Assessing the Impact of Decentralization on COVID-19 Containment Measures, Public Trust in Government, and Trust in the Vaccine: A Multi-Country Study

Countries implemented COVID-19 containment measures based on their decentralization level, which influenced public trust in both the government and the vaccine. This study aimed to evaluate how decentralization influenced the effectiveness of COVID-19 containment measures, public trust in government, and trust in the vaccine across 18 countries.

A cross-sectional design was employed, drawing on a multi-country dataset from an international survey conducted in 2022. Data were collected through stratified random sampling, using an online survey administered via country-specific panels.

Multiple states with 18 countries.

18 000 adult participants.

Decentralization was assessed using the Regional Authority Index, and government containment responses were measured with the COVID-19 Government Response Stringency Index. Trust in government and trust in COVID-19 vaccines were evaluated through survey items on confidence in equitable vaccine delivery and perceived vaccine safety, respectively, both measured on a 5-point Likert scale. Sociodemographic characteristics (age, gender, education, and income) were included as individual-level covariates, while country-level indicators (GDP per capita, Socio-Demographic Index, Healthcare Access and Quality Index, Global Health Security Index, Sustainable Development Goals Index, health expenditure, COVID-19 case rates, and inflation) were incorporated as contextual variables.

Decentralization significantly increased public trust in government but was negatively associated with the stringency of containment measures. Vaccine trust and higher education were positively linked to trust in government and vaccine acceptance. However, higher COVID-19 case rates correlated with reduced public trust. Government stringency was driven more by outbreak severity than decentralization alone.

Decentralization can bolster trust in government, but its impact on containment effectiveness depends on local capacity and coordination. These findings highlight the importance of institutional trust and governance structures in pandemic response outcomes.