As the United States manages yet another winter rise of COVID-19 cases — although not as severe as previous years — public health institutions and experts are looking ahead to the next pandemic and questioning if the country is ready to respond.
Health institutions at the federal and local levels are already retooling or revamping operations as the pandemic enters its fourth year: Centers for Disease Control and Prevention Director Rochelle Walensky plans to overhaul the agency after facing criticism for its pandemic response, and public health departments around the country are working to improve how they communicate information with their communities.
Amid these changes, 55% of U.S. adults said they trust public health institutions to manage a potential future pandemic based on how COVID-19 was handled, compared with 37% who said they do not trust institutions to handle the response, according to a new Morning Consult survey. Meanwhile, 8% of adults said they do not know or have no opinion.
Still, a key piece to an effective response to a future pandemic will not solely be whether governments and health agencies improve their emergency procedures, but whether the public will listen to them if they do.
“The trust has gone down, for sure, for public health institutions during this crisis and this experience,” said Jennifer Kates, senior vice president and director of global health & HIV policy at the Kaiser Family Foundation. “It definitely presents an obstacle.”
Multiple factors have hurt health institutions’ trust
Kates, who helped lead KFF’s COVID-19 work, said there are multiple reasons for the public’s erosion of trust, including the complexity of communicating public health information, rapidly changing details during a crisis, especially early on, and the increased presence of agencies like the CDC or National Institutes of Health in peoples’ lives.
“We saw public health front and center every day,” Kates said. “A part of this is there's almost a face of this response that people wouldn't have known about, necessarily, before.”
Another factor contributing to the decline of trust in public health institutions is that the pandemic has been “incredibly politicized,” Kates said, with partisan divides around messaging and public health measures like wearing face masks or getting vaccinated.
Those gaps are reflected in the survey: Among respondents who said they trust institutions to manage the next pandemic “a lot,” nearly 2 in 3 were Democrats, while Republicans accounted for more than half of those who responded “not at all.”
Democrats, Older Americans Are More Likely to Trust Public Health Institutions to Manage a Future Pandemic
There was a generational divide, as well: Baby boomers made up 45% of those who said they trust health institutions “a lot,” compared with 26% who said “not at all.” Gen Zers and millennials, meanwhile, made up a larger share of those who do not trust public health institutions on future pandemics than those who do.
Americans trust health agencies more than the White House for information and news
The CDC announced a step in its overhaul last week, hiring Maine CDC Director Nirav Shah as Walensky’s second-in-command. More changes are coming as the country’s leading public health agency grapples with a public that is looking at it more critically. Net approval for the agency’s handling of the pandemic (the share who approve minus those who disapprove) plummeted from plus 70 in March 2020 to plus 24 in December 2022, according to a Morning Consult tracker.
Vish Viswanath, professor of health communication at Harvard’s T.H. Chan School of Public Health, said there had traditionally been a high level of trust in health institutions prior to the pandemic, but the CDC and others “have taken a real hit” over the past three years. He, too, pointed to politicization as well as communication mistakes made during the early days of the pandemic as reasons for the decline, including inconsistent messaging around wearing face masks.
Despite those messaging miscues, there is agreement among a majority of the public that several of those coronavirus mitigation measures have been effective.
Americans Say Social Distancing, Vaccines, Masking Are the Most Effective Strategies to Manage the COVID-19 Pandemic
And despite the drop in approval for health institutions, Morning Consult data shows that roughly 2 in 3 U.S. adults said they trust public health information from the CDC and NIH, compared to just under half (48%) who said they trust information from the White House.
A partisan divide appeared in these responses: Democrats were more likely than Republicans to trust information from the three institutions surveyed, particularly the White House (71% vs. 25%).
Public Is Much More Skeptical of White House Than CDC, NIH for Health Information
A spokesperson for the Department of Health and Human Services, the agency that houses the CDC and NIH, said in an email that “the erosion of trust in our public health institutions is a real problem that hurts our ability to keep the public safe and healthy. That’s why HHS is committed to ensuring the nation's public health guidance and messaging are based on facts and science and that we’re being transparent about what we do and don't know.”
The spokesperson pointed to the “We Can Do This” public education campaign to help combat COVID-19 disinformation as an example of an ongoing and related agency initiative. The White House did not provide a statement when asked for comment.
Whether politicization has contributed to a permanent loss in public trust in public health institutions is difficult to tell, both Kates and Viswanath said. But it could be a crucial question if there is another pandemic, as people may not follow recommended public health measures based solely on political identification.
How the United States responds to another pandemic will not solely rely on the CDC, Kates noted, but also Congress and other agencies. She said that the CDC does need to be more transparent about data and information, which is in Walensky’s report, but the United States should increase funding for public health agencies and improve local public health infrastructure that’s been depleted by the pandemic.
Viswanath said time will tell whether the efforts of the CDC and other agencies are impactful, but doubts that the country has learned the right lessons yet from COVID-19. Work to improve communication processes and public health infrastructure should start now, he said, because another emergency will inevitably come.
“You can’t build trust during a crisis,” Viswanath said. “Trust is something you build over time, which you tap into during a crisis.”