Trust is the bedrock of all relationships and is a key ingredient to establishing effective relationships between different players, be it researchers, communities, countries, policymakers or scientists. In this blog Lynda Keeru shares a discussion between Prof Doris Schroeder, Lauren Paremoer and Ethan Greenwood in the Trust, Trustworthiness and the COVID-19 pandemic webinar, organized by the Global Health Network. The blog captures lessons, best practices and processes in build and maintaining trust in international research particularly in the face of epidemics.
Doris defined trust, trustworthiness and explained to the webinar participants on the difference between the two. Trust is given while trustworthiness needs to be earned. Public health authorities and governments need to earn trust of the population they serve and the population/citizens on the other hand should give trust.
Community engagement and various other exercises should be included in research processes to increase trust in international research. Doris noted that it is not often that the trustworthiness is examined and emphasized and that this should be done regularly. She reflected on the key things that should be done to strengthen trust and identified fairness, respect, care and honesty as key values. They are not only ethical values, but also personal characteristics. To this end, you can assess whether a person acts with fairness, respect, care and honesty; or whether they act out of the opposite which is self-interest, manipulation, hypocrisy and dishonesty. During the COVID-19 pandemic, significant distrust was observed among countries during the pandemic. Unfortunately, it requires a lot of courage to point out when leaders are operating from a point of self-interest. A closer relationship between ethicists and psychologists would help pinpoint particular topics and issues; like manipulation in social media that hampers COVID-19 efforts.
Doris shared best practices from a project she was involved in that aimed to build trust in international research despite significant resource differentials. She indicated that a majority of leaders were from low- and middle-income countries (LMICs) and the majority of team leaders were women. They had two communities from Kenya and South Africa involved from the start who gave input on exploitation risks. They documented 88 such risks. They then analyzed and mapped them out into ethical value. All of them zeroed into fairness, respect, care and honesty. This work has been translated into a practical framework for others to use.
Lauren’s presentation focused on social citizenship and the idea that states have an obligation to realize the welfare of citizens. This could mean their health but also their welfare in other dimensions including education. States are positioned differently in the global political economy in terms of ability to realize this obligation. Historically, LMICs have struggled to realize the social rights of their citizens and one of the key drivers of this has been the lack of access to public monies and resources in order to deliver on the promises of social inclusion.
A long view by political scientists locates this lack in historical dynamics, particularly colonial dynamics. The incorporation in the global political economy has led to developing states focusing more on extractivist modes of production, to prioritize their foreign obligations more that their social obligations towards citizens. For this reason, even with COVID-19, many citizens have felt abandoned by their states and having abandoned prioritization of their wellbeing in the service of growing the economy and serving needs of global capital. On a concrete level, this is reflected in disinvestment of systems, particularly public health systems and the increasing privatization of care. These are some of the structural issues that made it hard for citizens to access care during the pandemic; and this was experienced both in the global north and south.
In LMICs, problems with trust are not necessarily only with the state, but also with the global political economy. A concrete example of this is that in November 2021, South African scientists undertook excellent surveillance on COVID-19 mutations and they identified the Omicron variant and were transparent in their communication. They said that it was highly contagious and because of where South Africa is positioned in the global political economy, they received a lot of blows including border closures and stigmatization. Owing to this, when we think of trust, we should not think of it only in terms of government versus citizens.
Ethan shared a presentation with a focus in the context of the pandemic. Just when the pandemic had begun and lockdowns were in full swing, trust in scientists across the world increased in every region except for Sub-Saharan Africa, Russia and Central Asia. Trust generally increased in all types of institutions including doctors and governments. One explanation for this might be since all people were in this crisis, they had no choice but to trust what they were told. People interviewed stated that they trusted doctors and nurses the most, then health organizations, closely followed by governments. Despite the high trust in scientists, only a quarter of people felt that their governments valued scientific advice.
Trust in what science creates in terms of trust in vaccines is very much linked to trust in scientists but it is not a black and white issue and it varies. In France for instance, trust in scientists is high and distrust in vaccines is also quite low. The correlation generally does stand. In LMIC’s, trust tends to be high and whether or not there was trust for vaccines, it did not make a difference.
In order to increase trust, scientists must and should listen and understand the needs of the public. Trust among the public really does vary within countries. In about 80% of countries where people said that they were living comfortably, they were more likely to trust scientists than those who said that they did not were just getting by or struggling. It is important for governments and other partners to be perceived as competent and reliable. Consistent communication is also crucial.
Prof. Doris Schroeder
Dr. Lauren Paremoer
Prof. Michael Parker