A multifaceted analysis of decreasing trust in health institutions in the EU during the COVID-19 pandemic

Background
Public trust is crucial during health crises, such as the COVID-19 pandemic, for the effective implementation
of scientific and policy interventions. This study investigates factors contributing to the decline in trust in the health
sector within the European Union during the pandemic.

Methods
Using the publicly available 2020–2022 Standard Eurobarometer dataset, we employed a "geography of trust"
approach. We applied equal quantile mapping to visualise high and low trust countries and Local Spatial Autocorrela-
tion (LISA) to identify statistically significant clusters. Using a series of one-way ANOVA, we found associations between
socio-economic and other variables available in the same dataset with trust.

Results
Trust in health institutions and medical staff declined in 20 of 27 EU countries from 2020 to 2022. Clear geo-
graphical clusters of Western and Central Europe as the high-trust countries and Eastern Europe as the low-trust countries
emerged through mapping. One-way ANOVA revealed that contrary to several studies, age, gender, and most demo-
graphics did not vary with trust, but trust was directly associated with the satisfaction with measures taken to fight the
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COVID-19 pandemic, and individual perceptions about their life and national affairs (p < 0.001).
Conclusion High-trust Western European countries share characteristics in health systems, governance, and pandemic
responses. Understanding this interplay could inform trust-building strategies. The persistent low trust in Eastern Europe
may stem from slow government responses and requires nuanced approaches considering unique contexts. The decline
in traditionally high-trust countries highlights challenges even in established social contexts. This study provides valu-
able insights for policymakers aiming to foster trust during health crises.