Authors: Dr. Asahngwa Constantine, Dr. Denis Foretia, Dr. Gobina Ronald, Wilfred Ngwa, Dr. Charlotte Bongfen, Dr. Odette Kibu, Dr. Nkengafac Fobellah (Pdf Version)
In Cameroon the battle against COVID-19 is far from over as the disease still continue to claim many lives and aggravates the deepening poverty situation of Cameroonians. According to reports from the Ministry of Health (as from 8th of December, 2020), Cameroon has recorded 24,752 infected cases, 23,344 recoveries and 433 deaths.  The economic consequences of the disease remain preoccupying as many people have experienced a decline in their businesses. The government of Cameroon through the Prime Minister published a national response plan which aimed at combating the disease, highlighting preventive measures and effective management of confirmed positive cases. Some of these measures include the prohibition of mass gatherings above 50 persons, maintaining physical distancing, wearing of face mask in public places, frequent handwashing with soap or using hand sanitizers and isolation of infected persons.  These measures and others are currently being implemented since March, 2020.
Although the government has been doing its best to bring this pandemic to an end, this has not been without challenges. One of the challenges is the decline of public trust in government’s policy decisions and institutions, which if not given sufficient attention may compromise all the efforts and resources already galvanize for this battle against COVID-19. Drawing from published literature, we discuss the factors responsible for the decline of public trust, how the lack of trust can hamper interventions and control efforts and some suggestions how this challenge can be tackled to enhance effective interventions to combat COVID-19 in Cameroon.
Triggers of distrust
Lack of transparency and openness in the entire intervention process can bring about public distrust in government’s actions and policy decisions. With respect to the fight against COVID-19, there are several areas where the lack of transparency and openness have been visible. Amongst them one can identify lapses in government’s communication strategy as accurate information regarding trends on infected cases, recoveries and deaths from COVID-19 are not provided to the public in a timely and consistent manner.  The distribution of intervention packages from the Head of State to targeted beneficiaries have not been transparent and open as complains about corruption and mismanagement of funds have been raised. . Furthermore, some media and members of the public have questioned the credibility of the process/method and results of some patients diagnosed and detected as COVID-19 positive. They argue that some people have been wrongly diagnosed and confirmed as COVID-19 positive.  The management of COVID-19 patients is another area where concerns have been raised with respect to access to services. It was made public by the Minister of Health that patients diagnosed with COVID- 19 or suspected of having the disease and placed in quarantine will be taken care of free of charge. However, this has not been the case as victims complain of mismanagement, segregation and tribalism in the management of COVID-19 patients. Some are abandoned in quarantine without food to fend for themselves during confinement. . All these areas demonstrating lack of transparency and openness easily breeds seeds of distrust in government policy decisions and intervention efforts. A similar experience occurred during the fight against the Ebola Virus epidemic in Liberia 
Fake news, misinformation and disinformation:
In Cameroon like in many other parts of the world the phenomenon of fake news, misinformation and disinformation remains a cause for concern especially in times of pandemics like COVI-D 19. The perpetrators of these false information include both traditional public and private media organizations (press and audiovisual), social media (WhatsApp, Facebook, twitter, YouTube etc) and individuals within and out of the community.  False, unverified and inaccurate information are provided to members of the public which many may consider some as truthful which they are not and vice versa.  For example, people are exposed to wrong information about the causes, methods of treatment and prevention of COVID-19 from all these different media outlets. When the right information is provided, it is then considered as false and when it is from the public media, the begin to show suspicion, doubts and distrust for the government regarding that particular information. When more and more people nurse these kinds of thinking there are likely to have negative consequences as will be demonstrated in the proceeding section.
Knowledge gaps and misconceptions
In Cameroon some people are not knowledgeable about the COVID-19 pandemic in all its facets. This can partly be attributed to the fact that the virus is new and everybody is still in the learning process. The general public largely depend on government and other media organizations to provide trust worthy, accurate and reliable information about the pandemic. To some extent this has been done, but to say everybody has the right knowledge about the disease in Cameroon will be an overstatement.  Flaws in the communication process and content from both traditional and social media outlets are partly responsible for the ignorance that looms amongst many Cameroonians especially those who reside in rural and hard to reach grassroot communities. 
When people are ignorant about a sensitive health issue like the COVID-19 pandemic they easily become vulnerable to perpetrators of fake news, misinformation and disinformation. In Yaoundé, it is commonly perceived that COVID-19 is a virus that was manufactured in a laboratory in China, while some people belief that there is no COVID-19 pandemic. With these perceptions people are likely to distrust the information ventilated on the media that provides a contrary view to their already held perceptions.
All the above-mentioned factors fuel public distrust in government policy decisions and institutions relating to the fight against the COVID-19 pandemic. The decline of public trust in government has implications for effective interventions to combat the disease in Cameroon.
Impact of public distrust in government policy on the fight against COVID-19
Considering the strategic role of trust in the fight against pandemics such as COVID-19, its decline has negative implications for the implementation of effective interventions. First, when there is public distrust in government’s policy decisions and institutions, people will hardly change their mentality with respect to the negative perceptions, impact misconceptions and other stereotypes they have build about the pandemic. At this point the communication messages government will provide (even if the content is truthful and accurate) may not be able to deconstruct already established knowledge, misconceptions and negative perceptions.  This will negatively affect intervention efforts as it will be a hindrance to behavior change. This was the case during the Ebola Virus pandemic in Liberia and the Democratic Republic of Congo (DRC). [14,15] Second, a decline in public trust with respect to governments policy decisions and institutions will hinder full compliance by the public to the recommended preventive behaviors as stipulated in the National Response Strategy. There have been numerous complains by the Ministry of Health about the non-adherence of the population to preventive measures. In the city of Yaoundé, it is very common to find people in public places without maintaining physical distancing or avoiding gathering of more than 50 persons. Many people are no longer wearing a mask and if they do, it is placed on the chin, including the forces of law and order who are called to ensure that members of the public respect all the preventive measures as stipulated in the response strategy. The practice of frequent washing of hands with soap or sanitizers is gradually becoming a thing of the past as the water containers remain dry in most public places, with no more checks on visitors to insure compliance. While government acknowledges the presence of COVID-19 and calls on the public to continue respecting all preventive measures, many people belief the pandemic is over. All these non-adherent behaviors and practices partly emanates from the growing public distrust in governments policy decisions and institutions with respect to the current COVID-19 pandemic in Cameroon. All these behaviors linked to distrust can compromise intervention efforts and resources used to combat the disease. [16,17] The lack of confidence in what government instructs the public to do even raises questions about public acceptance of a vaccine for COVID-19 if one was available. Studies have shown that public distrust in governments intervention strategy during pandemics often leads to low vaccine uptake. [4,16]
In order to build and strengthen public trust in governments policy decisions and institutions the following actions are needed:
- There is need for the government to communicate true and accurate information to the public in a transparent, open and timely manner.
- Government need to demonstrate leadership in developing and implementing effective and innovative ways to fight fake news, misinformation and disinformation in Cameroon.
- Government and its partners need an effective educative strategy to communicate the right information on COVID-19 to the general public and ensure a wide geographic coverage.
Public trust in government policy decisions and institutions is declining within the context of the current fight against the COVID-19 pandemic which has implications for effective interventions to eradicate this disease. Urgent attention and actions are required in order to consolidate efforts made so far.