Trust in public health is eroding, and the implications are far reaching. We, as a field, have to fix this. Over the weekend Any forward-facing scientist can tell you that receiving dangerous messages has been a common occurrence throughout the pandemic. But the hate, resentment, frustration, and anger was crystallized in one instance over the weekend: Elon Musk—the world’s richest man and new owner of Twitter—wrote the post below.
Communication is so vital. Science and tech types often think they know everything, including how to communicate so the message is heard by all sorts of audiences. They don’t. (English major married to a mechanical engineering major for over 30 years, plus I spent my career writing tech manuals.) The medical community needs to decide what message they want to send, then let people trained in communications do the talking. For me, the messaging throughout the pandemic (but especially in the beginning) was severely lacking in cohesiveness and anticipating what different audiences might ask. Even now, many people believe the vaccines were created “overnight,” because the message that the technology had been developed over the last decade wasn’t communicated. Compare it to something the average person can understand, e.g “it’s still a car, but we tweaked the styling.” The messaging on masks was doomed when the first direction on masking was that it “wasn’t necessary.” People are left wondering who and what to trust when messaging keeps changing, and they found stability with the outliers who clung to incorrect information no matter what.
I appreciate what you are trying to do here. I do. But as a medical student of the early 2000s we were also told that no one should be in pain, treat pain aggressively and if we don’t we are bad doctors. People cannot become addicted if they have true pain. There were “studies” to back this up… We have to continue to question the motives and the policies of our government and our public health system. If we do not, people die. We have an ongoing opioid epidemic to prove this.
Let us not forget that the cdc originally told the public that masks were not necessary. This was not true, doctors knew this. But we needed to say this to prevent panic and preserve PPE for the medical community. Was that the right move? What if instead they came out and said we need to treat this like a war-time emergency? We need all people who have masks to drop them off so that the medical community can go to war against this virus.
So now everyone is questioning Fauci. He will be the scapegoat for the science community. I stand behind him as a physician having to make extremely difficult decisions to protect the lives of many. No question. That is what doctors do. But at the same time, the cdc is also telling people to believe that a a specific type of virus naturally appeared in one of the only cities in the entire world that happens to study these exact viruses. When you hear the sound of hooves…. This is no zebra.
If we don’t question it, we cannot make policies that will truly protect the public. If we cannot admit when we made a mistake, more people will die.
I am a physician. I believe in science. I am terribly disappointed in public health and policy--often to the point of despair. The decision to make NPI for the pandemic personal decision and then not adequately educate people has led to excess deaths. I abhor the CDC and that is a huge disappointment. I think this is a deeply polarized country where people are just spoiling for a fight, but for public health to not follow the science, but to follow politics makes me so disappointed and skeptical.
If we’re going to restore trust we need to start with an elementary school program that teaches critical thinking skills. These are just as important as learning to read or do arithmetic.
Katelyn - Curious where you side in the debate on viral Gain of Function research?
Do you support the views of Ralph Baric, Peter Daszak, Shi Zengli, and Anthony Fauci that it is useful to create chimera viruses which don't exist yet in nature in case someday they do exist in nature? Should we increase in the transmission and/or pathogenicity of potential pandemic pathogens in labs in order to potentially develop therapeutics as they argue?
I think this is where the "prosecute/fauci" tweet comes from, as each day more evidence comes to light that the lab leak is likely, and while Fauci was only tangentially involved (funding a small amount of money), off camera he was shoring up opposition to even exploring this hypothesis which we only learned of years later through FOIA requests.
He was duplicitous in 2020 when in his public facing role he acted like this was an absurd conspiracy theory for quacks, but behind the scenes was organizing the very people involved in this research to get their ducks in a row and publish papers guaranteeing it was natural origins (just look at the history of how the Proximal Origins paper came about) - then back in public facing pretending he had no involvement in those studies and they were just a product of science.
Then, Fauci, with the support of our government, got social media companies to suppress and censor any discussion of the lab leak hypothesis for over a year. He likely perjured himself in May of 2021 (though I truly believe he was ignorant of what was initially going on - he's high level and can't always be in-the-weeds).
I assume Musk got even more details on how the sausage was made in suppressing the lab leak through acquisition of Twitter and prompted this tweet.
What I don't understand is how the left (which I am a part of) is giving Fauci a complete pass on this when every FOIA request, every new piece of information, continues to make it very likely the virus was created in a lab, it did accidentally leak (as is somewhat common), Fauci realized our ties to the lab, realized he was on record for supporting this type of research, and did everything he could to shift focus to natural origin and halt any discussion considering a lab leak.
EVEN if it was natural origin, his actions behind the scenes in 2020 were unethical and not in the spirit of science.
First, I want to say thanks for the work you have and are doing. I have spent my career as an emergency physician, now as medical director of a health department in a small rural county in North Carolina. I have no public health background, so once I discovered your work, it has been invaluable. Thanks
I hope you’ll be able to take a few moments to hear these comments. They also come from my experience as a coach working with doctors burned out and/or struggling in their beaurocracies, as well as what I learned following a professional catastrophe by researching and writing a book about what leads a person to make the decisions they do.
I’m going to be a bit provocative here. I don’t think we in public health should focus on the goal getting people to trust public health. It's certainly possible, but not really in our control. Feeling responsible for something out of one’s control is a recipe for frustration.
What we can do is give people the opportunity to trust those of us in public health. That is in our control.
And I don’t think the ‘mistakes’ we in public health have made were mistakes at all. Here’s what I mean. It seems in the face of so much uncertainty, people fell into one of three camps. 1) Looking for ‘answers’ and trusting those with more expertise; 2) Looking for ‘answers,’ not sure who to listen to, but ultimately deciding to trust those with more expertise; 3) Looking for ‘answers’ and in the absence of hearing anything that resonated, instead looked to connect the dots in a way that was plausible enough as a guide to act on.
Our brain’s main job is to decide what the next step is going to be in the face of the uncertainty we each live with each and every day. What task should I do first? What’s the weather really going to do today? What do I do for my kids today? On and on and on, not to mention local, national and international issues.
People are used to hearing the ‘answer’ from science- usually hearing it once the groundwork has been done, mostly out of sight until enough has been done to draw conclusions. But this was very different. Science was evolving in real time. It illuminates how difficult it is for many to live with the uncertainty of evolving science. Those in the 3rd camp have not been able to at all. In truth, science never had a chance with these folks. Science was unable to provide the very thing they were looking for- a certain ‘answer.’ They viewed the pandemic as a problem to be solved rather than what it really is- a dilemma needing a strategy for how best to respond. And when the given ’answers’ either didn’t pan out or had to be changed in the face of a changing landscape, their only recourse was to blame someone for getting it wrong because, well, their ‘answer’ was wrong. And so it had to be the ‘expert’s’ fault. Searching for a solution when the issue is a dilemma is a frustrating dead end.
It was also revealing to me that our decisions largely- and value judgements for sure- take place outside of awareness, in what Shankar Vedentim calls the Hidden Brain (HB)- processing we have no insight into and no idea is going on. It starts from a person’s worldview- the way they believe the world works and the ‘rules’ they use to navigate this- a product of genetics, upbringing and experience. Think about someone who views the world as a glass half empty vs a glass half full; or an optimist who always sees the opportunity vs a someone who always sees the way it won’t work. This worldview forms the lens through which we interpret the data our senses tell us and from which the Hidden Brain forms a story to explain what’s going on. And this is all happening outside awareness. We just do not even know this is going on or even realize we have a worldview that underpins decisions and choices.
And the HB does not communicate in words. The story is passed to the aware functions through feelings, emotions, intuitions, and it is there we attach words, numbers and descriptions in order to share it and ‘think’ about it. When we have a belief, it is not the product of having ‘rationally’ considered the factors in making these value judgements. It is a product of hanging the ‘facts’ on the scaffold of a worldview to form that story. And the default approach of the aware brain is to rationalize, justify, and defend the story, ignoring, dismissing or overlooking that which does not support it. I liken that to the job of a press secretary. It’s just easier to do that. And we are not even aware of that. We think we have thought through and made a reasonable conclusion. This is why facts do not change a mind not open to receiving the facts. Our inner press secretary is just that powerful.
We do, however, have the ability to think things through, embrace the data that becomes apparent and reflect this back to the HB; it’s just takes a lot of brain power to do. In any event, it is the HB that decides whether to amend the story, again outside any awareness, and balanced against that worldview. We can change our mind- but this takes a catalyst- something really impactful that makes it clear that maybe the current story is not the best one available to explain what’s going on and upon which to base choices. And a catalyst cannot be manufactured. It is only in looking back that you can say something was a catalyst. And our stories are so closely tied to self image and self worth, it takes something pretty significant for our minds to be willing to spend the energy to ‘rethink’ the story.
So if I expect to regain trust, this suggests there is something I can do to be that catalyst.
And that is not possible.
What I can do is to provide an opportunity. The person can take it or not. I cannot tell you how many groups, elected officials, school boards, pastors, angry public I have stood before during the pandemic absorbing the negative energy- as we all have for sure- some able to grasp my feeble attempt to put their concerns into the context I have tried to describe above; most not ready. I cannot count the number of phone calls and emails from concerned fellow citizens asking for advice- true for all of us- appreciative because they trusted me with guidance in the face of uncertainty. Was I always right? That didn’t matter as long as it helped them to choose their next step.
What I think I have learned is: try less to depend on regaining trust, and more to support people to take their ‘best next step’ given what is known at the given moment in the given circumstances. I think this means supporting people to frame their issue in a way that they can make use of the data that is known at that time to gain ‘enough’ certainty in the given circumstances to take the next step that seems best. In the end, that’s all people really want and need.
And by their experience about how it worked out, perhaps that gives further credence to group 1 to continue trusting, to group 2 to decide where to put their trust and maybe group 3 to experience a catalyst to make it worthwhile to ‘rethink’ their story, and over time, enough group 3 people do that in favor of trusting public health that it is no longer acceptable by most of the others to not believe that way.
As an evangelical pastor said to me after many conversations: “I hear stuff different from what you are saying, but I believe you because you’ve never steered me wrong.” Truth is I never steered him at all. He made his own choices; I just helped him frame his issues.
It’s a long road, but if we in public health are to sustain and survive, think of ‘regaining trust’ as an aspiration- something we hope can happen, but when it does not, not feeling like we have failed- and instead focus on supporting people in their decision making- an expectation we can live up to; whether the person takes the opportunity or not is something only they can do. That’s a lot less draining, and we can save our energy for where it’s best deployed, and be ok with living with the consequences because as you say, when it comes to a virus, we are all in it together.
maybe, just maybe …..
Thanks for hanging on to read all this.
Sorry if I have just repeated stuff you already know
Thank you for being such a strong voice for public health science. It would be interesting to know how other fields of science are perceived by the public- NASA, green energy, seismologists, etc. My sense is that NASA does a good job of communicating as does Dr. Lucy Jones in disaster preparedness. Dr. Fauci is, of course, a national treasure as are you. Thank you for translating scientific data into layperson's language.
I think it is literally vital for survival of civil society (and in the face of global warming - all of us) to take your and Oxford's excellent analysis one step further. In their prescient book from 2010, THE SPIRIT LEVEL, Wilkerson and Pickett, two English health epidemiologists relate many parameters of societal morbidity (including trust), both internationally and among all US states, to levels of INCOME INEQUALITY. This analysis was reinforced by a 2016 paper "Growing Apart, Losing Trust? The Impact of Inequality on Social Capital" by Eric D. Gould and Alexander Hijzenfrom written in 2016 for the IMF.
It is quite apparent to everyone that the USA is living through an unprecedented period of income and wealth inequalities and disparities. While the pandemic induces fear and irrational responses on an intimate personal and family level, income inequality systemically disrupts civil society - societal and governmental institutions - creating systemic and environmental malaise, alienation, insecurity and deeper fear. The power of the very, very wealthy distorts legalities, politics, industry, governance, communication, employment as well as faith, hope and trust. No wonder people are acting bat-shit crazy in the public square. MAGA is a symptom not the disease. DeSantis is an infectious agent, not a commensial politician.
Primary prevention in this case means disrupting our passive "politics as usual" to stop the government supported robbery and redistribute resources to people and civil society. The American Rescue Plan by President Biden was, in fact, an unprecedented, revolutionary approach to government in these times of need - and it worked. Alas, few people realize this (AOC and Sen Warren, Thomas Picketty do) and an articulate politics to both fight the pandemic and monopoly wealthy has yet to be born. The first step in finding a cure is to know the origins.
"Infectious diseases violate the assumption of independence—what one person does directly impacts the person next to them.” This concept seems to me to be the most basic and the least accepted of the entire COVID experience. The idea that we don’t have unfettered freedom to do what we individually want frequently has a deaf audience. Poor analogies were made such as mandatory seat belt wearing - which in itself had a significant negative reaction when it was introduced. Comparisons to stopping at stop signs and red lights would have been better. Of course unscrupulous politicians taking advantage of public fears and the innate selfishness in most of us - to a greater or lesser degree - hasn’t helped. This notion of common good should draw upon existing, largely accepted rules of appropriate behavior. As for diminishing trust in science and medical science, one need only look to lack of vaccine compliance that had been creeping into the mainstream more and more, even pre-COVID. And climate change deniers. The Republican party has led the way on these issues of denials and I will never vote for one again unless he clearly supports the science and walks the walk. As for communication and trust in the CDC et al, the lack of confidence has been fostered by the unwillingness of those bureaucrats to admit their (sometimes stupid) mistakes. Like the WHO first telling us that it was spread by contact and then - only after the beseeching of hundreds of scientists acknowledged not the basic truth and a mistake on its part, but put out a lame qualifying statement that COVID “might” be spread through respiratory exposure. This is the sort of thing that just leaves people - well educated or not - with no confidence in public health organizations. Talking down to people, as well, is a serious problem as it offends and turns off people to even listening. Admitting to ignorance and explaining the “why" of the ignorance - not enough data - would make reversals of advice more widely forgiven and accepted. We should also overhaul the FDA et al, which were (laudably) created to protect the public from dangerous drugs and inculcate an attitude that permitting new solutions to significant crises and major problems of disease shouldn’t take so long. Cost/benefit analysis is too slanted to delay and caution than to actively trying to solve problems that impact a whole society and are urgent.
Katelyn - thank you for all the time you commit to these articles. Been a reader for many months.
Speaking from personal experience, I think the motives behind the decisions throughout the pandemic are eroding the trust. One thing that needs to be done is direct conversation with people that are losing their trust in the community before they get lost and turned off completely. I know this can be difficult with extreme members of certain political bases but hope isn't lost with people who are now raising an eyebrow.
As an example, initial messaging regarding vaccines was to get vaccinated/boosted because it would help reduce the spread and severity of the disease. My first bout of COVID (Delta era), before my vaccination, was asymptomatic with the exception of loss of taste and smell which returned after a few days.
My experience wasn't severe but it was still something I didn't want to experience again and got vaccinated within a week of eligibility due to the messaging. Several months later, after my son's daycare was dealing with an outbreak, I spread COVID to several people (5-6 I know of) despite the vaccine, prior infection, and not having any symptoms other than a headache. My family members that were boosted had far more severe disease than I did. It led me to think, why did I get this vaccine and why did they get boosted? Who benefitted from the vaccination? I certainly didn't and the people in my household/community didn't.
Now I am being told to get boosted and was recently chastised by an urgent care doctor for not being boosted. Why? CDC website doesn't give me any clear reason except to "prevent severe illness". I personally never experience severe illness and have a natural level of immunity by now so why get vaccinated?
The only motivator for this message that I can see is profit for the drug makers? Maybe? But now I am skeptical whereas I never was before.
I believe in the scientific community as a whole. It's made up of good people with the intentions of doing what is right for many. I received my flu shot like I have done for most of life. I believe in the science behind it. But this vaccine isn't something I trust anymore.
As it relates to this pandemic, I now out-right refuse to get boosted until I see a reason that addresses my concerns with it. CDC isn't clear, there is too much noise to research an answer. It's a conversation I had with my PCP as well and been told it isn't necessary. It's contrarian to the overall public health message.
Dialogue and messaging needs to exist for people like me. I'll never align with the likes of Musk and disagree with the notion to "prosecute Fauci" - absolutely ridiculous. There are many people in the middle who have been turned off from the guidance and the way things have been handled throughout the pandemic. It is still possible to get their trust back and not get caught up in the big picture of statistics, surveys, etc. Focus needs to be on messaging to the people who are willing to listen.
I find the list of professions that scientists still rater higher than a little fascinating. ("Overall, trust in scientists has decreased throughout the pandemic, but ever so slightly. Interestingly it remained higher than public confidence in business officials, the military, public school principals, religious leaders, police officers, and elected officials.") What do they all have in common? They are in a position of authority and essentially get to "tell people what to do". Our country was founded on the idea that no one can tell us how to worship, what to say or what to believe. But in generations past there was still respect for what experts in their field said, because those experts had the education and knowledge base to speak from. But in the past several decades, we've been taught that OUR beliefs are somehow better or more important than those of the experts. We've been told to "do our own research" and somehow that has come to mean a quick Google search or mining social media for what we WANT to hear, not what the scientific or data based truth is. As someone who has worked in a hospital setting for over 20 years I've watched this play out at the bedside over and over. I agree that advocating for yourself is wildly important. But self advocacy is NOT using a Google search to "prove" you're "righter" than the expert. Self advocacy is about questioning things you think might be wrong and then having a discussion where both sides actually listen the each other and then fiond a way to come to an understanding of each other. And it feels as though throughout this pandemic, self advocacy has come to mean Google and social media, not actual research of reputable sites, not open and honest discussion. The same is playing out in our educational institutions at the same time. Expertise is being attacked by those who WANT to hear something less uncomfortable, less difficult. We've become a nation of self proclaimed experts. And I can only imagine how terrifying that is to the actual experts who are being attacked on a daily basis. I've seen the fallout of the "I know better" mentality: caring for patients in hallways because there are no rooms left, having to actually put our hospital on Divert (something we really never thought we'd have to do, but are now doing on a surprisingly frequent basis) due to lack of staffed beds, and patients we've built rapport with dying because they didn't beleive the science of masks and vaccines. I fear for our future. And I realize I've rambled. But a lot has been percolating in my mind for a very long time. Your missives help to keep it from boil;ing over too often, so thank you for that.
You're right on! Communities across the country have to tackle this issue. Example: a dear friend who only has a high school education tried to convince me that vaccines basically change your body at the cellular level. I gently asked her why she believes that. She replied that friend had told her she read it on the internet. I asked her what proof she had of this. She paused and said she didn't know, but her friend wouldn't lie. I said I wasn't calling her friend a liar, I was questioning her proof of this as she was claiming this as a fact which I had never seen. She paused and asked me if this was misinformation. I said it was. (She knows I read extensively in this arena.) I said it is really important to look for the scientific proof before condemning something that saves lives. I am tired of dealing with all this bogus info...as I am sure you are...and I think this has to become Public Health Job Number One...get the conversation open regarding How do you determine if something is fact or not. ( Sorry for the long post. ) Thank you for doing what you do!
Katelyn, good article and no easy answer to the Elon Musk's of the world who have such outlandish reach and in this case does harm to our nation as well as our profession of Public Health.
I am confident he is truly ignorant regarding Public Health history and pathogens causing Pandemics.
Many of the TV news spokespersons painted Dr Fauci as "The Nation's Top Doctor).
He has had an excellent career but he has become the target of politicians and right wing news for not having all the answers and rapidly ending the pandemic. No easy answer but commision for Public Health would be a great start if Bipartisan.
I don't know how to build an electric car company (or want to be a Billionaire) nor does he know public health. Pointing out the obvious ... that he is speaking out on a topic where his success in his life has not made him a public health expert but has allowed him to take for granted societies public health accomplishments over the years.
Regarding the issue of interpersonal trust, vaccination etc, my suggestion is ..... look to Mexico. Mexico is a mess politically, but there is virtually no vaccine denial. People do not trust the government with good reason, but they do trust each other. Thank you for your continuing contribution to public health.
Communication is so vital. Science and tech types often think they know everything, including how to communicate so the message is heard by all sorts of audiences. They don’t. (English major married to a mechanical engineering major for over 30 years, plus I spent my career writing tech manuals.) The medical community needs to decide what message they want to send, then let people trained in communications do the talking. For me, the messaging throughout the pandemic (but especially in the beginning) was severely lacking in cohesiveness and anticipating what different audiences might ask. Even now, many people believe the vaccines were created “overnight,” because the message that the technology had been developed over the last decade wasn’t communicated. Compare it to something the average person can understand, e.g “it’s still a car, but we tweaked the styling.” The messaging on masks was doomed when the first direction on masking was that it “wasn’t necessary.” People are left wondering who and what to trust when messaging keeps changing, and they found stability with the outliers who clung to incorrect information no matter what.
I appreciate what you are trying to do here. I do. But as a medical student of the early 2000s we were also told that no one should be in pain, treat pain aggressively and if we don’t we are bad doctors. People cannot become addicted if they have true pain. There were “studies” to back this up… We have to continue to question the motives and the policies of our government and our public health system. If we do not, people die. We have an ongoing opioid epidemic to prove this.
Let us not forget that the cdc originally told the public that masks were not necessary. This was not true, doctors knew this. But we needed to say this to prevent panic and preserve PPE for the medical community. Was that the right move? What if instead they came out and said we need to treat this like a war-time emergency? We need all people who have masks to drop them off so that the medical community can go to war against this virus.
So now everyone is questioning Fauci. He will be the scapegoat for the science community. I stand behind him as a physician having to make extremely difficult decisions to protect the lives of many. No question. That is what doctors do. But at the same time, the cdc is also telling people to believe that a a specific type of virus naturally appeared in one of the only cities in the entire world that happens to study these exact viruses. When you hear the sound of hooves…. This is no zebra.
If we don’t question it, we cannot make policies that will truly protect the public. If we cannot admit when we made a mistake, more people will die.
I am a physician. I believe in science. I am terribly disappointed in public health and policy--often to the point of despair. The decision to make NPI for the pandemic personal decision and then not adequately educate people has led to excess deaths. I abhor the CDC and that is a huge disappointment. I think this is a deeply polarized country where people are just spoiling for a fight, but for public health to not follow the science, but to follow politics makes me so disappointed and skeptical.
If we’re going to restore trust we need to start with an elementary school program that teaches critical thinking skills. These are just as important as learning to read or do arithmetic.
Katelyn - Curious where you side in the debate on viral Gain of Function research?
Do you support the views of Ralph Baric, Peter Daszak, Shi Zengli, and Anthony Fauci that it is useful to create chimera viruses which don't exist yet in nature in case someday they do exist in nature? Should we increase in the transmission and/or pathogenicity of potential pandemic pathogens in labs in order to potentially develop therapeutics as they argue?
I think this is where the "prosecute/fauci" tweet comes from, as each day more evidence comes to light that the lab leak is likely, and while Fauci was only tangentially involved (funding a small amount of money), off camera he was shoring up opposition to even exploring this hypothesis which we only learned of years later through FOIA requests.
He was duplicitous in 2020 when in his public facing role he acted like this was an absurd conspiracy theory for quacks, but behind the scenes was organizing the very people involved in this research to get their ducks in a row and publish papers guaranteeing it was natural origins (just look at the history of how the Proximal Origins paper came about) - then back in public facing pretending he had no involvement in those studies and they were just a product of science.
Then, Fauci, with the support of our government, got social media companies to suppress and censor any discussion of the lab leak hypothesis for over a year. He likely perjured himself in May of 2021 (though I truly believe he was ignorant of what was initially going on - he's high level and can't always be in-the-weeds).
I assume Musk got even more details on how the sausage was made in suppressing the lab leak through acquisition of Twitter and prompted this tweet.
What I don't understand is how the left (which I am a part of) is giving Fauci a complete pass on this when every FOIA request, every new piece of information, continues to make it very likely the virus was created in a lab, it did accidentally leak (as is somewhat common), Fauci realized our ties to the lab, realized he was on record for supporting this type of research, and did everything he could to shift focus to natural origin and halt any discussion considering a lab leak.
EVEN if it was natural origin, his actions behind the scenes in 2020 were unethical and not in the spirit of science.
First, I want to say thanks for the work you have and are doing. I have spent my career as an emergency physician, now as medical director of a health department in a small rural county in North Carolina. I have no public health background, so once I discovered your work, it has been invaluable. Thanks
I hope you’ll be able to take a few moments to hear these comments. They also come from my experience as a coach working with doctors burned out and/or struggling in their beaurocracies, as well as what I learned following a professional catastrophe by researching and writing a book about what leads a person to make the decisions they do.
I’m going to be a bit provocative here. I don’t think we in public health should focus on the goal getting people to trust public health. It's certainly possible, but not really in our control. Feeling responsible for something out of one’s control is a recipe for frustration.
What we can do is give people the opportunity to trust those of us in public health. That is in our control.
And I don’t think the ‘mistakes’ we in public health have made were mistakes at all. Here’s what I mean. It seems in the face of so much uncertainty, people fell into one of three camps. 1) Looking for ‘answers’ and trusting those with more expertise; 2) Looking for ‘answers,’ not sure who to listen to, but ultimately deciding to trust those with more expertise; 3) Looking for ‘answers’ and in the absence of hearing anything that resonated, instead looked to connect the dots in a way that was plausible enough as a guide to act on.
Our brain’s main job is to decide what the next step is going to be in the face of the uncertainty we each live with each and every day. What task should I do first? What’s the weather really going to do today? What do I do for my kids today? On and on and on, not to mention local, national and international issues.
People are used to hearing the ‘answer’ from science- usually hearing it once the groundwork has been done, mostly out of sight until enough has been done to draw conclusions. But this was very different. Science was evolving in real time. It illuminates how difficult it is for many to live with the uncertainty of evolving science. Those in the 3rd camp have not been able to at all. In truth, science never had a chance with these folks. Science was unable to provide the very thing they were looking for- a certain ‘answer.’ They viewed the pandemic as a problem to be solved rather than what it really is- a dilemma needing a strategy for how best to respond. And when the given ’answers’ either didn’t pan out or had to be changed in the face of a changing landscape, their only recourse was to blame someone for getting it wrong because, well, their ‘answer’ was wrong. And so it had to be the ‘expert’s’ fault. Searching for a solution when the issue is a dilemma is a frustrating dead end.
It was also revealing to me that our decisions largely- and value judgements for sure- take place outside of awareness, in what Shankar Vedentim calls the Hidden Brain (HB)- processing we have no insight into and no idea is going on. It starts from a person’s worldview- the way they believe the world works and the ‘rules’ they use to navigate this- a product of genetics, upbringing and experience. Think about someone who views the world as a glass half empty vs a glass half full; or an optimist who always sees the opportunity vs a someone who always sees the way it won’t work. This worldview forms the lens through which we interpret the data our senses tell us and from which the Hidden Brain forms a story to explain what’s going on. And this is all happening outside awareness. We just do not even know this is going on or even realize we have a worldview that underpins decisions and choices.
And the HB does not communicate in words. The story is passed to the aware functions through feelings, emotions, intuitions, and it is there we attach words, numbers and descriptions in order to share it and ‘think’ about it. When we have a belief, it is not the product of having ‘rationally’ considered the factors in making these value judgements. It is a product of hanging the ‘facts’ on the scaffold of a worldview to form that story. And the default approach of the aware brain is to rationalize, justify, and defend the story, ignoring, dismissing or overlooking that which does not support it. I liken that to the job of a press secretary. It’s just easier to do that. And we are not even aware of that. We think we have thought through and made a reasonable conclusion. This is why facts do not change a mind not open to receiving the facts. Our inner press secretary is just that powerful.
We do, however, have the ability to think things through, embrace the data that becomes apparent and reflect this back to the HB; it’s just takes a lot of brain power to do. In any event, it is the HB that decides whether to amend the story, again outside any awareness, and balanced against that worldview. We can change our mind- but this takes a catalyst- something really impactful that makes it clear that maybe the current story is not the best one available to explain what’s going on and upon which to base choices. And a catalyst cannot be manufactured. It is only in looking back that you can say something was a catalyst. And our stories are so closely tied to self image and self worth, it takes something pretty significant for our minds to be willing to spend the energy to ‘rethink’ the story.
So if I expect to regain trust, this suggests there is something I can do to be that catalyst.
And that is not possible.
What I can do is to provide an opportunity. The person can take it or not. I cannot tell you how many groups, elected officials, school boards, pastors, angry public I have stood before during the pandemic absorbing the negative energy- as we all have for sure- some able to grasp my feeble attempt to put their concerns into the context I have tried to describe above; most not ready. I cannot count the number of phone calls and emails from concerned fellow citizens asking for advice- true for all of us- appreciative because they trusted me with guidance in the face of uncertainty. Was I always right? That didn’t matter as long as it helped them to choose their next step.
What I think I have learned is: try less to depend on regaining trust, and more to support people to take their ‘best next step’ given what is known at the given moment in the given circumstances. I think this means supporting people to frame their issue in a way that they can make use of the data that is known at that time to gain ‘enough’ certainty in the given circumstances to take the next step that seems best. In the end, that’s all people really want and need.
And by their experience about how it worked out, perhaps that gives further credence to group 1 to continue trusting, to group 2 to decide where to put their trust and maybe group 3 to experience a catalyst to make it worthwhile to ‘rethink’ their story, and over time, enough group 3 people do that in favor of trusting public health that it is no longer acceptable by most of the others to not believe that way.
As an evangelical pastor said to me after many conversations: “I hear stuff different from what you are saying, but I believe you because you’ve never steered me wrong.” Truth is I never steered him at all. He made his own choices; I just helped him frame his issues.
It’s a long road, but if we in public health are to sustain and survive, think of ‘regaining trust’ as an aspiration- something we hope can happen, but when it does not, not feeling like we have failed- and instead focus on supporting people in their decision making- an expectation we can live up to; whether the person takes the opportunity or not is something only they can do. That’s a lot less draining, and we can save our energy for where it’s best deployed, and be ok with living with the consequences because as you say, when it comes to a virus, we are all in it together.
maybe, just maybe …..
Thanks for hanging on to read all this.
Sorry if I have just repeated stuff you already know
I’ll be interested in your thoughts.
Respectfully,
Mark Jaben
Thank you for being such a strong voice for public health science. It would be interesting to know how other fields of science are perceived by the public- NASA, green energy, seismologists, etc. My sense is that NASA does a good job of communicating as does Dr. Lucy Jones in disaster preparedness. Dr. Fauci is, of course, a national treasure as are you. Thank you for translating scientific data into layperson's language.
If Government has no idea what they've done wrong, I'm not sure a "listening session" will help.
In order to repair public trust, Government must:
1) Take RESPONSIBILITY, as in "we did this, and it was wrong;"
2) REPAIR the damage they've cause, such as pay back wages to those who lost jobs due to vaccine mandates;
3) Do whatever it takes not to REPEAT past mistakes.
I think it is literally vital for survival of civil society (and in the face of global warming - all of us) to take your and Oxford's excellent analysis one step further. In their prescient book from 2010, THE SPIRIT LEVEL, Wilkerson and Pickett, two English health epidemiologists relate many parameters of societal morbidity (including trust), both internationally and among all US states, to levels of INCOME INEQUALITY. This analysis was reinforced by a 2016 paper "Growing Apart, Losing Trust? The Impact of Inequality on Social Capital" by Eric D. Gould and Alexander Hijzenfrom written in 2016 for the IMF.
It is quite apparent to everyone that the USA is living through an unprecedented period of income and wealth inequalities and disparities. While the pandemic induces fear and irrational responses on an intimate personal and family level, income inequality systemically disrupts civil society - societal and governmental institutions - creating systemic and environmental malaise, alienation, insecurity and deeper fear. The power of the very, very wealthy distorts legalities, politics, industry, governance, communication, employment as well as faith, hope and trust. No wonder people are acting bat-shit crazy in the public square. MAGA is a symptom not the disease. DeSantis is an infectious agent, not a commensial politician.
Primary prevention in this case means disrupting our passive "politics as usual" to stop the government supported robbery and redistribute resources to people and civil society. The American Rescue Plan by President Biden was, in fact, an unprecedented, revolutionary approach to government in these times of need - and it worked. Alas, few people realize this (AOC and Sen Warren, Thomas Picketty do) and an articulate politics to both fight the pandemic and monopoly wealthy has yet to be born. The first step in finding a cure is to know the origins.
"Infectious diseases violate the assumption of independence—what one person does directly impacts the person next to them.” This concept seems to me to be the most basic and the least accepted of the entire COVID experience. The idea that we don’t have unfettered freedom to do what we individually want frequently has a deaf audience. Poor analogies were made such as mandatory seat belt wearing - which in itself had a significant negative reaction when it was introduced. Comparisons to stopping at stop signs and red lights would have been better. Of course unscrupulous politicians taking advantage of public fears and the innate selfishness in most of us - to a greater or lesser degree - hasn’t helped. This notion of common good should draw upon existing, largely accepted rules of appropriate behavior. As for diminishing trust in science and medical science, one need only look to lack of vaccine compliance that had been creeping into the mainstream more and more, even pre-COVID. And climate change deniers. The Republican party has led the way on these issues of denials and I will never vote for one again unless he clearly supports the science and walks the walk. As for communication and trust in the CDC et al, the lack of confidence has been fostered by the unwillingness of those bureaucrats to admit their (sometimes stupid) mistakes. Like the WHO first telling us that it was spread by contact and then - only after the beseeching of hundreds of scientists acknowledged not the basic truth and a mistake on its part, but put out a lame qualifying statement that COVID “might” be spread through respiratory exposure. This is the sort of thing that just leaves people - well educated or not - with no confidence in public health organizations. Talking down to people, as well, is a serious problem as it offends and turns off people to even listening. Admitting to ignorance and explaining the “why" of the ignorance - not enough data - would make reversals of advice more widely forgiven and accepted. We should also overhaul the FDA et al, which were (laudably) created to protect the public from dangerous drugs and inculcate an attitude that permitting new solutions to significant crises and major problems of disease shouldn’t take so long. Cost/benefit analysis is too slanted to delay and caution than to actively trying to solve problems that impact a whole society and are urgent.
Katelyn - thank you for all the time you commit to these articles. Been a reader for many months.
Speaking from personal experience, I think the motives behind the decisions throughout the pandemic are eroding the trust. One thing that needs to be done is direct conversation with people that are losing their trust in the community before they get lost and turned off completely. I know this can be difficult with extreme members of certain political bases but hope isn't lost with people who are now raising an eyebrow.
As an example, initial messaging regarding vaccines was to get vaccinated/boosted because it would help reduce the spread and severity of the disease. My first bout of COVID (Delta era), before my vaccination, was asymptomatic with the exception of loss of taste and smell which returned after a few days.
My experience wasn't severe but it was still something I didn't want to experience again and got vaccinated within a week of eligibility due to the messaging. Several months later, after my son's daycare was dealing with an outbreak, I spread COVID to several people (5-6 I know of) despite the vaccine, prior infection, and not having any symptoms other than a headache. My family members that were boosted had far more severe disease than I did. It led me to think, why did I get this vaccine and why did they get boosted? Who benefitted from the vaccination? I certainly didn't and the people in my household/community didn't.
Now I am being told to get boosted and was recently chastised by an urgent care doctor for not being boosted. Why? CDC website doesn't give me any clear reason except to "prevent severe illness". I personally never experience severe illness and have a natural level of immunity by now so why get vaccinated?
The only motivator for this message that I can see is profit for the drug makers? Maybe? But now I am skeptical whereas I never was before.
I believe in the scientific community as a whole. It's made up of good people with the intentions of doing what is right for many. I received my flu shot like I have done for most of life. I believe in the science behind it. But this vaccine isn't something I trust anymore.
As it relates to this pandemic, I now out-right refuse to get boosted until I see a reason that addresses my concerns with it. CDC isn't clear, there is too much noise to research an answer. It's a conversation I had with my PCP as well and been told it isn't necessary. It's contrarian to the overall public health message.
Dialogue and messaging needs to exist for people like me. I'll never align with the likes of Musk and disagree with the notion to "prosecute Fauci" - absolutely ridiculous. There are many people in the middle who have been turned off from the guidance and the way things have been handled throughout the pandemic. It is still possible to get their trust back and not get caught up in the big picture of statistics, surveys, etc. Focus needs to be on messaging to the people who are willing to listen.
I am still wearing a mask whenever I am indoors in public.
https://www.theguardian.com/us-news/2022/dec/10/masks-tripledemic-covid-flu-rsv-us?utm_term=639482d3ebf91058c0fd4088e31b0d71&utm_campaign=GuardianTodayUS&utm_source=esp&utm_medium=Email&CMP=GTUS_email
I find the list of professions that scientists still rater higher than a little fascinating. ("Overall, trust in scientists has decreased throughout the pandemic, but ever so slightly. Interestingly it remained higher than public confidence in business officials, the military, public school principals, religious leaders, police officers, and elected officials.") What do they all have in common? They are in a position of authority and essentially get to "tell people what to do". Our country was founded on the idea that no one can tell us how to worship, what to say or what to believe. But in generations past there was still respect for what experts in their field said, because those experts had the education and knowledge base to speak from. But in the past several decades, we've been taught that OUR beliefs are somehow better or more important than those of the experts. We've been told to "do our own research" and somehow that has come to mean a quick Google search or mining social media for what we WANT to hear, not what the scientific or data based truth is. As someone who has worked in a hospital setting for over 20 years I've watched this play out at the bedside over and over. I agree that advocating for yourself is wildly important. But self advocacy is NOT using a Google search to "prove" you're "righter" than the expert. Self advocacy is about questioning things you think might be wrong and then having a discussion where both sides actually listen the each other and then fiond a way to come to an understanding of each other. And it feels as though throughout this pandemic, self advocacy has come to mean Google and social media, not actual research of reputable sites, not open and honest discussion. The same is playing out in our educational institutions at the same time. Expertise is being attacked by those who WANT to hear something less uncomfortable, less difficult. We've become a nation of self proclaimed experts. And I can only imagine how terrifying that is to the actual experts who are being attacked on a daily basis. I've seen the fallout of the "I know better" mentality: caring for patients in hallways because there are no rooms left, having to actually put our hospital on Divert (something we really never thought we'd have to do, but are now doing on a surprisingly frequent basis) due to lack of staffed beds, and patients we've built rapport with dying because they didn't beleive the science of masks and vaccines. I fear for our future. And I realize I've rambled. But a lot has been percolating in my mind for a very long time. Your missives help to keep it from boil;ing over too often, so thank you for that.
You're right on! Communities across the country have to tackle this issue. Example: a dear friend who only has a high school education tried to convince me that vaccines basically change your body at the cellular level. I gently asked her why she believes that. She replied that friend had told her she read it on the internet. I asked her what proof she had of this. She paused and said she didn't know, but her friend wouldn't lie. I said I wasn't calling her friend a liar, I was questioning her proof of this as she was claiming this as a fact which I had never seen. She paused and asked me if this was misinformation. I said it was. (She knows I read extensively in this arena.) I said it is really important to look for the scientific proof before condemning something that saves lives. I am tired of dealing with all this bogus info...as I am sure you are...and I think this has to become Public Health Job Number One...get the conversation open regarding How do you determine if something is fact or not. ( Sorry for the long post. ) Thank you for doing what you do!
Katelyn, good article and no easy answer to the Elon Musk's of the world who have such outlandish reach and in this case does harm to our nation as well as our profession of Public Health.
I am confident he is truly ignorant regarding Public Health history and pathogens causing Pandemics.
Many of the TV news spokespersons painted Dr Fauci as "The Nation's Top Doctor).
He has had an excellent career but he has become the target of politicians and right wing news for not having all the answers and rapidly ending the pandemic. No easy answer but commision for Public Health would be a great start if Bipartisan.
I don't know how to build an electric car company (or want to be a Billionaire) nor does he know public health. Pointing out the obvious ... that he is speaking out on a topic where his success in his life has not made him a public health expert but has allowed him to take for granted societies public health accomplishments over the years.
Regarding the issue of interpersonal trust, vaccination etc, my suggestion is ..... look to Mexico. Mexico is a mess politically, but there is virtually no vaccine denial. People do not trust the government with good reason, but they do trust each other. Thank you for your continuing contribution to public health.