Public health officials debate how to respond to loss of trust after pandemic

How did public health became a four-letter word, and what to do about it?

America’s public health leaders gathered in Minneapolis this week to grapple with the frustrating reality that too many people stopped listening to them during the COVID-19 pandemic, and still aren’t heeding their advice today.

The question looming over the conference of the American Public Health Association: how to win trust back, especially when views on public health are rooted in cultural or political beliefs.

Public health has traditionally involved one-way communication and scientists telling communities how to protect themselves from chronic diseases such as obesity, infections such as influenza, and environmental threats such as lead in old paint. That approach isn’t working, said Dr. Simbo Ige, commissioner of the Chicago Department of Public Health. Public health workers must listen, she said, even to people guided by misinformation.

“If you don’t understand how people arrive at some of these ideas, it is very hard to correct,” she said. “Our first instinct is [to say], ‘No, you are wrong.’ You cannot motivate people with shame and guilt. You have to try and spend some time to understand where [they] are coming from.”

Trust has fractured somewhat along political lines, as Republicans were more likely during the pandemic to oppose government mask-wearing requirements and vaccine mandates that were put in place in an attempt to slow the spread of COVID-19. A study last fall showed lingering resentment over the pandemic response made Republicans even less trusting of cancer-prevention messages.

Mistrust extends beyond politics, though. Minnesota once had one of the nation’s highest rates of children vaccinated for measles by the time they entered kindergarten, at 94%. That rate dropped to 87% at the start of the 2022-2023 school year, sixth-worst among states.

Minnesota consequently has reported 60 measles cases this year, the second-most among states. The outbreak is largely among unvaccinated Somali children whose parents have harbored fears, contradicted by research, that the vaccine can lead to autism.

Moving forward might require looking back at the pandemic response, both to learn from mistakes and understand how they hurt people, said Eric Klinenberg, a New York University sociology professor who examined the pandemic with a book about seven people who lived through it. Not doing so until now has allowed divisions and mistrust to fester, he added.

“Everybody was ready to move on and I knew that would be a fatal mistake,” he said, “because if we don’t learn the lessons from what we lived through in 2020, we really are doomed to do something similar next time.”

Problems stemmed from public health leaders overselling the effectiveness of COVID-19 response strategies to gain public buy-in, and not acknowledging what they didn’t know about the new coronavirus, said Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy.

Overconfidence made scientists look wrong or like flip-floppers when information changed about how the virus spreads and whether masks would protect people, he said. Some leaders also oversold the longevity of COVID-19 vaccines, creating resentment when it turned out that they functioned more like influenza shots that needed regular booster doses to maintain protection, he said.

“These are good vaccines, not great vaccines,” he said. “If you listened to us in the first days after approval, it came across that these are great vaccines — we can take our masks off now and everything will be fine. And we just lost a lot of credibility there.”

The results of next week’s election could shape the next public health challenges.

Republican Donald Trump as president could blunt federal agencies such as the Centers for Disease Control and Prevention, challenging state and local agencies to lead their own responses to outbreaks and public health emergencies. Osterholm said Trump’s approach could be “beyond devastating” and gut the nation’s readiness for emerging threats, taking his first publicly partisan stance after 50 years of working with Democrat and Republican administrations.

A win for Vice President Kamala Harris, on the other hand, could deepen resentment among Republicans and further reduce their confidence in public health guidance.

No matter who is in charge, public health leaders said they need to form closer connections with communities. Uriel Rosales Tlatenchi, a public health educator for Ramsey County Public Health, said agencies need to funnel their messages through community leaders who are more trusted when offering public health guidance.

They are particularly effective, he said, when “fighting that misinformation that exists around various health topics.”

Children’s Minnesota partnered late last year with Twin Cities Muslim leaders to gain a fatwa, or religious clarification, sanctioning donor breast milk for women who couldn’t produce enough on their own to feed their newborns.

Conference leaders also encouraged greater use of mayors in public health campaigns, because surveys suggest they are more trusted than other politicians.

Kim Norton, mayor of Rochester, spoke at the conference about how her community has racial disparities in healthy food access and health outcomes, despite the advantages of low poverty and the local availability of Mayo Clinic. She has tried to use her influence to keep Rochester focused on that issue.

“I can use the bully pulpit that I have,” she said, “in addressing the health disparities, access to food and really working on that.”