A little while back I did a short post expressing skepticism about some claims that corruption was a significant contributor to the Ebola outbreak in West Africa. I agree that insofar as corruption diverts resources from public health and sanitation, or leads to undersupply of necessary medicines and supplies, it is likely to worsen both the frequency and magnitude of public health problems. But I was more skeptical that there was any direct evidence that the admittedly rampant corruption in places like Liberia, Sierra Leone, and Nigeria was a major contributor to that particular public health crisis.
Last month I was fortunate enough to moderate a panel on corruption and public health at the World Bank’s International Corruption Hunters Alliance meeting, and the presentations at that panel have altered my thinking about this issue somewhat. More generally, several of the presenters from countries hit hard by Ebola — including Commissioner Joseph Kamara of Sierra Leone’s Anti-Corruption Commission and Commissioner Aba Hamilton-Dolo of the Liberian Anti-Corruption Commission — made a convincing case that corruption has been, if not a primary cause, then at least a significant contributor to the extent and severity of the Ebola outbreak. Of course, there is still relatively little direct evidence, and it’s reasonable to wonder whether commissioners on anti-corruption commissions may be likely to overestimate the significance of their particular issue area for the most pressing immediate crisis facing their nations. Nonetheless, they did make a plausible case that corruption, while perhaps not a direct contributor to the outbreak, has significantly impeded the response.
On this point, Commissioner Hamilton-Dolo emphasized an important argument that I hadn’t really paid enough attention to, even though I quoted Professor Taryn Vian making essentially the same point in my earlier post: in addition to the squandering of public health resources, corruption may also impede the effective response to public health crises by undermining trust in government. The argument, as I understand it, goes something like this:
In the midst of a public health crisis, the government needs to issue instructions–very rapidly–and people need to follow them: quarantine orders, evacuation orders, instructions about what to do and what to avoid in order to prevent the spread of a disease like Ebola, etc. The degree to which people are willing to comply with these instructions depends, at least in part, on how much people have confidence in their government, how much they trust it, and how much they view its commands as legitimate. Particularly in the midst of a public health crisis like the Ebola outbreak, it is simply not possible for the government–especially in a high-population, relatively low-capacity state–to coerce compliance within the necessary timeframes. However, corruption (or, more accurately, the perception of widespread corruption) erodes trust in government; this is true even for forms of corruption that have nothing directly to do with public health, or the reliability of government health directives. The claim, as I understand it, is that the perception of widespread government corruption–rampant bribery, embezzlement, favoritism, conflict-of-interest, and the like–causes a generally negative, untrusting attitude toward the government, and that as a consequence, when in the midst of a public health crisis the government says “Do this, don’t do that, etc.”, people are more likely to simply ignore the government instructions, particularly if they seem burdensome.
Is this right? It certainly seems plausible to me. And there is a fairly extensive academic literature establishing a strong negative correlation between perceived corruption and trust in, or perceived legitimacy of, the government. (For some examples, see here, here, and here.) There is, of course, an obvious problem with disentangling causation: it’s quite possible that lack of trust in government may worsen corruption, as well as the other way around. But the link is at least plausible. I’m less familiar with the literature on responses to public health emergencies, but I wouldn’t be surprised if there were evidence suggesting that people are less likely to follow inconvenient or burdensome instructions from the government, or to take government health warnings seriously, if the government is perceived generally as less legitimate and trustworthy.
All that said, I haven’t seen any research that directly and convincingly establishes a link between general perceptions of dishonesty/corruption in government and propensity to ignore government public health instructions or advice. And I certainly don’t know of any evidence, other than Commissioner Hamilton-Dolo’s personal (and presumably well-informed) observations, that this phenomenon impeded the effectiveness of the response to Ebola in the recent West African outbreak. Perhaps some of our readers out there, with more knowledge about these issues than I have, might weigh in on both the plausibility and substantive significance of this hypothesis?