Preparing Australia for future pandemics: strengthening trust, social capital and resilience

The findings of the COVID‐19 Response Inquiry, an independent report, which was commissioned by the Albanese government into Australia's response to the coronavirus disease 2019 (COVID‐19) pandemic, were released on 29 October 2024. The independent panel, which had substantial experience in public health and economic policy, made nine guiding recommendations and 26 actions to improve Australia's preparedness to manage future public health emergencies.1 Following extensive stakeholder engagement,2,3 the Inquiry highlighted the loss of trust and eroded confidence in government, and emphasised the importance of rebuilding trust and resilience with populations, communities and settings that were most negatively affected by the COVID‐19 pandemic and related measures. Equity was emphasised as a cornerstone for pandemic preparedness, to proactively address populations most at risk and consider existing inequities in health when developing pandemic responses.1 The Inquiry found that, in Australia, similar to other high and middle‐income countries,4,5,6 the COVID‐19 pandemic disproportionately affected priority populations through morbidity, mortality and the impact of the pandemic response measures.1 Priority populations were defined as those groups who experienced an inequitable burden of disease and disparities in health and economic outcomes during the COVID‐19 pandemic.1 These differences arise due to inequities in the social determinants of health, including education, employment, socio‐economic group, housing stability, access to health care, and experiences of racism.1 Individuals may also experience intersecting layers of inequity and face disproportionate impacts from pandemic response measures.1

In Australia, non‐Australian born individuals, those living in areas of higher socio‐economic disadvantage, and Aboriginal and Torres Strait Islander peoples died of COVID‐19 at higher rates than non‐Aboriginal and Torres Strait Islander peoples born in Australia.7,8 Public health restrictions also affected priority populations disproportionately, specifically culturally and linguistically diverse communities, people with disabilities, people experiencing homelessness, children, and individuals in residential aged care.1

In this perspective article we outline the critical knowledge gaps in understanding the roles of trust, social capital and resilience in balancing future pandemic public health restrictions with disease transmission and mortality, and the key role these factors may play in future pandemic preparedness.

Knowledge gaps: the role of trust, social capital and resilience in the COVID‐19 pandemic

Trust in government and science, social capital and individual resilience have been shown to affect individuals’ and communities’ recovery from natural disasters, economic crises, and pandemics.9 However, modelling of optimal COVID‐19 public health restrictions has largely neglected these elements, instead focusing on health and economic benefits such as cost‐effectiveness, infection rates and mortality.10 As governments and policy makers prepare for future pandemics, trust, social capital and resilience should be examined and quantified to determine their roles in mitigating the harms of future pandemics on priority populations as part of equitable recovery and future responses (Box).

Restoring trust in government and science is critical to pandemic preparedness

Trust in government and science have been shown to be important factors in crises, including natural disasters, economic crises and pandemics. The COVID‐19 Inquiry found that although trust in government was high during the early phase of the pandemic in Australia, there was a growing loss of trust as the pandemic restrictions remained in place.1 The Inquiry found that the rationale for population‐based behavioural interventions were supported by the available evidence early in the pandemic and communicated clearly to the community. However, later in the COVID‐19 pandemic, trust in government declined because of the stringency and duration of restrictions and mandated measures and the lack of transparency and supporting evidence for public health decisions.1 Trust in science in Australia has been among the highest globally both before and after the COVID‐19 pandemic.11,12 However, trust in science was challenged during the pandemic when jurisdictions took different approaches in similar situations while telling the public they were listening to science. The Inquiry also found that trust in science was eroded by vaccine mandates when community members experienced becoming sick with COVID‐19 after receiving the vaccination.3 Concerningly, in a 2024 community survey conducted for the Inquiry, 21% of the 2126 respondents said they would not get a vaccine offered by the government in a future public health emergency, and a further 17% said they may or may not get vaccinated.3 The Inquiry found that a range of individual negative experiences undermined trust in government, including being stranded overseas, not being permitted to see dying loved ones, feeling frustration around changing restrictions, and being unable to access supports.1

Research has shown that trust may also play a role in the rate of COVID‐19 cases and mortality. A large study of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infections and deaths in 177 countries (January 2020 – September 2021) found that higher government and interpersonal trust was strongly and significantly associated with fewer infections, but not with the case fatality rate.9 High government and interpersonal trust and lower government corruption were associated with higher COVID‐19 vaccine coverage in both high and middle‐income countries. The study estimated that if the modelled associations were causal — for example, if government and interpersonal trust in all countries was increased to that of Denmark (75th percentile) — global infections may have been reduced by 53.2% due to government and interpersonal trust.9 Other studies have found that trust in national government was inversely related to COVID‐19 cases and deaths.13 Increasing trust in government was also associated with adoption of public health measures (eg, handwashing, avoiding crowded spaces, self‐quarantine) and pro‐social behaviours (willingness to help others with COVID‐19 and make personal sacrifices to prevent transmission) that may reduce COVID‐19 mortality.14

Trust in science has been associated with higher adherence to social distancing recommendations. Trust in science also predicts an individuals’ likelihood of adhering to prescribed government recommended measures (eg, social distancing, self‐isolation, handwashing) and discretionary COVID‐19 behaviours (eg, donating to COVID‐19 causes).15,16 Of note, a lack of trust in government and science has been shown to follow a social inequality gradient,17 with the poorest 10% significantly more likely to distrust government and science than the wealthiest 10%.18 The COVID‐19 Inquiry emphasised that a loss of trust in government was associated with the level and enforcement of restrictions during the pandemic, highlighting examples such as the lockdowns in public housing towers in Melbourne as eroding trust in police and other authorities among lower socio‐economic and culturally and linguistically diverse communities.1

Explore the role of social capital in future health crises

Social capital is a contextual and multidimensional concept that includes social connectedness and capacity to mobilise social resources.19 Social capital and social infrastructure — the social ties that enable community trust, mutual support and collective action — have been shown to act as “shock absorbers” in recovery from natural disasters.20 The role of social capital was not directly assessed by the Inquiry. However, social cohesion, a byproduct of social capital, was emphasised as an essential component of the social fabric to protect against the economic shocks of the COVID‐19 pandemic. The Inquiry also recognised that, during the pandemic, social cohesion was at risk of harm from racism and discrimination in the community, disinformation and misinformation.1

Research examining the role of social capital during the COVID‐19 pandemic has found that higher levels of social capital (related to civic and institutional bodies) is associated with lower COVID‐19 positivity rates in the United States, after adjusting for health system and individual factors such as social vulnerability, health care and governance capacity and partisanship.21 In another study of over 2700 US counties, higher social capital — trust (in family and communities) and social factors (helping behaviours and collective efficacy) — were associated with fewer COVID‐19 cases and deaths and reduced transmission.22 Counties above the 75th percentile of social capital distribution had 18% fewer COVID‐19 cases and 5.7% fewer deaths than counties below the 75th percentile. Similar inverse relationships between social capital and COVID‐19 mortality have been reported in Europe, where a one standard deviation increase in social capital led to 14–34% fewer COVID‐19 cases and 6–35% fewer excess deaths.23

However, a global study of the relationships between social capital and COVID‐19 mortality in 37 countries in October 2020 found mixed effects.24 This study found that community attachment and social trust (belief in others’ honesty, integrity and reliability) were associated with more COVID‐19 deaths, whereas increased family bonds and security were associated with fewer COVID‐19 deaths. A large data linkage study of 84 countries early in the pandemic found a similar mixed effect of social capital on COVID‐19 deaths, reporting that mortality was positively associated with social trust and negatively associated with social capital from civic engagement and confidence in state institutions.25 The existing literature on the role of social capital during the COVID‐19 pandemic demonstrates complex and sometimes conflicting associations, which needs to be quantified further with research.

Build resilience in interpandemic periods

Resilience refers to individual capacities, the resources and social supports available to individuals, and the circumstances in which they live, work and study.26 Resilience encompasses “bouncing back” from disturbances, negative life events and illness, adaptability, and “bouncing forward” from a disaster.27 It buffers the negative effects of traumatic events such as natural disasters and protects against post‐traumatic stress disorder, and as such, is key to pandemic recovery and future pandemic preparedness.28 However, data on the impact of resilience during COVID‐19 are scarce, and most studies assess its effect on personal wellbeing and psychological health rather than mortality. Studies have shown that self‐reported resilience during the pandemic mediates the relationship between hope, psychological health and subjective wellbeing, which improved psychological health substantially.29 Among nurses, more personal resilience, organisational support and social support was associated with less COVID‐19‐related anxiety.30 Large studies in Israel and the US associated individual resilience and wellbeing with lower COVID‐19 distress.31,32 Building organisational and professional support, particularly for health care workers, may be another key component of pandemic preparedness in mitigating burnout, anxiety and depression among frontline workers.33

The importance of individual circumstances and experiences during the COVID‐19 pandemic has been highlighted in a recent Australian Human Rights Commission report.34 The report's key findings emphasise the impact of the pandemic on groups that cannot easily be categorised using demographic data, such as the challenges of homeschooling for both parents and school‐aged children, individuals experiencing domestic and family violence, those without financial supports to buffer loss of income and people unable to work from home. These findings reiterate the contextual nature of resilience and the importance of improving resilience factors for individuals and communities during interpandemic periods.

Conclusion

The Australian COVID‐19 Inquiry report has found that the government can no longer rely on people willingly adhering to public health restrictions similar to those implemented during the COVID‐19 pandemic in a future public health emergency.1 The Inquiry found that aspects of the pandemic response diminished trust and eroded public confidence.1 National planning for future pandemics must be centred on a rebuilding of trust, social cohesion and the social contract between government and the people, to be adequately prepared for public health emergencies. As the future Australian Centre for Disease Control is being established to prepare and respond to future public health emergencies, we believe that social scientists should be embedded within the organisation to examine and quantify factors such as trust, social capital and resilience. The integration of social sciences with natural (empirical) sciences and epidemiology is essential to better understand the roles these factors have in mitigating the negative effects of future pandemics and related measures on priority populations.