HLTH 2022: Trust in public health shaken by COVID-19 response

Panelists say lack of clear explanations for public health policy decisions adds to problem.

Confidence in the public health system has eroded since the start of the COVID-19 pandemic, and public health officials themselves are partially responsible, according to a group of experts in the field.

“There are a lot of unforced errors that we in public health made [during the pandemic,]“ said Leana Wen, MD, former commissioner of Baltimore’s health department and a professor of health policy and management at George Washington University. “And I think it’s easy to point our fingers at, quote, the other side, like social media and politicians spreading misinformation, but we also need to take a hard look at what we in public healthmight have done better.”

Wen’s remarks came during a panel discussion, “The Broken Trust Between Public and Health” at the 2022 HLTH conference in Las Vegas.

Looking back, Wen said, public health officials could have better explained how evolving understanding of COVID caused changes in recommendations for countering the disease.

“If there’s anything I wish we had done differently, it’s emphasizing that change is the bedrock of good public health policy. If the science changes, if circumstances change, you would expect that the recommendations also change. And I think that could have been communicated more forcefully,” she said,

Ezekiel J. Emanuel, MD, PhD, professor and vice president for global initiatives at the University of Pennsylvania’s Perelman School of Medicine and a venture partner at Oak HC/FT, cited changing CDC and World Health Organization recommendations on slowing the aerosol spread of COVID. “If you get something wrong that is so fundamental, and you’re resistant to changing it, I think it undermines public trust,” he said.

In addition, officials didn’t always consider the impact that decisions made in the interest of public health had on peoples’ lives. “A lot of the public felt during the pandemic as if the government wasn’t taking their situation into account,” Emanuel said, citing the example of school closings. “People had a sense like, ‘those government officials did not understand how this one action really turns my life upside down. That attitude really does undermine people’s confidence.”

Emanuel added that eroding public confidence in public health is occurring in the context of other trends, including a decline in trust of expertise that has been fanned by Republicans, and the ability of social media to spread false information. “Loss of trust iswider than just in public health,” he said.

Panelist Amy Abernethy, MD, PhD, president of clinical studies platforms at Verily, noted the impact of the public being able to view, for the first time, FDA advisory committee debates regarding COVID vaccines and boosters.

“The public saw the messiness of interpreting the data with micro-evaluations of safety events, and what did that really mean for populations and scale,” she said. “In the past we’ve shielded the public from that messiness, and now in a place where we’re trying to help the public understand and interpret the messiness in real time.”

Emanuel said the current divisiveness of the nation’s politics contributes to the undermining of public trust because “a lot of people think it’s to their political advantage to attack the experts.” Those attacks have led to the departures of many experienced public health officials leaving, which has been detrimental to the long-term good of the country, he said.

Wen said she is concerned that the backlash against COVID-mandated health restrictions has bled over into other areas of public health, citing the laws many states have enacted restricting the authority of local and state public health officials. “I hate the fact that public health has been politicized and polarized because of COVID,” she said.

Restoring trust in public health, Abernethy said, will depend on improving communication between health officials and the public.

“We have to help people understand the information in front of them in ways that are easily accessible. Making sure we incorporate into our work experts in many different types of communications. And we’ve got to keep doing the science and getting that right.”