A recent in-depth review published in the prestigious British medical journal The Lancet, in part using Gallup World Poll data, demonstrated a significant correlation between trust in government and COVID-19 infections. The review looked at COVID-related outcomes, trust in government and interpersonal trust (along with many other variables) across 177 countries. The analysis and results were complex, with the usual caveats and statistical cautions -- but in the end, the authors concluded that "higher levels of trust (government and interpersonal) had large, statistically significant associations with fewer infections for the entire study period."
Thomas J. Bollyky, the study's lead author, and his colleagues summarized the findings in a Wall Street Journal op-ed, "Especially in free societies, whether a country succeeds or fails in mobilizing public trust -- between its citizens and their government but also among citizens themselves -- may help to explain its success or failure in limiting infections and death from COVID-19." And, in The BMJ, Bollyky said, "Trust is an area where governments can move the needle, and the fact that it outweighs traditional measures of healthcare capacity and pandemic preparedness should be a wakeup call for all of us as we face the ongoing pandemic and the threat of future disease outbreaks."
Americans' Trust in Government Leaves Much Room for Improvement
These results certainly give reason for us to focus our attention on Americans' levels of trust in their federal government. Here, as has been well-established, we find significant room for improvement -- assuming our goal is, as the Lancet authors suggest, moving Americans' government trust needle.
In 2021, 39% of Americans had a great deal or fair amount of trust in the federal government to handle either domestic or international affairs. The international trust number is the lowest in Gallup's history of asking the question. The domestic trust number is among the lowest. Similarly, Pew Research reports that 24% of Americans say they can trust the government to do what is right "just about always" or "most of the time," near that organization's historic lows.
Plus, Gallup's January update of the most important problem facing the nation shows that 23% of Americans name some aspect of government as the country's top problem, with another 7% mentioning the need to unify the country. That's higher than the percentage mentioning COVID (20%) and the percentage naming some aspect of the economy (22%).
These low levels of confidence in government, coupled with the broad conclusions from the Lancet study, suggest that increased trust in government could have mitigated the impact of COVID in the U.S. -- and, in theory, could do so in the future.
There is at least one caveat attached to this conclusion, however -- the so-called ecological fallacy. This relates to problems associated with efforts to draw individual-level inferences from group-level relationships.
MSNBC headlined its report on the Lancet analysis as follows: "Study shows trust in government helps fight the pandemic." This implies causality at the individual level -- that is, if individuals' trust in government were higher, there would be fewer COVID infections, hospitalizations and deaths. But data showing correlations at the country-by-country level don't support this type of causal inference at the individual level.
The famous sociologist Emile Durkheim many years ago noted that European localities with dominant Protestant populations had higher suicide rates than localities with dominant Catholic populations. But as scholars have pointed out, this doesn't necessarily mean that at the individual level Protestants were more likely to commit suicide. Religious identity and suicide rates in each country could have been high or low for reasons that had nothing to do with one causing the other. Another oft-quoted example was given by William S. Robinson in the 1950s. He noted that literacy was higher in U.S. states where there were more immigrants. This didn't mean, he pointed out, that immigrants were more literate. In fact, the data he analyzed showed that on an individual level, immigrants were actually less literate than others. It just so happened that immigrants had settled in states that had higher levels of literacy.
The authors of the Lancet study take note of this caution in their conclusions: "Finally, this is an ecological analysis and was not designed to provide information about the causes of COVID-19 variation. Although we hope these results will spur discussion about the drivers of COVID-19 outcomes, a causal analysis would require more data and a different study design." In other words, the correlation between trust in government and lower COVID incidence does not necessarily mean that the first of these causes the second. But the data certainly, as they suggest, spur discussion and lead us to look at other individual-level data that speak to the posited relationships.
A poll conducted by CNBC last fall concluded that unvaccinated Americans' reasons for not getting the vaccine included low trust in the federal government. Census Bureau data from December show that lack of trust in the vaccine and lack of trust in the government are among the top reasons chosen by the unvaccinated to explain their vaccine decision-making. And a 2021 poll conducted by Axios/Ipsos showed that Americans' trust in information from the government is much lower among the unvaccinated than among the vaccinated.
None of these studies employs the double-blinded experimental methodology used in medical science to demonstrate direct causality between a treatment or drug and improved health outcomes. I do think, however, it is plausible to assume that Americans' trust in government is at least partially related to their willingness to adhere to government vaccine recommendations. In turn, adherence to government recommendations that Americans get vaccinated and boosted is directly related to lower levels of COVID-19 infections and hospitalizations.
Trust in Government Has to Be Earned
We are now witnessing an interesting (and important) situation in regard to masks in schools that is less straightforward in providing support for the conclusion that trust in government leads to better COVID outcomes. The federal government's Centers for Disease Control and Prevention still officially recommends that students wear masks in schools. But an increasing number of states, including many large states, are dropping the requirement -- that is, going against the advice of the federal government. Significantly, these announcements are coming from Democratic governors in contravention of the recommendations emanating from a Democratic administration. This signifies a direct lack of confidence and trust in what the federal government is saying about masks.
In this situation, unlike the vaccine issue, the actual science -- that is, the physical and social health impact of states (and individual school districts) removing mask mandates in public schools -- is not straightforward. States and the CDC are looking at the same data, presumably, and arriving at different conclusions. It is unclear whether in this instance higher levels of trust in the federal government and its recommendations would lead to more positive health outcomes.
One might assume it is an accepted public good if the citizens of a country have confidence in their federal government. If so, there is certainly room for improvement. Pew Research found a few years ago, for example, that when asked why the public's confidence in government is lower than it was in the past, the No. 1 category of responses given by Americans dealt with the perceptions of poor government performance. Government, in short, must earn its citizens' trust by exhibiting high levels of competence, efficiency and effectiveness in executing its responsibilities.
All of this has not gone unnoticed. President Joe Biden in December signed an executive order, "Transforming Federal Customer Experience and Service Delivery to Rebuild Trust in Government," which addresses these issues head-on. As Biden noted in his announcement, "We have to prove democracy still works, that our government still works and can deliver for our people." This would appear to be a quite reasonable objective.