The most important healthcare tool is trust

LONDON — Doctors and nurses have traditionally been among the most trusted people in society. According to the Wellcome Global Monitor, the largest-ever survey of public attitudes toward science and health, that remains true: More than 70 per cent of survey participants reported that they trust scientists, doctors and nurses. But their responses also indicate that there is no room for complacency.

Half of the 149,000 respondents, representing over 140 countries, reported that they know little or nothing about science, and almost one in five don’t think that it benefits them personally. This lack of engagement with science raises serious — even life-threatening — risks.

Consider attitudes toward vaccines. Globally, the vast majority of people recognize that vaccines are safe, effective, and important. But in some wealthy countries, the share of people who trust vaccines is plummeting. In France, for example, 33 per cent of people do not believe that vaccines are safe and effective.

The impact of vaccines depends on herd immunity: The protection of communities, including people who cannot be immunised for reasons like illness or age, by vaccinating most of their members. While most children in France still receive the measles vaccine, there are areas where immunisation rates have fallen below the herd-immunity threshold of around 95 per cent.The results have been devastating. The number of measles cases reported in France increased sixfold in 2018: three people died, and many more were left with life-altering health problems. 

Falling immunisation rates in some areas of the United States and the Philippines also produced measles epidemics in those countries in 2018 and 2019. 

Education undoubtedly plays a role in shaping attitudes toward vaccines, but so do myriad personal, social, religious, and cultural factors — and, most fundamentally, trust. In fact, trust in science and healthcare is linked to trust in government and other national institutions. When confidence in one is lost, confidence in the rest tends to suffer as well. And when faith in all of these spheres is depleted, the consequences are typically disastrous.

The Democratic Republic of the Congo is a case in point. Decades of war, insecurity and neglect have decimated trust in institutions across the east of the country. So, when an Ebola epidemic broke out last August, those charged with implementing the response — including government officials, international health agencies, and even local community health workers — were met with deep suspicion and even hostility. Treatment centres have been attacked, leaving health workers dead and injured. Meanwhile, the epidemic’s death toll has continued to rise.

To prevent the Ebola outbreak from escalating further, the relevant actors — from health workers to government officials — must re-engage with the affected communities and win back their trust. Fortunately, as neighbouring Rwanda has proven, this is entirely possible.

In 1994, Rwanda endured a brutal genocide, in which an estimated 800,000 people were killed in the space of only 100 days. This harrowing experience left behind destroyed property, a failed state and a traumatised population with little faith in local or international institutions. National basic immunisation coverage was less than 30 per cent.

But, in the ensuing years, government and international partners engaged actively with local communities, in order to rebuild trust. Their efforts worked: Wellcome Global Monitor shows that 99 per cent of people in Rwanda now recognise that vaccines are effective and important, and 97 per cent have confidence in their health system overall — more than in any other country.

This has enabled significant progress on health. Basic immunization coverage is now up to 95 per cent. 

In 2010, Rwanda became the first country in Africa to introduce a programme focused on reducing the risk of cervical cancer — the most common cancer in Rwandan women — by providing the vaccine against human papillomavirus (HPV). The government aims to eliminate cervical cancer deaths within the next few decades.

Public-health outcomes like that cannot be achieved without trust. No matter how exciting the treatment, how clever the delivery method, or how robust the science, there will be no impact unless the local community is open to it.

A single survey cannot explain why people feel the way they do, let alone offer a foolproof strategy for governments, international institutions and healthcare professionals seeking to win people’s trust. But, as the world faces profound science-related challenges — from climate change to antimicrobial resistance — policymakers, practitioners, and civic leaders would do well to learn as much as possible from the Wellcome Global Monitor’s unprecedented, unique, and invaluable data.

Jeremy Farrar is Director of the Wellcome Trust, a global charitable foundation dedicated to improving health. Project Syndicate, 2019.
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