Human communication

Why public trust matters in a pandemic – until it doesn’t

With the COVID-19 omicron variant loosening its grip, a “let’s leave it all behind” sentiment is growing in the United States. But what appears to be the right path, eyes forward, may be the deceptive reboot of circular pandemic politics.

As a medical anthropologist working in the field of health security for decades, I can tell you that it has a name, “panic and negligence”. Policymakers wake up to a catastrophic outbreak to the value of a strong public health sector only to go back to slumber after the crisis, until another outbreak frightens them again.

A lesser-known trend worries me more, however, when responders discover late in an emergency that trust — not just biomedicine — is needed to control contagion. After rushing to act on this truth, they forget about it until the next major health crisis.

Successful public health interventions in an outbreak depend on public trust, actionable information, and a community-owned response. Witness the 2003 SARS epidemic, the 2009 H1N1 flu pandemic, Zika in the Americas from 2015 to 2016, and now, the COVID-19 pandemic, among others.

In our lifetime, this lesson has failed to stick, though ignoring it can be deadly.

At the start of the Ebola epidemic in West Africa from 2014 to 2016, the response failed due to poor communication and a decision-making process disconnected from experiences on the ground. This initial approach created fear and mistrust in communities that had been served by a weak health system. Those suspected of infection avoided testing, families hid their sick and health workers faced pushbacks, sometimes violence. But when the response involved the community as problem solvers and got their input, surveillance improved, safe burials increased and viral transmission slowed.

The “find out and ignore” cycle may be unraveling, some say. UN agencies and health and humanitarian organizations have detailed valuable strategies on community engagement in the face of outbreaks. Social scientists explained to their peers, donors and national governments how to integrate human factors into health security.

However, these global developments are unlikely to influence national health security. The United States fiercely guards its sovereignty and disregards international guidelines. Technological innovation is deeply rooted in our national identity, our economic system and our health care system.

And so, we refuse to learn that epidemics have a human side. Our pandemic vaccination strategy is a clear case.

Public confidence in vaccines was a key component of the H1N1 flu pandemic. Many Americans have rejected vaccines because of perceived safety issues: The technology was “new,” “untested,” and/or “rushed” — all unfounded fears. Some people of color were wary of pandemic vaccine promotions because of past and present actions by health care institutions that, coupled with a lack of access, contributed to immunization disparities.

By the time the SARS-CoV-2 virus emerged, that information was lost.

Operation Warp Speed ​​— the initiative to develop and distribute COVID-19 pandemic vaccines to the American population — was strictly a laboratory and logistics operation. The company aimed for biological breakthroughs; it had no equivalent to ensure social success. The U.S. COVID-19 vaccination campaign caught up before vaccines were even available in December 2020.

Lack of access and lack of confidence in vaccines has re-emerged in predictable ways, especially for low-income communities of color. Community advocates and public health have since worked hard to overcome these issues.

Hyperlocal outreach and workarounds — like empowering black-owned hair salons and hair salons as community health centers — are narrowing the COVID-19 vaccine coverage gap between whites and people of color. Hair professionals talk about vaccines with their customers without judgment and hold vaccination clinics in their stores. High-contact approaches can still benefit the white community if we devote energy and resources to outreach.

Earlier this month, a research study widely reported in The Lancet raised hopes that the policy cycle regarding the sociality of epidemics was collapsing. According to data from 177 countries, trust in government and trust among citizens predicted fewer COVID-19 infections. Pandemic preparedness and health system capacity – key preparedness/response measures – have not.

To apply these lessons and avoid an unhealthy new cycle in US health security, we have four steps to take.

1. Center public trust issues in any national COVID-19 commission.

Factors that have helped or hindered Americans from cooperating with public health interventions require investigation, including sick leave policies, institutional biases, and logistical barriers. A critical review of the response must take priority over pathogen origins politics, and the bipartisan PREVENT Pandemics Act should empower a council on public trust and aid in health crises rather than the proposed advisory committee on communication and information. More than messaging drives behaviors like mask-wearing and vaccination.

2. Integrate social science expertise at the highest levels of policy-making.

Credentials for health security leadership should extend beyond medical and life sciences. Alondra Nelson, the first sociologist to head the Office of Science and Technology Policy (OSTP), heralds a new trend. As appointees rotate, OSTP, the National Security Council, and the Office of the HHS Assistant Secretary for Preparedness and Response should create permanent positions in their organizations to provide strategic social science advice on biological incidents.

3. Allocate a portion of investments in medical countermeasures to social effectiveness research and development.

The Biden administration’s proposal to transform U.S. pandemic preparedness capabilities includes an “expanded science workplan” to realize the production of flexible vaccines, therapies and diagnostics at speeds not yet possible. This $42 billion investment will be more likely to succeed if there is a well-funded strategy to investigate the socio-behavioural factors that determine public access and acceptance of advanced technologies.

4. Design a trust infrastructure that connects communities and public health.

For the American people to trust the pandemic preparedness system, it must engage communities before, during, and after an emergency. This requires an abundant, skilled and sustainably funded workforce. Community health workers, as written in the PREVENT Pandemics Act, are essential, as are a full complement of health promoters, risk communicators, translators, social media strategists and social scientists in the local health services.

Health security must prioritize both trust and technology – only then can we prevent painful and prolonged outbreaks in the future.

Monica Schoch-Spana, Ph.D., a medical anthropologist, is a senior fellow at the Johns Hopkins Center for Health Security and senior scientist in the Department of Environmental Health and Engineering at the Johns Hopkins Bloomberg School of Public Health. Since 1998, she has focused her public health career on generating and applying evidence to advise policy makers and practitioners on how to effectively engage with individuals, businesses, and faith and community groups in efforts to management of catastrophic health events..