What impacts public compliance with COVID-19 restrictions?

The rapid onset of the coronavirus disease 2019 (COVID-19) pandemic across the globe made widespread restrictions on public movements and interactions a necessity. These measures, called non-pharmaceutical interventions (NPIs), are dependent to a very large extent on the cooperation and engagement of the public.

New research by scientists at the Institute for Environmental Decisions, ETH Zurich, Switzerland, reports that risk perception and public acceptance of NPIs depends on both worldview and levels of social trust. The study also found that, paradoxically, when the number of cases decreased in the period between the first and second waves, public willingness to comply with these measures fell.

The researchers recently published their findings in the PNAS journal.


Trust may be measured in terms of either social trust or interpersonal trust. Social trust is understood as a population's confidence in its government. It is characterized by beliefs among the general public that its government is best placed to make executive decisions that protect its health and wellbeing.

The effect of high social trust is compliance with public health measures and acceptance of government information and advice. Conversely, general interpersonal trust puts reliance on most people, which implies unwillingness to see them as potential threats to one's health.

The scientists conducted the study using measures of cultural cognition, with a scale between an individualistic viewpoint on the one hand vs. a communitarian perspective on the other. They aimed to examine the prediction that the former would be associated with reduced risk perceptions regarding the pandemic. And that this, along with low social trust, would mediate lower acceptance of NPIs meant to contain viral transmission and reduce the number of infections at one time.

How the study was carried out

The study used data collected in two surveys. The first was between March 27 and April 5, 2020, and the second between April 17 and April 26, 2020. The NPIs in place were the same during both periods, including the opening of only pharmacies and food stores, school closures, and restriction of gatherings to five people or less.

The findings indicate that public perception of the pandemic underwent a drastic change between the two study periods. During the second part of the study, risks were perceived to be lower at this time than at the earlier time point. Social trust also declined, while the feeling that the cost of the NPIs were too high for the benefit expected in terms of viral containment.

The result, as expected, was lower acceptance of these measures in the second survey. This was especially so with people who had individualistic worldviews, poor appreciation of the COVID-19-related health risks laid out by the government, convictions that the NPIs were not worth the benefit, and high trust in other people.

Interestingly, the participants' viewpoints in the first survey predicted their attitude in the second wave, to a large extent, indicating that even with lower infection rates, the general acceptance of NPIs continued on a stable level.

Predictors of acceptance

Individualistic worldviews and high interpersonal trust predicted lower acceptance of the measures to contain viral spread. But people who felt themselves to be at risk were much more willing to accept these measures. Most of all, those who felt greater social trust and perceived higher risk levels at the second time point were more willing to accept these measures than the people who experienced a decrease in both these parameters.

In contrast, those who thought the NPIs were overkill in terms of their perceived benefit were less likely to accept them.

What are the implications?

So to answer the original question: What decides the level of public acceptance of COVID-19 NPIs? Social trust, health risk perceptions, individual worldview and science seem to be equally relevant in shaping public attitudes.

These findings indicate that epidemiologic recommendations on viral containment must be tempered by pragmatic considerations of economic sustainability and, more importantly, public acceptance. This is especially so as a pandemic or similar crisis situation drags on, as opposed to a short-lived urgent state.

The researchers write:

Our results suggest that as soon as the measures attain success or the public is tired of the implemented restrictions, public acceptance declines, and it seems difficult to prolong the measures as may be desirable from an epidemiological standpoint. The importance of worldviews and trust for public acceptance of the measures further suggests the necessity of a political discussion about the implemented measures."

Journal reference:
Dr. Liji Thomas

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.


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