Publication date: 
February 1, 2022

SEATTLE—Low levels of government and social trust, as well as higher levels of government corruption, are strongly correlated to higher COVID-19 infection rates around the world, according to a new peer-reviewed study published today in The Lancet. Other indicators, including pandemic preparedness indices, democracy, income inequality, universal health care, and hospital capacity, failed to show a significant relationship with COVID-19 infection rates or infection-fatality rates.

COVID-19 has been called an “epidemiological mystery,” with mortality rates higher in many wealthy countries with greater health-care resources than in poor nations, and deaths varying dramatically, even among countries within close geographical proximity.

The study of 177 countries, conducted by a team of researchers from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington School of Medicine and the Council on Foreign Relations (CFR), found that the wide variation between countries in COVID-19 infection rates cannot be explained by many often-cited factors in politics (e.g., democracy and populism), state capacity (e.g., government effectiveness), health care (e.g., hospital beds or universal health coverage), or social factors (e.g., economic inequality or trust in science). The findings suggest that if all societies had trust in government at least as high as Denmark, which is in the 75th percentile, the world would have experienced 13% fewer infections. If social trust (trust in other people) reached the same level, the effect would be even larger: 40% fewer infections globally.

“Many of the factors that influence COVID-19 outcomes, such as seasonality, age structure, and population density, are out of the hands of decision-makers,” said Director of CFR’s Global Health Program Thomas J. Bollyky, a lead author of the study. “Trust is an area where governments can move the needle, and the fact that it outweighs traditional measures of health-care capacity and pandemic preparedness should be a wakeup call for all of us as we face the ongoing COVID-19 pandemic and the threat of future disease outbreaks.”

High levels of government and social trust as well as lower government corruption were all associated with higher vaccine coverage. Lower levels of government corruption were associated with reductions in mobility during the pandemic, suggesting greater compliance with social distancing rules.

The findings also suggest that promoting better health, such as reducing body mass index and lowering smoking rates, may help prevent illnesses and deaths during future pandemics.

The researchers analyzed a dozen pandemic preparedness indices, seven health-care capacity indicators, and ten additional demographic, social, and political conditions, and adjusted for many known biological drivers of infection like age and seasonal effects. A high ranking on the leading health system capacity and pandemic preparedness measures has not only been insufficient for success in this pandemic, but it also has been unnecessary. Countries like the Philippines and the Dominican Republic, which rank relatively low on pandemic preparedness and health-care access and quality, maintained low rates of infections and deaths throughout the study period, while other nations with higher rankings, including the United States and France, faced much worse outcomes for both infections and fatalities.

“Trust can be fostered by governments during a crisis,” said Erin Hulland, a researcher at IHME and co-first author of the study. “Clear risk communication and community engagement strategies have worked to build trust during other disease outbreaks, even in post-conflict West African countries during the Ebola epidemic. We hope these findings can be leveraged to increase support for strategies that can improve trust and bolster resilience against future threats.”  

The data from this analysis will be available to download at the Global Health Data Exchange.

An independent population health research organization based at the University of Washington School of Medicine, the Institute for Health Metrics and Evaluation (IHME) works with collaborators around the world to develop timely, relevant, and scientifically valid evidence that illuminates the state of health everywhere. In making our research available and approachable, we aim to inform health policy and practice in pursuit of our vision: all people living long lives in full health.

The Council on Foreign Relations (CFR) is an independent, nonpartisan membership organization, think tank, and publisher dedicated to improving understanding of the world and the foreign policy choices facing the United States and other countries. CFR, in collaboration with IHME, publishes Think Global Health (TGH), a multi-contributor website that examines the ways in which changes in health are reshaping economies, societies, and the everyday lives of people around the globe.