Trust, the missing piece in our pandemic management
PremiumNew studies validate the importance of behavioural analysis for good pandemic management
While the world remains in the grip of covid, crucial efforts are already underway to unravel this “epidemiological mystery". This pandemic has not followed the pattern of many other communicable diseases. Low-income countries with fewer healthcare resources were expected to have a higher burden of covid. Instead, it was the wealthier countries with better healthcare resources that got most affected. The countries that experts believed to be best prepared to mitigate the effects of a pandemic were not the most successful at doing so. In this context, two studies provide some surprising insights.
Lockdowns were the most widely used non-pharmaceutical intervention to minimize the spread of coronavirus. The decision of governments and health authorities to impose shutdowns as a way to arrest the pandemic was based on forecasts made by epidemiological studies, such as a famous one by the Imperial College London. Lockdowns contributed to reducing economic activity, worsening unemployment, disrupting children’s schooling, increasing domestic violence and causing political unrest. But how much did they contribute to curbing covid mortality, their main goal?
‘A literature review and meta-analysis of the effects of lockdowns on covid-19 mortality’ done by Jonas Herby, Lars Jonung, and Steve H. Hanke and submitted to the Studies in Applied Economics series of the Johns Hopkins Institute for Applied Economics, Global Health and the Study of Business Enterprise offers a surprising finding. The meta-analysis fails to confirm that lockdowns have had a significant effect on mortality rates. Lockdowns in Europe and the US reduced covid mortality by only 0.2% on average. Shelter-in-place orders (SIPOs) were also ineffective. They only reduced mortality by 2.9% on average. So the net conclusion of this study is that lockdown policies were ill-founded and should be rejected as a pandemic policy instrument.
This analysis already has its critics. It is seen as having cherry-picked studies to fit a particular point of view, while rejecting others. Since a large number of people were adversely affected by lockdowns, this debate could gain intensity. But in the midst of all these debates, an obvious question is bound to come up: If lockdowns were not effective in preventing the spread of the pandemic, what else mattered in its management? A paper published few days ago in The Lancet could provide the answer.
‘Pandemic Preparedness and Covid-19: An Exploratory Analysis of Infection and Fatality Rates, and Contextual Factors Associated with Preparedness in 177 Countries, from Jan 1, 2020, to Sept 30, 2021’ offers some interesting insights. The researchers considered various factors that could predict the pandemic’s spread. These included environmental seasonality, population density, gross domestic product (GDP), age distribution of the population, mean body-mass index (BMI), exposure to air pollution, smoking rates, prevalence of pulmonary disease and cancer, changes in mobility patterns, vaccination rates and several other factors. They also assessed the impact of interpersonal and governmental trust. When it came to predicting fatality rates, age stood out. This could explain why rich countries that have a larger proportion of old people had a disproportionate number of deaths. The most surprising were the factors found to have mattered the most when it came to predicting the number of people infected in each country. Among these, measures of trust in fellow citizens and trust in the government had larger, statistically-significant associations with lower infection rates.
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One way to quantify the contribution of trust to covid outcomes is to create a ‘what if’ scenario. According to the study, if interpersonal trust were to reach the 75th percentile, the level of South Korea, it would have prevented 40.3% of global infections. If trust in governments were to reach the same percentile, the level in Denmark, it would have reduced global infections by 12.9%. The level of trust in a country—among citizens and between citizens and their government—is something that an administration can prepare for and enhance during a crisis. This analysis thus suggests that building trust among fellow citizens and in the government might be one of the best investments a country can make to mount a more effective response to future pandemic threats.
The meta-analysis study by Herby, Jonung and Hanke mentioned earlier throws new light on the behavioural aspects of pandemic management. It distinguishes between the effects of mandatory and voluntary behavioural changes. The study found that on an average, voluntary behavioural changes are 10 times as crucial as mandatory behavioural changes in combating covid. This explains why several epidemiological model simulations, which did not model appropriate behaviour traits endogenously, failed to accurately forecast the effect of lockdowns.
The covid pandemic was not just a medical problem. If so, a biomedical solution like a vaccine should have ended it. This pandemic reminds us that public health is really rooted in trust. Policymakers should be aware that beneath every societal problem, there are deep-rooted behavioural undertones. Unless we address these behavioural vulnerabilities, the world will always be defenceless against fast-spreading viruses. And traditional solutions like vaccines will lie unused in nearby health centres.
Biju Dominic is the chief evangelist, Fractal Analytics and chairman, FinalMile Consulting
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