What can federal health agencies do to revive the fading trust of the public?

Confidence in public health entities is spiraling downward in the U.S., and once-revered Washington institutions like the CDC and NIH are among the casualties in serious condition. How to break the negative momentum?

For starters, by injecting evidence-based interventions directly into care settings and community conversations. This means relying on physicians backed by messaging support from local health authorities.

Researchers offer the suggestion after analyzing data from four separate surveys.

“Several factors have been shown to contribute to [the present decline] of confidence, including misinformation about healthcare and public health services, and socioeconomic challenges caused by the pandemic,” write Amyn Malik, MPH, PhD, MBBS, and colleagues at the University of Texas’s O’Donnell School of Public Health. 

“Recent studies have suggested that behavioral interventions—especially those which use trusted messengers to communicate with less confident communities—may play a role in reestablishing trust in public health institutions,” the authors point out.  

CDC led the dive    

The four surveys drew responses from around 3,100 American adults, total, between 2020 and 2024. The first two surveys solicited thoughts and behaviors related to the COVID-10 pandemic. The second two asked about the 2022 and 2024 mpox, or monkeypox, outbreaks. 

In addition, the commissioned survey-takers asked participants a series of questions about their perceptions of public health entities. 

Among the key findings to come from the project: 

• Between February and May 2020, the percentage of respondents reporting high confidence in the CDC decreased from 82% to 68% before dropping to 56% in 2022. 
   
• Between 2022 and 2024, confidence in the CDC increased to 60%; however, the change was not statistically significant. 
   
• Confidence in the NIH, HHS, state health departments and professional medical organizations dropped by 25%, 13%, 16%, and 26%, respectively, from February 2020 to June 2022. 
   
• Despite slight increases between June 2022 and October 2024, confidence in all institutions remained significantly lower than in February 2020.

FDA held its own  

Against these troubling figures, participants’ perceptions of authoritative health voices closer to home is striking. 

For example, respondents’ confidence in their own doctor and local health departments increased between 2022 and 2024 by 5% and 19%, respectively. This reversed the prevailing trend before that two-year window, when trust in local physicians and health departments ranged from stagnant to sliding. 

Further, while the HHS, CDC and NIH were falling in favor over that four-year stretch, overall confidence in the FDA held steady. 

Interestingly, the UT researchers found, confidence in the White House increased by 10% from February 2020 (29%) to October 2024 (39%). 

Time for a trust turnaround 

In their discussion section, Malik and co-authors state their study “highlights the potential of local health entities, including physicians and local health departments, to act as trusted messengers and effectively communicate about public health.”

“Local health authorities should be aware of this influence when they interact with patients and the public, particularly when discussing complex health topics like COVID-19 vaccination,” they remark before calling the need for strategic interventions “urgent.”

The study was published June 26 in PLOS Global Public Health and is available in full for free.