It all starts with trust — something politicians just don’t have. On the list of people and groups Americans trust, politicians are right down at the bottom, lower even than journalists. Even among the most trusting Americans, only 46 percent have any confidence our elected officials will make decisions in our best interest. Americans’ trust in government itself is at its lowest point since we started systematically measuring it. Only one-fifth of us trust the federal government to do the right thing.

And trust — in politicians and the government they represent — turns out to be a pretty important part of effectively responding to an epidemic. For example, in a 2006 survey that came out after the SARS epidemic, Blendon and his colleagues found that Americans were less likely to trust their government to tell them accurate information about an outbreak than citizens of Hong Kong, Singapore or Taiwan — and that those lower trust scores were correlated with less support for wearing face masks, getting a vaccine or agreeing to have their temperature taken before they enter a public building.

Other studies have come to similar conclusions. Generally speaking, the more trust Americans have in the government, the less likely they are to refuse vaccines.