Exploring how bioethics can address trust and polarization challenges revealed during the COVID-19 pandemic
Imagine a global storm that threatens every human life on Earth. Scientists work tirelessly to understand the danger and design protections. Governments implement safety measures based on this knowledge. But instead of uniting against the common threat, societies fracture along invisible fault lines. Trust evaporates precisely when it's needed most. This was the reality of the COVID-19 pandemic—not just a health crisis, but a profound test of human solidarity that exposed deepening divides in our increasingly interconnected world.
The pandemic revealed what bioethicists had warned about for decades: that advanced medical technologies mean little without the social trust to implement them effectively.
Polarization can prove as dangerous as any virus, affecting compliance with public health measures and vaccine uptake across political lines.
As we examine this landscape of division, a critical question emerges: How can the field of bioethics help us navigate this crisis of trust and build more resilient societies for future challenges?
While COVID-19 was spreading as a biological pathogen, another contagion was infecting our social systems: polarization. Research distinguishes between two related but distinct forms of this phenomenon. Political polarization refers to the divergence of political beliefs and opinions along ideological lines, while affective polarization describes the feelings of dislike and distrust that individuals hold toward those from groups with opposite views 5 .
This distinction matters profoundly for public health. It's one thing for citizens to disagree about appropriate policy responses; it's another for them to view those with different opinions as immoral or untrustworthy. During the pandemic, affective polarization transformed public health measures like mask-wearing and vaccination from neutral protective actions into political identity markers 5 .
The health consequences of this polarization were stark and measurable. Studies found that:
Predicted compliance with public health guidelines, with counties that voted for one presidential candidate showing significantly different movement patterns during lockdowns 5 .
For each unit increase in state-level perceived polarization, the incidence rate of experiencing poor physical health increased by 1.03 times 5 .
Varied dramatically along political lines, with presidential "out-partisans" having lower odds of adhering to government vaccination recommendations than "in-partisans" 5 .
| Type of Polarization | Impact on Health Behaviors | Health Outcomes |
|---|---|---|
| Political polarization | Reduced compliance with mask mandates and social distancing | Increased infection rates in highly polarized communities |
| Affective polarization | Decreased vaccine uptake among opposition party supporters | Higher COVID-19 mortality in politically aligned geographic areas |
| Perceived polarization | Increased psychological distress and anxiety | Worsened mental health outcomes during pandemic |
In June 2021, as vaccines were rolling out across the United Kingdom, researchers conducted a revealing natural experiment on trust modulation 7 . They surveyed a demographically representative sample of over 2,000 UK adults, asking a deceptively simple question: "Would you say you now trust scientists more, less, or about the same as you did at the start of the pandemic?"
The study employed sophisticated methodological safeguards to ensure validity. Researchers included negative controls (such as asking about trust in geologists) to test whether any changes were specific to pandemic-relevant sciences. They also conducted an experiment within the survey, asking half the respondents about their trust in pharmaceutical company Pfizer (deeply involved in vaccine development) and the other half about GlaxoSmithKline (less involved in COVID-19 vaccines) 7 .
The results revealed a complex story about the changing landscape of trust during the pandemic. While a reassuring 33% of respondents reported increased trust in scientists, 7% reported decreased trust—a statistically significant shift that wasn't observed in negative controls 7 .
The most revealing finding, however, was what researchers termed trust polarization. Those who reported not trusting science prior to the pandemic were more likely to become even less trusting, while those with preexisting trust became more confident in scientists. This "backfire effect" meant that the pandemic experience didn't just increase or decrease trust on average—it amplified existing attitudes, widening the trust gap between different segments of society 7 .
Most importantly, these changes in trust correlated directly with health behaviors. Increased trust predicted greater willingness to receive COVID-19 vaccines, demonstrating that these shifts had tangible consequences for public health 7 .
| Predictor Variable | Effect on Trust | Statistical Significance |
|---|---|---|
| Age | Older populations increased trust more | Significant |
| Prior degree of trust | Those with low pre-pandemic trust became less trusting; those with high trust became more trusting | Highly significant (polarization effect) |
| Educational attainment | No significant predictive value | Not significant |
| Political attitude | No significant predictive value | Not significant |
| Religiosity | No significant predictive value | Not significant |
Existing trust levels varied across population segments
Trust gap widened as those with high trust increased confidence and those with low trust became more distrustful
Polarized trust affects willingness to follow public health guidance and accept vaccines
Traditional biomedical ethics has often focused on individual autonomy, emphasizing the right of patients to make their own healthcare decisions. This framework, known as principlism, centers on four moral principles: autonomy, benevolence, non-maleficence, and justice 1 . During the pandemic, however, the limitations of this individual-focused approach became apparent.
As Vardit Ravitsky, a prominent bioethicist, explains: "Covid-19 emphasizes our connectedness. The virus threatens us all and requires a global response. It also shows that the actions of each of us have immediate and dramatic impacts on others" 2 . This realization has accelerated a shift toward what American biologist Van Rensselaer Potter originally termed Global Bioethics—an approach that considers the effects of medical practices on the quality of life and survival of humanity as a whole, using an interdisciplinary approach that combines life sciences with social sciences 1 .
This expanded ethical framework demands a focus on what some bioethicists term practical justice—moving beyond theoretical discussions of fairness to implement concrete strategies that achieve equitable distribution of health technologies' benefits and burdens . The pandemic revealed stark injustices in how different communities experienced both the disease and the control measures.
The research suggests several pathways for addressing the trust and polarization challenges exposed by the pandemic:
Physicians in stress studies reported that transparent communication from institutional leadership was crucial for maintaining trust during crisis 8 . The same principle applies to public health communication—acknowledging uncertainty and being honest about what is known and unknown builds credibility over time.
Top-down communication is insufficient. Effective public health requires engaging communities as partners, particularly those with historical reasons for distrusting medical institutions 6 .
Bioethicists argue for strengthening frameworks of distributive justice to ensure that resource allocation decisions are equitable, coherent, and transparent—not just during pandemics but as a permanent feature of healthcare systems 2 .
The pandemic made clear that nationalistic approaches to health crises ultimately fail. Bioethics must develop tools for thinking about our obligations to each other across borders, recognizing that local decisions have global impacts 2 .
| Research Method | Application in Pandemic Studies | Key Insights Generated |
|---|---|---|
| Representative population surveys | Tracking changes in trust in scientists over time | Revealed trust polarization pattern |
| Feeling thermometers | Measuring affective polarization between groups | Quantified emotional component of political divisions |
| Social distance scales | Assessing willingness to engage with opposing groups | Documented how polarization extends beyond opinions to relationships |
| Multivariable regression modeling | Identifying predictors of vaccine hesitancy | Isolated political affiliation as significant factor beyond demographics |
| Qualitative interviews with healthcare professionals | Documenting moral stress and ethical challenges | Revealed how systemic factors impact frontline workers |
The COVID-19 pandemic presented humanity with more than a medical challenge—it stress-tested our social contracts, our information ecosystems, and our capacity for collective action. The diagnosis is clear: we are suffering from a severe case of polarization and trust deficit. The prescription, according to bioethics insights, involves rebuilding our approaches to public health around justice, transparency, and recognition of our fundamental interconnectedness.
The pandemic's legacy for bioethics may be what Vardit Ravitsky describes as "a dramatic shift towards areas that need growing recognition and faster implementation," particularly "justice in a global context" with "an emphasis on fairness, transparency, trust, solidarity, and compassion as leading values" 2 . This positive legacy could transform these difficult times into a turning point toward a more equitable and resilient global society.
The divides the pandemic revealed and exacerbated won't heal on their own—but the field of bioethics offers both a framework for understanding these challenges and a roadmap for addressing them. By applying these insights, we can hope to emerge from this crisis not just with better protocols for the next pandemic, but with stronger bonds of trust that will serve us well in facing whatever challenges come next.
The pandemic amplified existing trust levels rather than creating consensus
An expanded ethical framework is needed to address interconnected challenges
Practical strategies exist to rebuild trust and address polarization