{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T04:05:50Z","timestamp":1789272350016,"version":"build-2803163510"},"reference-count":34,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T00:00:00Z","timestamp":1789171200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T00:00:00Z","timestamp":1789171200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Milbank Quarterly"],"abstract":"<jats:sec>\n                    <jats:label\/>\n                    <jats:p>\n                      <jats:boxed-text content-type=\"box\" position=\"anchor\">\n                        <jats:caption>\n                          <jats:title>Policy Points<\/jats:title>\n                        <\/jats:caption>\n                        <jats:p>\n                          <jats:list list-type=\"bullet\">\n                            <jats:list-item>\n                              <jats:p>Institutional trust appears to constitute an essential component of pandemic preparedness. Czech excess mortality\u201449% higher than Austria's and approximately twice the European mean\u2014illustrates that governance failures can undermine functional preparedness assets.<\/jats:p>\n                            <\/jats:list-item>\n                            <jats:list-item>\n                              <jats:p>The observed 8\u201310\u2010week lag between trust decline and mortality divergence is consistent with a potential early\u2010warning window. Regular monitoring of public trust may identify governance deterioration before preventable mortality escalates, thereby operationalizing trust as a measurable governance outcome.<\/jats:p>\n                            <\/jats:list-item>\n                            <jats:list-item>\n                              <jats:p>Competent health leadership continuity is a protective factor, not a guarantee. Five Czech health ministers in 15 months coincided with the deterioration in public cooperation, demonstrating how political instability weakens pandemic\u2010response capacities even where technical preparedness exists.<\/jats:p>\n                            <\/jats:list-item>\n                          <\/jats:list>\n                        <\/jats:p>\n                      <\/jats:boxed-text>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Context<\/jats:title>\n                    <jats:p>The Czech Republic's COVID\u201019 excess mortality represents a preparedness paradox. Despite entering the pandemic with substantial technical capacity\u2014including the highest intensive care unit density in the Organisation for Economic Co\u2010operation and Development, an early national mask mandate, and an initially effective contact\u2010tracing system\u2014that country experienced age\u2010standardized excess mortality of 15.24 per 10,000, approximately twice the European mean and 49% higher than neighboring Austria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This mixed\u2010methods comparative case analysis examined relevant data from March 2020 through December 2023. Austria was chosen as a comparative governance benchmark to the Czech Republic because it closely matched that country's initial governmental trust level (entering the pandemic within approximately two percentage points), and Slovakia is a historically and geographically proximate comparator. Age\u2010standardized excess mortality was examined alongside government trust measures, mobility indicators, vaccination data, and policy stringency indices. Exploratory lag correlations assessed the temporal relationship between changes in trust and subsequent mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>Czech governmental trust declined from approximately 71% to 19% during the pandemic period, among the largest declines in Europe. Austrian trust remained comparatively stable, whereas Slovakia also experienced a substantial decline in trust alongside high excess mortality. Czech mortality divergence from Austria emerged approximately 8\u201310 weeks after trust deterioration. Four mechanisms are proposed through which trust erosion may have influenced mortality: reduced compliance with public health measures, vaccine hesitancy, collapse of contact tracing, and governance\u2010associated misperceptions of the scientific consensus.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This analysis suggests that governance stability and institutional trust appear to function as important public health pandemic preparedness measures.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1468-0009.70130","type":"journal-article","created":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T03:15:11Z","timestamp":1789269311000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Czech Conundrum: Institutional Trust Erosion and COVID\u201019 Pandemic Mortality"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4579-9560","authenticated-orcid":false,"given":"Charles P.","family":"Webel","sequence":"first","affiliation":[{"name":"School of International Relations and Communications University of New York in Prague"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,12]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"OECD Health Statistics[database].Organisation for Economic Co\u2010operation and Development; 2019\u20102020 data. 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