Public trust in governments is important for effective pandemic control but has been badly damaged. What might help to rebuild it? Jennifer Doggett investigates.
Jennifer Doggett writes:
Vaccine shortages have been in the spotlight as Australia struggles to combat the spread of the COVID Delta variant.
But another crucial component of our public health response is also in short supply.
Public trust in governments’ ability to contain the pandemic is waning. With the growing crisis in NSW, governments need to act urgently to rebuild confidence in public health measures to contain current outbreaks and to support the vaccine rollout.
The extension of the lockdown in NSW will only be effective in stopping the spread of the Delta variant if NSW residents adhere to the lockdown requirements and follow advice on testing and isolating.
Without widespread support for these measures, the NSW Government will be powerless to prevent further outbreaks. Despite the tough words from Premier Gladys Berejiklian, the NSW Government does not have the resources to police and enforce these measures in the face of widespread public dissent.
International experience demonstrates the important role of trust in the success of public health measures to combat the COVID pandemic.
A major factor in the devastating death toll in the USA from COVID was the lack of consistent support across the community for public health responses. The lack of trust in COVID vaccination in some areas of the country is now causing outbreaks and preventable deaths.
The USA is the richest country in the world but could not buy its way out of the pandemic. Poor leadership, political divisions and a lack of trust in public health measures hindered an effective response, resulting in over 600,000 deaths there to date – more than any other country.
Last year, in the initial stages of the pandemic, trust in government was high.
However, the level of trust in the Coalition Government has deteriorated since then due to repeated policy failures, the politicisation of the pandemic response and inconsistent and inadequate public communications.
Border closures between states (and even divisions within cities) have challenged our identity as Australians.
Unless this trend is reversed, Australia will face a longer and harder road out of the pandemic and will be unable to prevent more hospitalisations and deaths.
Rebuilding public trust will be a challenge when current governments are clearly failing the community in many other areas of health, such as in addressing the health impacts of climate change (which in the long term will be much more damaging than COVID.)
Given this poor track record, governments should not expect automatic support from the community for COVID response measures – particularly from sections of the community who have previously been overlooked and ignored in policy development processes.
Rebuilding trust will require a genuine effort from governments to refrain from the politicisation of the pandemic response, increase transparency around policy decision making and to improve engagement with affected communities.
Some suggestions for action are outlined below.
1. Stop politicising the responses
A key factor undermining trust in public health measures is the ongoing politicisation by governments of the pandemic response, including jurisdictional and partisan disputes and the scapegoating of experts and advisory bodies.
While in the early days of the pandemic there appeared to be a commitment to a unified response via the National Cabinet, this quickly deteriorated into jurisdictional disputes over border closures and vaccine supply.
Federal and state leaders have fought public and partisan political battles and pitched the interests of their citizens against each other rather than promoting a joint approach across political and jurisdictional lines.
Even within Coalition ranks there has been public disagreement about public health measures. This disunity has been exacerbated by the Prime Minister’s failure to act when Coalition members actively undermine the Government’s approach.
The undermining and scapegoating of expert advice to governments has further eroded trust in governments, and their ability to prioritise the long-term well-being of the community over short-term political interests.
The Federal Government has performed particularly poorly in this regard, with alleged backgrounding of the media against senior bureaucrats and other government insiders, including most recently against Federal Health Minister Greg Hunt.
The Prime Minister has also been widely criticised for failing to apologise for clear policy failures, while blaming expert advisory groups for government decisions.
Senior figures associated with the pandemic response, such as former Deputy Chief Medical Officer Dr Nick Coatsworth, have publicly criticised the Australian Technical Advisory Group on Immunisation (ATAGI) and attacked independent academics for stating their opinions about the AstraZeneca vaccine and other pandemic issue.
2. Clarify the role of expert advice
One simple action that governments can take is to clarify the role of experts in providing advice that is then used by political leaders to develop policies.
Experts play a critical role in informing Australia’s COVID response. But they are not policy makers and are not accountable to the community for how governments respond to their advice.
Bureaucrats also play an important role in advising governments but as non-elected representatives should never be made responsible for political decisions.
If public servants, advisory groups and other experts are scapegoated for policy failures, they may well be reluctant to provide information to government in the future.
This will undermine Australia’s ability to develop evidence-based and effective public policy responses and is not in the long-term interests of either governments or the community.
While ATAGI’s advice on the AstraZeneca vaccine may have been very politically inconvenient, their statements make clear their considerations have been driven by scientific evidence rather than political considerations
If political leaders want input from Australia’s best and brightest scientists and experts, they need to respect their autonomy and independence, and not make them responsible for political and policy failures.
3. Media’s responsibilities
The media can also play an important role by clarifying the role of experts in advising governments and in educating themselves on the range of different disciplines involved in the COVID response.
Frequently the media reports on “medical advice” or “health advice” as though there is one agreed position on COVID responses from experts.
The reality is that COVID is a complex public policy issue with many dimensions.
Experts from a range of different disciplines (including medicine, public health, virology, communications and logistics, among others) all bring different perspectives that should be taken into account by governments when forming their public policy response.
There is no single authoritative opinion on COVID and the media has a responsibility to reflect this in reporting on this issue.
Articles such as this recent Crikey story are both unfair and unhelpful in criticising experts who have a great deal to offer in the current pandemic environment.
For example, ABC broadcaster Dr Norman Swan has considerable expertise in public communications on health and medical issues and is likely much more up to date on COVID than most practising clinicians who have little time to spend on getting across this issue.
Policy consultant and UNSW Adjunct Professor Bill Bowtell has decades of experience in public health responses to infectious diseases and is internationally recognised for his expertise in this area. His knowledge and networks are a valuable resource that should be used to inform Australia’s COVID response.
Media reporting on COVID responses could do much more to educate the public about the multidisciplinary nature of public health and the need for input from a range of different experts across academia, health, public policy and other sectors.
4. Address communications failures
Communication from governments and health authorities is also crucial to building public trust. There have been some excellent examples of government communication during the COVID pandemic but also many areas for improvement.
Among the positive examples are the daily press conferences held by Victorian Premier Daniel Andrews (and to a lesser extent other state premiers).
The inclusion of sign language interpreters at press conferences has made them accessible for the Deaf community and federal and state departments of health have regular updates on COVID infections, hospitalisations and deaths.
Some state governments have produced engaging and well-targeted communications and used social media to spread essential information.
Unfortunately, these efforts have been undermined by multiple communications failures by governments.
The Commonwealth’s COVID communications were slow to release and were widely criticised for poor messaging and cultural insensitivity.
Inadequate provision of microphones to journalists at press conferences prevents viewers from hearing their questioning of political leaders and spokespeople.
Too little effort has gone into the distribution of information on COVID that was collected and produced by governments. Most people don’t go to government department websites for health information and even if they do, they are not very user-friendly and are difficult to navigate.
Conflicting messages from politicians have added to the confusion and clouded an already complex issue.
The lack of an agreed consistent message from governments has led to the media and community focussing on other sources of information, for example, the advice from ATAGI on vaccinations.
This has caused problems, not because ATAGI’s advice was problematic but because its role is to advise government. ATAGI has never been a public-facing organisation and should not be responsible for the Government’s communications to the public.
Communicating about risk and public health issues is a complex area and needs expert input.
This expertise should be used to develop effective and consistent government communications and should not be left to health departments or expert groups without experience and knowledge of public health risk communications.
5. Draw on communities’ knowledge and networks
The lack of systematic community input into government decision making on COVID is also undermining trust in Australia’s public health response.
COVID presents a complex policy environment. Governments need to balance the competing risks and benefits of various possible responses across diverse communities.
Clearly in an emergency situation, such as the initial stages of the pandemic last year, quick decision making is required and extensive consultation is impossible.
But as we move forward into the “chronic” phase of the pandemic, this needs to change.
Around the world countries have responded very differently to this public health threat. All options have risks and benefits and while evidence does show that an early hard lockdown reduces both deaths and economic impacts, this response carries some significant costs.
This new analysis in BMJ Global Health by researchers from Australia, the UK and USA, ‘Is the cure really worse than the disease? The health impacts of lockdowns during COVID-19’, concludes:
It appears clear from evidence to date that government interventions, even more restrictive ones such as stay-at-home orders, are beneficial in some circumstances and unlikely to be causing harms more extreme than the pandemic itself.”
Australian governments will maximise public support for future pandemic responses if they take into account the values and concerns of our diverse communities.
This is unlikely to occur given that currently consumer and community engagement is limited to a single consumer representative on some of the expert advisory groups, such as ATAGI.
Governments also need to do better in engaging with the groups most impacted by containment measures and those most vulnerable to COVID. These include Aboriginal and Torres Strait Islander people, older Australians, people with disabilities and chronic conditions migrant communities and people in insecure and sub-standard housing.
Now the initial crisis has passed, we also need to establish ongoing mechanisms for consultation with these communities about future COVID responses.
Rebuilding trust in the public health response to COVID is critical to our long term success in combatting the pandemic. Along with action in the above areas, governments at all levels (in particular federal) should also:
Regulate social media platforms: As discussed in this article by Associate Professor Lesley Russell, more needs to be done to combat the spread of COVID mis/disinformation via social media. One strategy worth considering is for the Australian Government to follow the lead of the US Surgeon General and release an Advisory to warn the public about the urgent threat of health misinformation. The Government should also do more to prevent high profile Australians, such as Clive Palmer, Alan Jones, George Christensen and Craig Kelly from spreading mis/disinformation.
Learn from experience: If we are going to require lockdowns in the future, we need to learn from past mistakes and be better prepared to reduce the adverse impacts on vulnerable groups. We also need to learn from the success of Aboriginal and Torres Strait Islander communities, who are now being internationally recognised for their community-led approaches.
Watch public health leader Adjunct Professor Michael Moore
See our previous coverage of health communications.
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