The World Health Organization declared COVID-19 to be a public health emergency of international concern on 30 January 2020 and then a pandemic on 11 March 2020. In early 2020, a group of UK scientists volunteered to provide the public with up-to-date and transparent scientific information. The group formed the Independent Scientific Advisory Group for Emergencies (Independent SAGE) and provided live weekly briefings to the public via YouTube. In this Perspective, we describe how and why this group came together and the challenges it faced. We reflect on 4 years of scientific information broadcasting and discuss the guiding principles followed by Independent SAGE, which may be broadly transferable for strengthening the scientist-public dialogue during public health emergencies in future settings. We discuss the provision of clarity and transparency, engagement with the science-policy interface, the practice of interdisciplinarity, the centrality of addressing inequity, the need for dialogue and partnership with the public, the importance of support for advocacy groups, the diversification of communication channels and modalities, the adoption of regular and organized internal communications, the resourcing and support of the group's communications and the active opposition of misinformation and disinformation campaigns. We reflect on what we might do differently next time and propose research aimed at building the evidence base for optimizing informal scientific advisory groups in crisis situations.

The UK government's response to the COVID-19 pandemic included a 'test, trace and isolate' strategy. Testing services for healthcare workers, care homes and schools accounted for the greatest spend and volume of tests. We reviewed relevant literature to identify common and unique barriers and facilitators to engaging with each of these testing services.

Scoping review.

PubMed, Scopus and the WHO COVID-19 Research Database were searched for evidence published between 1 January 2020 and 7 November 2022. This was supplemented by evidence identified via free-text searches on Google Scholar and provided by the UK Health Security Agency (UKHSA).

Data were extracted by a team of reviewers and synthesised thematically under the broad headings of perceptions, experiences, barriers and facilitators to engaging with the COVID-19 testing programme.

This study included 40 sources, including 17 from projects that informed UKHSA's decisions during the pandemic. Eight themes emerged and were used to categorise barriers and facilitators to engaging with the testing services for healthcare workers, care homes and schools: (1) perceived value, (2) trust in the tests and public bodies, (3) importance of infrastructure, (4) impact of media and social networks, (5) physical burden of the test, (6) perceived capability to undertake testing, (7) importance of relevant information and 8) consequences of testing.

Universal barriers and facilitators to engagement with the testing programme related to the core elements of each testing service, such as uncomfortable specimen collection and the influence of media and peers; these could be mitigated or leveraged to increase engagement across settings. However, the individuals involved, perceptions of value and available resources differed across services, leading to unique experiences between settings. Thus, consideration of context is crucial when designing and implementing a testing programme in response to a pandemic.

This paper discusses the importance of a social identity approach to crisis leadership in the context of global crises such as the Covid-19 pandemic and emphasizes the interconnected relationships between leaders and followers. I highlight the role of leaders in fostering unity and shaping citizens' responses especially during crises. I discuss the nature of crises and the significant role of political leaders in guiding societal responses and suggest that crisis leadership extends beyond individual competencies and behaviours and involves a shift from individual to collective responses. With this, I introduce the social identity approach to leadership that views leadership as a social influence process and emphasizes the importance of creating a sense of 'we-ness' among followers. Following from that, crisis leadership involves leaders constructing defining features of collective identity and efficacy to address crises appropriately. However, the value of this approach depends on the careful definition of shared identity boundaries, consideration of diverse experiences within society, the evolving nature of crisis leadership over time and potential consequences of crisis leadership. The sustainability of identity leadership, the dynamics of intergroup and subgroup processes, and the complexities of various crises are identified as areas requiring further research.

This study aimed to investigate the combined effects of individual, household, and community-level factors on coronavirus disease 2019 (COVID-19) vaccination intention using a multilevel analysis.

This cross-sectional study analyzed raw data from the 2021 Korea Community Health Survey and regional statistics from 255 health centers, with a final sample of 229,216 individuals. Multilevel analysis was conducted, focusing on individual, household, and community-level factors. Individual-level factors included demographics, health status, and COVID-19 concerns; household-level factors included income and marital status; and community-level factors included city type and vaccination rates.

At the individual level, significant differences were observed across all variables. At the household level, higher vaccination intention was associated with households of 4 or more members and a monthly income of 4 million Korean won or more. At the community level, higher flu vaccination rates, greater concern about COVID-19 infection, and higher COVID-19 vaccination rates were linked to increased vaccination intention.

This study highlights that COVID-19 vaccination intention is influenced by factors at the individual, household, and community levels. Vaccination strategies that integrate household and community-level approaches may be more effective. Policymakers should consider both individual and social health factors when designing vaccination policies.

The COVID-19 pandemic exacerbated pre-existing societal inequities. Our study addresses the dearth of studies on how intersecting factors of disadvantage and discrimination affected pandemic daily life for disabled people from minoritised ethnic groups, aiming to improve their experiences and social, health and well-being outcomes.

Through an intersectionality lens, to: explore and compare, by location and time, survey and qualitative data on changing needs for social, health and well-being outcomes relate coping strategies/solutions to these explore formal and informal network issues/affordances gain insights from synthesising our data contextualise and explore transferability of findings co-create outputs with stakeholders.

Mixed-methods, asset-based, underpinned by embodiment disability models and intersectionality, integrating three strands: (secondary): analysis of existing cohort/panel data, literature review (primary: quantitative): new survey (n = 4326), three times over 18 months (primary: qualitative): semistructured interviews (n = 271), interviewee co-create workshops (n = 104) 5 and 10 months later, mixed stakeholder co-design workshops (n = 30) for rapid-impact solutions to issues, key informant interviews (n = 4).

United Kingdom and Republic of Ireland.

Strand 2: community-dwelling migrants, White British comparators, with/without disability. Strand 3: focus on Arab, South Asian, African, Central/East European, or White British heritage with/without disability.

We found strong adherence to pandemic restrictions (where accommodation, economic situations and disability allowed) due to COVID-19 vulnerabilities. High vaccine hesitancy (despite eventual uptake) resulted from side-effect concerns and (mis)trust in the government. Many relied on food banks, local organisations, communities and informal networks. Pandemic-related income loss was common, particularly affecting undocumented migrants. Participants reported a crisis in mental health care, non-holistic social and housing care, and inaccessible, poor-quality and discriminatory remote health/social care. They preferred private care (which they could not easily afford), community or self-help online support. Lower socioeconomic status, mental health and mobility issues reduced well-being. Individual and community assets and coping strategies mitigated some issues, adapted over different pandemic phases, and focused on empowerment, self-reflection, self-care and social connectivity. Technology needs cut across these.

We could not explore area-level social distancing and infection rates. Data collection was largely online, possibly excluding some older, digitally deprived or more disabled participants. Participants engaged differently in online and face-to-face co-create workshops. Our qualitative data over-represent England and South Asian people and use contestable categories.

Different intersecting factors led to different experiences, with low socioeconomic status particularly significant. Overall, disability and minoritised ethnic identities led to worse pandemic experiences. Our co-design work shows how to build on the assets and strengths; simple changes in professional communication and understanding should improve experience. Minoritised groups can easily be involved in policy and practice decision-making, reducing marginalisation, with better сare and outcomes.

More research is needed on: (1) the impact of the post-pandemic economic situation and migration policies on migrant mental health/well-being; (2) supporting empowerment strategies across disadvantaged intersecting identities; and (3) technological deprivation and the cultural and disability-relevant acceptability of remote consultations. We found some differences in the devolved nations, which need elucidation.

This study is registered as ISRCTN40370, PROSPERO CRD42021262590 and CRD42022355254.

This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR132914) and is published in full in Health and Social Care Delivery Research; Vol. 13, No. 2. See the NIHR Funding and Awards website for further award information.

The COVID-19 pandemic prompted governments worldwide to introduce social distancing measures, including school closures and restrictions on in-person socialising. However, adherence to social distancing was challenging for many - particularly adolescents, for whom social interaction is crucial for development. The current study aimed to identify individual-level influences on adherence to social distancing in a longitudinal sample of adolescents aged 11-20 years in England, who took part in a randomised controlled trial. At baseline, 460 participants completed detailed pre-pandemic assessments, including mental health and well-being, altruism, delayed reward discounting, rejection sensitivity, prosociality and susceptibility to prosocial and anti-social influence. Of these, 205 participants reported their compliance with COVID-19 social distancing rules and attendance at social gatherings between June and August 2020. Bayesian ordinal regression models were used to predict adherence to social distancing from predictors, controlling for age at pandemic, gender, day of assessment, and intervention group. The results indicated that higher levels of prosociality, altruism and lower susceptibility to anti-social influence were associated with higher adherence to social distancing. Pre-pandemic levels of depression, anxiety, delayed reward discounting, rejection sensitivity, conduct problems and emotional awareness were not robustly related to the outcomes. These findings have implications for understanding how adolescents comply with public health guidelines, highlighting the role of social influence and peer norms.

The coronavirus pandemic increased the role played by scientific advisers in counselling governments and citizens on issues around public health. This raises questions about how citizens evaluate scientists, and in particular the grounds on which they trust them. Previous studies have identified various factors associated with trust in scientists, although few have systematically explored a range of judgements and their relative effects. This study takes advantage of scientific advisers' heightened public profile during the pandemic to explore how people's trust in scientists is shaped by perceptions of their features and traits, along with evaluations of their behaviour and role within the decision-making process. The study also considers people's trust in politicians, thereby enabling us to identify whether trust in scientists reflects similar or distinctive considerations to trust in partisan actors. Data are derived from specially designed conjoint experiments and surveys of nationally representative samples in Britain and the United States.

In late 2020, the COVID-19 vaccine acceptance rates of Chinese people living in the UK were estimated between 52% and 57%, significantly lower than that of the general population (76%). This disparity formed a primary motivation for this study which explored Chinese communities' overall understanding of and attitude towards the COVID-19 vaccines, the sources of information about the vaccines and levels of (dis)trust in these sources.

29 focus groups with 154 participants from UK-based Chinese communities of varied sociodemographic backgrounds were conducted between March and November 2021. Focus group data were coded with NVivo and analysed using thematic analysis.

Participants generally had a good understanding of the health benefits of the vaccines, however, many still had concerns about vaccine safety and efficacy. They accessed COVID-19 vaccine information from a multitude of sources and had diverse information needs which to a large extent shaped their knowledge of and attitude towards the vaccines. Participants generally had good digital access and some have developed good digital literacy enabling discernment of mis/disinformation. The ways in which they accessed and engaged with various types of information sources were differentiated by diversities in country/regions of origin, years of residence and main language/dialects spoken. They also demonstrated varying degrees of trust about the communication around vaccines depending on the perceived expertise of the authority, their character and the perceived accuracy and transparency of the information.

The UK government and health authorities need to understand Chinese communities' diverse information needs and cultural practices to form culturally and linguistically appropriate COVID-19 vaccine communication strategies to develop trust, targeting not the entire community but subgroups within the community via credible media sources and community networks.

COVID-19 demonstrated the complex manner in which discourses from risk science are manipulated to legitimize government action. We use Foucault's theory of Governmentality to explore how a risk science discourse shaped national and local government action during COVID-19. We theorize how national government policymakers and local government risk managers were objectified by (and subjectified themselves to) risk science models, results, and discourses. From this theoretical position we analyze a dataset, including observations of risk science discourse and 22 qualitative interviews, to understand the challenges that national government policymakers, risk scientists, and local government risk managers faced during COVID-19. Findings from our Foucauldian discourse analysis show how, through power and knowledge, competing discourses emerge in a situation that was disturbed by uncertainty-which created disturbed senders (policymakers and risk scientists) and disturbed receivers (risk managers) of risk science. First, we explore the interaction between risk science and policymakers, including how the disturbed context enabled policymakers to select discourse from risk science to justify their policies. This showed government's sociopolitical leveraging of scientific power and knowledge by positioning itself as being submissive to "follow the science." Second, we discuss how risk managers (1) were objectified by the discourse from policymakers that required them to be obedient to risk science, and paradoxically (2) used the disturbed context to justify resisting government objectification through their human agency to subjectify themselves and take action. Using these concepts, we explore the foundation of risk science influence in COVID-19.

This study compared COVID-19 vaccination intentions in those with and without chronic diseases (CDs and non-CDs) in South Korea. We hypothesized that the factors associated with COVID-19 vaccination intentions would differ between CDs and non-CDs in South Korea.

Using survey data collected through a Korean online panel in June 2021, we conducted a cross-sectional secondary data analysis. Of the 2292 participants, 411 had at least one chronic disease. To construct a comparable dataset, we selected non-CDs via a 1:1 case-control matching for age and gender. We then utilized a multivariable binary logistic regression model to explore the factors contributing to COVID-19 vaccination intentions in CDs and non-CDs.

All told, over 75% of participants in both groups indicated that they intended to vaccinate against COVID-19. In both groups, those who mistrusted general vaccine benefits reported significantly lower COVID-19 vaccination intentions. Regarding factors associated with vaccination intentions, CDs identified anxiety regarding coronavirus and exposure to COVID-19 vaccination promotions at the community level, while non-CDs highlighted hesitancy regarding vaccines and confidence in government/health services.

Improving vaccination acceptance will require the development and implementation of tailored approaches for CDs and non-CDs and efforts to minimize general vaccine mistrust.

To explore how the use of, and trust in, different sources of advice and information on COVID-19 differed across the four UK nations and between different sociodemographic groups and their associations with COVID-19 vaccination status.

We used a UK-wide representative survey conducted in July 2021, which included data on uptake of COVID-19 vaccination, trust in information sources, use of sources and geographical and sociodemographic variables. We used multivariate logistic regression to identify factors associated with completed or planned COVID-19 vaccination.

Trust in the NHS, followed by trust in scientists, were the strongest predictors of vaccination intention. NHS websites were the most used (56% across the UK); only the Scottish government website had a higher level of reported use (58%). Using either source was associated with a positive vaccination status as were use of the GP and television as sources of advice. Use of social media, family and friends, and 'none' of the sources enquired about, were all linked to a lower likelihood of being or intending to get vaccinated. Compared to those in England, respondents in other UK nations were less likely to trust the central UK government for advice on COVID-19. There was considerable variation by age in trust and use of some, but not all, sources of advice, with predicted probabilities ranging from 35% among the youngest age group to 62% among those aged 65 years or older. There were also significant differences by annual household income and by occupational class for trust in government, with higher incomes correlating with greater likelihood of trust.

This study demonstrates high levels of trust in the key sources of public health advice and there was a positive association between using official sources of advice and vaccination intentions, even in the context of overall high vaccination rates. Our findings highlight the need for the UK and devolved governments to value the importance of public trust in the health system and take appropriate measures to avoid undermining such trust.

Several governments from African countries, including the Democratic Republic of the Congo (DRC), implemented stringent public health measures to curb COVID-19 transmission in the early phases of the pandemic. While these restrictive measures are believed to have contributed to lowering case incidence and related mortality in DRC, data on the population's knowledge and adherence are limited. This study aimed to assess the knowledge, perception, attitudes, and practices of COVID-19 preventive measures and associated factors among adult residents of Matadi, thereby generating evidence for a strategy adjustment as the COVID-19 response is transitioning from emergency to control status.

We used data from a population-based cross-sectional study conducted in October 2021. Consenting participants were enrolled through a multi-stage cluster sampling approach and administered a pre-tested structured questionnaire using a mobile application (Epicollect 5). We analyzed adult participants' data using STATA 15.1. Univariable and multivariable analyses were applied to identify factors associated with good knowledge, good perception, positive attitude and good practice.

We included 1,269 adult respondents for the secondary analysis. One respondent in six was female. The median age was 36 years (IQR 24-50). Most respondents (76.5%) had good knowledge. Respondents aged 40-49 years and those with vocational education level were 1.7 time (AOR 1.75, 95% CI 1.07-2.87) and twice as likely (AOR 2.06, 95% CI 1.01-4.21) to have good knowledge. Preventive measures were perceived as efficient by 45% of respondents. Good perception was associated with education level, profession, average household monthly income and good knowledge. Only 40% of respondents had a positive attitude. A positive attitude was associated with age, education level, and good knowledge. Respondents having good practice represented 5.8%. Good practice was associated with good knowledge, attitude and perception.

Most respondents were knowledgeable, had a good perception of government-related COVID-19 preventive measures, a moderately positive attitude and an extremely low level of good practice. Current COVID-19 preventive strategies, including vaccination rollout, need adjustment into high-efficiency, context-based and risk group-specific interventions. Evidence generated by this study will improve preparedness and response to future outbreaks.

Stigma, lack of trust in authorities, and poor knowledge can prevent health-seeking behaviour, worsen physical and mental health, and undermine efforts to control transmission during disease outbreaks. These factors are particularly salient with diseases such as mpox, for which 96% of cases in the 2022-2023 UK outbreak were identified among gay, bisexual, queer and men who have sex with men (MSM). This study explored stigma and health-seeking behaviour in Liverpool through the lens of the recent mpox outbreak.

Primary sources of data were interviews with national and regional key informants involved in the mpox response, and participatory workshops with priority populations. Workshop recruitment targeted Grindr users (geosocial dating/hookup app) and at risk MSM; immigrant, black and ethnic minority MSM; and male sex workers in Liverpool. Data were analysed using a deductive framework approach, building on the Health Stigma and Discrimination Framework.

Key informant interviews (n = 11) and five workshops (n = 15) were conducted. There were prevalent reports of anticipated and experienced stigma due to mpox public health messaging alongside high demand and uptake of the mpox vaccine and regular attendance at sexual health clinics. Respondents believed the limited impact of stigma on health-seeking behaviour was due to actions by the LGBTQ + community, the third sector, and local sexual health clinics. Key informants from the LGBTQ + community and primary healthcare felt their collective action to tackle mpox was undermined by central public health authorities citing under-resourcing; a reliance on goodwill; poor communication; and tokenistic engagement. Mpox communication was further challenged by a lack of evidence on disease transmission and risk. This challenge was exacerbated by the impact of the COVID-19 pandemic on the scientific community, public perceptions of infectious disease, and trust in public health authorities.

The LGBTQ + community and local sexual health clinics took crucial actions to counter stigma and support health seeking behaviour during the 2022-2023 UK mpox outbreak. Lessons from rights based and inclusive community-led approaches during outbreaks should be heeded in the UK, working towards more meaningful and timely collaboration between affected communities, primary healthcare, and regional and national public health authorities.

This paper is one of a collection on challenges facing health systems in the future. One obvious challenge is how to transform to meet changing health needs and take advantage of emerging treatment opportunities. However, we argue that effective transformations are only possible if there is trust in the health system.

We focus on three of the many relationships that require trust in health systems, trust by patients and the public, by health workers, and by politicians. Unfortunately, we are seeing a concerning loss of trust in these relationships and, for too long, the importance of trust to health policymaking and health system functioning has been overlooked and under-valued. We contend that trust must be given the attention, time, and resources it warrants as an indispensable element of any health system and, in this paper, we review why trust is so important in health systems, how trust has been thought about by scholars from different disciplines, what we know about its place in health systems, and how we can give it greater prominence in research and policy.

Trust is essential if health systems are to meet the challenges of the 21st century but it is too often overlooked or, in some cases, undermined.

Public health messages disseminated by trusted government authorities are likely to have more influence over individuals' intentions and behaviors. However, individuals worldwide have different levels of trust in government authorities, which leads to varying levels of compliance intentions. Additionally, these trust levels may vary during major public crises, such as pandemics. Based on a COVID-19 pandemic communication survey (N = 3,065) disseminated throughout six countries (Australia, Finland, Italy, South Korea, Sweden, and the United States), this study examined the association among trust in distinct government sources, cultural orientations, and health behavioral intentions. Findings indicated that trust in official health communication sources at four governmental levels (i.e. national government, the head of the national government, the national health authority, and the chief representative of the national health authority) was related to vaccination intentions and other behavioral compliance intentions (i.e. willingness to prevent COVID-19 infection in other ways). Meanwhile, these direct associations were mediated by the cultural orientations of power distance and uncertainty avoidance. Findings also revealed that the direct association of trust in government sources and the indirect relationship through the above cultural orientations varied by country. This study offers insight into the important role of credible sources and individuals' cultural orientations in the domain of health communication aimed at influencing behavioral intentions.

Assessing perceptions of the COVID-19 vaccines is essential for understanding vaccine hesitancy and for improving uptake during public health emergencies. In the complicated landscape of COVID-19 vaccine mandates and rampant misinformation, many individuals faced challenges during vaccination decision-making. The purpose of our mixed methods study is to elucidate factors affecting vaccine decision-making and to highlight the discourse surrounding the COVID-19 vaccines in diverse and underserved communities.

This mixed methods study was conducted in Arizona, Florida, Minnesota, and Wisconsin between March and November 2021, combining a cross-sectional survey (n = 3593) and focus groups (n = 47).

The groups least likely to report receiving a vaccination were non-Hispanic Whites, Indigenous people, males, and those with moderate socioeconomic status (SES). Those indicating high and low SES reported similar vaccination uptake. Focus group data highlighted resistance to mandates, distrust, misinformation, and concerns about the rapid development surrounding the COVID-19 vaccines. Psychological reactance theory posits that strongly persuasive messaging and social pressure can be perceived as a threat to freedom, encouraging an individual to take action to restore that freedom.

Our findings indicate that a subsection of participants felt pressured to get the vaccine, which led to weaker intentions to vaccinate. These results suggest that vaccine rollout strategies should be reevaluated to improve and facilitate informed decision-making.

The COVID-19 pandemic has brought into sharp focus the shifting role of healthcare evidence in public health presentations. This article investigates the rhetoric of those presentations as a phenomenon indicating both the commitment to evidence-based public health messaging and its political loading in three interlinked case studies: computer-generated imagery ; 'podium' presentation and the NSO Fleming leak of COVID-19 contact tracing data. The pandemic has seen healthcare evidence attain ever-greater visibility in public forums, and those forums have themselves undergone rapid transformation. 'Podium' presentations such as press conferences have featured colourful imagery, and the manifold visualisations of SARS-CoV-2 which have accompanied television broadcasts and web pages display an insistent internal rhetoric. I analyse both forms of rhetoric for what they say about the 'forensic' moment created by COVID-19, and evaluate each in relation to Weizman's conception of the forum, which enables both 'frontstage' corporate and governmental image-building and public scrutiny. This paper evaluates the politics of the presentational strategies which have arisen around COVID-19 and the ethical potential of the forum.

To control the spread of coronavirus disease 2019 (COVID-19), governments are increasingly relying on the public to voluntarily manage risk. Effectiveness is likely to rely in part on how much the public trusts the Government's response. We examined the English public's trust in the Conservative Government to control the spread of COVID-19 after the initial 'crisis' period.

We analyzed eight rounds of a longitudinal survey of 1899 smartphone users aged 18-79 in England between October 2020 and December 2021. We fitted a random-effects logit model to identify personal characteristics and opinions associated with trust in the Conservative Government to control the spread of COVID-19.

Trust was lowest in January 2021 (28%) and highest in March 2021 (44%). Being older, having lower educational attainment and aligning with the Conservative Party were predictors of higher levels of trust. Conversely, being less deprived, reporting that Government communications were not clear and considering that the measures taken by the Government went too far or not far enough were predictors of being less likely to report a great deal or a fair amount of trust in the Government to control the pandemic.

Trust in the Government's response was found to be low throughout the study. Our findings suggest that there may be scope to avoid losing trust by aligning Government actions more closely with scientific advice and public opinion, and through clearer public health messaging. However, it remains unclear whether and how higher trust in the Government's response would increase compliance with Government advice.

Uncertainty around statistics is inevitable. However, communicators of uncertain statistics, particularly in high-stakes and potentially political circumstances, may be concerned that presenting uncertainties could undermine the perceived trustworthiness of the information or its source. In a large survey experiment (Study 1; N = 10 519), we report that communicating uncertainty around present COVID-19 statistics in the form of a numeric range (versus no uncertainty) may lead to slightly lower perceived trustworthiness of the number presented but has no impact on perceived trustworthiness of the source of the information. We also show that this minimal impact of numeric uncertainty on trustworthiness is also present when communicating future, projected COVID-19 statistics (Study 2; N = 2,309). Conversely, we find statements about the mere existence of uncertainty, without quantification, can reduce both perceived trustworthiness of the numbers and of their source. Our findings add to others suggesting that communicators can be transparent about statistical uncertainty without undermining their credibility as a source but should endeavour to provide a quantification, such as a numeric range, where possible.

This research extends prior studies by the Finnish Institute for Health and Welfare on pandemic-related risk perception, concentrating on the role of trust in health authorities and its impact on public health outcomes.

The paper aims to investigate variations in trust levels over time and across social media platforms, as well as to further explore 12 subcategories of political mistrust. It seeks to understand the dynamics of political trust, including mistrust accumulation, fluctuations over time, and changes in topic relevance. Additionally, the study aims to compare qualitative research findings with those obtained through computational methods.

Data were gathered from a large-scale data set consisting of 13,629 Twitter and Facebook posts from 2020 to 2023 related to COVID-19. For analysis, a fine-tuned FinBERT model with an 80% accuracy rate was used for predicting political mistrust. The BERTopic model was also used for superior topic modeling performance.

Our preliminary analysis identifies 43 mistrust-related topics categorized into 9 major themes. The most salient topics include COVID-19 mortality, coping strategies, polymerase chain reaction testing, and vaccine efficacy. Discourse related to mistrust in authority is associated with perceptions of disease severity, willingness to adopt health measures, and information-seeking behavior. Our findings highlight that the distinct user engagement mechanisms and platform features of Facebook and Twitter contributed to varying patterns of mistrust and susceptibility to misinformation during the pandemic.

The study highlights the effectiveness of computational methods like natural language processing in managing large-scale engagement and misinformation. It underscores the critical role of trust in health authorities for effective risk communication and public compliance. The findings also emphasize the necessity for transparent communication from authorities, concluding that a holistic approach to public health communication is integral for managing health crises effectively.

Trust plays a crucial role in implementing public health interventions against the COVID-19 pandemic. We examined the prospective associations of interpersonal, institutional, and media trust with vaccination rates and excess mortality over time in two multinational studies. In study 1, we investigated the country-level relationships between interpersonal trust, vaccination rates, and excess mortality across 54 countries. Interpersonal trust at the country level was calculated by aggregating data of 80,317 participants from the World Values Survey in 2017-20. Data on vaccination rates and excess mortality were obtained from the World Health Organization. Our findings indicated that higher levels of interpersonal trust were linked to higher vaccination rates and lower excess mortality rates in both 2020 and 2021. In study 2, we collected data from 18,171 adults in 35 countries/societies, stratified by age, gender, and region of residence. At the country/society level, interpersonal trust and trust in local healthcare facilities, local healthcare services, and healthcare professionals were associated with higher vaccination rates and lower excess mortality, whereas social media trust was associated with lower vaccination rates and higher excess mortality across three time points over 2 years. Our findings are robust when controlling for country-level covariates of the government stringency index, population density, and medical resources (i.e. critical care beds) in both studies.

The use of behavioural science and behaviour change within local authorities and public health has supported healthful change; as evidenced by its importance and contribution to reducing harm during the COVID-19 pandemic. It can provide valuable information to enable the creation of evidence-based intervention strategies, co-created with the people they are aimed at, in an effective and efficient manner.

This study aimed to use the COM-B model to understand the Capability, Opportunity and Motivation of performing a constellation of eight COVID-19 disease prevention behaviours related to the slogans of 'Hands, Face, Space, Fresh Air'; 'Find, Isolate, Test, (FIT), and Vaccinate' in those employed in workplaces identified as high risk for transmission of the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) to support intervention development.

This qualitative study recruited twenty-three participants (16 female, 7 male), who were interviewed from three environments (schools, care homes, warehouses) across three local authorities. Semi-structured interviews were analysed using thematic analysis.

Ten core themes were identified inductively; (1) knowledge and skills, (2) regulating the behaviour, (3) willingness to act, (4) necessity and concerns, (5) emotional impact, (6) conducive environment, (7) societal influence, (8) no longer united against COVID-19, (9) credible leadership, and (10) inconsistent adherence to COVID-19 prevention behaviours. Themes were then deductively mapped to the COM-B model of behaviour change and the theoretical domains framework and a logic model using the behaviour change wheel (BCW) was produced to inform intervention design.

This study offers a novel approach to analysis that has included eight behaviours within a single thematic analysis and COM-B diagnosis. This will enable local authorities to direct limited resources to overarching priorities. Of key importance, was the need for supportive and credible leadership, alongside developing interventions collaboratively with the target audience. COVID-19 has had an emotional toll on those interviewed, however, promoting the value of disease prevention behaviours, over and above their costs, can facilitate behaviour. Developing knowledge and skills, through education, training, marketing and modelling can further facilitate behaviour. This supports guidance produced by the British Psychological Society COVID-19 behavioural science and disease prevention taskforce.

Objectives: Social distancing and self-isolation were key parts of the UK's strategy for reducing the spread of COVID-19. This study explored young people's attitudes, perceptions and experiences of social distancing and social isolation during the COVID-19 pandemic. Methods: Qualitative individual, family and paired-friendship interviews were conducted. All 26 participants lived or worked in East London and were aged between 20 and 39 years. Results: Qualitative analysis revealed three main themes: 1) trust and breaking of the social distancing and self-isolation rules-trust in their friends to be careful and say if they are unwell; 2) own rule making-making their own household rules which made them less guilty about breaking national rules as they were adhering to rules (albeit their own); and 3) lack of clarity around self isolation and the need for practical support-confusion around length of time needed to self isolate and what self-isolation really meant. Conclusion: Developing more effective and targeted communications and practical support mechanisms to encourage better adherence to social distancing and self-isolation rules among young people will be essential to prevent the spread of COVID-19.

We examine the extent to which exposure to higher relative COVID-19 mortality (RM), influences health system trust (HST), and whether changes in HST explain the perceived ease of compliance with pandemic restrictions during the COVID-19 pandemic. Drawing on evidence from two representative surveys covering all regions of 28 European countries before and after the first COVID-19 wave, and using a difference in differences strategy together with Coarsened Exact Matching (CEM), we document that living in a region with higher RM during the first wave of the pandemic increased HST. However, the positive effect of RM on HST is driven by individuals over 45 years of age, and the opposite effect is found among younger cohorts. Furthemore, we find that a higher HST reduces the costs of complying with COVID-19 restrictions, but only so long as excess mortality does not exceed the average by more than 20%, at which point the ease of complying with COVID-19 restrictions significantly declines, offsetting the positive effect of trust in the healthcare system. Our interpretation of these estimates is that a higher RM is interpreted as a risk signal among those over 45, and as a signal of health-care system failure among younger age individuals.

Social trust-between governments and people and between individuals-and trust in science were proposed as prerequisites for tackling covid. Others suggested less democratic societies were more able to impose strict rules stopping the virus. These propositions were tested for a group of mainly advanced countries. The dependent variable is cumulated deaths from covid. Findings are broken down between (a) OECD member countries, (b) these and countries having cooperation agreements with it, and (c) all these plus China. They are also broken down by time-between (a) the period before the appearance of "new variants" in late 2020 and (b) the period from then until end September 2021. The best, most parsimonious, models explain nearly half of the changes in the level of deaths. Trust in government improves outcomes, as does interpersonal trust. Vaccine antipathy does not play a role. Also, there is little indication that authoritarian regimes performed better than higher trust societies. In the first period, increasing wealth inequality-indicating a more divided society-is related to higher death rates. Hospital bed availability is important then, but not thereafter. Furthermore, as the pandemic persisted, the importance of pre-existing levels of social trust declined. The paper warns that institutions and cultures cannot easily be transferred from one country to another. Nor would all transfers be desired. It also suggests that some other lessons of what contributed to better outcomes under covid might be relevant for the monkeypox virus-its successor public health emergency.

The regulations introduced under the UK's Coronavirus Act 2020 to help curb the spread of COVID-19 caused considerable confusion due to conflation between what was regarded as 'guidance' and what was 'law'. The fast-paced nature of the pandemic meant that restrictions on public liberty and increased police powers to enforce the new 'rules' led to accusations of over-zealous enforcement behaviour of some officers, including a record number of Fixed Penalty Notices (FPNs) issued. This paper explores the experiences of police officers in a range of English police forces, using 28 h of qualitative interview data at two research points in time (2020 and 2022). The extracts presented here illustrate some of the challenges that officers faced enforcing the frequently changing rules and regulations during the COVID-19 pandemic in the UK.

During a public health crisis, government sector is considered the natural leader for overall preparedness and management efforts. Integrating the literature from public relations and public health disciplines, this study proposes a theoretical model to predict individuals' perceptions, communicative action, as well as their behaviors to follow the governments' instructions in the early stages of the COVID-19 outbreak in the United States. Linking relationship management factors and the framework of the situational theory of problem-solving, the findings of this study demonstrate that authentic communication and relational quality can help increase positive perceptual, attitudinal, and behavioral outcomes desired by governments regarding pandemic management. However, our findings suggested that unproductive uses of authentic governmental communication may create adverse effects on publics' perceptions and interpretations and thus pose potential risks, particularly when a public health issue is significantly politicized. Specifically, this study found that, in the case of the COVID-19 pandemic in which the Trump administration was blamed for lack of planning and halting responses in the fight against the virus, conservatives who believe that the federal government is practicing authentic communication during the pandemic would consider the issue less important and irreverent; meanwhile, they would recognize more barriers to adopt preventive actions. Theoretical and practical implications are discussed.

This study aims to explore how pandemic-related media use relates to both protective and overprotective behaviors and to probe the underlying mechanisms. The data were collected online during the early outbreak of COVID-19 in China, and a total of 1118 valid cases, which covered the 30 provincial administrative divisions in mainland China, were collected. Results showed that official government media use was positively associated with protective behaviors and institutional trust was an important mediator. Commercial media use was also found to be positively associated with overprotective behavior, and anxiety mediated this relationship. Findings of this study suggested that different media sources could play completely different roles. Institutional trust in government institutions and medical care systems were equally critical in translating the media effect into public compliance with the preventive measures advocated by the relevant departments. Media outlets and practitioners should also be responsible in order to avoid causing unnecessary anxiety among the public so as to reduce irrational overprotective behaviors.

In existing festival research, trust is often placed at the post-experience stage by scholars, and there is no research to explore the relationship between festivalscape, trust, and experience. In addition, the main function of trust is to reduce uncertainty and risk perception. Existing festival-related research scenarios do not have typical risks, which will limit the findings of the research. This research focuses on festivals under covid-19 pandemic, which is a typical risky scenario. Exploring the antecedent variables and the consequences of the trust of the festival participants in this context may therefore make up the deficiency of existing research. Several interesting findings have been made: the perception of the festivalscape during the pandemic has been significantly simplified. Epidemic prevention measures and staff may increase trust, but trust cannot have a direct and significant impact on festival satisfaction. While staff positively strengthen trust, they will have a significant negative impact on satisfaction.

We test the hypothesis that COVID-19 vaccine hesitancy is attributable to distrustful complacency-an interactive combination of low concern and low trust. Across two studies, 9,695 respondents from different parts of Britain reported their level of concern about COVID-19, trust in the UK government, and intention to accept or refuse the vaccine. Multilevel regression analysis, controlling for geographic area and relevant demographics, confirmed the predicted interactive effect of concern and trust. Across studies, respondents with both low trust and low concern were 10%-22% more vaccine hesitant than respondents with either high trust or high concern, and 26%-29% more hesitant than respondents with both high trust and high concern. Results hold equally among White, Black, and Muslim respondents, consistent with the view that regardless of mean-level differences, a common process underlies vaccine hesitancy, underlining the importance of tackling distrustful complacency both generally and specifically among unvaccinated individuals and populations.

Using the Health Belief Model as a conceptual framework, we investigated the association between attitudes towards COVID-19, COVID-19 vaccinations, and vaccine hesitancy and change in these variables over a 9-month period in a UK cohort.

The COPE study cohort (n = 11,113) was recruited via an online survey at enrolment in March/April 2020. The study was advertised via the HealthWise Wales research registry and social media. Follow-up data were available for 6942 people at 3 months (June/July 2020) and 5037 at 12 months (March/April 2021) post-enrolment. Measures included demographics, perceived threat of COVID-19, perceived control, intention to accept or decline a COVID-19 vaccination, and attitudes towards vaccination. Logistic regression models were fitted cross-sectionally at 3 and 12 months to assess the association between motivational factors and vaccine hesitancy. Longitudinal changes in motivational variables for vaccine-hesitant and non-hesitant groups were examined using mixed-effect analysis of variance models.

Fear of COVID-19, perceived susceptibility to COVID-19, and perceived personal control over COVID-19 infection transmission decreased between the 3- and 12-month surveys. Vaccine hesitancy at 12 months was independently associated with low fear of the disease and more negative attitudes towards COVID-19 vaccination. Specific barriers to COVID-19 vaccine uptake included concerns about safety and efficacy in light of its rapid development, mistrust of government and pharmaceutical companies, dislike of coercive policies, and perceived lack of relaxation in COVID-19-related restrictions as the vaccination programme progressed.

Decreasing fear of COVID-19, perceived susceptibility to the disease, and perceptions of personal control over reducing infection-transmission may impact future COVID-19 vaccination uptake.

COVID-19 (coronavirus) and climate change are both global issues that have wide-reaching and serious consequences for human health, the economy, and social outcomes for populations around the world, and both require a combination of systemic governmental policies and community support for action. This paper compares people's responses to the coronavirus pandemic and climate change in the United Kingdom (UK). A representative survey of the UK population (n = 1,518) conducted in November and December 2020 explored public perceptions of (a) personal and government responsibility, (b) efficacy and trust, and (c) support for policies to address the two issues. The results show that, while there are a number of similarities between coronavirus and climate change, major differences exist regarding individual action. In comparison to the coronavirus pandemic, people feel less personal responsibility, think that their own personal actions are less efficacious, and express lower levels of support for (in particular individual-level) policies to address climate change. These findings suggest that experiences from the coronavirus pandemic cannot directly be translated to climate change, and thus that climate change is likely to require different policy responses and framing.

Science communication can provide people with more accurate information on pandemic health risks by translating complex scientific topics into language that helps people make more informed choices on how to protect themselves and others. During pandemics, experts in medicine, science, public health, and communication are important sources of knowledge for science communication. This study uses the COVID-19 pandemic to explore these experts' opinions and knowledge of what to communicate to the public during a pandemic. The research question is: What are the key topics to communicate to the public about health risks during a pandemic?

We purposively sampled 13 experts in medicine, science, public health, and communication for individual interviews, with a range of different types of knowledge of COVID-19 risk and communication at the national, regional and hospital levels in Norway. The interview transcripts were coded and analysed inductively in a qualitative thematic analysis.

The study's findings emphasise three central topics pertaining to communication about pandemic health risk during the first year of the COVID-19 pandemic in Norway: 1) how the virus enters the human body and generates disease; 2) how to protect oneself and others from being infected; and 3) pandemic health risk for the individual and the society.

The key topics emerging from the expert interviews relate to concepts originating from multiple disciplinary fields, and can inform frameworks for interprofessional communication about health risks during a pandemic. The study highlights the complexity of communicating pandemic messages, due to scientific uncertainty, fear of risk amplification, and heterogeneity in public health and scientific literacy. The study contributes with insight into the complex communication processes of pandemic health risk communication.

(1) Background: The COVID-19 pandemic provided a unique opportunity to investigate how moral reasoning is influenced by individuals' exposure to a crisis and by personal, societal and temporal proximity. We examined how Italians and Germans judged different behaviors that arose because of the pandemic, which affected health and societal matters. (2) Methods: Over the course of four months and three assessment periods, we used an observational online survey to assess participants' judgments regarding seven scenarios that addressed distributive shortages during the pandemic. (3) Results: Overall, there was no clear answering pattern across all scenarios. For a variation of triage and pandemic restrictions, most participants selected a mean value, which can be interpreted as deferring the choice. For the other scenarios, most participants used the extremes of the scale, thereby reflecting a clear opinion of the public regarding the moral issue. In addition, moral reasoning varied across the two countries, assessment periods, fear, and age. (4) Conclusions: By using scenarios that were taken from real-life experiences, the current study addresses criticism that moral research mostly relies on unrealistic scenarios that lack in external validity, plausibility, and proximity to everyday situations. In addition, it shows how lay people regard measures of public health and societal decision-making.

(1) To investigate factors associated with intention to self-isolate, request a test, and share details of close contacts when required. (2) To determine whether associations were stronger during periods when less stringent national COVID-19 restrictions were in place.

Series of cross-sectional nationally representative surveys. We selected survey waves where different national restrictions were in place in England (first lockdown, summer release, second lockdown, third lockdown).

We investigated whether psychological factors and increased out-of-home activity in the last week were associated with intention to self-isolate and request a test if you were to develop COVID-19 symptoms, and intention to share details of contacts if you were to test positive. We also investigated whether the strength of associations differed by timepoint in the pandemic.

Intention to self-isolate, request a test and share details of contacts were associated with greater perceived risk of COVID-19 to people in the United Kingdom, knowing that COVID-19 transmission can be asymptomatic, and agreeing that personal behaviour has an impact on COVID-19 transmission. There were few differences in strength of associations by timepoint suggesting these effects are broadly stable over time.

Psychological factors were associated with intention to adhere to key components of the contact tracing system; there was no evidence for an association with increased out-of-home activity. Messages that increase knowledge that COVID-19 can be transmitted even if someone does not have symptoms and that an individual's actions can contribute to the spread of the virus may promote engagement with the test, trace, and isolate system.

The paper is located at the crossroads of two modern intellectual movements. The first, evidence-based policy, seeks to locate vital information that will inform and improve key policy decisions on such matters as population health, social welfare, and human wellbeing. The second, complexity theory, describes the nature of the social world and perceives human action as persistently adaptive and social institutions as incessantly self-transformative. The first assumes that policies and programmes can achieve sufficient control to meet specific and measurable objectives. The second assumes that social actions are sufficiently capricious so that the society never conforms to anyone's plans - even those of the most powerful. The unparalleled resources committed to control the unprecedented attack of the COVID-19 pandemic are the epitome of complexity. The long struggle to contain the virus thus constitutes an ideal test bed to investigate this paradigmatic split. The paper undertakes this mission - focusing specifically on the effectiveness non-pharmaceutical interventions and examining evidence from the UK and Spain.

In this conceptual paper, we argue that at times of crisis, what is sometimes called "evidence-based" or "science-driven" policymaking-establishing scientific truths and then implementing them-must be tempered by a more agile, deliberative and inclusive approach which acknowledges and embraces uncertainty. We offer pragmatism as one potential option, using examples from the UK to illustrate how such an approach might have changed particular crisis decisions and led to better outcomes. We propose that to better prepare for the next public health crisis, five pragmatism-informed shifts are needed in the science-policy relationship: from scientism to science-informed narrative rationality that emerges from practice; from knowledge-then-action to acting judiciously under uncertainty; from hierarchies of evidence to pluralist inquiry; from polarized camps to frame-reflective dialogue; and from an "inside-track" science-policy dialogue to greater participatory democracy. We suggest an agenda for a pragmatist-informed program of applied research on crisis public health policymaking.

The distrust, delay and refusal of vaccinations represent serious threats to global public health. As demonstrated by the dramatic worldwide impact of the COVID-19 pandemic, adequate vaccine coverage against infectious diseases is essential towards the preservation and function of virtually every aspect of our society. While the determinants of vaccine hesitancy and pandemic concern have been widely investigated, conflicting evidence exists with regards to their association with education levels and political views.

This study aimed to investigate whether science literacy levels and standpoint on social and economic matters are associated with different levels of vaccine confidence and COVID-19 concern. An online survey was circulated amongst participants recruited via convenience sampling, and data were analysed using non-parametric statistical tests.

The survey (n = 389) highlighted that participants who studied Science at General Certificate of Secondary Education level have a lower vaccine confidence than those with both lower and higher levels of science education. Participants with neutral/centrist political views expressed lower confidence than those with a libertarian social stance or a left-wing economic stance. A higher concern with the COVID-19 pandemic was associated with lower levels of science education, libertarian social views, and left-wing economic views.

The present study provides novel insight on the educational and political factors associated with vaccine hesitancy and pandemic concern within a British population sample.

This paper, written to mark the 50th anniversary of the Faculty of Public Health, reflects on the challenges to governance in a United Kingdom outside the European Union. Drawing on Virchow's call to address the political determinants of health, it describes a situation in which the current government consistently displays disregard for the institutions of state, and the principles on which they are based, such as honesty and the rule of law. It argues that this is a departure from the past and that it undermines the trust that is essential for effective public health policies that attract public support. It ends with a challenge to the public health establishment in the United Kingdom to decide whether they will challenge the decline in public standards, and thus promote structures that can consider and prioritize health or continue to pick up the pieces of political failings.

The impact of physical disability on protective behaviors during COVID-19 has been little studied. This retrospective study compared the 699 the self-declared behaviors of 699 people with disabilities before and after the relaxation of COVID-19 restrictions in England. We found that people with disabilities in England showed high compliance with protective behaviors and mitigation strategies during a period of legal restrictions. Following the lifting of restrictions, respondents engaged in less social mixing, fewer distancing and hygiene behaviors and were less likely to use face coverings. Hierarchical regressions revealed that socio-economic status, age, and gender moderated protective behaviors: while those with higher socio-economic status were more relaxed with regard to hygiene and distancing behaviors, they were more cautious about mixing with others after the end of restrictions. Age, (male) gender, and being unvaccinated were positively associated with relaxation in the use of facemasks in public places, not needing a carer with fewer out-of-home visits. Taken together these findings suggest that the removal of restrictions had an unequal impact on the population of England, placing a disproportionate burden on some people with disabilities.