How Americans Trusted Public Health Agencies During COVID-19

Americans’ trust in public health agencies as it relates to the COVID-19 pandemic is not significantly related to their capability to mitigate the pandemic disease itself, according to new survey data.¹ Rather, it is stringent on beliefs that said agencies are following scientific evidence while providing appropriate resources and recommendations on health and safety to the public.

In a first-of-its-kind, nationally representative survey of 4000-plus US adults, a team of investigators reported outcomes showing varied standards for and strength of trust in regional, state and federal public health agencies amid COVID-19 outbreaks.

With today marking the third anniversary of the COVID-19 outbreak being declared a global pandemic by the World Health Organization (WHO), the new findings provide timely perspective into the public’s standards and expectations of its representative public health officials and organizations in this and future crises.

Led by Gillian K. SteelFisher, a senior research scientist at the Harvard T.H. Chan School of Public Health, investigators sought to analyze public trust in federal, state and local public health agencies amid the COVID-19 pandemic—hoping to understand the degree of trust US adults put in available information and their rationale for said degrees of trust.

They noted that most research into the topic of public trust during the pandemic has been relevant to government agencies and officials, or on the impact of individual and demographic characteristics in public trust. An untapped avenue of research remains the rationale of the individual American that would influence greater or lower levels of public health trust.

“Without better understanding of these reasons, it is difficult to mobilize support for needed response policies or to develop strategies that help foster trust,” they wrote. “Understanding reasons for trust and lack of trust across all levels of government would advance important dialogue about policy and communication approaches that can help public health leaders grow trust and bolster against declines during extended waves of COVID-19 and future crises.”

SteelFisher and colleagues used data from a cross-sectional online and telephone survey they conducted in February 2022 designed to represent the US adult population. Their analysis included 4208 US adults aged ≥18 years old recruited by mail. The survey was conducted by online and telephone access from February 1 – 22, 2022.

The survey included questions pertaining to 3 topics of analysis:

1. The degree to which respondents trusted different agencies providing health recommendations, including the Centers for Disease Control and Prevention (CDC), and state and local-level public health departments, among others.
2. Their degree of trust in those agencies on accurate information pertaining to COVID-19, and any of 14 different reasons for that degree.
3. Their valuation of differing reasons as to why they may or may not trust a public health agency.

In analysis of different sources of health recommendations and information, survey respondents graded doctors (54%) and nurses (48%) as having the highest rate of a “great deal of trust” among options. Scientists (44%) and pharmacists (40%) also received high rates of the uppermost degree of trust.

Agencies including the CDC (37%) and National Institutes of Health (33%) scored relatively well as having a “great deal” of trust; about one-fourth of respondents had a great deal of trust in state and local officials. All these agencies fared better in rates of great trust compared to state and local elected officials, and religious leaders.

Regarding information pertaining to COVID-19, 42% of respondents said they have a great deal of trust in the CDC—higher than that of state (31%) or local public health departments (34%). The greatest rationale given for higher trust in the CDC included the idea that the agency followed scientifically valid research (94%) and included relevant experts (92%). Respondents also endorsed the CDC’s work to make COVID-19 vaccines and testing more widely available (83$), and their clear recommendations on protection from the virus (79%).

Such reasons were consistently reported among the respondents who expressed a great deal of trust in their local and state public health departments—though at slightly lower rates. Reasons pertaining to a sense of compassionate or hands-on work were more commonly reported for state and local agencies versus federal agencies.

Regarding lowered trust, the leading reason reported across all levels of public health agencies was the respondent’s sense of politic influence on recommendations and policies (74% for CDC; 72% for state; 70% for local). A majority of respondents with less trust for agencies additionally cited the influence of private sectors on recommendations and policies as a major reason as well. Many respondents not trusting of agencies additionally took issue with what they believed to be too many conflicting recommendations (73% for CDC; 61% for state; 58% for local).

In assessing the data, investigators first noted the lack of correlation between health agencies’ capability to control an outbreak and public trust—“despite what may seem a natural assumption.”

“Rather, public trust in agencies is related to beliefs that agencies follow scientific evidence in developing policies; have made appropriate resources, such as tests or vaccines, available; and give clear recommendations about how people can protect themselves,” they wrote. “Thus, our results provide a critical reminder that public health leaders need not be perfect in crises and need not contain outbreaks immediately to maintain public trust.”

The team concluded that their survey findings emphasized the critical role of communication by health agencies in times of emergencies—especially in how the communication balances the agencies’ anchor to scientific discovery so as to not appear contradictory or unreliable to the greater public.

“Further, greater support for conversation about communication efforts between levels of government are needed, so that policies are adapted locally as relevant while still adhering to coherent national efforts,” they wrote. Although communication guidelines have suggested as much, the evidence base for these approaches has been lacking, and communication programs have been historically underfunded, even in emergencies.”

References

1. ^{SteelFisher GK, Findling MG, Caporello HL, et al. Trust In US Federal, State, And Local Public Health Agencies During COVID-19: Responses And Policy Implications. Health Aff (Millwood). 2023;42(3):328-337. doi:10.1377/hlthaff.2022.01204}