With the House still investigating the pandemic, its origins, and our government's responses -- and with perhaps the most well-known public health figure in the hot seat (Anthony Fauci, MD) -- now seems a good time to reflect on how we might begin to restore our trust in public health.
Understanding the Root of Conspiracy Theories
In the mid-to-late 90s, I worked for a member of Congress who represented the high desert of California. If you have never visited this area, it is both beautiful and dangerous. Hot and dry with few people, it is home to two of the most famous military facilities in the world: Edwards Air Force Base and Naval Air Weapons Station at China Lake. Both are renowned, though one more than the other. While the Space Shuttle occasionally landed at Edwards, affording it more attention, China Lake is not as well-known. Yet, it is the home to the development and testing of some of the most advanced weapons in the military's arsenal.
For many who live around China Lake, the base has been the focus of many conspiracy theories. I know this because when I worked for the Congressman representing the area, I took phone calls from residents wanting to know what was going on out there or those who wanted to report odd things flying in the air. What I learned from these calls was that at the heart of every conspiracy theory, there is always a grain of truth.
Yes, funny things did fly around China Lake, but they were not UFOs, nor were they evidence of a U.N. takeover. This was instead evidence of top-secret testing and training that was going on at China Lake. So, when they called, I listened to their questions, ideas, and theories, and took them seriously. I did not dismiss them but provided information about what was going on.
For most folks, this tactic worked. They just wanted to know what was going on and be assured it did not mean the end of their way of life living in the high desert.
Conspiracy theories are born from many factors. A lack of knowledge or information and fear are two of the greatest elements. If someone does not know about something and then they hear about it (often quickly and without forewarning), curiosity combined with a lack of facts can lead to all manner of ideas. Add fear to this mix and voilà -- a conspiracy theory can be born.
Going back to the high desert, people did see things wobbling around in the sky, they did see U.N. vehicles and planes from NATO countries on rail cars and flying in the sky. They did not know why. Add in the fear of a rapidly changing world and they became certain we were under attack. And add in one new element -- the emerging internet and its ability to spread misinformation quickly and widely -- and conspiracy theories abounded.
So, what does this have to do with restoring trust in our public health system? "Everything," is the answer.
Modern Day Distrust
During the COVID pandemic, trust in public health, the groups and organizations that carried it out, and the leaders who tried to manage it took a beating. This is undisputed.
Taking lessons from the people of California's high desert, I learned that we need to listen better and deeper to our citizens. We need to understand that there are nuggets of truth in misinformation and conspiracy theories; we need to respond to those nuggets; we need to let people in on the truths we know and don't know; and we need to have faith and trust they will be able to digest this information and, in the end, do the right thing for themselves and others. This can be hard in an emerging pandemic, but it still needs to be done.
The pandemic had all the elements of a conspiracy theory extravaganza -- COVID came upon us quickly with no warning. Society virtually shut down, and we had to make significant changes in our behavior, because we knew next to nothing about this virus and how it was spreading and who was most vulnerable. We had no treatments as people got very sick and died all around us. But we couldn't see anything. The enemy was invisible -- a very scary notion.
But then we developed a vaccine in record time and treatments too -- too quickly by many folks' reckoning. It was never effectively conveyed to the public that mRNA vaccines were not really "new" -- they'd been in the R&D pipeline for . We neither explained how the FDA approval system worked, nor did we accurately describe the benefit of the COVID vaccines. The general public did not understand that they do not make us bullet-proof from the virus, but would keep most of us who got vaccinated alive.
Masking policy was also an example of this dynamic at work. The country was completely unprepared for the pandemic. Our experts didn't know exactly how the virus spread. But they did know masks may be a useful tool (as they are in medical settings). Yet, there weren't enough for everyone, so the government initially said . Then the government learned more about transmission of this novel virus and our mask supply increased, and officials said we should wear them. Ultimately, they were mandated in many places. There was little to no public explanation for what sounded like a flip-flop.
To make matters worse, when mandates did emerge, officials made it sound like wearing a mask was nearly foolproof. Masks work as designed. If they didn't, why do physicians, nurses, and technicians wear them in the operating room? Why are they worn in an infectious disease ward? Why, when the CDC sends staff to help with an Ebola outbreak, do they wear masks? Because they do have a benefit. But they are not 100% effective.
Our government should have done a better job talking to Americans about the pandemic. We could have trusted the public's ability to understand the debate. But we did not.
Restoring Trust
Public health is not something the public spends much -- if any -- time thinking about, though we all enjoy its silent benefits every day.
If we want to reestablish a level of trust in our health, science, and medicines, we need to engage the public more directly -- talk to them, not at them, in a language and style they will understand. And most importantly, we must trust them to broadly understand the discussion. We must meet them where they are, including being afraid and being mistrustful of what they do not understand.
is a senior director at APCO, a global public affairs and strategic communications consultancy. He is a 30-plus-year veteran of healthcare communications, including serving as the spokesman at HHS during the 9/11 and anthrax attacks in 2001.