Confidence in public institutions is critical in containing the COVID-19 pandemic

This paper investigates the relative importance of confidence in public institutions to explain cross-country differences in the severity of the coronavirus disease 2019 (COVID-19) pandemic. We find that a 1 SD increase (e.g., the actual difference between the United States and Finland) in confidence is associated with 56.3% fewer predicted deaths per million inhabitants. Confidence in public institutions is one of the most important predictors of deaths attributed to COVID-19, compared to country-level measures of health risks, the health system, demographics, economic and political development, and social capital. We show for the first time that confidence in public institutions encompasses more than just the unobserved quality of health or public services in general. If confidence only included the perceived quality, it would be associated with other health and social outcomes such as breast cancer recovery rates or imprisonment as well, but this is not the case. Moreover, our results indicate that fighting a pandemic requires citizens to cooperate with their governments, and willingness to cooperate relies on confidence in public institutions.