James Gathany/CDC

American Public Health Institutions Need to Rebuild Public Trust, University of Idaho Research Finds

Throughout the pandemic, many have spread false and misleading information about coronavirus vaccines and treatments.

If public health institutions want Americans to follow their lead, they will need to work on building the public’s trust, a study led by Idaho researchers suggests.

A paper on the study was published in May in the journal PLOS One. The study was a collaboration between eight University of Idaho researchers and one University of Texas-Austin researcher.

“Importantly, our research suggests cultivating trust in authorities tasked with communicating public health information would be the optimal way to increase (behaviors that protect health) to slow the spread of future pandemics,” the researchers wrote in the paper.

They surveyed 1,034 households in Idaho, Texas and Vermont between October and December 2020. At that time, vaccines for COVID-19 were not yet widely available. Public health officials recommended, and continue to recommend, non-pharmaceutical methods to protect against the virus, such as masking and social distancing. But a handful of groups in Idaho and elsewhere protested mask mandates and other public health orders and guidelines. Meanwhile, a surge of COVID-19 overwhelmed hospitals across the U.S. and nearly forced Idaho’s health care system into a last-resort triage protocol.

The study found that Americans at the time made choices to reduce their risk of a perceived threat. The more they trusted public health authorities, the more likely they were to accurately judge their health risk and take actions to protect against disease, the researchers wrote.

People in rural areas trusted government less and saw COVID-19 as less of a health risk; those in urban areas had more trust in institutions and believed COVID-19 to be more of a health risk.

“On average, rural Americans are older, are more likely to live in poverty, have higher rates of chronic disease and disability, and are less likely to be insured than urban dwellers,” the researchers wrote.

The trust deficit they identified “creates additional vulnerabilities to COVID-19 in rural communities,” they wrote.

The survey also asked people about the perceived threat of economic risk, and risk to the community versus the individual. Several questions asked about a person’s own behaviors in settings where the people around them do or don’t follow public health recommendations; for example, if nobody in a grocery store was wearing a mask, would they?

The findings echo similar research conducted before the coronavirus pandemic.

“For instance, during the 2009 H1N1 (i.e., ‘swine flu’) outbreak, individuals who reported less confidence in the government were less likely to take the vaccine, which resulted in a large amount of unused vaccines,” a group of researchers wrote in a paper also published in PLOS One, in 2017. “Additionally, in a study of HPV vaccine acceptance, mothers who reported high trust in the government were more likely to accept the vaccine.”

Throughout the current pandemic, individuals and groups have spread false and misleading information about coronavirus vaccines and treatments. In Idaho, some of those individuals have been elected officials or members of public health boards.

“In the case of COVID-19, trust in the message and the messenger has been undermined by several factors,” the University of Idaho researchers wrote in their May journal article. “Namely, there was a lack of uniform national, state and local strategies; inadequate reach, accessibility, and consistency of public health information; and widespread misinformation and disinformation that was not adequately refuted. Studies suggest that misinformation not only erodes trust in public health authorities, but also decreases the motivation to seek and adopt correct information.”

Government leaders and health authorities have changed their recommendations many times during the pandemic, often in response to new discoveries, shifting threat levels, and new drugs and vaccines. But federal public health agencies — particularly the Centers for Disease Control and Prevention — have drawn criticism and mistrust from all sides: from health experts concerned about COVID-19, to anti-vaccination activists who downplay the risks of COVID-19, to members of the general public.

“The primary driver of how people act is what they perceive as the health risk to themselves,” Benjamin Ridenhour, a University of Idaho mathematics professor and lead author of the research paper, said in a news release about the study. “One way that people determine that is by what the government is telling them. So, it’s important to have clear messaging.”

The study added to existing evidence that pandemic-related behaviors align with political ideology. But more than politics, trust in health institutions had the largest influence on a person’s risk perception.

The study was funded by a grant from the National Institute of General Medical Sciences.

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