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440 Bull World Health Organ 2024;102:440–447| doi: http://dx.doi.org/10.2471/BLT.23.289979
Introduction
Many studies of how well countries responded to health
crises acknowledge the importance of trust.1–5 Higher levels
of trust in government and interpersonal trust (i.e. trust in
others) early in the coronavirus disease 2019 (COVID-19)
pandemic were found to be associated with greater compli-
ance with stay-at-home measures in studies of 19 European
nations, and with greater hand-washing and mask-wearing
in a study of 18 African Union Member States.6–8 Aer vac-
cines became available, trust in national health authorities
and interpersonal trust were linked to higher vaccination
coverage rates internationally and to greater willingness to
heed health advice on the use of vaccines.9 With 4 years of
the pandemic now behind us, trust in government and trust
in others, as assessed in leading surveys, proved the best
explanations for the substantial and persistent cross-country
dierences in COVID-19 outcomes in comparisons of similar
countries that adjusted for relevant biological factors, such
as age and the prevalence of key pre-existing comorbidities.10
Similarly, the results of a large study of inter-state dier-
ences in the United States of America highlighted the role
of interpersonal trust.11
is research on the role of trust in responses to health
emergencies suggests that the most eective way for a gov-
ernment to protect its citizens during a crisis is to persuade
them to take voluntary measures to protect themselves and
one another. However, implementing protective measures (e.g.
contact tracing, social distancing, isolation, mask-wearing
and vaccination) in a crisis involves changes in personal and
community behaviour, which most governments nd hard to
monitor or compel at a population level. Accordingly, wide-
spread adoption of protective measures, even when mandated,
depends on the public’s cooperation. Several studies have
shown that cooperation depends on trust between citizens and
their governments and among citizens themselves, especially
in democracies.12,13 Individuals are more likely to cooperate
with recommended or mandated measures when they perceive
their governments as trustworthy (i.e. that the government
knows what it is doing and that it is acting for the common
good) and they believe that public health programmes will
be administered fairly and competently.14,15 Having greater
trust in other people helps motivate individuals to cooperate
to protect others in the community. Trust also reduces their
fear of being misled into adopting protective measures when
almost no one else is doing so.11,16,17
With the number of dangerous disease outbreaks on
the rise globally, the ability to mobilize the public’s trust in
a health crisis has never been more essential – or harder to
maintain. Growing political polarization, persistent racial and
social inequities, and rapidly changing medical technology
may make it easier than ever for minor medical concerns and
misinformation to erode public condence.18 In particular,
the rise of social media and articial intelligence has made it
simpler and cheaper to spread and amplify false information
and to disseminate fake news stories than was previously
possible with traditional media.19,20 Under the fast-changing
circumstances of a pandemic, uncertainty, fear and anxiety can
help the purveyors of mis- and disinformation to undermine
the public’s trust that science and health systems can provide
them with the best medical countermeasures.21
Despite widespread acknowledgement of the importance
of trust during a pandemic, few intergovernmental institutions
or governments have formulated concrete proposals on how
to monitor trust in government and interpersonal trust, or on
how to incorporate such assessments into preparing for the
440
a Council on Foreign Relations, 1777 F Street, NW, Washington, DC 20006, United States of America.
b Department of Political Science, Aarhus University, Aarhus, Denmark.
Correspondence to Thomas J Bollyky (email: tbollyky@ cfr .org).
(Submitted: 30 June 2023 – Revised version received: 13 February 2024 – Accepted: 20 March 2024 – Published online: 30 April 2024 )
A practical agenda for incorporating trust into pandemic preparedness
and response
Thomas J Bollykya & Michael Bang Petersenb
Abstract Despite widespread acknowledgement that trust is important in a pandemic, few concrete proposals exist on how to incorporate
trust into preparing for the next health crisis. One reason is that building trust is rightly perceived as slow and challenging. Although trust
in public institutions and one another is essential in preparing for a pandemic, countries should plan for the possibility that efforts to
instil or restore trust may fail. Incorporating trust into pandemic preparedness means acknowledging that polarization, partisanship and
misinformation may persist and engaging with communities as they currently are, not as we would wish them to be. This paper presents
a practical policy agenda for incorporating mistrust as a risk factor in pandemic preparedness and response planning. We propose two
sets of evidence-based strategies: (i) strategies for ensuring the trust that already exists in a community is sustained during a crisis, such
as mitigating pandemic fatigue by health interventions and honest and transparent sense-making communication; and (ii) strategies for
promoting cooperation in communities where people mistrust their governments and neighbours, sometimes for legitimate, historical
reasons. Where there is mistrust, pandemic preparedness and responses must rely less on coercion and more on tailoring local policies and
building partnerships with community institutions and leaders to help people overcome difficulties they encounter in cooperating with
public health guidance. The regular monitoring of interpersonal and government trust at national and local levels is a way of enabling this
context-specific pandemic preparedness and response planning.
Policy & practice
Policy & practice
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next health crisis.
22–24
One reason is that,
although research on the importance
of trust in pandemic responses “makes
intuitive sense”, as Bill Gates argued in
his 2022 book on preparing for the next
pandemic,
25
such research does not
“easily translate into practical advice”
to donors and policy-makers because
“building trust between people and their
government takes years of painstaking,
purposeful work”.
15,25
Building social
trust – the belief that most people can
be trusted – is no easier. Some scholars
suggest that progress on social trust re-
quires systemic shis, such as reducing
corruption and economic inequa lity, and
maintaining fair and ecient state insti-
tutions.
26,27
Another concern is that much
of the research on trust to date has taken
place in Europe and North America.
Consequently, this research may not be
generalizable to other settings. Neverthe-
less, there is enough emerging evidence
from low- and middle-income countries
to raise concerns about whether govern-
ments are paying sucient attention to
the role of trust in planning eective
pandemic responses.
4,5,7,28
Although building faith in public
institutions and one another is essen-
tial in preparing and responding to
pandemics, countries should plan for
the possibility that eorts to instil or
restore that faith may fail. To that end,
governments should prepare to engage
with communities as they currently
are, not as we would wish them to be.
Pandemic preparedness should involve
identifying and listening to communi-
ties’ reasons for mistrust in institutions
and others, and monitoring and manag-
ing that mistrust as a pandemic risk.
29
Consequently, governments should use
the lessons learnt from monitoring mis-
trust to develop local pandemic plans
that guard against the deterioration of
trust during an emergency, and that can
succeed even in communities where the
level of trust is low.
Here we present a practical policy
agenda for incorporating mistrust as
a risk factor into pandemic prepared-
ness and response planning. Our
proposal includes two sets of concrete,
evidence-based strategies: (i) strategies
for ensuring the trust that already exists
in a community is sustained during a
crisis; and (ii) strategies for engaging
and promoting cooperation even in
communities where distrust runs deep-
est. Our approach to developing these
proposals is detailed in Box 1.
Sustaining trust during a
health emergency
e degree of trust present in any society
has specic historical, cultural and po-
litical roots.26,27 Trust is oen built slowly
over decades rather than months but can
disappear quickly. A key concern for any
decision-maker or authority during a
health emergency is to not lose the trust
already in place. is section highlights
insights from the COVID-19 pandemic
and previous epidemics on how to sus-
tain trust during a crisis.
Buffer pandemic fatigue
Pandemic fatigue demotivates compli-
ance with health interventions and erodes
trust in government guidance and crisis
management generally.32 e concept of
pandemic fatigue emerged during the
COVID-19 pandemic and refers to the
accumulated exhaustion that occurs over a
prolonged crisis due to: (i) the emotional,
psychosocial and material costs of comply-
ing with extended public health and social
measures; and (ii) a constantly shiing
information landscape concerning the
threat and utility of those public health
measures.32 As these feelings accumulate
over time, interventions imposed later in
a crisis or sustained longer may fuel more
fatigue than interventions imposed dur-
ing its early days.32 Pandemic fatigue may
also spur individuals to consume more
alternative media and misinformation,
which could further undermine trust
more broadly in government guidance and
interventions. In the most severely aected
individuals, this fatigue may be one source
of radicalization and violent protest during
a health emergency.33 Research suggests
that the more severe the epidemic, the less
the level of fatigue – all else being equal.32
People can handle high compliance costs
if complying feels meaningful and there is
a clearly dened exit strategy.
Policy-makers can mitigate pandem-
ic fatigue using health interventions in
two ways. First, decision-makers can re-
duce the unnecessary cost and inequity of
emergency health interventions as much
as possible.32 Policy-makers should:
(i) invest in social protection policies
and programmes to buer the economic
strain that accompanies stay-at-home
orders, restrictions on gatherings, and
other emergency measures; (ii) identify
groups with psychosocial vulnerabili-
ties and provide access to support; and
(iii) scale back public health measures as
soon as the epidemiological situation al-
lows. Second, interventions need to make
sense to the public and be perceived as
meaningful. is approach requires being
transparent about the current evidence
base for interventions. Entering into dia-
logue with local communities on societal
trade-os can help policy-makers better
align emergency health interventions
with local cultural values and economic
and educational needs.
Invest in sense-making
communication
Knowledge, evidence and recommen-
dations can change rapidly during an
emergency. Consequently, crisis commu-
nicators face a core dilemma: it is oen
not possible to provide a straightforward
message that is consistent over time, yet
communication needs to be timely and
consistently actionable. Here, we refer
to communication that navigates this
dilemma as sense-making communica-
tion because it enables the public to make
sense of health advice and understand
why that advice is likely to change over
the course of an emergency.
During the COVID-19 pandemic,
an individual’s feeling of ecacy was
associated with increased compliance
with health authorities’ advice and with
greater support for pandemic manage-
Box 1. Development of policy proposals for incorporating trust into pandemic
preparedness and response, 2024
In developing our policy proposals for incorporating trust into pandemic preparedness
planning, we: (i) conducted thorough literature reviews of the Scopus, Google Scholar and
PubMed® databases in April 2023 and January 2024 by searching for, for example, the terms
trust, compliance and cooperation in article abstracts or titles, without any language or date
restrictions; (ii) incorporated lessons from our personal research and activities in the coronavirus
disease 2019 (COVID-19) pandemic, during which one of us served as an advisor to the Danish
government on a national trust-monitoring and social-listening project; and (iii) took into account
feedback from a consultation on a preliminary version of this proposal organized by WHO’s Health
Emergencies Programme on 25 May 2023, which involved a wide range of representatives from
WHO Member States, researchers, experts and members of civil society.30,31
WHO: World Health Organization.
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Thomas J Bollyky & Michael Bang Petersen
Policy & practice
ment.34 People feel ecacious when
they: (i) have a clear sense of what to do;
(ii) understand why they need to comply
with a measure to deal eectively with a
threat; and (iii) can comply without too
high a cost.35 Research during the pan-
demic indicated that feelings of ecacy
were elicited by transparent and honest
descriptions of the overall strategy for
handling the epidemic and of the exact
role of the individual in that strategy.36 A
challenge, of course, is that the strategy
and the role of the individual will shi
over the course of the pandemic.
Transparency and honesty are at the
core of sense-making communication.
Research during the COVID-19 pan-
demic showed that acknowledging the
negative side-eects of a vaccine could
lower uptake but increased the public’s
trust in the health communicator and
raised trust generally.37 In contrast,
providing vague assurances about a
vaccine’s safety lowered both accep-
tance of the vaccine and trust in health
communicators. ese observations
conrm earlier research which found
that the transparent communication of
uncertainty preserves trust in the com-
municator and trust overall.38
Although the goals of clarity and
transparency may seem to be in tension,
eective sense-making communication
should nonetheless strive to achieve
both. Sense-making communication
should provide clear, actionable advice
about recommended public behaviour
and admit any relevant uncertainties.
To earn the trust of the public, health
communicators must in turn trust the
public to manage complex, concerning
and changing information.39,40
Although research shows trans-
parency has a positive eect in both
high- and low-trust settings, strategies
involving transparency may be more
successful in societies that already have
a high level of trust.37 Partisans and
opportunists may exploit revelations of
uncertainty to sow doubt in ethnically
or politically polarized settings. During
the COVID-19 pandemic, people in
states and counties in the United States
that voted heavily for the Republican
presidential candidate in 2020, or that
had a higher level of consumption of
conservative news sources, stayed at
home less, used masks less and had
lower vaccine coverage.11,41
Given the fear that transparent
communication may backre in low-
trust environments, future health crisis
communicators should tailor their
engagement with communities to lo-
cal needs by liaising with community
groups and leaders. is topic is ex-
plored in greater depth in the section on
fostering cooperation in communities
with low levels of trust in government
and their neighbours.
e challenge of providing sense-
making communication in a crisis
becomes more dicult if that crisis
involves an infodemic, which the World
Health Organization (WHO) has de-
ned as occurring when “too much
information including false or mislead-
ing information in digital and physical
environments” proliferates during a dis-
ease outbreak.42 During the COVID-19
pandemic, people were highly active in
seeking information. Even though they
overwhelmingly turned towards trust-
worthy information sources, the sheer
amount of information complicated the
task of health communicators.43
In a crisis, extreme and critical
voices may join together to create on-
line echo chambers, which are usually
driven by a small group of highly active
individuals.44 During the COVID-19
pandemic, up to 65% of vaccine-re-
lated misinformation on mainstream
social media was attributable to just
12 highly active accounts.45 Research
into understanding how authorities
can engage constructively with activist
online groups is still in its infancy. Key
components are likely to be: (i) a strong
online presence for health authorities;
(ii) investment in digital literacy to
promote resilience against mis- and
dis-information; and (iii) cooperation
with social media platforms to ensure
their algorithms do not amplify harmful
disinformation during an emergency.
Avoid sowing social tension
An eective response to a public health
emergency requires collective action
whereby individuals limit the exercise
of their individual freedoms to advance
the interest of the group, for example by
changing their behaviour to suppress the
transmission of dangerous pathogens to
protect the most vulnerable.46 Such collec-
tive action requires social trust – the trust
people have that other people are also con-
tributing to the joint action.47 A standard
nding in psychological and economic
research is that people react with anger
and limit their own contributions when
those not contributing are observed to
free-ride on others’ joint eorts.48
One way in which mistrust between
citizens emerged during the COVID-19
pandemic was via the moral condemna-
tion of people who did not observe the
advice of health authorities.49 Across
both developed and developing coun-
tries, individuals who were vaccinated
against COVID-19 were more likely
to exclude unvaccinated individuals
from family interactions.50 In addition,
decision-makers used moral rhetoric
to justify interventions that were par-
ticularly burdensome to those who
were not vaccinated.51 Such feelings of
antipathy also led to measures – and
public support for measures – that ar-
guably restricted freedom of movement
and speech.50–53 In turn, individuals
who were not vaccinated felt pressured
and discriminated against, with the
result that groups whose trust in the
authorities and in pandemic responses
was already limited became even less
trusting.54,55
Research shows that condemnation
is common in the context of collective
action,56 but it was oen counterproduc-
tive during the COVID-19 pandemic.
Health authorities should invest in
building a thorough and nuanced un-
derstanding of the factors underlying
opposition to their advice. is under-
standing could improve responses to
that opposition and help authorities
communicate with the rest of the pub-
lic about those concerns. For example,
during the COVID-19 pandemic, an un-
vaccinated person may have had: (i) an
underlying medical condition; (ii) nega-
tive past experiences with the health au-
thorities (e.g. as a member of an ethnic
or racial minority); (iii) safety concerns
due to prior public health scandals; or
(iv) ethical questions about vaccine
equity. Reducing such a complex mix
of considerations to a moral position
or a simplied stereotype can entrench
opposition in the subset of unvaccinated
people who could still be persuaded to
adopt public health measures.
Fostering cooperation in
communities with limited
trust
Governments need pandemic strategies
that can succeed in the communities that
currently exist, not just in the cohesive
communities they hope to build. Incor-
porating trust into pandemic prepared-
ness involves: (i) acknowledging that
polarization, partisanship and misin-
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Thomas J Bollyky & Michael Bang Petersen Incorporating trust into pandemic preparedness and response
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formation may persist; (ii) monitoring
trust at national and subnational levels;
and (iii) engaging local institutions and
community leaders to develop strategies
to foster cooperation even in communi-
ties with limited trust in either govern-
ment or their neighbours.
Although relatively few studies
have examined cooperation in societies
with low levels of trust, there has been
research in regions where people have
legitimate, historical reasons to mistrust
their governments and neighbours.57,58
e rst lesson this research teaches is
that mandates can generate instability,
pushback and conict in divided com-
munities. Although a mandate can spur
cooperation in more harmonious soci-
eties by convincing potential holdouts
that everyone else will comply, research
suggests they may have the opposite ef-
fect in low-trust communities.59 A study
of 41 communities with low levels of
government trust during the COVID-19
pandemic found no link between strin-
gent rules and greater cooperation with
hand-washing or physical distancing.60
Especially in such settings, governments
must rely less on coercion and more on
building policies that can help people
overcome the diculties they encounter
in cooperating with public health guid-
ance. For example, states in the United
States that employed social protec-
tion policies, such as paid family and
sick leave, appeared to have increased
compliance with emergency response
measures among people who otherwise
could not aord to comply.29
e second lesson that emerges from
this research is that cultural, religious and
kinship ties can help low-trust communi-
ties set aside historical mistrust and suspi-
cions about government measures. Dur-
ing the 2014 Ebola virus disease outbreak
in Liberia, for instance, viral transmission
rates started falling aer governments
and nongovernmental organizations
recruited community youth leaders, pas-
tors and imams to check households for
infected people. Likewise, in Sierra Leone,
community liaisons helped increase ac-
ceptance of Ebola vaccine trials.
61
In the
United States, local churches, community
vaccine ambassadors and even local bar-
ber shops provided focal points encourag-
ing cooperation around COVID-19 vac-
cination in majority Black communities
with historical reasons to distrust public
health campaigns.
62
Even in settings
where management of the COVID-19
pandemic was politicized, endorsement
of vaccines by trusted community leaders
increased acceptance among community
members.
63
Ultimately, cultural, political and
religious ties that can spread misin-
formation can also foster the spread
of accurate information and motivate
cooperation with eective public health
measures.
18
Partnering with local phy-
sicians, health centres and faith-based
institutions can help identify trusted
messengers, improve data collection
and advance public health priorities.
64
Moreover, community engagement in
planning and decision-making may
help to ensure local values and prefer-
ences are respected and are used to
guide communication with the com-
munity during future crises.
65
Monitoring trust during a
health emergency
Investing in the real-time monitoring
of the public’s trust in decision-makers,
scientists, health authorities, the health
system and each other is necessary to
assess levels of community trust levels
and the impact of health interventions
on trust. When appropriate, authorities
should also monitor the trust in the
overall emergency response strategy.
e infrastructure for monitoring
trust should be set up in advance of a
crisis to assess the baseline level of trust
in a community, and it should incorpo-
rate standardized measures of trust from
the burgeoning research literature. At
the country level, data on some baseline
measures are already available through
existing sources, such as the World Val-
ues Survey.
66
Such large-scale surveys,
however, do not provide data at the sub-
national level for individual countries.
As part of a pandemic preparedness
and response plan, a dedicated trust
monitoring unit could be established
by, or in partnership with, university re-
searchers with the relevant social science
expertise. e appropriate infrastructure
for trust monitoring would involve: (i) a
system for collecting ne-grained, valid
data on trust; (ii) a system for processing,
analysing and interpreting these data in
real time to guide responses to adverse
events; and (iii) a mechanism for convey-
ing information to relevant policy-makers
and decision-makers at subnational and
national levels. Extensive subgroup analy-
ses must also be conducted to identify
communities with particularly low levels
of trust to guide the design and deploy-
ment of suitable interventions. Moreover,
the data produced should be openly avail-
able to build and sustain condence in
eorts to monitor trust.
For any assessment of the public’s
level of trust to be useful, the data col-
lected must be representative. However,
members of groups that do not trust
the government are more likely to opt
out of surveys and, in addition, other
research approaches (e.g. social media
monitoring) may not adequately capture
the sentiments of the silent majority. A
lack of adequate representativeness can
result in false estimates of the level of
trust and the misidentication of factors
inuencing trust.67
Accordingly, a successful strategy
for monitoring mistrust as a risk to an ef-
fective health emergency response must
rely on a combination of methods, such
as representative online surveys, social
media monitoring and ethnographic
eld observations. Surveys can assess the
public’s trust that the government and
other members of the community will
respond eectively to a health emergen-
cy. Social media monitoring will provide
information about the views of the most
vocal individuals and about misinforma-
tion that is circulating, whereas ethno-
graphic eld observations can collect
in-depth information on considerations
important to dierent groups and com-
munities.68 Use of this combination of
methods is consistent with the concept
of social listening within infodemic
management that WHO proposed dur-
ing the COVID-19 pandemic. Infodemic
management is intended to be a practical
means of identifying and addressing the
questions, concerns, information voids,
perceptions, behaviours, and mis- and
disinformation that may be spreading
through communities during a health
emergency.42,69 A concrete example of
the feasibility of large-scale social lis-
tening was the HOPE project (i.e. how
democracies cope with COVID-19) in
Denmark,70 which used all three meth-
ods of social listening mentioned here.
In essence, a trust monitoring
system is a dedicated system for care-
fully listening to popular concerns about
government and community responses
to a health crisis, and for integrating
those concerns into the decision-making
process guiding those responses. Al-
though it requires time, money and
training to succeed, trust monitoring did
prove eective during the COVID-19
pandemic.71 at said, there is much
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444 Bull World Health Organ 2024;102:440–447| doi: http://dx.doi.org/10.2471/BLT.23.289979
Thomas J Bollyky & Michael Bang Petersen
Policy & practice
more to learn about the role of trust in
pandemic preparedness. is statement
is especially true in low- and middle-
income countries, where researchers are
developing locally tailored, behavioural
science approaches that can contribute
to global understanding of the role of
trust in health emergencies.72
Conclusion
An eective pandemic response requires
the cooperation of billions. e CO-
VID-19 pandemic revealed that many
societies around the globe were too di-
vided and riven by mistrust to mobilize
their citizens to protect themselves and
others during a crisis. Although restor-
ing faith in public health institutions
and one another is essential, countries
must prepare for failure by developing
strategies that encourage cooperation
in communities as they currently are.
Low public trust is a pandemic risk
factor that should be monitored and
mitigated to enable public health and
social responses to health emergencies
to succeed, even in communities with
a historical mistrust of government
and their neighbours. Being alert to
changes in public condence, nurtur-
ing cooperation amid polarization and
social strife, and tailoring nimble policy
responses to local needs will all be criti-
cal for ensuring better outcomes when
the next dangerous outbreak occurs. ■
Competing interests: None declared.
© 2024 The authors; licensee World Health Organization.
This is an open access article distributed under the terms of the Creative Commons Attribution IGO License (http://creativecommons.org/licenses/by/3.0/igo/legalcode),
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any reproduction of this article there should
not be any suggestion that WHO or this article endorse any specific organization or products. The use of the WHO logo is not permitted. This notice should be preserved
along with the article’s original URL.
摘 要
关于将信任纳入大流行病防范和应对工作范畴的实用议程
尽管人们普遍承认在大流行病蔓延时信任非常重要，
但是极少有人就如何将建立信任纳入下一场健康危机
防范工作范畴提出具体的建议。其中一个原因是人们
理所当然地认为建立信任是一个非常缓慢且具有挑战
性的过程。尽管对公共机构的信任和互相信任对于防
范大流行病至关重要，但是各国也应做好培养或恢复
信任的工作有可能会付诸东流的准备。将建立信任纳
入大流行病防范工作的范畴意味着承认两极分化、党
派偏见和错误信息可能会持续存在，且我们需基于社
区当前状态而非我们所希望其呈现的状态与其进行互
动。本文提出了一项实用的政策议程，将不信任作为
一项风险因素纳入大流行病防范和应对工作的规划。
我们提出了两套循证策略 ：（i）确保在危机期间继续
维持社区中已经建立的信任关系的策略，例如通过卫
生干预措施和秉持真诚透明原则开展的有意义沟通来
缓解流行病疲劳 ；以及（ii）在人们不信任政府及其
邻居（有时因合理的历史原因）的社区实施旨在促进
合作的策略。如果发现不信任的情况，则在制定大流
行病防范和应对措施时，必须减少实施高压政策，同
时依据当地实际情况制定当地政策并与社区机构和领
导人建立伙伴关系，从而帮助人们克服困难以配合实
施公共卫生指南。定期监测国家和地方层面的人际和
政府信任情况，有利于制定符合具体实情的大流行病
防范和应对工作规划。
(1)
(2)
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Thomas J Bollyky & Michael Bang Petersen Incorporating trust into pandemic preparedness and response
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Résumé
Un programme concret visant à inclure la conance dans la préparation et la riposte aux pandémies
Bien qu'il soit largement admis que la confiance est un facteur crucial lors
d'une pandémie, peu de propositions concrètes ont été formulées quant
aux modalités de son intégration dans la préparation aux prochaines
crises sanitaires. L'une des raisons tient au fait qu'établir la confiance
est considéré, à juste titre, comme un processus lent et complexe. La
confiance mutuelle et celle placée dans les institutions publiques est
essentielle dans la préparation aux pandémies, les pays devraient donc
tenir compte de la possibilité que leurs efforts pour instaurer ou restaurer
cette confiance échouent. Intégrer ce facteur dans la préparation aux
pandémies signifie reconnaître que la polarisation, la partialité et la
désinformation sont susceptibles de persister. Cela signifie aussi travailler
avec les communautés telles qu'elles sont actuellement, et non telles
que nous souhaiterions qu'elles soient. Le présent document dévoile
un programme politique concret visant à inclure la méfiance comme
facteur de risque dans la planification des mesures de préparation et
de riposte aux pandémies. Nous suggérons deux types de stratégies
fondées sur des données factuelles: (i) des stratégies visant à préserver
la confiance préexistante au sein d'une communauté durant une crise,
notamment en luttant contre la lassitude face aux pandémies par
le biais d'interventions de santé et d'une communication honnête,
transparente et sensée; mais aussi (ii) des stratégies qui favorisent la
coopération dans les communautés dont les membres se méfient
de leur gouvernement et de leurs voisins, parfois pour des raisons
historiques légitimes. Lorsque des doutes subsistent, les mesures de
préparation et de riposte aux pandémies doivent éviter de recourir à la
contrainte et privilégier des politiques locales adaptées ainsi que des
partenariats avec les responsables et les institutions de la communauté,
afin d'aider les gens à surmonter les difficultés qu'ils rencontrent vis-à-vis
des directives de santé publique. Un suivi régulier de la confiance envers
les autres et les autorités à l'échelle régionale et nationale permet de
planifier une préparation et une riposte spécifiques face aux pandémies.
Резюме
Практическая программа действий по обеспечению готовности к пандемии и реагированию на нее
Несмотря на широкое признание того, что доверие играет
важную роль во время пандемии, существует мало конкретных
предложений о повышении уровня доверия при подготовке
к следующему кризису в области здравоохранения. Одна из
причин заключается в том, что укрепление доверия справедливо
воспринимается как медленный и сложный процесс. Хотя
доверие к государственным учреждениям и друг к другу имеет
большое значение для подготовки к пандемии, странам следует
учитывать возможность того, что усилия по формированию
или восстановлению доверия могут оказаться безуспешными.
Включение доверия в процесс обеспечения готовности к
пандемии означает признание факта сохранения поляризации,
предвзятости и дезинформации, а также взаимодействие с
сообществами в их текущем состоянии, а не в том, в котором их
хотелось бы видеть. В данной работе представлена практическая
программа действий по учету недоверия как фактора риска
при планировании готовности к пандемии и ответных
мер. В данной статье предлагаются два набора стратегий,
основанных на фактических данных: (i) стратегии поддержания
доверия, уже существующего в сообществе, во время кризиса,
например смягчение пандемической усталости путем оказания
медицинской помощи и честной и прозрачной коммуникации;
(ii) стратегии развития сотрудничества в сообществах, где
люди не доверяют своим правительствам и соседям, иногда
по вполне обоснованным, историческим причинам. Там, где
существует недоверие, меры по обеспечению готовности
к пандемии и ответные меры должны в меньшей степени
основываться на принуждении, а в большей – на разработке
локальной политики и налаживании партнерских отношений
с общественными институтами и лидерами с целью помочь
людям преодолеть трудности, с которыми они сталкиваются
при сотрудничестве с органами здравоохранения. Регулярный
мониторинг межличностного и правительственного доверия на
национальном и местном уровнях является одним из способов
планирования готовности к пандемии и ответных мер с учетом
конкретных условий.
Resumen
Un programa práctico para incorporar la conanza a la preparación y respuesta ante una pandemia
A pesar del reconocimiento generalizado de que la confianza es
importante en una pandemia, existen pocas propuestas concretas sobre
cómo incorporarla a la preparación para la próxima crisis sanitaria. Uno
de los motivos es que generar confianza se percibe, con razón, como
algo lento y difícil. Aunque la confianza en las instituciones públicas y en
los demás es esencial en la preparación para una pandemia, los países
deben prever la posibilidad de que fracasen los esfuerzos por infundir
o restablecer la confianza. Incorporar la confianza a la preparación ante
una pandemia significa reconocer que la polarización, el partidismo y la
desinformación pueden persistir y comprometerse con las comunidades
tal y como son actualmente, no como desearíamos que fueran. Este
documento presenta una agenda política práctica para incorporar la
desconfianza como factor de riesgo en la planificación de la preparación
y respuesta ante una pandemia. Proponemos dos conjuntos de
estrategias basadas en la evidencia: (i) estrategias para garantizar que
la confianza que ya existe en una comunidad se mantenga durante
una crisis, como mitigar la fatiga pandémica mediante intervenciones
sanitarias y una comunicación honesta y transparente que haga entrar
en razón; y (ii) estrategias para promover la cooperación en comunidades
donde las personas desconfían de sus gobiernos y vecinos, a veces por
razones legítimas e históricas. Cuando hay desconfianza, la preparación y
las respuestas ante una pandemia se deben basar menos en la coerción y
más en la adaptación de las políticas locales y la creación de asociaciones
con las instituciones y los líderes de la comunidad para ayudar a las
personas a superar las dificultades que encuentran en la cooperación
con las orientaciones de salud pública. El seguimiento periódico de la
confianza interpersonal y gubernamental a nivel nacional y local es una
forma de hacer posible esta planificación de la preparación y respuesta
ante una pandemia específica para cada contexto.
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Incorporating trust into pandemic preparedness and response
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446 Bull World Health Organ 2024;102:440–447| doi: http://dx.doi.org/10.2471/BLT.23.289979
Thomas J Bollyky & Michael Bang Petersen
Policy & practice
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