title: Public health and public trust: Survey evidence from the Ebola Virus Disease epidemic in Liberia.
abstract: Trust in government has long been viewed as an important determinant of citizens' compliance with public health policies, especially in times of crisis. Yet evidence on this relationship remains scarce, particularly in the developing world. We use results from a representative survey conducted during the 2014-15 Ebola Virus Disease (EVD) epidemic in Monrovia, Liberia to assess the relationship between trust in government and compliance with EVD control interventions. We find that respondents who expressed low trust in government were much less likely to take precautions against EVD in their homes, or to abide by government-mandated social distancing mechanisms designed to contain the spread of the virus. They were also much less likely to support potentially contentious control policies, such as "safe burial" of EVD-infected bodies. Contrary to stereotypes, we find no evidence that respondents who distrusted government were any more or less likely to understand EVD's symptoms and transmission pathways. While only correlational, these results suggest that respondents who refused to comply may have done so not because they failed to understand how EVD is transmitted, but rather because they did not trust the capacity or integrity of government institutions to recommend precautions and implement policies to slow EVD's spread. We also find that respondents who experienced hardships during the epidemic expressed less trust in government than those who did not, suggesting the possibility of a vicious cycle between distrust, non-compliance, hardships and further distrust. Finally, we find that respondents who trusted international non-governmental organizations (INGOs) were no more or less likely to support or comply with EVD control policies, suggesting that while INGOs can contribute in indispensable ways to crisis response, they cannot substitute for government institutions in the eyes of citizens. We conclude by discussing the implications of our findings for future public health crises.
authors.affiliation: Department of Political Science and Watson Institute for International and Public Affairs, Brown University, Box 1970, Providence, RI 02906, USA. Electronic address: robert_blair@brown.edu.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Blair
authors.affiliation: Department of Political Science, MIT, 77 Massachusetts Ave., E53-413, Cambridge, MA 02142, USA. Electronic address: bmorse@mit.edu.
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: Morse
authors.affiliation: Department of Political Science, MIT, 77 Massachusetts Ave., E53-413, Cambridge, MA 02142, USA. Electronic address: l_tsai@mit.edu.
authors.forename: Lily L
authors.initials: LL
authors.lastname: Tsai
mesh_terms: D004196:Disease Outbreaks / Q000517:prevention & control*; D035082:Federal Government; D019142:Hemorrhagic Fever, Ebola / Q000517:prevention & control / Q000523:psychology* / Q000628:therapy; D006801:Humans; D007988:Liberia; D009938:Organizations / Q000592:standards; D011634:Public Health / Q000592:standards*; D011795:Surveys and Questionnaires; D035502:Trust
keywords: Ebola Virus Disease; Epidemics; Household surveys; Liberia; Trust in government