As winter continues, COVID-19 cases, hospitalizations, and deaths are projected to increase. Despite the important actions taken by federal public health agencies to curb the pandemic, public trust in these agencies such as the Centers for Disease Control and Prevention, the National Institutes of Health, and the Food and Drug Administration, and their world class career scientists has decreased during the pandemic. Many Americans are feeling pandemic fatigue, which has caused increased tension between federal health agencies, state governments, and the public, particularly around mask wearing, school closures, business lockdowns, and restrictions on gatherings. Public health leaders on the national and state level have even received death threats and other forms of intimidation in an effort to force them to change their policy positions. Fatigue from COVID-19 has worsened the polarization in the country and made the road to ending the pandemic much more difficult to navigate. Restoring trust in these institutions and our nation’s leading health experts is critical to making progress in fighting the coronavirus.
According to a poll conducted August 28-September 3 by the Kaiser Family Foundation (KFF), public confidence in the CDC dropped 16 percentage points since April 2020. When polling Republicans, the survey found confidence in the CDC fell from 90% to 60%, while confidence amongst Democrats dropped from 86% to 74% during the same period. While confidence decreased amongst both parties, the stark contrast indicates a partisan divide in how members of each party view the health agency. A key concern is that the Trump administration was often in disagreement with federal health agencies, which created doubt and polarized perceptions between the president’s supporters and others. The president has also targeted remarks at public health agencies and government officials, such as Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, and CDC Director Robert Redfield, further undermining their leadership and raising unfounded doubts about their expertise.
Many Republicans have looked to the president for guidance on handling the virus. According to the same KFF poll, approximately half of Republicans believe that hydroxychloroquine is a possible treatment for COVID-19, despite evidence to the contrary. That is consistent with President Trump’s stated views on the subject months earlier. And 20% of people, irrespective of political party, believe wearing a mask is harmful to one’s health.
In addition to a divide among party lines, there is historically lower trust between health care professionals and communities of color due to a legacy of discrimination and exploitation of Black Americans, such as in instances of unethical medical research like the Tuskegee Syphilis Study. This distrust has carried over into the current pandemic even as, due to long-standing social and health inequities, communities of color have experienced a disproportionate share of COVID-19 cases and deaths. According to an updated KFF December poll, 35% of Black adults said they definitely or probably would not get vaccinated, compared to 26% of white and Hispanic Americans who said they definitely or probably would not get vaccinated. Despite the significant level of vaccine skepticism, particularly among Black adults, and the potential harm it may cause, only half of the COVID-19 state vaccine distribution plans specifically mention communicating with ethnic and racial minorities about the vaccine, and only a third of these plans mention addressing vaccine misinformation. Federal and local agencies and public health experts need to find measurable ways to gain trust at the community level, particularly in communities of color, to convince people to take the vaccine.
As vaccines rollout across the country, we recommend three ways to help restore trust in federal agencies and government health experts. Restored trust will help the federal government to effectively overcome any challenges, such as preventing the spread of the new COVID-19 variant from the UK and accelerating vaccine distribution.
Provide clear and consistent communication to the public and to state and local officials
A key failure of the coronavirus response has been the lack of clear communication from public officials and health agencies. For example, early on in the pandemic, public officials offered differing opinions about the severity of the threat of COVID-19. Federal officials will need to be clear in their messaging, provide consistent information, and rely on the most up-to-date scientific evidence. Public officials should also place public health professionals from federal and local health agencies front and center, providing an opportunity for these experts to demonstrate their expertise and communicate how their agency is responding. This can prevent crucial health information from being influenced by partisan rhetoric and restore trust in our federal health authorities.
It is important to note that we are still learning about the novel coronavirus, and guidance is subject to change; however, public officials should be as transparent as possible in communicating their policies by explaining changes based on the most recent scientific evidence. Furthermore, officials should reaffirm that they will adjust their policies as research continues.
Create transparency and trust around the vaccine distribution process
As we continue distributing the vaccines, it will be paramount for federal officials to provide as much transparency as possible. First and foremost, the safety and efficacy of the vaccine must continue to be clearly communicated to the public as the vaccine distribution process begins. A Government Accountability Office report found that the FDA did not disclose its scientific review of safety and efficacy data when granting emergency use authorization for four therapeutics to treat COVID-19. The report recommends that the FDA disclose this information to the public which would improve public trust in its decisions to grant emergency use authorization.
Secondly, the administration will need to provide transparency when allocating and distributing the vaccine across the country. This will be a markedly difficult task, as each state, territory, and local government has their own plan for distributing the vaccine. However, the CDC and other federal officials will still need to communicate information at the national level and provide transparency about the process whenever possible.
Make efforts to reach communities of color
The National Governors Association created a memorandum with a set of proposals that governors can take to reduce the disproportionate impact of COVID-19 on communities of color. One proposal is to create a Health Equity Response Team. The Biden administration recently announced the creation of a Health Equity Task Force. In addition to the task force, the administration must work with leaders in communities of color to build trust and work to address policies and programs that do not promote health equity. This could also mean leveraging current federal programs to disseminate information about COVID-19 and the resources offered to ensure financial challenges and social barriers no longer enlarge health disparities. For instance, Mississippi is using the Head Start program to disseminate information regarding COVID-19 specifically to reach communities of color.
Community Health Workers (CHWs) can also be a helpful resource to reach communities of color and other vulnerable groups. CHWs typically reside in the communities they serve, meaning that they usually share ethnicity, language, and life experiences with members of their communities. CHWs can develop culturally appropriate health education materials and can uniquely serve as messengers directly to where community members eat, play, work, worship, and live. We need to leverage the abilities of CHWs to provide outreach and education about the virus and vaccine in order to best reach all communities, including communities of color.
The incoming Biden administration and other elected officials face the formidable challenge of curbing the pandemic. Although federal health agencies, in close collaboration with private sector partners, have made significant progress in expanding our scientific understanding of the virus, informing decision-makers, and even bringing a vaccine to the public in record time, there is much more to be done to overcome the pandemic. It is imperative that the incoming Biden administration restore trust in science and health agencies in order for our country to reduce transmission, ensure uptake of the vaccine, and successfully fend off the coronavirus.
In the coming weeks, the Bipartisan Policy Center’s Future of Health Care initiative will release a report outlining short-term recommendations that address many of these issues and much more to accelerate America’s response to the pandemic.