The centrality of (mis)trust in pandemic preparedness in Sub-Saharan Africa: a conceptual framework

Trust is central to pandemic preparedness and the degree to which the population has trust in policymakers and health authorities during an outbreak is based upon historical and social context as well as policy decisions. This paper aims to translate complex ethnographic knowledge into a conceptual framework to simplify multiple temporalities and spatialities of trust. This model is based on the literature, consulting experts and experience conducting research and providing technical assistance in a policy environment during the 2014-16 West Africa Ebola out-break and the 2019-23 COVID-19 pandemic. Trust varies according to past and present decisions and realities and the model focuses on the complexities of trust depending upon populations' historical experience with medicine, (in)effective health systems, social context, colonial history, (dis)trust in public authority and social determinants of health. The world is increasingly interconnected and transdisciplinary and new approaches are needed to deal with these changes. A holistic, context-driven approach which forefronts the importance of gaining the trust of populations and addresses the new problems created during modern experiences of pandemics and epidemics is key to future preparedness efforts.