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Trust in the federal government is at an all-time low, and now the polarized fight over a new Supreme Court justice promises to erode trust in that critical and supposedly neutral institution, which has been slowly dropping for years. But there is another loss of trust we need to worry about: the way the Trump Administration’s handling of the COVID-19 pandemic is undermining trust in the government agencies whose job it is to keep us safe from disease. Long after COVID-19 has become just another endemic infectious disease, the loss of trust in these agencies could continue to take an insidious toll on our health in all sorts of ways.
We depend on the Centers for Disease Control, the Food and Drug Administration, the National Institutes of Health, and the other agencies of the Department of Health and Human Services not only for their expertise but also for their commitment to our health, not the economic health of the industries they oversee or the political health of their political bosses. We need to know that when it comes to our safety, the agencies that are supposed to protect us are honest and genuinely on the public’s side, our side, the truest measure of what trust is all about.
But the integrity of those agencies, which have long had general public confidence (62% of Americans think the government does a good or very good job ensuring the safety of food and medicine), has been challenged by the Trump administration, which has altered FDA and CDC policy, manipulated critical health messaging, and even distorted scientific facts. The president himself has actively undermined trust in those agencies, with tweets that charge the FDA with delaying vaccine development, or challenge the CDC’s view (universally held by neutral public health experts) that masks are critical to reducing the spread of airborne infectious disease.
These attacks and distortions may have some small impact on this November’s election. But they are likely to have a lasting impact on public health in America. Without trust in the integrity of the agencies that oversee our public health and medical systems, we are less likely to take the vaccines they say are safe, to follow the policies and guidelines they recommend will protect us, or believe the scientific facts their expertise provides to help us make the healthiest possible choices. And this goes way beyond COVID-19, to anything that carries the FDA or CDC or NIH/government science “brand.”
The current situation offers one ominous example; as the President contradicts his own scientists with promises of COVID-19 vaccine before the election, faith in the safety of a potential vaccine may be eroded. But consider what else this loss of trust might do. General childhood vaccine hesitancy or outright refusal, already frighteningly high, is likely to grow. Participation in flu vaccination, already low in part because of lack of trust in vaccine safety, may decline. FDA approvals of new drugs or medical tests might be questioned more, and their warnings about dangerous quack medicines and health cures are more likely to be ignored. Faith in CDC research tracking diseases like COVID-19, critical to combatting those diseases, may decline. The scientific work of the National Institutes of Health may be doubted.
Rising suspicion about the trustworthiness of the people and agencies running America’s public health programs will inevitably mean more people sick, and more dead.
That this is happening in the context of presidential politics makes the problem worse, because even more than normal in this election season we are driven to see things through the lenses of our tribe’s beliefs rather than thinking about them for ourselves. Witness the surveys that show trust in public health officials is diminishing far more among the supporters of President Trump. You don’t have to look far to see evidence of an impact among those on the political right; the angry refusal to acknowledge the scientifically established importance of masks or social distancing, the deadly belief that COVID-19 is a hoax, the FOX News-promoted theory that the CDC is inflating the death toll to hurt Trump’s reelection chances.
These things all spread disease and death, because viruses and bacteria don’t care about what party you belong to… and even if only one group of people fails to adopt healthy behaviors, the way they act has a huge impact on how safe or unsafe we all are. A key element that shapes our behaviors is trust.
As social animals, we have evolved to understand that our safety depends on the people we live among — our friends and neighbors and colleagues. Working together, we can protect ourselves better than working alone. So we are constantly judging whether we can trust the people we know and the people around us… and whether we can trust the government agencies we have created to help protect us. Does it feel like they are honest? Does it feel like they are on our side? The more we trust, the more likely we are to rely on their expertise and follow their guidance. The less we trust, the less likely it is that we’ll do what those health experts suggest.
This is why the undermining of trust in the CDC and FDA and the NIH (and the World Health Organization) is so dangerous. Attacks on their integrity degrade their ability to protect our health. The impact of this administration's actions on the trustworthiness of these important agencies may be felt for a long time to come, and it will be measured in increased illness and death not just from COVID-19 but from all the food and medical threats we face.
