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Recent studies suggest that trust in government and public health experts is vital for acceptance of public health recommendations during the COVID-19 pandemic. It is increasingly clear that mistrust in public health recommendation affects efforts to slowdown the spread of COVID-19 in many countries. The objective of this study is to identify perceived drivers of mistrust in public health responses to COVID-19 in Ghana, using concept mapping with a range of local stakeholders (n = 21). The study was conducted between July and August 2020. Fifty-two items describing factors that influence mistrust in COVID-19 response were identified across eight themes. Out of eight clusters that emerged, participants rated weak health system, distrust in politicians and state institutions, and politicization of response measures as the most important and prevalent drivers of mistrust . The results show that the old narrative of cultural beliefs and illiteracy is not sufficient for understanding mistrust in public health programs during epidemics in SSA, at least in the case of COVID-19 in Ghana. This study demonstrates the need for global health practitioners to pay attention to structural forces and political relations in order to paint a fuller picture of mistrust during epidemics and pandemics.

Public health response to COVID-19 pandemic and drivers of mistrust in Ghana