Trust and Localization: The Missing Tools in Pandemic Preparedness and Response

What is humanity’s best defense against a pandemic or other major threat? You’d be partially right to think: high-tech equipment in gleaming new health facilities, a computer farm in the cloud to collect and share data, highly qualified clinical staff, vast sums for vaccine research and development, and expansive budgets funding expensive national public health systems.

If so, you’d be among those who continue to miss some vital, largely unheralded, and intertwined elements: trust and localization.  That’s the theme of a blog by James White and Rachel Lobe-Costonis that PLoS (Public Library of Science) Global Health Policy published. 

The blog went on to say that a fearless and well-trained workforce, new technologies, and adequate financing to enable action are crucial but insufficient. How do we know this? Let’s look at the 2019 Global Health Security Index, which assessed 195 countries using 34 indicators in categories ranging from prevention and detection to finance. The health systems of the United States and United Kingdom ranked #1 and #2 on the GHSI scale in 2019. But despite their resources, they performed atrociously in their COVID-19 response. In March 2023, the U.K. ranked #176 in COVID-19 deaths per 100,000 out of 195, while the U.S. ranked #181.

What’s missing? The best predictor of pandemic response success was and remains societal interpersonal trust: confidence your neighbor will do the right thing for the common good. That was the conclusion of studies published last year in both The Lancet and Scientific Reports.

Trust and localization go hand in hand. Doctors, nurses, and community health workers form the grassroots effort to keep people well. People you see every day–grocery store workers, public transit drivers, sanitation crews–ensure critical services are available when and where they’re needed to save people’s lives in a pandemic. These are the people neighbors should and can trust.

Investing in community communications channels that provide trusted information from these sources increases the likelihood people will take steps to protect themselves and others. It means relying not on just health workers but also on everyone from religious leaders to teachers, people who understand local culture and can develop messages that resonate with their communities’ values and unique needs.

The blog went on to note how the Abt-led, USAID-funded Local Health System Sustainability project promoted the role of such local actors to help address COVID-19 and HIV. The blog concluded that the people and community structures we interact with every day, perhaps more than any international effort or global organization, will determine our future. And possibly our very survival.