The Washington PostDemocracy Dies in Darkness

Opinion In responding to a pandemic, biology matters. But so does trust.

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February 5, 2022 at 8:00 a.m. EST
Workers wear protective equipment at a coronavirus testing site on Jan. 26 in Los Angeles. (Marcio Jose Sanchez/AP)

The covid-19 death toll in the United States has soared again, and the U.S. per capita death rate now exceeds that of other wealthy nations. Why? Wasn’t the United States supposed to be best prepared for such a calamity? What accounts for the different pandemic fates of nations and peoples — and what can they do to prepare better for next time? The answers lie in biology, but also in human behavior.

This is the kernel of wisdom in a new study published in the Lancet that examined how 177 nations fared from Jan. 1, 2020, to Sept. 30, 2021, and the impact of various factors on sickness and death. The study examined infections per capita and each country’s infection-fatality ratio, the proportion of deaths among all infected individuals. It was led by Thomas J. Bollyky, director of the global health program at the Council on Foreign Relations, along with Erin N. Hulland and Joseph Dieleman of the Institute for Health Metrics and Evaluation at the University of Washington, with others. It measured the impact on the pandemic of such factors as age, economic output, population density, air pollution, body mass index, smoking, cancer prevalence and trust in government and interpersonal trust, among other things.

For many factors, the correlations weren’t clear, but some stood out. Most importantly, there is a link between lower infection rates and three factors: trust in government, greater interpersonal trust and less government corruption. The researchers said “higher levels of trust (government and interpersonal) had large, statistically significant associations with fewer infections for the entire study period.”

This is not a new idea but explains so much of what has occurred in the United States and elsewhere over the past two years. Especially in free societies, a high degree of trust in government and among people has led to better pandemic outcomes because people were more willing to comply with public health guidance — to wear masks and social distance, for example. But in the United States, the rise of distrust, misinformation and suspicion has seriously eroded that compliance, and has taken a toll. The study points out that higher trust also leads to a greater number of people getting vaccinated, and thus fewer deaths. Trust is important, the researchers found, not only by people in their governments, but between individuals. When people trust each other, such as in wearing masks when prescribed, it reduces the pandemic burden for all. The researchers also found that smoking and obesity, both health risk factors that can be reduced, contribute to worse outcomes.

Before the pandemic, the general thought was that the United States and other wealthier countries were the best prepared for such an emergency. But it didn’t turn out that way. Why? Heavy spending on health alone, the new study says, didn’t protect people against the consequences of “poor leadership and dysfunctional political environments.”

These lessons ought to be heeded in preparing for the next calamity. Government officials must realize that much depends on clear risk communication that builds and sustains public confidence. Once that is lost, it is exceedingly difficult to rebuild.

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Members of the Editorial Board: Opinion Editor David Shipley, Deputy Opinion Editor Charles Lane and Deputy Opinion Editor Stephen Stromberg, as well as writers Mary Duenwald, Shadi Hamid, David E. Hoffman, James Hohmann, Heather Long, Mili Mitra, Eduardo Porter, Keith B. Richburg and Molly Roberts.