Uncertain Times: Trust Matters During The Pandemic

Uncertain Times: Trust Matters During The Pandemic

Michael Calnan, Simon J Williams and Jonathan Gabe

Much has already been written on trust in the social sciences, and why trust matters in social relations, but how are these trust relations playing out in the current Covid crisis? In what follows we take a closer look at this question with particular reference to the following trust relations during the pandemic: trust in the government in England, trust in the numbers, trust in the public, and trust in the Covid-related technologies which feature in this quest to track and beat the pandemic.

First, however, a word or two about what trust is and why it matters….

Trust: Definition and Dimensions
Trust is a multi-layered concept which consists of a “cognitive element (grounded in rational and instrumental judgements) and an affective dimension (grounded in relationships and affective bonds) generated through interaction, empathy and identification with others.

In terms of its dimensions and dynamics trust has been characterised by one party, the trustor, having positive expectations regarding the competence, knowledge and skills of the other party, the trustee, to do a good job (competence trust) and to be able to work in their best interests (intentional trust) with beneficence, fairness and integrity.  Public and patient trust matters not only because it is a precursor to social action such as consulting a clinician, disclosing information in a clinical encounter, following doctors’ orders or adherence to public health messages. Public trust is also necessary to support and legitimise the position, reputation and policies of institutions, as is experts’ trust in these matters too. Reciprocally, government trust in its publics matters as this has a bearing on the policies developed and how they are enacted.

This description in turn suggests other sub-types of trust, such as altruistic, acquiescent and conditional trust, compared to more explicit forms of distrust. How then are these forms of trust playing out in the current pandemic?

Trusting the Government – Contours and Controversies
Whilst the government enjoyed considerable public support at the outset of the crisis — in part due to support for the Prime Minister in times of crisis and a rally around the flag effect — a series of controversies have since served to test public patience and erode trust in the government, with overall support beginning to wane on specific counts. This for example includes doubts over whether the government acted quickly enough at the outset, failures in testing (see here and here ) and further controversies since, including calls for the resignation of the PM’s top aide, Dominic Cummings, after news  that that he may have broken lockdown rules himself, with the subsequent drama which is now unfolding.

At the time of writing an Ipsos Mori Survey on behalf of King’s College London’s Policy Institute has revealed that ‘trust and confidence in the government’s response to coronavirus has declined significantly between 1-3 April and 20-22 May’ with an 18% drop (from 69% to 51%) in the proportion of people who trust the government to control the spread of Covid-19. Similarly, the proportion who trust the government information on coronavirus fell by 17% from 76% to 59%. The Cummings controversy appears to have further dented the government’s credibility in the eyes of the public.

Concerns too have been raised, in the media and by a range of experts themselves, over the degree to which the government is in fact following a ‘science-led’ approach in its handling of the crisis such as in easing the lockdown too soon. This also includes concerns voiced over the membership (who is and isn’t included) and operation of the Scientific Advisory Group for Emergencies (SAGE), how scientific advice should be free from ‘political interference’, and the subsequent setting up of an independent group of experts to ‘shadow’ SAGE by the former government chief scientific adviser, not to mention the resignation of one member of the SAGE committee for breaking lockdown rules at the time.

Members of the medical profession too have also raised strong criticism of the government’s handling of the crisis so far. Take the editorial in the British Medical Journal, for example, which sums up the government’s track record so far, as ‘too little, too late, too flawed’, including problems of ‘delay and dilution’ and a ‘narrow scientific view’.

At stake here then, conceptually speaking, are important issues to do with both competence trust and intentional trust regarding the government’s handling of the crisis so far, particularly in the eyes of some sections of the media and other experts. Trust too, however, in which experts the government most trusts, as the aforementioned controversies over the composition and operation of SAGE suggest.

Trusting the Numbers – Troubles and Translations
A second critical issue concerns trust in the numbers we are being bombarded with on a daily basis and the mathematical models behind these figures and projections, including the charting of curves and how to flatten them.

The models and numbers, as Rhodes and Lancaster remind us, have a social life far beyond their official production and presentation at these government briefings, from reportage in the news media to debates on social media and in our living rooms. The provision of these data in turn has prompted claims, as Montgomery and Englemann note, that we are becoming ‘‘armchair epidemiologists’ in our discussions over the numbers, the models and how to ‘flatten the curve’.

Whilst this may suggest something more than simply acquiescent trust on the part of the public, a case of more deliberative trust perhaps, the most explicit examples of explicit distrust arguably seem to be coming from the experts themselves on two main counts.

First, disapproval as much as distrust over these ‘armchair epidemiologists’ and their contributions to the debate so far, as Montgomery and Englemann discuss.

Second, distrust expressed at the Governments’ own presentation of these numbers. Perhaps the most vocal critic on this count so far is Sir David Spieglehalter, who recently criticised the Government’s daily briefings as nothing less than ‘number theatre’. The government’s method of giving out numbers on deaths and tests with very precise figures, in other words, is ‘actually not the trustworthy communication of statistics’ according to Spieglhalter.

Trusting the Public – Trust Relations in the Community
It is not simply a question of public trust in the government of course, but of the government’s trust in the public to adhere to its policies and the public’s trust in itself in the shape of communal or social trust relations during the pandemic.

Taking each of these in turn.

A number of government representatives have expressed surprise about the level of public adherence as there were concerns about behavioural fatigue. Yet early evidence suggests people have adhered in the main to social distancing and isolation measures, despite many perceiving themselves at low risk. The government’s switch to its new ‘stay alert’ strategy in England also suggests its trust in the public, although (i) people seem to be less inclined now to social distance than they were previously during full lockdown, and (ii) this may be as much driven by economic necessity as it is by outright trust, including an attempt perhaps to nudge the public into taking what is described as ‘responsible risk’ judgements. In some countries, such as Sweden, there is evidence of mutual trust between the public and the government, although currently Sweden’s death per capita rate from the virus is one of the highest in the World.

As for the public’s trust in itself through community trust relations, this too is proving particularly critical during the pandemic. Collective social trust is being called for in these policies which involves the public trusting in one another and having some responsibility for vulnerable and older people – a form of altruistic trust.  The success of this will depend on societal cohesion which has been tested by Brexit, but such cohesion has been manifested in the recruitment of volunteers (750,000) to help the NHS and the weekly public applause for NHS (and social care) staff, although one anonymous doctor at least is now saying NHS staff have had enough of clapping. However, this might once again reflect trust in the institution of the NHS rather than explicit trust in government policy. The Prime Minister’s personal experience with Covid -19 and the NHS may have also enhanced public perceptions of the government’s commitment to its policies.  Johnson indeed, as William Davies notes, has ‘never been as popular as he was during his hospitalisation.’

Trust in Technologies: Hopes and Fears
Technology is another key actor in this unfolding storyline, from ventilators to the hunt for drugs to manage the virus, and from testing, tracing and tracking technologies to hopes of a vaccine. Again, a number of different dimensions of trust may be pointed to here regarding these technologies as key actors in this unfolding pandemic storyline.

Take the Government’s new NHS contact tracing app which is currently being trialled in the Isle of Wight with reports of mixed results. The question of trust is crucial to information sharing as a trusting relationship should facilitate the flow of information. Concerns have been specifically raised here over privacy regarding these data, particularly as they are being collected centrally by the government compared to other rival Apple and Google apps.

Delays in rolling out the new app may however start to undermine trust in this technology. Having hope as well as trust has also been shown to be a means for bridging or managing uncertainty. Thus, the optimism about the hopes for a vaccine might be seen not only as a more straightforward way out of the restrictions but also as a way of enhancing public morale, although government ministers have also stated that a vaccine may in fact never be found, in an attempt to lower expectations. It is also worth noting that a vaccine may not be welcomed by all in the population given the level of hesitancy or lack of trust in some countries for vaccination programmes particularly involving children.

As for the merits of high-tech versus low-tech approaches to the pandemic, well again we should remember, as the BMJ Editorial makes patently clear, that a robust public health approach is required which includes a localised responses to tackling the pandemic.

The Politics of Trust
In these ways, then, the pandemic throws into critical relief how and why trust matters, from trust in the government during the pandemic to trust in the community and from trust in the numbers to trust in the technologies to help us out of our current predicament.

These trust relations, as we have suggested, are interrelated. Moreover, public trust needs to be earned and increased transparency can enhance this. The government would do well to remember this during and beyond the pandemic, perhaps by being more open about how scientific evidence is being interpreted and enacted.

As Brian Cox has recently commented,  ‘we need to see how ministers made the decisions, and how they may have changed their minds as new knowledge becomes available, because this is the way to enhance public trust’. And we also need of course to trust that those making the rules are also following them themselves. Whether we can trust the government to do so, of course, remains to be seen. Time will tell…

 

Michael Calnan is Professor of Medical Sociology at the University of Kent. Simon Williams is Emeritus Professor of Sociology in the Department of Sociology at the University of Warwick. Jonathan Gabe is Emeritus Professor of Sociology in the School of Law and Social Sciences, Royal Holloway University.

Image: Marco Verch Professional.

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