This section defends the augmentation strategy from seemingly strong initial challenges. Although this is not intended to be exhaustive, the discussion demonstrates that challenges can be met by a more nuanced account of the strategy.
An immediate response to the strategy under discussion is that trust is an interpersonal attitude, so it is irrelevant to the way people relate to organisations. In other words, people trust other people, on the basis of perceived trustworthiness, so it is a category error to think people trust institutions. This challenge is strengthened by the fact that the most obvious way of meeting it won’t work. This obvious solution is that people do not trust organisations per se; rather, they trust the individual professionals who staff them. For example, patients don’t trust hospitals, they trust individual doctors, nurses, administrative staff, etc., who work there and with whom they interact. This seems to meet the challenge by recasting public trust in organisations as interpersonal after all. But it clearly won’t help in the current context, because members of the public do not interact with public health professionals who staff public health institutions in the way they interact with their doctor and other health care providers.Footnote 13
The better way to meet the challenge starts by clarifying it. To recall, the two main components of the philosophical analysis of trust are reactive attitudes to failures of trust (principally, a sense of betrayal and feelings of resentment) and value congruence (i.e., trust is elicited by perceiving trustworthiness on the basis of shared values). So, the objection under discussion is that these reactive attitudes, and value congruence, do not belong in the relationship between people and institutions. Put like this, the objection is simply false, because there is a wealth of theoretical and empirical support for the view that people do trust organisations. For example, this is well established in sociological critiques of organisations . And analysts in other disciplines have defended the notion of public trust, showing that people not only rely on, but also trust, organisations as well as other people; that failures of trust in organisations elicit the relevant reactive attitudes, and that trust is based on the perception that the organisations in question shares the public’s values .
The challenge can be revived by arguing that, although the public trust some sorts of organisations, they don’t trust those relevant in this context, namely, health care institutions or institutions responsible for managing data. But this is also unconvincing. There is clear anecdotal evidence of value congruence between the public and healthcare institutions; a case in point is the British public’s response to the current coronavirus pandemic, which is characterised by a recognition that the NHS shares its values, resulting in an outpouring of support.Footnote 14 The very nature of public health institutions suggests that their values will align with the public’s, since the point of public health organisations is to act in the public’s best interests. And this is confirmed by empirical evidence that there is public trust in healthcare actors, grounded in value congruence , and that trust based on shared values reduces privacy concerns and thereby increases willingness to share personal information . This has been transposed to the management of health data; for example, as previously mentioned, Sheehan et al.’s discussion of trust and trustworthiness in the context of using patient data for research in the NHS alludes throughout to institutions’ values and their congruence with the public .Footnote 15
Still, the objection isn’t fully dispelled, because it does seem odd to think that people trust organisations in exactly the same way as they trust each other. For example, it would be odd for someone to feel as betrayed by, or as resentful towards, an organisation as they would when let down by a partner or best friend. But this version of the challenge can be met by a more nuanced account of the trusting relationship. So far, we have starkly contrasted reliance and trust for the sake of clarity and brevity, but the taxonomy of relevant attitudes is more complex than this. To illustrate, in this journal, Holland and Stocks  distinguished two ‘species of trust’: ‘general trust’ exists between partners, close friends, and so on; ‘specific trust’ is an attitude one person adopts towards another in order to achieve a goal, but their relationship has developed beyond mere reliance.Footnote 16 The relevant reactive attitudes—such as feeling betrayed and resentful—are appropriate to both species of trust, but to a different degree. For example, betrayal of general trust ‘is profound and shocking, causing intense psychological harm’ [12 at p. 271]; by contrast, failures of specific trust also generate a sense of betrayal and feelings of resentment, but to a lesser extent and with a different qualitative feel.
Holland and Stocks  illustrate their general/specific trust distinction by contrasting the reliance one places in a taxi service, with the trust (in the ‘specific’ sense) a passenger gradually develops in their regular taxi driver whom they get know over a period of time. It would be inappropriate for the passenger who trusts their taxi driver (in the ‘specific’ sense) to experience ‘profound and shocking betrayal’ or ‘intense psychological harm’, if they let them down. Nonetheless, they would feel betrayed, and resentment is appropriate, albeit to a lesser and amended extent.Footnote 17 Assuming the attitude appropriate to organisations is that of ‘specific trust’ deals with the challenge under discussion: we have the reactive attitudes distinctive of trust—for example, feeling betrayed and resentful—towards organisations we find trustworthy, but in an attenuated sense and to a lesser degree than in the case of ‘general trust’.Footnote 18
But these sorts of worries have still not been fully dispelled. There is another version of the challenge that, although trust and trustworthiness are appropriate to organisations as well as in interpersonal relations, this does not extend to the sort of institutions in which we are interested. This other version focuses on the fact that public health information is acquired and used by a network of state-backed government agents—including national, regional, and local bodies—and mistrust of government is well documented. More nuanced accounts of the trusting relationship, as illustrated by Holland and Stocks , cannot be enlisted here, because the challenge is that people do not trust governments at all, not even in an attenuated sense or to a lesser extent. And this challenge is strengthened further because it arises even in political systems where there is a democratic mandate: people in complex, developed democracies are too far removed from political decision making to feel reassured that they can trust government agents; and attempts to enhance democratic legitimation—opinion polls, citizens’ juries, and so on—fall short of providing the requisite reassurance to engender public trust grounded in the perceived trustworthiness of governments and their agents.
But this challenge is not fatal to the augmentation strategy. Distrust of government in the context of public health is not uniform. For example, public mistrust is most strongly elicited by liberty-limiting public health interventions which are paternalistically motivated—hence, paternalism is a major motivation for and feature of public health ethics —but the public are much less distrustful of public health measures clearly aimed at avoiding third party harms (hence the generally high rates of compliance with current restrictions to reduce transmission of Covid-19). So, we need to ask how forceful this challenge is in the specific case of public trust in institutions responsible for managing public health information. And the answer is, ‘not very’, because the vast majority of public health work—and associated information management—is not the sort that elicits public distrust on the grounds of being state sanctioned. The overwhelming majority of people are not outraged by standard public health information gathering practices, or data collection during public health emergencies. So, we can acknowledge that the public mistrust governments and their agents—and even that the public has serious misgivings about the role of the state in public health interventions which flout individual liberties—whilst promoting public trust in public health information management.Footnote 19