As a frontline doctor in a Malaysian public hospital during the 2009 H1N1 “swine flu” outbreak, I witnessed first-hand how trust and public confidence are as important as isolation rooms and antiviral medicines. Outbreaks have always caused strong emotions of fear and panic, and now perhaps even anger after the death of the whistle-blower doctor in Wuhan. But how is this new coronavirus outbreak different from previous ones and what can we do about it? Fear is normal during times of danger – it’s what has kept us alive through millions of years of evolution. During outbreaks, we fear because we don’t know enough, what we know keeps changing, scientists and governments can’t seem to agree on the facts, and we fear death from unnatural or unpredictable causes. Cognitive dissonance only makes it worse – we ask ourselves why, if there’s nothing to worry about, millions of people are under quarantine, for example. Psychologically, we fear things we can’t see or control. Sociopolitically, we imagined that borders will protect us from “foreign threats”, so we panic when viruses penetrate these borders so effortlessly. Since 2009, three tectonic shifts have taken place to worsen these fears. First, social media – the technology of tomorrow – is being used by societies stuck with the preparedness of yesterday. Second, trust in governments is at historical lows, further eroded by opaque and inconsistent outbreak responses. And third is a combustible mixture of latent racism and increasing nationalism that has been lit by irresponsible politicians. Social media Just 11 years ago, only 17 per cent of the world had smartphones, there were only 30 million Twitter and 360 million Facebook accounts, and WhatsApp had just launched. Today, smartphone penetration is at 45 per cent, 500 million tweets are sent every day and 2.9 billion people use Facebook, Messenger, WhatsApp or Instagram each month. Social media has given everyone a platform, but not everyone knows how to use it responsibly. The velocity, volume and variety of information can be terrifying. For the average citizen, given their limited bandwidth and time, it’s easier to trust friends and family than distant, faceless experts, and quicker to just hit forward without verifying. Big tech companies claim to merely offer “neutral platforms” as an excuse to avoid responsibility for user-generated content. But are they really neutral if they are home to a morass of fake news, hate speech, political misinformation and extremist rhetoric? Entire education systems must be revamped to train the population how to search for, verify and use information. Big Tech must self-regulate and be regulated in ways that protect free speech while eliminating dumb, divisive or dangerous rhetoric. During outbreaks, governments, health professionals, traditional media, civil society and responsible citizens must “flood the zone” with truth and solidarity, to flush out trolls, racists and bigots. Declining trust Trust in institutions, politicians and governments is declining, mostly thanks to political polarisation and a general deterioration in people’s quality of life, public services and institutional performance. Health authorities and public health care services have been caught on the back foot. Much of this isn’t their fault, as science alone has never been the sole criterion for health care decisions: politics, economics and the social contract all played important roles. Are we overreacting to coronavirus threat and merely creating bigger risks? Outbreaks are different. Saving lives is the overriding objective, and cool, calm and evidence-based science must take precedence. However, in societies with trust deficits in politicians such as in Hong Kong , the United States and Malaysia , or in authoritarian and opaque societies like mainland China ’s, doctors and scientists try to dissociate themselves from their political masters with varying levels of success. Political leaders must work with health care professionals to make decisions during an outbreak – yet during this crisis some political leaders are seemingly making decisions largely on political grounds without giving science an equal say. This outbreak will burn itself out, leaving us to prepare for the next one, which will require both adequate investment in response capabilities to strengthen our health systems and system-wide upgrades. Universal health coverage, enhanced primary care and competent professionals will not only mitigate outbreaks but also help manage ageing populations with non-communicable diseases. Increasing nationalism Globalisation has undoubtedly polarised societies around the world, with nationalist instincts manifesting in discrimination or xenophobia against certain ethnicities during this outbreak. Travel bans, a convenient fig leaf for latent racism, are increasingly being deployed despite little evidence that they work against viruses that have no passports. Coronavirus outbreak: the plague of fear and prejudice could be just as lethal This outbreak may have started in China, but it’s not China’s fault, just like the 2009 H1N1 outbreak that started in the United States – causing up to 575,000 deaths – wasn’t theirs. The World Health Organisation ’s calls for solidarity are correct: this is a war between species, not between countries. Helping China, and every country facing an outbreak, is not only compassionate and ethical, but also common sense. Global scientific collaboration must accelerate with freer and more transparent data sharing. Open-access repositories operated by neutral brokers like the WHO or the European Union can be trust-building instruments. Academic, publishing, intellectual property and patent systems must reform their incentive structures to reward collaboration, not destructive competition. In the meantime, we can and should help China as much as possible while worldwide, health systems should shift from containment to mitigation strategies. This will not be the last time the world reels from an outbreak of infectious disease. Health leaders must recognise the shifting technological, sociopolitical and geopolitical landscapes in which we now operate to formulate solutions. Science alone can’t save us, but a combination of science, compassion, public trust, good governance and solidarity can. Dr Swee Kheng Khor specialises in health systems, health policies and global health, and is currently based at the University of Oxford.