Deadly disease outbreaks don't just challenge public health, they undermine public trust in government institutions, according to new research by political scientists at Indiana University Bloomington and the University of Konstanz in Germany.
Associate Professor of Political Science Ore Koren
The study, "Infectious disease outbreaks drive political mistrust," published in the journal Proceedings of the National Academy of Sciences (PNAS), reveals that exposure to infectious-disease outbreaks significantly reduces public confidence in key political institutions, including presidents, parliaments, and ruling parties.
The study was co-authored by Ore Koren, Associate Professor of Political Science in the College of Arts and Sciences at IU Bloomington, and Nils Weidmann, Professor of Political Science at the University of Konstanz.
Utilizing data from the Afrobarometer project, a large-scale survey across dozens of African nations that tracks public opinion on governance, democracy, and social issues, Koren and Weidmann found that populations living close to where an outbreak recently occurred show a statistically significant drop in trust.
"Such crises provoke not only public health crises but also political polarization, the erosion of trust in governance, and potential democratic backsliding," the study authors write. "Exposure to outbreaks leads to a noticeable change in political allegiances as trust in the ruling establishment and the internal security apparatus declines."
Trust in government can facilitate public cooperation by increasing the likelihood that citizens comply with public-health guidance, pay taxes, participate in elections, and engage in collective action. When that trust declines, governments often face greater challenges in managing crises, and citizens may be less willing to engage with public institutions.
The study focuses on "zoonotic" diseases, which are infections that have an animal reservoir but can "jump" to humans and include - among others - deadly pathogens such as Ebola, Marburg, and H1N1 influenza. By combining geolocated outbreak data with survey responses, the researchers compared people that have lived near an outbreak over the past several years to similar individuals farther away.
Koren and Weidmann used a statistical technique called "coarsened exact matching," which allows for fair comparisons between groups with similar demographics, geographic contexts, and other factors, isolating the effect of outbreak exposure on trust.
The results were clear: people living within roughly 100 kilometers of an outbreak, and surveyed within five years afterward, reported significantly lower trust in several political institutions. The decline affected not only presidents and parliaments but also electoral commissions, opposition parties, and police forces. Trust in the military appeared largely unaffected.
"Our results show that outbreaks are not only biological events but major social-political phenomena," Koren and Weidmann write. "They can reshape how citizens view their government."
Implications for Policymakers and Communities
For policymakers and public-health officials, the study suggests that responses to outbreaks must extend beyond medicine and containment strategies. Maintaining and rebuilding public confidence is equally crucial. If institutions lose credibility during or after a health crisis, citizens may ignore official guidance, withdraw from political participation, or engage in distrustful behaviors.
In practical terms, the authors emphasize the importance of integrating public-health preparedness with institutional trust-building. Transparent communication, equitable access to treatment, visible accountability, and community-driven participation are essential to prevent erosion of trust and ensure effective crisis management.
Communities that are already vulnerable, which include rural or remote regions with limited access to healthcare and government resources, may be most affected. The decline in trust can compound the harm caused by disease outbreaks, making recovery slower and social cohesion harder to maintain.
The study's findings have particular resonance in the wake of the COVID-19 pandemic, which has exposed vulnerabilities not only in healthcare systems but also in government credibility and public trust. "Outbreaks must be viewed not just as medical events but political ones, with consequences for societies long after the immediate health threat has passed," the authors write.
Further, Koren and Weidmann note that responding to infectious-disease outbreaks requires more than medical interventions. "There is a critical need for policy strategies that integrate public-health preparedness with efforts to preserve and rebuild institutional trust during outbreaks." For example, governments should not only contain and treat diseases but also communicate transparently, ensure equitable access to healthcare, and actively engage communities in the response process. Doing so, the authors assert, may prevent political polarization, sustain social cohesion, and strengthen democratic resilience.
For governments, the findings suggest that public health outcomes and political trust are closely linked; weaknesses in either area may contribute to social fragmentation and reduce the effectiveness of democratic governance.
Koren is a recent recipient of the prestigious Humboldt Research Fellowship from the Alexander von Humboldt Foundation in Germany. During the fellowship, he collaborated with Weidmann on several projects related to public health, political mistrust, and instability, including this study.
