Higher trust in public health agencies during COVID-19 driven more by beliefs that agencies led with clear, science-based recommendations and provided protective resources, than by beliefs that agencies controlled outbreak
Lower trust driven by concerns about external influence and conflicting recommendations
Peer-Reviewed PublicationBoston, MA—In the first nationally representative survey of U.S. adults on reasons for trust in federal, state, and local public health agencies’ information during the COVID-19 pandemic, researchers at Harvard T.H. Chan School of Public Health and colleagues found that the Centers for Disease Control and Prevention (CDC) was highly trusted for information by more than one-third of U.S. adults, whereas state and local health departments were highly trusted by about one-quarter. An additional 37-51% of adults trusted these public health agencies somewhat, and <10% reported no trust at all in these agencies for health information.
High levels of trust were not primarily due to people believing agencies had “done a good job” controlling the spread of COVID-19, but rather to public beliefs that agencies communicated clear, science-based recommendations and provided protective resources, such as tests and vaccines. The survey found that lower levels of trust were primarily related to beliefs that health recommendations were influenced by politics or corporations, or were conflicting.
“Trust in public health agencies is crucial for enabling effective policies that save lives during emergencies,” said lead author Dr. Gillian SteelFisher, principal research scientist in the Department of Health Policy and Management and director of global polling at the Harvard Opinion Research Program. “Emergency programs have been underfunded for decades, but these data make clear how important it is to ensure public health agencies have appropriate stockpiles, have authority to make decisions based on scientific information, and have a stronger communication infrastructure.”
The survey’s findings will be published March 6, 2023, in the March issue of Health Affairs, a themed issue focused on public health lessons learned during the COVID-19 pandemic in the U.S. The survey was conducted in February 2022 among a nationally representative sample of 4,208 U.S. adults.
The researchers also found significant differences in reasons that the public trusts federal, state, and local public health agencies. Public trust in the CDC was related primarily to beliefs in their scientific expertise, whereas trust in state and local public health agencies was more related to their provision of direct, compassionate care.
In addition, the study found key differences in the primary reasons why adults had lower levels of trust. Among those who reported trusting public health agencies “somewhat” concerns were focused on conflicting recommendations and the perception of political influence. By comparison, those who reported trusting agencies “not very much” or “not at all” raised many more concerns, including agencies’ recommendations going “too far” and limited trust in government generally.
The researchers used the results to suggest takeaways to inform public health leaders in COVID-19 and future emergencies. They suggested a need to enhance policies around stockpiles of protective resources such as masks; to support a robust communication infrastructure in which public health agencies are given clear authority to disseminate science-based recommendations; and to engage trusted partners, such as clinicians and religious leaders, to amplify agency communications. Such measures would allow public health agencies to develop strategies to more effectively engage different segments of the public who have varying levels of trust, the researchers said.
Other Harvard Chan School co-authors included Dr. Mary Findling and Hannah Caporello.
The study was conducted through a cooperative agreement between the Centers for Disease Control and Prevention (CDC) and the Association of State and Territorial Health Officials, who subcontracted to the Harvard T. H. Chan School of Public Health.
“Trust in US Federal, State, and Local Public Health Agencies During COVID-19: Responses and Policy Implications,” Gillian K. Steelfisher, Mary G. Findling, Hannah L. Caporello, Keri M. Lubell, Kathleen G. Vidoloff Melville, Lindsay Lane, Alyssa A. Boyea, Thomas J. Schafer, Eran N. Ben-Porath, Health Affairs, March 6, 2023, doi: 10.1377/hlthaff.2022.01204
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Harvard T.H. Chan School of Public Health brings together dedicated experts from many disciplines to educate new generations of global health leaders and produce powerful ideas that improve the lives and health of people everywhere. As a community of leading scientists, educators, and students, we work together to take innovative ideas from the laboratory to people’s lives—not only making scientific breakthroughs, but also working to change individual behaviors, public policies, and health care practices. Each year, more than 400 faculty members at Harvard Chan School teach 1,000-plus full-time students from around the world and train thousands more through online and executive education courses. Founded in 1913 as the Harvard-MIT School of Health Officers, the School is recognized as America’s oldest professional training program in public health.
JOURNAL
Health Affairs
METHOD OF RESEARCH
Survey
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Trust In US Federal, State, And Local Public Health Agencies During COVID-19: Responses And Policy Implications
ARTICLE PUBLICATION DATE
6-Mar-2023
Commentary outlines steps to strengthen U.S. laboratory system and pandemic preparedness
Weaknesses in the United States laboratory system, which were illuminated during the COVID-19 pandemic, underscore a need for policy changes to improve the country’s infectious disease response, according to a new analysis by a Weill Cornell Medicine investigator.
The analysis, published Mar. 6 in the March issue of Health Affairs, was co-authored by Dr. Jay Varma, professor of population health sciences and medicine at Weill Cornell Medicine, Dr. Jill Taylor of the Association of Public Health Laboratories, and Dr. Joshua Sharfstein, vice dean for public health practice and community engagement at the Johns Hopkins Bloomberg School of Public Health. The authors suggest government and private institutions collaborate to implement systemic changes to improve the monitoring and tracking of highly transmissible diseases.
“The laboratory system in the U.S. is a patchwork of different organizations inside and outside of the government that have to work together in a seamless way to ensure that the American people have the highest quality diagnostic testing and that public health organizations receive data in a clear and quick way to take immediate action,” said lead author Dr. Varma, who is also a director of the Cornell Center for Pandemic Prevention and Response.
Laboratory testing helps identify disease in a population, determine how a disease may evolve, detect outbreaks and assess the impact of disease control measures like vaccination. With inefficient test execution and faulty test design during the COVID-19 pandemic, the Centers for Disease Control and Prevention’s (CDC) “stepwise” approach to developing tests was too slow and insufficient to match the pace of the highly transmissible virus – setting up the institution to be a “single point of failure” when monitoring disease spread, writes the authors. These problems arose again during the 2022 outbreak of Mpox, with the nation facing medical supply shortages and delayed test results due to the lack of clarity and coordination between many different sources reporting public health data.
To address these limitations, the authors acknowledged the need for federal financial investment and provided estimated costs of improving staffing, equipment, infrastructure, and creating secure data systems for the U.S. health system over the next ten years. The authors also suggested internal improvements in CDC structure and operations, and having the institution collaborate with public and private labs to create a “national road map” defining roles and responsibilities for all involved at each stage of a disease outbreak as it evolves. Specifically, the CDC can work with the Food and Drug Administration (FDA) to create a regulatory pathway for at-home tests and with the National Institutes of Health (NIH) to coordinate a national database for standardized clinical information.
“The CDC needs to be legally empowered and sufficiently funded to serve as the leading government agency to implement public health strategy,” said Dr. Varma. “The people who can really ensure that happens are elected officials.”
In establishing public-private partnerships, the U.S. laboratory system can improve the reliability and efficacy of current disease tracking methods. Furthermore, the authors encourage expanding the Strategic National Stockpile and increasing access to testing resources, especially early in an outbreak – key investments to prepare the United States for the next pandemic.
“What is critical here is making sure the government, media and the public have the real-time information about the nature of an infectious disease,” explained Dr. Varma. “Making these policy changes will not only improve the quality of testing and reporting and the speed of developing new tests, but also have an impact on rebuilding the confidence in public health.”
Many Weill Cornell Medicine physicians and scientists maintain relationships and collaborate with external organizations to foster scientific innovation and provide expert guidance. The institution makes these disclosures public to ensure transparency. For this information, see profile for Dr. Varma.
JOURNAL
Health Affairs
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