The ABCs of Covid-19 prevention in Malawi: Authority, benefits, and costs of compliance

A wide array of authorities-from religious leaders to government ministers-call upon citizens to take preventative measures against Covid-19. Which authorities can most effectively gain public compliance, and which measures will the public take up? Moreover, do people comply with authorities out of respect for their legitimacy, due to their expertise, or for fear of sanctioning? Answers to these questions are important for development practitioners, who need to understand how different partnerships might affect health behavior, and for scholars interested in understanding authority, legitimacy, and compliance. We explore these questions using a conjoint experiment embedded in a telephone survey of 641 Malawians. Individuals in our sample are more likely to say that they will comply with precautionary measures when the costs are low and expected benefits are high. Respondents view both traditional authorities and hospital heads as legitimately issuing directives and having the ability to monitor and sanction non-compliance, but appear to comply more with hospital heads and to do so out of respect for their expertise. These results emphasize how who issues directives affects whether individuals comply and provides insights as to why they do so. The findings also reflect individuals' cost-benefit calculations when considering precautionary measures, highlighting the importance of steps that can reduce costs (e.g., food security or income measures) or accurately reflect risks (e.g., information signaling the prevalence of Covid-19). The study not only helps to address the Coronavirus crisis but also has important implications for broader questions of authority and compliance.

Public health and public trust: Survey evidence from the Ebola Virus Disease epidemic in Liberia

Trust in government has long been viewed as an important determinant of citizens' compliance with public health policies, especially in times of crisis. Yet evidence on this relationship remains scarce, particularly in the developing world. We use results from a representative survey conducted during the 2014-15 Ebola Virus Disease (EVD) epidemic in Monrovia, Liberia to assess the relationship between trust in government and compliance with EVD control interventions. We find that respondents who expressed low trust in government were much less likely to take precautions against EVD in their homes, or to abide by government-mandated social distancing mechanisms designed to contain the spread of the virus. They were also much less likely to support potentially contentious control policies, such as "safe burial" of EVD-infected bodies. Contrary to stereotypes, we find no evidence that respondents who distrusted government were any more or less likely to understand EVD's symptoms and transmission pathways. While only correlational, these results suggest that respondents who refused to comply may have done so not because they failed to understand how EVD is transmitted, but rather because they did not trust the capacity or integrity of government institutions to recommend precautions and implement policies to slow EVD's spread. We also find that respondents who experienced hardships during the epidemic expressed less trust in government than those who did not, suggesting the possibility of a vicious cycle between distrust, non-compliance, hardships and further distrust. Finally, we find that respondents who trusted international non-governmental organizations (INGOs) were no more or less likely to support or comply with EVD control policies, suggesting that while INGOs can contribute in indispensable ways to crisis response, they cannot substitute for government institutions in the eyes of citizens. We conclude by discussing the implications of our findings for future public health crises.