusted by only 16% of those interviewed. However, the local government garnered the trust of 63% of respondents, indicating an important role for them in implementing any coronavirus response.

In Diffa, Tillabery, and Tahoua regions of Niger, traditional and religious leaders enjoyed the highest levels of trust, with around 89% of those interviewed trusting them to do the right thing. In Uganda such leaders also outperformed others, with three quarters of Ugandan respondents trusting them. This underlines the need to ensure such actors understand and are on board with public health measures, so that they promote accurate information within their communities. Their input can also increase the effectiveness of local information campaigns.

In some contexts local civil society organisations enjoyed similarly high levels of trust, but in others, such as in Nampula and Zambézia districts of Mozambique, civil society was trusted only by around a quarter of people, whilst the local authorities enjoyed the trust of nearly 90%. This suggests that civil society organisations working in these areas will need to act cautiously, avoid promoting their brands, and work to support the institutions that people trust.

Some contexts face immense challenges in gaining enough community trust for an effective coronavirus response. Respondents in three districts in Pakistan, showed widespread distrust in all of the 13 institutions and organisations asked about; the local government was distrusted by 97% of people. In other regions of the country, levels of trust were only somewhat higher. Finding an effective means to get vital public health messages across about coronavirus and combat the rumours and misinformation that continue to hamper polio vaccination drives will require a localised approach and creative solutions in such low-trust societies.

The trends that emerge

Whilst the results vary across locations, trust tends to be higher in institutions and groups that function at the local level, such as the local government, local civil society organisations, and traditional or religious leaders, albeit with some exceptions. This is in line with findings from past studies on trust and underlines the importance of ensuring local groups are informed, included and engaged in coronavirus responses or future vaccination drives. Such groups can play an important role in relaying information to marginalized communities who may otherwise be cynical towards information from the national government or international organisations.

Times of crisis also bring the opportunity for trust to be gradually built on or further eroded. This global pandemic may allow state and civil society actors to build trust amongst the people they serve if they choose transparency, implement balanced measures, provide dedicated support to the most vulnerable groups, and take action to help people follow public health measures. If they do, trust can be cemented in the foundations for a new, fairer and more sustainable economy and society that works for the many rather than the few.


Caroline van Koot - Hodges