March 7, 2023 — Political wars waged over public health recommendations on how to combat the COVID-19 pandemic have had a direct effect on trust in public health agencies such as the CDC and FDA, according to the results of a survey conducted by Harvard researchers.
The study, published on March 6 in the newspaper Health Affairsfound that people who had little or no trust in these and other public health agencies at the federal, state, and local levels believed that agency decisions were inconsistent, influenced by politics, and not based on science.
Among respondents who had a high level of trust in these agencies, only half said that doing a good job of controlling the pandemic was one of the main reasons for this trust. Instead, their trust in federal public health agencies was primarily tied to their belief that these institutions follow scientific evidence in policy making. People who trusted state and local agencies cited their direct and compassionate care.
The phone survey, conducted in February 2022, involved 4,208 American adults. The authors say their study is the first to examine the attitudes that help or hurt trust in public health agencies.
To put public health trust data into perspective, information provided by doctors and nurses was given the most trust of any category in the survey. Fifty-four percent of respondents said they trust doctors and 48% nurses. These professionals top the list in almost every survey because they are perceived as technically competent and compassionate, says the study’s lead author Gillian SteelFisher, PhD, senior researcher and deputy director of global polls at the Harvard Opinion Research Center.
Scientists (44%) and pharmacists (40%) also received relatively high trust. The CDC (37%) and the National Institutes of Health (33%) were on the next lowest rungs of the list. About a quarter of respondents trusted their local and national health services. For more information about COVID-19, 42% of respondents trusted the CDC, and about a third of them trusted state or local health departments.
Political influence suspected
Among the reported reasons for low trust in public health agencies, the one cited most often was the supposed political influence over their recommendations and policies. About three-quarters of respondents with low trust in agencies mentioned this as a factor in their attitudes. Half or more of respondents cited private sector influence on agency recommendations and policies. This was suggested more often for CDCs than for other agencies (60% of CDCs, versus 53% of state agencies and 48% of local agencies). Too many conflicting recommendations was another reason for lack of trust (73% for the CDC, versus 61% for state agencies and 58% for local agencies).
According to the study, the “politically influenced” view may have been linked to instances during the pandemic “in which legal authority from agencies to prevent and control the spread of COVID-19 was transferred to elected officials.” .
Without giving specific examples, SteelFisher says, “What people want to see is an agency leading with science, making rational, logical, science-based decisions. It’s not that some people say, “I don’t believe in science. It’s that what they consider scientific is different [from what they’re hearing]and they fear not to receive the truth.
Public health agencies need “clear lines of authority,” she says, and should give clear recommendations to elected officials instead of being swayed by those officials or others to “go in a certain direction.”
The media play a major role
The news media and some websites have contributed to this confusion by highlighting these controversies or promoting misinformation, she said.
“Policies around COVID have been discussed in the media as being politics-related,” she says. “So the media coverage of the influence of politics raises this concern.”
People not paying enough attention to news related to COVID-19 aren’t the problem, she says. They have [plenty] information, but the question is how much high-quality information is in their mix.
“Clickbait headlines can lead to these attitudes, and the algorithms behind people’s newsgathering resources can lead them in a particular direction. This contributes to a distorted narrative behind what is happening.
The survey results also showed that many people are concerned about corporate influence on public health policy, she says.
“It’s not just related to COVID; it comes from a wider concern about the development of drugs and vaccines. People want to know that there is an independent body that makes informed decisions and provides advice in the best interests of public health. People fear that there is something else behind the recommendations, and that leads to a loss of trust.
Agencies need to build public trust
Trust in what public health agencies say is key to getting people’s help in the fight against pandemics and other public health emergencies, the study found. GillFisher cited controversy over the CDC’s changing mask-wearing recommendations. At the start of the crisis, she noted, much was unknown about how the COVID-19 virus was transmitted; therefore, there have been well-known changes in what the agency has recommended about whether and where to wear masks and what types of masks to wear.
It should be considered natural in a public health emergency, where the scientific evidence keeps changing, she said. But if public trust is lacking, she noted, “there can be an inappropriate perception that policies are inconsistent. It is also difficult for the media environment, and there are media that benefit from it too.
where we go from here
The document makes some recommendations on how public health agencies can improve public trust in the future. Among them are the following:
- Make it clear that public health agencies, not elected officials, are the purveyors of scientific information to officials and the public.
- Explain how agency decisions are grounded in scientific evidence, so that changes in policy or recommendations are not seen as contradictory but rather responsive to new evidence.
- Tailor communication approaches to specific audience segments, based on their level of trust.
- Use the influence of doctors and nurses, who are more trusted than agencies, to convey public health messages to their patients.
Now is the time to implement these strategies before the next pandemic, SteelFisher argues. “Everyone is exhausted at the moment, so it’s hard to think about it. But it’s the right time, and we have some lessons learned.