The COVID-19 pandemic exposed a troubling vulnerability in global health security that had little to do with vaccines, ventilators, or surveillance technology: a widespread erosion of public trust that hampered the very interventions designed to save lives. Vaccine hesitancy, resistance to public health mandates, and skepticism of official messaging collectively blunted pandemic response efforts across countries with otherwise robust health systems. As new infectious disease threats — including H5N1 avian influenza and mpox — continue to emerge, a critical question confronts preparedness planners: are we doing enough, right now, to rebuild the public trust that future emergency responses will depend upon?
A new study published in Global Health Action suggests the answer is incomplete at best. Researchers at the University of Zurich conducted a systematic comparative analysis of the World Health Organization’s “five C” framework for health emergency prevention, preparedness, response, and resilience — one of the most globally influential pandemic preparedness tools developed in the wake of COVID-19. Their findings reveal that while the framework is substantively strong in several respects, it contains meaningful gaps in the trust-building principles that research has shown to be essential for securing public cooperation during a health crisis.
Where the WHO’s Preparedness Blueprint Falls Short
The study assessed the WHO’s five C framework — which organizes preparedness across five domains: collaborative surveillance, community protection, safe and scalable care, access to countermeasures, and emergency coordination — against an established public trust in health systems framework. Each trust-building principle was classified as explicitly present, implicitly present, or absent within each domain.
The results were uneven. Community protection emerged as the most trust-integrated component, with principles such as familiarity, information quality, net benefit, and time all present. The remaining four domains revealed notable deficiencies. The principle of time (meaning attention to how the public perceives the speed of health interventions, not merely operational timeliness) was absent from four of the five domains. Information quality was absent from both collaborative surveillance and emergency coordination. Privacy was absent from collaborative surveillance, and anonymity was missing from access to countermeasures.
That distinction between “time” as an operational concept and “time” as a trust-relevant principle is one of the study’s more important contributions. The framework frequently emphasizes speed in crisis response, which is necessary. But it consistently fails to address the flip side: when interventions are perceived as rushed, public trust can erode even when the underlying science was sound. That dynamic, the authors argue, is predictable and addressable, but only if it is built into preparedness planning in advance.
Trust Deficits Are Preparedness Deficits
The authors argue that trust-building principles should be embedded into two of the most operationally significant preparedness mechanisms available to WHO member states: the Joint External Evaluation process and National Action Plans for Health Security. In practice, this could mean expanding Joint External Evaluation indicators to assess whether countries have formal two-way communication mechanisms with communities — evaluating not just whether information is disseminated, but whether public concerns about privacy, data use, and governance are systematically captured and addressed.
Surveillance systems that fail to account for public privacy concerns will face reduced voluntary participation, weakening situational awareness at the moment early detection is most critical. Emergency coordination mechanisms that neglect to communicate transparently about rapid decisions will generate the same fragmented, trust-damaging messaging that characterized COVID-19 governance failures in numerous countries. These are not soft concerns — they are operational vulnerabilities.
Trust, unlike surge capacity or vaccine stockpiles, cannot be rapidly manufactured when a crisis is already underway. It must be accumulated over time through familiarity, transparency, and demonstrated respect for public autonomy and privacy. The inter-pandemic period is the only viable window to close these gaps — and that window is open now.
Sources and further reading:
Papadopoulos K, von Wyl V, Gille F. How to shore up trust during the “cold-period” between pandemics – closing the public trust gap in pandemic preparedness frameworks. Global Health Action. 23 April 2026.