Health agencies must regain people’s trust after Covid – News

It has contributed to issues such as vaccine hesitancy, failure to follow mask recommendations, protective measures and misinformation about the virus


By William A. Haseltine

Published: Wed 24 Aug 2022, 09:32 PM

As Centers for Disease Control and Prevention Director Rochelle Walensky recently acknowledged, poor public health communication and messaging throughout the Covid-19 pandemic has damaged public confidence in health agencies and institutions. This, in turn, has contributed to well-known issues such as vaccine hesitancy, failure to follow mask recommendations and other protective measures, and general misinformation about the virus and how it is transmitted.

According to a 2021 poll from the Robert Wood Johnson Foundation and the Harvard TH Chan School of Public Health, only 52% of Americans now have a great deal of trust in the CDC, and only 37% have a great deal of trust in the National Institutes of Health. or the Food and Drug Administration. State health services are not faring much better. Only 41% of Americans trust them, 44% local health departments, and the same poll shows positive ratings of the public health system fell from 43% to 34% between 2009 and 2021.

Clearly, public health agencies need to regain public trust, not only to tackle crises like Covid-19 and monkeypox, but also to address a wider range of ongoing health issues. This process must begin with a commitment to community engagement, partnerships in other sectors such as housing and education, effective communication at all levels, and transparency and integrity in decision-making. .

Public health officials often have to base their recommendations on incomplete data; as the data evolves, so do the recommendations. However, in a misguided effort to appear authoritarian, public health officials are rarely transparent about the nuances and fluid nature of what they communicate.

A perfect example is early advice on how SARS-CoV-2 is transmitted. The CDC was adamant that the coronavirus was spreading on surfaces and not through the air, rather than acknowledging that airborne transmission was still a strong possibility. This approach sowed confusion and mistrust, as the CDC eventually had to change its advisory (as it should have expected). After acknowledging that SARS-CoV-2 was spread by droplets, he finally also admitted that it was spread by aerosol particles.

As this example shows, credibility is often confused with infallibility, so public health officials can be slow to admit mistakes, further undermining their credibility. Transparency is key, especially in a time when online misinformation peddlers will seize every opportunity to discredit public health officials. Successful public health communication builds credibility by being effective, not by being set in stone.

Another cornerstone of sound communication is clarity. Public health officials should explain how the data and recommendations relate to people’s daily lives. Whether the information is correct or incorrect is a moot point if the audience does not understand what is being communicated.

Here, US officials failed the messaging test again when they failed to clarify that the effectiveness of COVID-19 vaccines was measured by hospitalizations, not infections. The public believed that vaccines would block transmission and infection; but when the Delta and Omicron variants emerged and caused an upsurge in infections, distrust and “recall fatigue” duly followed. As of August 3, only 32% of Americans had received their first booster shot.

In this case, public health officials could have used the example of the Salk polio vaccine to assure the public that a vaccine does not need to prevent infection or transmission to eradicate a disease. Or, they could have pointed out how much vaccines reduce the burden on our hospitals.

Unfortunately, other historical lessons do not seem to have been learned. Many public health officials have made a serious mistake in stigmatizing monkeypox as a disease that only threatens gay, bisexual and other men who have sex with men. Yet, while it is true that this population has been disproportionately affected by the current outbreak, monkeypox can be transmitted in any situation where there is close skin-to-skin contact with lesions.

By portraying monkeypox as a sexually transmitted infection, public health officials could give people the false impression that they are not at risk, preventing them from seeking a diagnosis or self-isolating if they contract the virus. The situation is no different from the early (incorrect) messages about the spread of HIV/AIDS only among homosexual populations.

More generally, public health messages are better understood and more likely to be believed when they come from trusted people within the communities to be reached. The messenger is often as important as the message, especially in communities where structural racism and historical trauma have made people reluctant to trust medical authorities.

Rather than issuing authoritative statements and assuming they will be heard, local public health officials should view their messages as part of an inclusive conversation. They should seek community voices and trusted advocates such as faith leaders, shelter managers, and food bank directors to collaborate on messaging and reach populations who may be vulnerable to health disparities.

Another good approach is that developed by the Ryan White HIV/AIDS Health Services Planning Councils. These are community groups appointed by local leaders whose members represent the general public, people living with HIV, funded service providers and other health and social service organizations. Planning Council members work together to identify the care needs of people living with HIV. They then determine which services have the highest priority and how much funding should be allocated to each. This inclusive decision-making model could be applied more broadly to public health planning and resource allocation.

The current climate of “alternative facts” and rampant misinformation presents many challenges for effective public health communication. But by learning from past mistakes and developing messages that are clear, inclusive and from the right sources, we can begin the difficult but necessary process of restoring trust in public health agencies before the next big crisis hits. .

– William A. Haseltine, a scientist, biotech entrepreneur and infectious disease expert, is chairman and president of the global health think tank ACCESS Health International.

– Project syndicate