As COVID-19 deaths mount, political meddling and disinformation erode trust in health agencies

Americans are losing trust in the nation’s premier public health agencies after months of misinformation, contradictory and confusing public statements, inadequate steps to control the coronavirus pandemic, and questionable political motives. Recent polls show that most people are worried that political pressure from the Trump administration will push regulators to approve a coronavirus vaccine before there is proof it is safe and effective.

This profound mistrust is fueled by the staggering absence of clear, unified national leadership on the public health crisis, a failure unparalleled in our history. The loss of public trust and the diminishing credibility of public health agencies hinders the country’s ability to stem the pandemic. Our public health agencies have a long, proud record of using facts based on science to inform us and to issue guidance and regulations that ensure our safety and promote our health. Trust in what they advise or require us to do is the currency by which they get our compliance.

If the public doesn’t know whom to believe, they will not follow sound public health advice — to wear a mask, wash your hands and keep your distance. The bungled emergency response and mistrust that has sown have already cost lives and slowed economic recovery. And the situation is getting worse every day, with more and more political meddling and disinformation, and growing uncertainty about the future.

Historically, when major pandemics have emerged, the Centers for Disease Control and Prevention, the world’s most competent disease control agency, has been at the forefront of the response. Recent outbreaks such as SARS-1, Zika and Ebola have all been stopped in their tracks, keeping the nation safe. In each case the agency had strong support from the White House, the leadership of the Department of Health and Human Services, and other federal agencies to bring the whole government to bear on the problem.

Yet in recent months, the CDC has been frequently muzzled and belittled. It is no longer the go-to source of public information. What we see now is censorship, mismanagement and misdirection.

The Trump administration has failed to use consistent messages on what people should do to protect themselves and their families. The administration has also failed to communicate in an empathetic way that would inspire the public confidence needed to drive compliance.

There are examples of state and local political leaders who have followed the science and used well-established emergency response principles to engender trust and gain better control of the pandemic. But the botched federal response hinders the overall effectiveness of even a well-run local one.

Effective risk communication is always the centerpiece of a sound emergency response. One well-known approach is: Be first, be right and be credible. Instead, we’ve heard too many responses that are late and wrong and do not follow the evidence. Spinning the truth may be good politically, but it is not an effective communications strategy during an emergency.

The core tenets of public health communication hold true now more than ever. Say what you know. Say what you don’t know. And when you’re wrong, which you will be in an evolving situation like our current pandemic, tell the public what has changed.

Wearing masks illustrates the communication challenge that we’re still fumbling to rectify. Initially, the public health community followed the long-held belief that masks would not be very helpful in fighting this type of disease. It was thought that the virus would behave like SARS-1 and spread only through symptomatic people, that cloth and simple masks were not effective in reducing transmission, and that people would be more likely to infect themselves by touching their masks. A shortage of specialized N-95 masks meant those should be reserved for health care workers and others more likely to be exposed to this novel coronavirus.

Science showed us, though, that SARS-CoV-2 is more infectious than SARS-1 and spreads asymptomatically in up to 40% of people. New research has demonstrated that simple cloth masks can reduce the spread of the disease by as much as 80%. So the guidance changed to recommend that everyone wear a mask when around people outside their immediate family or others they don’t know for sure are not infected.

This updated advice demonstrates the importance of using science and an evidence-based approach to decision-making. It also underscores the need to be clear when a recommendation changes based on new information. Far too many political leaders have demanded actions contrary to the facts. The haste to promote hydroxychloroquine, the push to approve convalescent plasma through an emergency use authorization, and recent efforts to promote herd immunity are all actions that the broad scientific community has rejected because the evidence around their use was not yet complete. Science doesn’t lie, and it cannot be rushed.

Recently, the nation hit a tragic milestone: 200,000 people have died from COVID-19 out of 6.8 million cases. The Washington Cathedral marked the occasion by ringing the bells 200 times to honor the dead; one ring for each 1,000 individuals. Those bells tolled as the U.S. leads the world in cases. We are now seeing a resurgence of the disease in almost half the states and significant mistrust in the basic prevention tools of mask-wearing and physical distancing. In a recent Pew Research Center poll, half of the people said they will not take a COVID-19 vaccine when one becomes available, and 78% expressed concerns that the approval process will move too fast and sidestep scientific standards.

So, where do we go from here, and how we rebuild trust? First, we need a unified national approach to fighting the pandemic. Second, we need leaders to communicate effectively, using sound risk communication principles with a consistent message. Third, we need to be forward-leaning and provide national leadership that allows for local decision-making but does not foster a state-by-state search for materials and supplies. This all must be driven by a science-based national pandemic response plan. We can do little about the past, but we can acknowledge the errors we’ve made, move forward and not repeat them.

As the American Public Health Association and more than 85 other public health and medical groups wrote to Vice President Mike Pence in mid-July, “It is vital that we lead with science and with the best data available. Our continued response to and successful recovery from the COVID-19 crisis depends on adherence to sound scientific and public health guidance from the experts.” If those experts are muzzled, we can’t expect trust.

We joined an even longer list of groups in urging Health and Human Services Secretary Alex Azar to “affirm the invaluable role of the Centers for Disease Control and Prevention and resist any efforts that would undermine its mission.”

Pushback like this has raised the visibility of the attacks on science-based public health agencies and has had some success in reversing specific actions. But the headwinds are very strong in favor of misinformation and politicization, so we must continue to speak out and demand an evidence-based response.

I believe in science. I believe in public health. And I believe we will all get through this with a responsible public health response. Rebuilding trust depends on more than a sound bite and will take time. Our political leaders must do all they can to shore up the credibility of nation’s public health agencies and instill public trust and confidence, or we will soon hear the Washington National Cathedral ring its bells 400 times.