Indianapolis, Indiana – Deadly disease outbreaks have long been seen as threats to public health, but new research suggests their consequences extend far beyond hospitals and clinics. According to a groundbreaking study co-authored by political scientists from Indiana University Bloomington and the University of Konstanz in Germany, outbreaks of infectious diseases can erode the very foundation of democratic governance—public trust.
The study, titled “Infectious disease outbreaks drive political mistrust,” was recently published in the journal Proceedings of the National Academy of Sciences (PNAS). The research shows that when communities experience an outbreak nearby, their trust in government institutions—ranging from presidents and parliaments to ruling parties and law enforcement—declines significantly.
The research was led by Ore Koren, Associate Professor of Political Science in the College of Arts and Sciences at Indiana University Bloomington, and Nils Weidmann, Professor of Political Science at the University of Konstanz. Their findings highlight how outbreaks, beyond their biological and social tolls, leave a lasting political impact that can weaken the relationship between citizens and their governments.
“Such crises provoke not only public health crises but also political polarization, the erosion of trust in governance, and potential democratic backsliding,” the study authors write. “Exposure to outbreaks leads to a noticeable change in political allegiances as trust in the ruling establishment and the internal security apparatus declines.”
To reach their conclusions, Koren and Weidmann relied on data from the Afrobarometer project—a large-scale public opinion survey spanning dozens of African nations that tracks citizens’ views on governance, democracy, and social issues. Using this dataset, they examined how proximity to disease outbreaks influenced levels of trust in government institutions.
By combining geolocated data on infectious disease outbreaks with Afrobarometer survey responses, the researchers were able to compare individuals living close to recent outbreaks with those residing farther away. The results revealed a clear pattern: people who lived within roughly 100 kilometers of an outbreak and were surveyed within five years afterward showed a measurable and consistent decline in trust toward political leaders and state institutions.
Interestingly, the erosion of trust extended beyond presidents and parliaments. Confidence in electoral commissions, opposition parties, and police forces also declined sharply. The one notable exception was the military, whose trust levels appeared largely unchanged by outbreak exposure.
The diseases studied were “zoonotic” in nature—pathogens that originate in animals but can jump to humans. This group includes well-known threats such as Ebola, Marburg, and the H1N1 influenza virus. These diseases often cause fear and uncertainty that can destabilize communities, and the study found that such fear translates directly into political consequences.
Koren and Weidmann used a sophisticated statistical method known as “coarsened exact matching” to ensure that comparisons between groups were fair and accurate. This approach allowed them to control for differences in demographics, economic conditions, geography, and other variables—making it possible to isolate the true effect of disease exposure on political trust.
“Our results show that outbreaks are not only biological events but major social-political phenomena,” the researchers write. “They can reshape how citizens view their government.”
The implications of this research are significant for both policymakers and public-health officials. When people lose trust in their governments during a health emergency, it becomes harder to contain the outbreak and to maintain social order. Citizens who distrust official messages are less likely to comply with safety measures, get vaccinated, or follow restrictions—creating a feedback loop that worsens the crisis.
Trust, as Koren and Weidmann note, is a crucial ingredient in effective governance. It encourages citizens to cooperate with authorities, pay taxes, participate in elections, and engage in collective efforts. When trust declines, the ability of governments to function efficiently and manage crises diminishes dramatically.
For governments, the findings serve as a reminder that public health responses cannot be separated from political and social dynamics. Containing an epidemic requires more than medical treatment—it demands transparent communication, fairness, and accountability. The study suggests that rebuilding trust must be part of any recovery plan following a health emergency.
Communities already facing socioeconomic hardship are often hit hardest. Rural or remote populations, which may have limited access to healthcare or reliable information, are especially vulnerable to both the physical and political consequences of outbreaks. As trust erodes, citizens may disengage from political processes altogether, making it even more difficult for governments to rebuild credibility once the crisis has passed.
The authors emphasize that policymakers must take a more integrated approach—one that combines public-health preparedness with strategies to protect institutional trust. This involves clear and consistent communication with the public, equitable access to medical care, and mechanisms that ensure transparency and accountability throughout the crisis.
“Outbreaks must be viewed not just as medical events but political ones, with consequences for societies long after the immediate health threat has passed,” the authors write.
Their research also resonates deeply in the aftermath of the COVID-19 pandemic, which exposed widespread weaknesses in both healthcare systems and political institutions across the globe. Around the world, governments faced growing skepticism, misinformation, and polarization—all of which mirrored the patterns identified by Koren and Weidmann in their study.
“There is a critical need for policy strategies that integrate public-health preparedness with efforts to preserve and rebuild institutional trust during outbreaks,” the authors argue. They note that effective crisis management involves not only containing disease spread but also ensuring that citizens feel informed, supported, and heard. Governments, they add, should engage communities directly in response efforts, allowing people to participate in shaping solutions that affect their lives.
Koren and Weidmann warn that without such efforts, the political costs of epidemics could persist long after the pathogens themselves are gone. Declining trust may weaken democratic institutions, encourage political polarization, and make societies more vulnerable to instability.
The broader message is clear: disease outbreaks test more than a country’s hospitals—they test the strength of its democracy. The ability to maintain trust amid fear and uncertainty determines not only how well a society survives a health crisis, but also how it emerges from it.
For Koren, this research marks another step in his growing portfolio of work examining the intersection of health, politics, and conflict. A recent recipient of the prestigious Humboldt Research Fellowship from the Alexander von Humboldt Foundation in Germany, he collaborated with Weidmann on several projects exploring political mistrust and instability. Their latest study provides valuable insight into how governments can better prepare for future outbreaks—not only by improving healthcare systems but by safeguarding the public’s faith in their institutions.
Ultimately, the study sends a powerful message to policymakers worldwide: protecting public health also means protecting public trust. When those two goals align, societies stand a far better chance of overcoming both disease and division.
