Denmark’s death toll during the pandemic was only 450 people per million citizens, compared to 1,982 per million in the United States. How did Denmark, and its 5.8 million people, beat the covid-19 pandemic?
As part of Denmark’s largest behavioral covid-19 research project (the HOPE project), we surveyed more than 400,000 individuals in Denmark and seven other countries. Our findings suggest that citizens’ high and stable trust in their health authorities has been a crucial factor in Denmark’s success. This trust, shown in the figure below, encouraged high vaccination rates and the successful implementation of key policies such as mass testing and coronavirus passports.
Trust in national health authorities, by country
How Denmark got people vaccinated
Research on vaccine hesitancy — including our own — consistently finds that lack of trust in authorities — government officials, local leaders and health experts, for instance — is one of the primary reasons people refuse to get vaccinated against the virus. This is hardly a surprise, given that few of us have more than a vague understanding of how vaccines work, let alone the ability to verify that the coronavirus vaccines will work as vaccine companies claim. This leaves people with a need to trust stakeholders, from scientists testing the vaccine to authorities approving and distributing it.
Over 90 percent of Danes trust the national health authorities, our survey data revealed. By last fall, over 80 percent of the eligible population was willing to get an approved vaccine, compared to less than 50 percent in the United States. While starting with high levels of trust certainly helps, sustaining this trust could be a challenge, especially if authorities may be tempted to promote vaccines that prove less effective or more risky than others. Our research shows that in these situations, transparent communication about all features of vaccines — including the negative ones — is key to sustain trust, even if in the short run it reduces vaccine acceptance.
Vaccine willingness levels, by country
This finding highlights that trust between citizens and the authorities ideally runs both ways, as authorities need to trust that citizens can weather bad news and still make responsible decisions. President Donald Trump later admitted to intentionally downplaying the coronavirus. In contrast, Danish authorities were — after a slow start — frank about the severity and the uncertainties of the crisis. They were also candid about the potential side effects of some vaccines and in March made the decision to suspend the use of the AstraZeneca vaccine. The health authorities argued that with the most vulnerable already vaccinated, and with the epidemic well under control, even the rare side-effects of AstraZeneca vaccine posed a larger threat to Danes than the virus itself.
Creating a collective project
Denmark initially paused the use of the AstraZeneca vaccine and later removed both the AstraZeneca and Johnson & Johnson vaccines from the public vaccine program, donating 3 million spare vaccines to developing countries. This prompted a delay in the otherwise efficient vaccine rollout for several weeks.
In the meantime, a core part of the solution to keep the virus under control was mass testing. At the peak, in the spring of 2021, Denmark performed 4 million tests (75 per 100 citizens) a week. And Danish authorities promoted compliance with testing and other covid-19 guidelines as a moral obligation — to put it simply, as the right thing to do for each other, building upon the collective approach to beating the pandemic.
Moralized issues can backfire and lead to conflict, which can easily spiral into shaming and condemnation from both sides. Despite their high levels of support for the government’s covid-19 policies, Danes did not appear to resort to blaming and shaming to keep each other in line. In other words, most people followed the advice of the authorities and didn’t take it upon themselves to police others. Indeed, our data shows that the support for government policies was so high that most of those who voted against the governing parties in the last election still thought the government was taking the necessary steps to handle the coronavirus.
Support for government covid-19 policies, by country
How Denmark avoided polarization — and bickering
One of the main threats to a collective project is partisan bickering, which often starts among the elites and then trickles down to the broader public. In a prolonged crisis like a pandemic, where the burden on citizens accumulates, public support inevitably decreases over time. But elite polarization can accelerate this development.
Denmark was in a favorable position to deal with a pandemic, as Danish political parties have a rich history of working together. Our surveys show that initially 80 percent of Danes felt their leaders were united against the coronavirus. This unity was shaken twice. In November 2020, the government’s decision to cull all mink in Denmark prompted widespread criticism about the legal and health merits of the decision.
A few months later, in February, the right-wing opposition strongly disagreed with the government about the best road map to reopen society. But after extensive negotiations on both occasions, Denmark’s parties came to a common understanding and feelings of polarization among citizens waned. The Danish opposition prioritized epidemic control over the potential electoral gains that polarization might offer.
In part, this common understanding was facilitated by a general commitment among political elites to follow the science, including medical research, epidemic modeling, economics and behavioral science — including the findings of the HOPE project.
Getting to the finish line
The final challenge is buffering the burden of restrictions. Our research shows that the social, financial and health burden of the pandemic fuels opposition against the political system. In Denmark, high compliance and support has made restrictions softer and made them seem meaningful, lowering this burden. As a consequence, Danes have suffered less during the pandemic and perceived mass testing and coronavirus passports as tools for protecting each other.
Danes trusted government and health authorities to make responsible and competent decisions to fight the pandemic, which for the most part they did. The Danish government and authorities in turn trusted the people of Denmark to behave responsibly and follow the guidelines.
Michael Bang Petersen (@M_B_Petersen) is a professor in the Department of Political Science at Aarhus University. He is the principal investigator of the HOPE project and advised the Danish government on the behavioral aspects of managing the covid-19 crisis.
Alexander Bor (@boralexander1) is a postdoctoral researcher at the Department of Political Science at Aarhus University and a member of the HOPE project.