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During A Disease Outbreak, Public Trust In Government Officials Is Crucial


During infectious disease outbreaks, public trust in the government and health officials becomes critical. Officials need to convince millions of people that they are telling the whole truth and that their guidance on what to do and what not to do should be followed. Now that the coronavirus appears to be spreading in some parts of the U.S., we asked NPR's Selena Simmons-Duffin to explain why trust in public health is important.

SELENA SIMMONS-DUFFIN, BYLINE: We've been here before. Remember H1N1 - avian flu? Howard Markel, a doctor and medical historian at the University of Michigan, says you can go way further back.

HOWARD MARKEL: Well, I'm a cholera man. I love a good cholera epidemic because it's just a wonderfully disgusting and easily spread disease.

SIMMONS-DUFFIN: Those outbreaks were in the 1800s. There was also the 1918 flu, polio, measles. The list goes on. Markel says throughout American history, the response to epidemics have always involved scapegoating racism and politics. He says as soon as you announce there's an epidemic, your country stands to lose a lot of money, so there's always an urge to wish it away.

MARKEL: Concealment is one of the big no-nos in the history of pandemics, and it happens again and again and again, sometimes for political reasons, sometimes for commercial reasons.

SIMMONS-DUFFIN: Clear and complete information about an epidemic is what establishes public trust, Markel says. So how's that going in the year 2020 with coronavirus? According to a Gallup poll last month, 77% of people felt confident the federal government could handle a coronavirus outbreak - not too shabby. However, that poll was done before there were cases of community spread around the country, before the first U.S. death was announced and before the Trump administration ramped up its response - holding press conferences, announcing new leaders - trying to get a hold of what has been, at times, a muddled message.

BETH CAMERON: I think that there is right now a little bit of a deficit of public trust.

SIMMONS-DUFFIN: That's Beth Cameron of the Nuclear Threat Initiative. She was senior director for global health security and biodefense on the White House's National Security Council, a position that was eliminated by the Trump administration in 2018. She thinks getting rid of her old position did mean the Trump administration lost time responding to coronavirus. They had to create a new task force, and it seems there were missteps with the CDC's test kits and guidance on who to test. Cameron says that trust deficit isn't irreversible.

CAMERON: I do think that that can be easily and quickly rectified if the administration continues to provide clear, scientific, fact-based communication on a regular basis.

SIMMONS-DUFFIN: She says without trust, there can be panic and chaos.

CAMERON: If people don't trust that the government is telling them the truth about the risk to themselves and their families, people start to make decisions that are not rational.

SIMMONS-DUFFIN: Like lining up for testing and treatment when they're not very sick, making it harder for the medical system to find the serious cases - public trust is needed when officials say, your risk is low, go about your normal life - which is what they're currently saying - and when things suddenly change and they say, we need cooperation in closing schools or canceling public events, for instance. And in epidemics, things do change. Markel says, in some ways, there's never been a better time in American history to have an epidemic.

MARKEL: We have the means, the will, the money and the technology to handle this problem.

SIMMONS-DUFFIN: Now officials just need to earn and keep the public's trust.

Selena Simmons-Duffin, NPR News.

(SOUNDBITE OF JAYDA G'S "SOUND OF FUCA") Transcript provided by NPR, Copyright NPR.

Selena Simmons-Duffin reports on health policy for NPR.