Kamal R. Mahtani and Sean Heneghan

“without trust we cannot stand” —Confucius

The UK is now entering its seventh week of lockdown, with no immediate signs of respite. At his first briefing since recovering from his illness, Boris Johnson the UK’s prime minister made it clear that the nation should “contain your impatience” as we approach “the end of the first phase of this conflict.” The prime minister spoke of the need to meet five tests before moving to a “second phase”—whatever that may be.

At the daily Coronavirus briefings, the UK government’s advisors have, thus far, confirmed that the vast majority of the public is listening, citing the rapid fall and continued lower level of daily use of transport as a surrogate for public adherence to social distancing.

The high adherence is probably influenced by several factors, including fear of catching or spreading the virus, law abidance and trust that the government is acting in the best interests of the nation. In return, the government has often justified its actions on the basis that they are being “led by the science”—a phrase we have become accustomed to hearing from politicians in recent weeks. And who could argue with this approach? Science, by its very nature, is built on systematic methods, objectivity, transparency, reproducibility, and critical review—all trustworthy characteristics.

However, the “led by the science” rhetoric has not been without criticism. Some of the criticisms include concern over a lack of transparency about who makes up the membership of the Scientific Advisory Group for Emergencies (SAGE), which provides independent scientific and technical advice to support Government decision-making during emergencies. The membership of this group has now been revealed. Others have criticised what they see as narrow views from the membership, with a lack of involvement from broader public health expertise, as well as over-dependence on modelling studies, which may not yet have been subject to critical review and have known limitations. In some cases, “rival” groups of scientific experts are coming together to offer advice on easing the lockdown. 

Public trust in science 

Reports of such tensions are unlikely to enhance public trust. If anything, recent history should have taught us how fragile the relationship between public trust and science can be. In June 2015, the then UK Chief Medical Officer asked the Academy of Medical Sciences to investigate how to restore public trust in scientific evidence for decision making. At the time, there was concern that widespread debate over government policies for the management of the 2009 swine-flu epidemic, including the impact of stockpiling antiviral drugs, could affect public trust negatively. In their report, the Academy recommended “openness in decision-making processes to allow wider society to judge whether decisions are made based on sufficiently robust and relevant evidence.” In 2019, the NHS Health Research Authority (HRA) launched the “Make it Public” campaign with the remit of “enhancing public trust in research evidence and enhancing public accountability.”

Losing trust has consequences

Trust in scientific evidence allows the public to make more balanced judgements on the treatments they are offered. Such thinking is imperative now, as the public is faced with significant public health interventions to tackle the covid-19 pandemic. However, despite the public-facing “led by the science” approach, a recent opinion poll reported a fall in public trust in the UK’s handling of the pandemic. This is worrying; as doubts and a loss of confidence during an outbreak may influence public behavioural responses.

Falling opinion polls may not be the only negative consequences to consider. A new pre-print study reports on how the UK public currently perceives and experiences the government’s pandemic strategy. Online focus groups were formed from members of the public, representing a range of genders, ethnicity, ages, and occupational backgrounds. Despite reporting adherence to social distancing measures, the participants reported a loss of meaning and self-worth, possibly explained by a loss of control. They also said a lack of trust in the government, which some accused of “politicising” the pandemic. The authors suggested that increasing the public’s sense of control should be part of future policy. 

A stronger relationship 

Building trust with the public should be a core theme of the government’s ongoing pandemic strategy, particularly as we look to ease lockdown restrictions. The public will need to trust the government that ministers are sensitive to the fears and anxieties people are experiencing, and have the right strategy to respond. In turn, the government will need to trust the public to implement the next phases of their plan—an example being the high uptake (50-60% of the population) of a mobile app that’s needed to make digital contact tracing possible. 

Greater access to information on Government websites, daily briefings – which now include questions from the public—and balanced ministerial media appearances are steps in the right direction to building that trust. But higher levels of engagement, communication that is open to assessment and high-quality public health education—including the potential strengths and limitations of the “led by science” strategy—may be needed to strengthen the relationship. Despite the ethical and logistical challenges this may present, such efforts may not only enhance trust but also contribute to mutually beneficial outcomes and a stronger relationship in the future.

Kamal R. Mahtani is a practising NHS GP, Associate Professor and Co-Director of the Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences.

Sean Heneghan is a Chartered Organisational Psychologist and Senior Tutor at the University of Oxford.

Both authors lead the University of Oxford Evidence-Based Healthcare Leadership Programme.

Acknowledgements: The authors are grateful to Jeffrey Aronson and Meena Mahtani for helpful comments on an earlier draft.

Disclaimer: The views expressed in this commentary represent the views of the authors and not necessarily those of the host institution, the NHS, the NIHR, or the Department of Health and Social Care. The views are not a substitute for professional medical advice.

Competing interests: None declared