Legitimacy and trust fundamentally determine a state’s ability to effectively implement policies. Without legitimacy, governments cannot rely on citizens to voluntarily comply with centrally mandated policies, making their implementation costly and the provision of public goods inefficient. This is particularly true in the case of public health interventions, where adherence to recommendations of governments determines the success of policies.
Large scale public health responses during epidemics can strongly affect the perception of states within a short period of time. Specifically the Ebola epidemic that raged in the West African countries of Guinea, Liberia, and Sierra Leone between 2014 and 2015 may have actually improved trust in governments in regions where government intervention was effective while undermining trust where this was not the case. Compared to pre-epidemic years, trust in government entities increased relatively more in regions that saw an intense transmission of Ebola. In Guéckédou, for example, the region in which the epidemic started and subsequently experienced high transmission rates, trust in government strongly increased. These results reflect changes in perceptions induced by the governments’ response to the epidemic rather than by the exposure to the disease itself. That is, in regions where central governments effectively worked to contain the epidemic, citizens began to trust their governments more.
Underlying the increase in trust are multiple causes. People who lived in places with high Ebola transmission rates valued government-led eradication efforts more compared to people who lived in less affected regions. Furthermore, legitimacy especially rose in regions where the majority of population belongs to ethnicities that are politically alienated. Within Guinea, for example, trust particularly rose in remote areas, such as above-mentioned Guéckédou, that have no strong representation in parliament. This suggests that the ability to eradicate a highly infectious disease may have helped excluded groups feel more confident in the quality of their central governments. The epidemic required central governments to involve and coordinate with local leaders and communities in their eradication efforts. This likely increased its legitimacy. If this effect persists, this has positive implication for economic development as legitimacy is an important determinant of state capacity. Greater legitimacy, for example, improves citizen’s tax compliance and thereby enhances the government’s capacity to provide public goods and administer its territories effectively. While this has positive implications for economic development in the longer run, the short-run effects of the epidemic have certainly been devastating. In addition to the strong impact on morbidity and mortality, economic growth has also been affected. A World Bank report, for example, shows that GDP growth has dropped significantly in all three affected countries as a result of the epidemic.
Ebola-induced changes in perceptions also entail political rewards. In the post-epidemic presidential elections, support for the incumbent party disproportionately increased in regions that saw a more intense transmission of the disease.
Taken together, this suggests that by reacting effectively to situations of emergency, governments can increase trust among citizens. In the context of weak states and developing countries, this leaves an important role for international organisations. By providing technical and financial support to governments, they cannot only help eradicate diseases, but also promote state legitimacy. The effectiveness of international relief efforts thereby crucially depends on the involvement of local leaders as well as consideration of local institutions and culture. Simple top-down approaches lack legitimacy and can even result in community resistance.
Featured image credit: Safety suits for the decontamination team by DFID (UK Department for International Development). CC by 2.0 via Flickr.