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Why do some people no longer trust public health agencies? Is it because COVID-19 wasn't quickly eliminated? Not necessarily, according to researchers.

"In a crisis of this scale, the U.S. public's trust in public health agencies for information is not strongly related to organizations' ability to eliminate the outbreak," wrote Gillian SteelFisher, PhD, deputy director of the Harvard Opinion Research Program at Harvard University in Boston, and colleagues in a . "Rather, public trust in agencies is related to beliefs that agencies follow scientific evidence in developing policies; have made appropriate resources, such as tests or vaccines, available; and give clear recommendations about how people can protect themselves."

"Public health leaders need not be perfect in crises and need not contain outbreaks immediately to maintain public trust," they added. "Instead, they must provide resources to the public, along with clear and consistent recommendations for personal action."

Public trust in government and major institutions "has been declining for decades, and the pandemic has raised concerns about trust in public health agencies in particular," the authors noted in their introduction. And although research has been done on public trust during the COVID-19 pandemic, most of it has focused on tracking levels of trust in government agencies over time or on individual demographic predictors of trust. What has been less examined, however, "is the reasons that people have higher and lower levels of trust."

To get at that issue, SteelFisher and colleagues conducted online and telephone surveys of 4,208 U.S. adults in February 2022, using a survey designed by the Harvard T.H. Chan School of Public Health in collaboration with the Association of State and Territorial Health Officials and the National Public Health Information Coalition. The survey was developed using American Association of Public Opinion Research best practices for survey research.

Respondents were asked about three areas: trust in the CDC, trust in their state health department, and trust in their local public health department, as well as trust in 10 additional groups. Further questions assigned participants to one of three groups, focusing on the CDC, their state public health department, or their local public health department. Surveyors followed up with participants to find out more about why they trusted various agencies a great deal, somewhat, not very much, or not at all.

Respondents also were asked who they trust as a source of information for health recommendations. Doctors and nurses rated highest, with about half of respondents reporting a "great deal" of trust in those two groups (54% and 48%, respectively). Other health professionals receiving similar ratings included scientists working on health issues (44%) and pharmacists (40%).

In terms of institutions, more than a third of respondents (39%) trusted the American Cancer Society for health recommendations a great deal; they had similar levels of trust in the CDC (37%) and NIH (33%), the survey found. On the other hand, only about one-fourth of respondents (26%) said they trusted their state and local public health departments a great deal; state and local elected officials and religious leaders were among the least trusted groups. For information about COVID-19 specifically, 42% of respondents had great trust in the CDC, compared with 31% of their state public health department and 34% for their local public health department.

For those who trusted the CDC a great deal, most said their trust came from the agency's scientific expertise, such as its use of scientifically validated research (listed by 94% as one of the reasons for trusting the agency) and having experts on staff (92%). Other reasons for trust included that the CDC had given clear recommendations for people to protect themselves (79%) and that the CDC's information matched that of other trusted sources (71%).

The authors listed five key takeaways for public health officials from their study:

Provide resources to the public, and let people know what they can do to protect themselves. "Policies to secure appropriate stocks of key resources (for example, personal protective equipment and vaccines) through better funding and monitoring of the Strategic National Stockpile must be prioritized even outside of emergencies to ensure their immediate availability at the start of outbreaks," they wrote.

Be aware that reasons for trust vary across agencies. "Trust in federal agencies is related primarily to beliefs in scientific expertise, whereas trust in state and local public health agencies is related primarily to their providing direct, compassionate care," the investigators said. "Agencies may be able to tailor their communication approaches on the basis of these results."

Know that the public's reasons for lower trust in agencies are related to perceived inconsistent decisions that are influenced by politics and not based in science. "Agencies should be given clear lanes of influence as the purveyors of scientific information to elected officials and the public," the authors wrote.

Messages should be tailored differently for different audiences. For example, in one segment that has "some" trust in public health officials, "concerns are focused on conflicting recommendations and the perception of political influence," the authors noted. "Therefore, to stabilize trust for this sub-segment, public health leaders need to prioritize clarity and consistency in messaging and processes, where possible."

Remember that most people still have at least some trust in public health agencies. "This may leave room for agencies to gain trust among those who are somewhat or not very trusting, particularly by working with more trusted partners," they said. Even though religious leaders, for example, aren't highly trusted to deliver health information, they "may be highly trusted for nonscientific information and perceived as caring about the community, so they are still credible partners to amplify messages, particularly in highly religious communities."

Limitations to the study included its cross-sectional -- rather than experimental -- design, meaning that causal interpretation is limited; and limitations related to the use of self-reported data. In addition, "results did not address reasons for trusting agencies beyond those recognized by respondents, although in actuality, other factors may have been at play," the authors wrote.

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