This month, we mark the second anniversary of the lockdown ordered by Western governments to prevent the spread of Covid-19. It is time to step back and consider what has happened, where we failed and how we can be better prepared for the next crisis. At present, the four forces that determine health outcomes are physical environment, economic environment, social environment, and personal choice/behavior. Now we can add a fifth to the list: trust.

The Lancet published an article two months ago on the important role of trust in determining vaccine willingness and lower infection rates from Covid-19. The team, led by Dr. Thomas J. Bollyky and Dr. Erin Hulland, examined data from 177 countries and territories. The stunning findings of the study were that global attainment of interpersonal trust in the 75th percentile (equivalent to Denmark) could have led to a 40 percent reduction in global infections, while the equivalent of Denmark’s level of trust in government would have reduced global infections by 13 percent.

Meanwhile, Dr. Heidi Larson, founding director of the Vaccine Confidence Project at the London School of Hygiene & Tropical Medicine, and author of STUCK: How Vaccine Rumors Start – and Why They Don’t Go Away, found: "Vaccine acceptance is about a relationship, about putting trust in scientists who design and develop vaccines, industries that produce them, health professionals who deliver them, and the institutions that govern them. That trust chain is a far more important lever of acceptance than any piece of information. Without these layers of confidence, even the more scientifically proven and well-communicated information may not be trusted." 

The Edelman Trust Barometer Special Report: Trust and Health, conducted last month in 10 markets (Canada, China, France, Germany, Japan, Mexico, Nigeria, South Korea, UK and the U.S.), looked at the impact of trust on health outcomes. Here are the key findings of the survey:

1. Trust influences individual health outcomes—There is a 21-percentage point difference (82 percent vs. 61 percent) in vaccination rates between those with higher and lower trust in the health ecosystem, across the nine markets in our global average. The difference is 38 percentage points for the U.S. (84 percent vs. 46 percent). There is also a 19-percentage point gap on doing preventive care/routine check-ups (66 percent vs. 47 percent) for those who have higher versus lower trust in the health ecosystem (with a stunning 28 percent compliance level in Canada for those with lower trust, versus those with higher trust at 56 percent).
2. Trust enables acceptance of evolving science—As health experts update their recommendations based on developing information, those with higher trust in the health ecosystem are 21 percentage points more likely to willingly accept the new guidance (72 percent vs. 51 percent). Those with lower trust are more likely to doubt the experts.
3. Trust allows for acceptance of public health measures despite curbs on personal freedoms—Those with higher trust in the health ecosystem are 16 percentage points more likely to agree with putting other people’s health risks ahead of concerns over personal liberties (58 percent vs. 42 percent). Respondents with lower trust were more likely to take the view that no one should be forced to accept medical treatments or adopt health-protecting behaviors they don’t want to.
4. Trust mitigates the health consequences of social disparities—Among those with low-income levels, achieving a higher trust level in the health ecosystem boosts vaccination rates by 14 percentage points, making it equivalent to high income earners (79 percent). The same positive effect is seen in preventive care, with low-income earners nearly as likely to seek regular checkups as high-income earners if they have higher trust in the health ecosystem. 
5. Trust is undermined by politics and lack of quality information—There has been a steep (10 percentage point) drop in confidence in making informed health decisions in the past five years, especially in lower income groups (down 14 percentage points to 54 percent). Over half (55 percent) worry that medical science is being used to support a political agenda, even higher among high-income earners (61 percent), urban dwellers (59 percent) and Republicans in the U.S. (61 percent). 
6. Trust is compromised by poor information consumption habits—Among those who are unvaccinated because they don’t want to be, the number one source of vaccine information is Internet search, followed by friends and family. Only half of respondents consume health information at least once a week; under 50 percent in nearly every Western democracy (UK at 37 percent).
7. Trust relies on ‘My Employer’—Over three quarters of employees want their employer to play a meaningful role in their health, from mental health support to providing health incentives and information. 
8. Trust in healthcare companies is under pressure—At the height of the pandemic, trust in healthcare companies spiked to 73 percent. That high has evaporated, with trust falling to 62 percent. Globally, trust in healthcare companies is lowest among rural, suburban and low-income respondents, while healthcare companies face particularly low trust in the U.S. among Blacks and Hispanics. 

This special Trust report is a call to action. We must recognize that science has been hijacked by politics, maligning trust in the health ecosystem. Moreover, government’s trust deficit has clouded healthcare advances, so much so that the speed to market by vaccine makers is seen not as a miracle but as an insufficiently tested, government-prompted intervention. Tempers are still raw; witness the mass protests in Ottawa against vaccine mandates by truck drivers in deeply civil Canada.

The task for communicators is to acknowledge that, as with government trust, overall health trust will not be rebuilt in the short term and not through the classic channels of mainstream media. Instead, those with lower trust in the healthcare system must be engaged directly—through their doctors, pharmacists, faith-based organizations and employers. And, as trust is built by action, racial and economic disparities on access to quality healthcare must be resolved as a matter of urgency.

Richard Edelman is CEO.