Openness and trust

Are Brean About the author
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Trust based on openness has been crucial in tackling the coronavirus pandemic so far. The first vaccines will be approved soon. This has put openness and trust to a new test.

Photo: Einar Nilsen

If anyone had said a year ago that in the lead-up to Christmas 2020, we would be discussing in all seriousness how many guests the government would allow us to have for the traditional Norwegian celebrations on Christmas Eve, we would have thought it was a joke.

And if they had gone on to say that at the same time, trust in the government would be record-high, we would have written them off as quite crazy.

However, that is precisely the situation we are in today. In November 2020, altogether 72 % of a representative sample of the Norwegian population answered that they trusted information from the government (1). Trust in the government has shown a slight increase throughout the autumn. And we’re not allowed to have more than ten guests on Christmas Eve.

In times of crisis, mutual trust between the authorities and the population is a two-way phenomenon: the population must have confidence in the authorities’ ability to deal with the crisis, and the authorities must have confidence that the population will comply with the applicable regulations. Trust is also a double-edged sword. If a democracy is to function, its citizens cannot be wide-eyed. The authorities must be accountable to their own critical population, a prerequisite for ensuring that power is exercised with due care over time.

With approval of the first vaccines just around the corner, public trust will face a new and important test

Trust is fleeting. In May 2020, it became known that Dominic Cummings, the UK Prime Minister’s aide, had broken the coronavirus regulations by driving 400 kilometres to a family estate while the country was in lockdown (2). When confronted with the accusations, he behaved arrogantly. In the following days, trust in the government’s response to the coronavirus fell considerably, and remained low for weeks. A study published in The Lancet claims to prove a clear causality – the so-called Cummings effect (2).

Norway has been spared the Cummings effect. Nevertheless, we have seen that trust can be fragile, most clearly in connection with the unsuccessful ‘infection-control app’. In April, prior to the launch of the app, 52 % of the population thought they would download it (3). After a lot of criticism, it was withdrawn. Now a new infection control app is about to be launched. This time we are more sceptical and only 41 % now think they will download it (3). This may be a lower percentage than required for the app to have the intended effect. The decline in trust may have destroyed the opportunity to put in place a potentially successful infection prevention measure.

Studies from several earlier epidemics, such as the outbreaks of Ebola in Liberia and the Democratic Republic of Congo, and the SARS outbreak in Hong Kong, have shown that the degree of confidence in the authorities is associated with compliance with the infection control guidelines (4). This is also the case during the coronavirus pandemic. When restrictions on movement were introduced in European countries in spring 2020, the fall in national mobility was clearly greatest in countries where trust in the government was highest (5). The effect appears to extend as far as the most important endpoint: mortality. In a survey comparing 84 countries, mortality due to COVID-19 was negatively associated with confidence in the national authorities, even when controlled for other factors (6).

Increased openness can only result in increased trust – and consequently greater vaccine coverage

Norway is one of the European countries that have so far managed best in the pandemic. There are multiple and complex reasons for this. However, high confidence in the government is an important factor. A strategy on the part of political as well as infection control authorities, based on transparency regarding the basis for decision-making, uncertainty and internal disagreement, has undoubtedly been instrumental. With approval of the first vaccines just around the corner, public trust will face a new and important test. Confidence is necessary in achieving a high vaccination coverage. Once again, such trust must be earned through openness. Nor are there any reasons today to doubt the Norwegian authorities in this respect.

However, the responsibility for openness about the vaccines extends beyond the national authorities. Transparency has traditionally been in short supply in pharmaceutical companies’ registration trials (7). Therefore, it was an important step forward when four of the largest vaccine manufacturers decided in October 2020 to make their study protocols for phase 3 trials publicly available (8). But there must be greater openness, because willingness to be vaccinated against COVID-19 is declining worldwide (9). While the principle of data sharing in biomedical research has long been debated, it has been little practised, at least not in registration trials (7). Phase 3 studies of COVID-19 vaccines are an excellent starting-point. All baseline data must be published. Increased openness can only result in increased trust – and consequently greater vaccine coverage. It boosts the chances that we ourselves can decide how many guests we will invite on Christmas Eve 2021.

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