The effect of COVID-19 on public trust in the World Health Organization: a natural experiment in 40 countries | Globalization and health

The COVID-19 epidemic has infected 274 million people and killed 5.35 million as of December 20, 2021 [1]. The pandemic continues to test the physical and mental health of people with highly transmissible variants of SARS-CoV-2 [2]leading to growing health disparities [3]. It also had a big impact on the economy, increasing both poverty and unemployment. [4]. The pandemic is making life more difficult for vulnerable people. The well-being of women especially deserves more attention given the systemic barriers (eg, sexism) to accessing resources and their position as the majority of front-line health care workers [5]. The duration of this pandemic is unprecedented in modern times, causing social unrest around the world.

The World Health Organization (WHO), founded in 1948, was the first United Nations agency devoted to global health affairs. The Constitution of the World Health Organization prescribes the rights and obligations of WHO to assist all peoples in attaining the highest possible level of health [6]. A central and historic duty of the WHO has been the management of the global regime for the control of international public health crises. [7]. The International Health Regulations (IHR) approved in 2005 set out the responsibilities and obligations of WHO and Member States for the prevention of disease, including the defense and control of the international spread of disease and the provision of preventive measures. public health response [8]. Since then, as the “sole source of legally binding international regulations for pandemic response” [9]WHO has played an increasingly important role in preventing the spread of disease between countries, as evidenced by its response to the pandemic influenza A(H1N1) virus in 2009, poliomyelitis in 2014, Zika in 2014, Ebola in 2014 and 2018 and COVID-19. 19 in 2020 [10].

The IHR, together with other instruments, such as the Global Outbreak Alert and Response Network (2000), the Pandemic Influenza Preparedness Framework (2011), the Network of Public Health Emergency Operations (2012) and the Emergency Contingency Fund (2015), also assist WHO in strengthening national public health systems [9]. In response to the pandemic, WHO plays a key role in two aspects: sharing the health emergency program and building the health system. The WHO Health Emergencies Program has had a significant impact around the world, playing a greater operational role. The health emergencies program includes the prevention of epidemics and pandemics and the response to health emergencies [11]. Throughout the program, tests, treatments and vaccines can be sourced in a timely manner, essential supplies shipped to countries, and health personnel can be protected and trained. In 2019, WHO responded to 55 emergencies in more than 44 countries and territories [10]. Several pandemics in the past have reminded us of the importance of preparedness, of a strong and shock-resilient health system, and of the need to ensure systems capable of maintaining essential health services without financial hardship, especially in times of of crisis. WHO reiterated its commitment to support countries in achieving universal health coverage. By 2019, 91 countries had improved patient safety and 42 countries had implemented national health workforce accounts [10].

During COVID-19, WHO is providing border support for leadership, policy dialogue and strategic support, as well as technical assistance and service delivery [12]. After the Wuhan Municipal Health Commission reported the cluster of atypical pneumonia cases, WHO set up the Incident Management Support Team on January 1, 2020 to deal with the outbreak. At the IHR Emergency Committee meeting held on January 30, 2020, WHO declared the novel coronavirus outbreak a Public Health Emergency of International Concern (USPPI) and helped establish mechanisms national and international emergency coordination. [13]. WHO has taken steps to respond to COVID-19 under a tight budget, such as convening an expert panel to develop interim guidance on best practices for vaccine effectiveness assessments [14]. As of December 31, 2020, 91% of countries had a COVID-19 preparedness and response plan, and 97% had a functioning COVID-19 coordination mechanism [15]. WHO also released the strategic preparedness and response plan to control the spread of the virus and provided technical assistance, including deploying emergency medical teams, establishing a global surveillance system and working with partner laboratories. [15].

Although Article 66 of the WHO Constitution requires legal capacity in the territory of each member [16] and the IHR states that “if a USPPI is declared, WHO shall develop and recommend the essential health measures to be implemented by Member States during such an emergency” [7]these “soft laws” fall short of binding responsibilities [9]and the review board noted that “the RSI has no bite” [17]. Some countries with weaker health systems are unable to follow WHO instructions well [18]. The WHO has also received a lot of criticism, including the irrationality of the WHO occupational health and safety guidelines on COVID-19 [19] and inability to meet the needs of the elderly [20]. Overall review is somewhat unfair [10] given that the failure to control the COVID-19 outbreak in the early stages was caused by ineffective early warning and lack of compliance with States’ obligations under the IHR together [21]. A possible crisis of confidence in the WHO is all the more detrimental as the pandemic poses a threat to vulnerable people and regions. Nevertheless, one can clearly see that the WHO has begun to reshape itself as a coordinator, strategic planner and leader of global health initiatives despite budget shortfalls and diminished status, especially given the growing influence of new and powerful actors. [22].

Only when people trust the WHO will they listen to its advice on pandemic prevention and control and promote global cooperation. It should be noted that trust in social institutions is associated with the adoption of preventive behaviors during the pandemic [23,24,25,26], and health awareness and behaviors are undoubtedly necessary protective measures. A previous study of Americans found that trust in WHO jurisdiction may play an important role in preventive health behaviors in addition to trust in the US Centers for Disease Control and Prevention (CDC). United. [27]. Trust in the WHO has been undermined in recent years. In addition to the above, the level of public trust in the WHO is influenced to some extent by the following.

The global political situation has influenced people’s trust in the WHO because the WHO is funded by a combination of wealth and population based membership fees and voluntary contributions. The news that then-President Donald Trump decided to withdraw the United States from the WHO on July 7, 2020 would call into question the WHO’s financial viability and the future of its many advocacy programs. health care and disease control. [28]. Second, the lack of a strong accountability mechanism, which led to states failing to meet IHR obligations, likely caused the WHO to lose confidence. [21]. For example, India refused to cooperate with the WHO to deal with the H5N1 flu in 2007 [29]. This is a clear violation of the IHR’s minimum response requirement and the member’s obligation to cooperate, but there are no punitive measures under the IHR. Finally, increasing or at least maintaining the quality and timeliness of health or crisis management services is crucial to maintaining trust in WHO. A study in Korea demonstrated that improved trust in central and local government is associated with proactive responses to the pandemic crisis, while deteriorating trust in religious organizations is a consequence of their late approach to the pandemic. crisis [30]. Given the important role of the WHO in global health governance, although many efforts have been made, a public health emergency that has not been effectively prevented and controlled, as evidenced by the increase in morbidity and mortality, is likely to lead to a decline in public confidence in WHO.

A longitudinal survey studied the evolution of public trust in institutions during and after the 2009 pandemic in Switzerland and revealed that trust in almost all institutions decreased between the start of the epidemic and one year later. . The magnitude of the decline was particularly high for the WHO and the pharmaceutical industry benefiting from a relatively high initial level of confidence [31]. Although some researchers who analyzed people’s trust in science during the pandemic and found that the overall level of trust in science remained unchanged after the first months of COVID-19 [32]the reliability of sources of information about COVID-19, such as mainstream media, state health departments, the CDC, the White House and a well-known university, has declined significantly in the United States [33]. However, given the importance of the WHO during this pandemic, the effect of COVID-19 on public trust in the WHO has not yet been well explored.

In this study, we used COVID-19 as a natural experiment to examine whether this pandemic caused a crisis of confidence in the WHO. To be more specific, we adopted a difference-in-differences (DID) method that compounded the variations in trust over time and space during COVID-19 to estimate the influence of COVID-19 on trust. of the public in the WHO. This may have implications for the far-reaching effect of the public health emergency on people’s beliefs, including trust in major international organisations. It can also illuminate the high priority WHO and other international organizations should place on global development, establishing and maintaining public credibility in the face of emergencies, and confidently preventing crises.

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