How Americans Trusted Public Health Authorities During COVID-19

How Americans Trusted Public Health Authorities During COVID-19

Credit: Unsplash/Jennifer Griffin

Americans’ trust in public health officials in the context of the COVID-19 pandemic is not significantly related to their ability to contain the pandemic themselves, according to new survey data.1 Rather, it is strictly assumed that these agencies follow scientific evidence and provide appropriate health and safety resources and recommendations to the public.

In a unique, nationally representative survey of more than 4,000 U.S. adults, a team of investigators reported findings showing differing standards and levels of trust in regional, state, and federal health officials amid COVID-19 outbreaks.

As today marks the third anniversary of the COVID-19 outbreak, which was declared a global pandemic by the World Health Organization (WHO), the new findings provide a timely insight into the public’s standards and expectations of their representative officials and public organizations health care in this and future crises.

Led by Gillian K. SteelFisher, a senior research scholar at Harvard TH Chan School of Public Health, investigators attempted to analyze public trust in federal, state, and local health officials amid the COVID-19 pandemic — in hoping to understand level of confidence US adults provide available information and their reasons for this level of confidence.

They found that most research on public trust during the pandemic has been relevant to government agencies and officials, or to the impact of individual and demographic characteristics on public trust. An unexplored avenue of research remains the justification of the individual American, which would affect more or less confidence in public health.

“Without a better understanding of these reasons, it is difficult to mobilize support for necessary response strategies or develop strategies that help promote trust,” they wrote. “Understanding the reasons for trust and lack of trust at all levels of government would drive an important dialogue on policy and communication approaches that can help public health leaders build trust and counteract declines during extended waves of COVID-19 and future crises.”

SteelFisher and colleagues used data from a cross-sectional online and telephone survey they conducted in February 2022 to represent the US adult population. Their analysis included 4208 US adults ≥ 18 years of age who were recruited by mail. The survey was conducted from February 1-22, 2022 via online and telephone access.

The survey consisted of questions on 3 analysis topics:

  1. The extent to which respondents trust various agencies that make health recommendations, including but not limited to the Centers for Disease Control and Prevention (CDC) and state and local health departments.
  2. Your level of trust in these authorities for accurate information on COVID-19 and one of 14 different reasons for that level.
  3. Their assessment of different reasons why they can or cannot trust a public health agency.

When analyzing different sources of health advice and information, respondents gave doctors (54%) and nurses (48%) the highest rates of “high confidence” among the options. Scientists (44%) and pharmacists (40%) also receive high values ​​for the highest level of trust.

Agencies such as the CDC (37%) and the National Institutes of Health (33%) did relatively well, having “very much” trust; About a quarter of respondents had high levels of trust in state and local officials. All of these agencies fared better when compared to state and local elected officials and religious leaders when it came to high trust ratings.

For information related to COVID-19, 42% of respondents said they have a high level of trust in the CDC — more than the state (31%) or local health department (34%). The most important reason for higher trust in the CDC was the idea that the agency follows scientifically sound research (94%) and involves relevant experts (92%). Respondents also supported the CDC’s work to make COVID-19 vaccines and tests more widely available ($83) and their clear recommendations for protection from the virus (79%).

Such reasons were consistently cited by respondents who expressed high levels of trust in their local and state health departments — albeit at slightly lower rates. Reasons related to a sense of compassion or practical work were given more frequently for state and local agencies than for federal agencies.

Regarding reduced trust, the top reason given at all levels of public health officials was respondents’ sense of political influence over recommendations and guidelines (74% for CDC; 72% for states; 70% for municipalities). Additionally, a majority of respondents who are less trusting of agencies also cited private sector influence on recommendations and policies as a key reason. Many respondents who do not trust government agencies also questioned what they felt was too many conflicting recommendations (73% for CDC; 61% for states; 58% for municipalities).

Analyzing the data, investigators first noted the lack of correlation between health officials’ ability to control an outbreak and public confidence — “despite a seemingly natural assumption.”

“Rather, public trust in agencies is related to the belief that agencies follow science when developing policies; have provided appropriate resources such as tests or vaccines; and give clear recommendations on how people can protect themselves,” they wrote. “Therefore, our findings provide an important reminder that public health leaders need not be perfect in crises and contain outbreaks immediately to maintain public confidence.”

The team concluded that their survey results emphasized the critical role of public health agency communication in emergencies — specifically, how communication balances the agency’s anchor for scientific discovery so as not to appear contradictory or unreliable to the general public.

“In addition, greater support is needed for discussions of communication efforts between levels of government so that policies are adjusted locally based on relevance while maintaining coherent national efforts,” they wrote. Although communication guidelines suggested this, the evidence base for these approaches was lacking, and communication programs have historically been underfunded, even in emergencies.”


  1. SteelFisher GK, Findling MG, Caporello HL, et al. Trust in U.S. federal, state, and local health agencies during COVID-19: responses and policy implications. Health Ape (Millwood). 2023;42(3):328-337. doi:10.1377/hlthaff.2022.01204

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