It was a bleak winter in the UK: the dreaded second wave of COVID-19 swept in with the cold and rain, triggering a return to nation-wide lockdown. The government-led vaccine rollout seeded hope while generating new uncertainties as cases continued to rise. Throughout this fraught period–November 2020 to April 2021–I was involved in remote ethnography as a member of the COVID & Care Research group, a team of LSE anthropologists assembled to ethnographically chart the disadvantage and stigma exacerbated by the pandemic in the UK. Alongside interviews with community health workers, I regularly attended the Public Health Communities Briefings organized by the Greater London Authority. These were held monthly on Zoom and offered the latest statistics on the spread of COVID-19, as well as advice on how to stay safe and clarification of lockdown rules.
On January 12th 2021, I joined hundreds of other health workers and community leaders at a special briefing marking “the Oxford Astra-Zeneca vaccine roll-out alongside the difficult news from the Prime Minister announcing further national restrictions, including the closing of all schools.”1 Previous meetings, organized by the Greater London Authority in partnership with NHS London and Public Health England, had coincided with the return to full lockdown in November and offered context for the distressing Downing Street announcements prohibiting Christmas mixing. The briefings were advertised to members of community, voluntary and faith organizations through existing mailing lists, social media, and WhatsApp groups created to facilitate mutual aid. The briefings’ keynote speakers, Professor Kevin Fenton and Regional Joint Chief Nurse Martin Machray, were presented as the scientific interpreters of national policy and apolitical purveyors of health advice. Beyond the practicalities, they offered reassurance that “we will get through this together” and rallied those listening to mobilize their communities as part of a collective pandemic response.
To the experts, trust was an asset to be marshaled in the fight against the virus; to many in the audience, it ran deeper, evoking the relationships and relational work at the core of their communities. The community organizers and volunteers who found themselves reluctantly championing the local public health response were tasked with juggling the implications of trust as noun and verb, mobilising it as a resource and maintaining it as enduring relationship.
Trust as Ever-Present
Trust was a word often invoked by VCS workers, volunteers and community leaders who participated in the COVID and Care project. By January 2021, lockdown announcements and hospitalization rates were underwritten by growing awareness that people of certain ethnic groups and the most resource-poor were more susceptible to infection and death from COVID-19. These unequal forms of suffering were continually pointed out by frontline workers, as well as by community-based advocates during the Public Health Communities Briefings.
Inequalities accompanying the vaccine roll-out brought new salience to the politics of division which had been reflected in official UK COVID-19 statistics since the start of the pandemic. Recognising low uptake among minority communities, the government quickly designated certain groups as “hard to reach”. Solutions to boost vaccination were predominantly promoted through tailored information campaigns (with the latest health advice being translated into non-English languages or through graphics). To access these at risk communities, responsibility was quickly placed on “super-locals,” those who know “the apparently hard-to-reach people intimately.” Enthusiasm for these strategies were reflected in the Communities Briefings; experts and scientists emphasized that health workers and community leaders “need to build those relationships” to encourage vaccination at a “hyperlocal level.” The government’s strategies of public health promotion employed such coded language as an “ethical fix,” invoking ideals of solidarity and equality while deferring the work of high-level structural change from the state to hyperlocal individuals.
The Community Public Health Briefings allowed me to watch the government’s designated experts negotiate the contradictions of a nation-wide pandemic response in real time. In these meetings, experts grappled openly with their words and with their roles as arbiters of government mandates, exposing a slippage between trust as instrument of efficiency and trust as a mode of historical relationality. This elision between the strategic and affective raises important questions for the meaning of trust, many of which were raised by attendees. During the February 2021 briefing, one person addressing engagement with the Black, Asian, and Minority Ethnic (BAME) community wrote in the Zoom chat, “Most people speaking on the COVID-19 lack basic understanding on how to engage properly with from BAME community [sic].” Other attendees chimed in, calling for recognition of the “good work being done but in bits and pieces and in using people’s own time, effort and finances,” and asking for “a top-level intervention…not just access to online resources and ideas.” Community health workers spoke to the injustice of demands placed on their already-stretched capacities and the implications of framing the trust of their communities as another resource to be mobilized and potentially depleted. Simplistic government narratives of trust building crumbled in this online space, where inequities were acknowledged, frustrations erupted, and experts doubled back on their words to smooth over inherent contradictions in pandemic-time governance.
Trust Experts?
In the public health briefings, spokespeople of the National Health Service and Public Health England invoked trust building as a long-term collaborative project, while simultaneously emphasizing the immediate and deadly consequences of mistrust. While the NHS is responsible for providing government-funded healthcare services, Public Health England (now the UK Health Security Agency) acts as an advisory organization producing research to guide implementation and policymaking. Addressing the meeting in February, Martin Machray, Joint Chief Nurse for the NHS in London, broadly acknowledged the need for national representatives to “earn that trust in the long term” while urging the attendees to go back to their communities with the latest guidance and vaccine information.2 Trust was presumed to be an instrument which lay at community leaders’ disposal, and it was emphasized that, in the words of Professor Kevin Fenton, “now is not the time to turn away from the tools that we have.” Trust-building on the part of the government was vaguely promised, while the trust of “hard-to-reach” communities was directly and urgently solicited–an unsettling clash of timescales.
Public health spokespeople were attuned to the tensions created by government demands—compounded by the anguish of loss and social isolation in lockdown—and chose their words carefully. They wove personal stories—their family’s experiences getting vaccinated, for example—in with acknowledgments of the scale of suffering, and interspersed anecdotes with statistics and virological findings. They endeared themselves by admitting the limits of their own expert knowledge and scientific uncertainties. In doing so, they exposed the unstable terrain from which national policy, though it claimed to be entirely data-driven, was issued. In humanizing themselves, they cast doubt on any authority claiming complete objectivity. The “regulatory state of exception” in which expedited decision-making and drug approval processes were justified by bureaucrats and scientists alike, distorted experts’ appeals to public trust.
The Emptiness of Trust
Empathy, humor, and heartfelt moments gestured towards a more enduring project of trust building between national health representatives and community support workers and organizations. This was not enough, however, to allay the anxieties of those caught up in webs of exclusion and neglect, predicated on years of austerity and associated moralizing. Memories of past abuses by health authorities were brought into fresh relief by accounts of present-day injustices, including cuts to welfare and social services that have left many in precarious financial positions. Media accounts casting certain communities as “spreaders” of the virus “land[ed] in already divided social environments” and “fuel[ed] stereotyping and blaming” of ethnic minorities. The online chat and Q&A of the Community Health Briefings provided space for these stereotypes to be contested and for narratives of blame to be reversed. Participants asked questions: “Are ALL vaccination centres fully accessible to disabled people?” “Why are unpaid family carers not being prioritised for vaccination?” “Are asylum seekers guaranteed protection?”—revealing diverse and specific motivations for attending. For those demanding answers, the process of building trust with government officials was secondary to the immediate needs of those who trusted them: neighbors, clients and family to whom they would be answerable after the Zoom call ended.
Where trust was invoked as a cure-all for deep-seated tensions, community health workers added heft and history. In the chat and Q&A, they asserted the historical genealogy of trust “eroded by the Windrush scandal and also the Grenfell Disaster, where people have not received the justice they deserved”. The wrongful detention and deportation of Commonwealth citizens who had arrived in the UK between 1948 and 1973 (“the Windrush generation”, named for the “HMT Empire Windrush” ship) and the collapse of the Grenfell tower block in 2017 were present in the online forum as representations of past betrayals. One attendee insisted “the whole conversation shouldn’t be about getting BAME community to get vaccinated. The current conversation is too pushing [sic]. This made people from BAME community to be suspicious and it brought back sad memory of bad experiences of vaccination in the BAME community.” A second poster pushed back “We do need to address issues in BAME communities—what we do need to think about is how we do this and ensure we are not being dictators but actually understand issues that have never ever been dealt with. I have heard it said ‘why are people interested in me now—I have always been here!’”
Their words resonated in the Zoom room but soon disappeared in the flood of messages and questions. In responding, the speakers, including those self-identifying as Black or “minority ethnic” reaffirmed the call to action for community leaders to translate and transmit health messaging through the channels at their disposal, to use the trust the government lacked to change minds and save lives. Acknowledging the burden of this mission and praising community leaders’ efforts only underscored the responsibilisation of those already financially and physically strained. Their frustrations layered upon each other, like the messages in the meeting chat, representing the volume of unanswered demand for government accountability among minoritized groups in the UK.
Trust: Slippage of Meaning
Unanswered questions and outbursts in the context of the Public Health Communities Briefings pointed to the slippage between intention and action, tacit acknowledgement, and tangible reparations. Throughout, the dual mandates of trust-building and the urgency of rapid response sat uneasily together, and I was drawn in by the tension, the subtle reworkings of off-line social precedent concentrated in these hour-long sessions. The interface the briefings provided between community health workers and top-level government experts allowed confrontations to occur, in real time and with some spontaneity. The meetings provided a window on pandemic-time governance and the deficiency of trust between government and marginalised communities, as well as the chance to comment and contest.
The tensions that emerged during the briefings were underscored by the temporality of the pandemic itself. From the start, resources had been commandeered for the sake of expediency—the labour of key workers for overburdened hospitals, supply chains for PPE, schools, and public buildings for vaccination clinics—saving lives through the tightening of logistics. The results, superimposed as they were on “longer temporalities of mistrust” were incomplete and unequal. Stigma and blame were fueled by fear and frustrations but also by urgency. Community members who felt scapegoated or steamrolled during the race to “get jabs in arms” resisted the assumption that local resources and relationships could be commandeered in the same way, for the sake of efficiency and optimization.
By looking specifically at trust, the slippage of government discourse during the pandemic comes into view. The word is familiar but contains unsettling inconsistencies; experts’ emphasis on its instrumentality contradicted its relational connotations, and this inconsistency fed doubts about the government’s underlying intentions. At the direst moments of the pandemic, trust and the labor of the trusted was commandeered with an urgency obstructive to truly mutualistic relationship-building. Now, with the pandemic fading, trust is being repurposed by policymakers as an asset to leverage in “levelling up” underperforming places and people. As long as its relational meaning is subordinated to its instrumental purpose, trust will continue to elude us.
NOTES
1. Excerpt from invitation email for Public Health Community Briefing Meeting, January 12, 2021.
2. Online Public Health Briefing, March 9th 2021.
About the Author
Milena Wuerth is a researcher on multiple projects related to care and crisis hosted at: the Firoz Lalji Institute for Africa, London School of Economics; the King’s College London Institute for Psychiatry, Psychology and Neuroscience (IOPPN); and the SOAS Department of Anthropology. Milena is currently pursuing an MSc Public Health student at the London School of Hygiene and Tropical Medicine (LSHTM).
Milena’s research and writing on this project has been supported by the LSE Covid & Care Research Group and the LSE Research and Impact Support Fund (RISF).