Rebuilding trust in public health and medicine in a time of declining trust in science

Abstract

Trust in public health and medical practitioners has declined since COVID‐19. Throughout the COVID‐19 pandemic, poor communication by medical and public health professionals coincident with the rise of social media enabled unverified, often erroneous information to spread quickly and widely. Providing accurate, fact‐based information is imperative to save lives and promote health. Using a robust, evidence‐based approach to tracking the spread of information and partnering with trusted messengers, states can take a leadership role in combatting misinformation and safeguarding the public's health.

INTRODUCTION

On February 26, 2025, a child died of the measles in Lubbock, Texas. The child's death was part of an ongoing measles outbreak in the South Plains and Panhandle region of Texas, with the epicenter in Gaines County. As of late March, more than 400 cases of measles were reported in Texas ¹ with the outbreak spreading to New Mexico. This is the first death from the measles in the US since 2015. Measles is a vaccine preventable illness. In Gaines County, Texas, 17.62% of school age children had a nonmedical vaccine exemption in 2023–2024 compared to 3.63% in Texas overall. ²

In response to the measles outbreak Robert F. Kennedy Jr., the newly confirmed secretary of HHS, was initially quoted as saying that the outbreak was “not unusual.” ³ But while outbreaks of measles are not necessarily unusual, this one is quite so because of its size and the death of the child. Ultimately, Kennedy did publish an op ed on Fox News ⁴ that provided accurate facts about the MMR vaccine and noted that the vaccine is crucial to avoiding the measles. However, Secretary Kennedy's subsequent recommendations for use of Vitamin A for measles and his long history ⁵ of public skepticism about vaccines have contributed to increasing doubts among many about the safety of historically well tested, lifesaving vaccines. ⁶

The measles outbreak in Texas makes vivid the challenge physicians and public health practitioners are facing in the current environment. Public trust in public health has been declining since the COVID‐19 pandemic. At the outset of the pandemic, 71.5% of adults reported considerable trust in physicians and hospitals. That percentage dropped to 40.1% in January 2024. ⁷ Part of the decline in trust of health professionals is a legacy of the poor communication. During Covid 19, different, sometimes conflicting messages were promulgated by federal, state, and local health leaders. Inconsistent and conflicting recommendations was reported as a key reason for mistrust in public health agencies during the pandemic. ⁸

Coincident with the decline in trust in medical and public health professionals is the rise of social media to enable unverified, often erroneous information to spread quickly and widely. In a recent JAMA Open study ⁹ of often overused medical tests, researchers found a high degree of misinformation in social media posts. Of the almost 1000 posts reviewed, only a little more than 6% relied on actual evidence versus personal anecdote or other rationales for their recommendations. This study is just one of many ¹⁰ that have documented the dangers of social media's influence in the spread of inaccurate health information.

Providing accurate, fact‐based health and medical information to the public is an imperative to save lives and promote health. Given the decline in trust of public health leaders and the embrace of anti‐scientific information spread by those currently in key governmental leadership roles, innovative approaches must be found to disseminate accurate health information to the public. One such approach is being tested now in Michigan using community‐based organizations and other trusted messengers to share accurate, scientifically based information about health.

MICHIGAN PUBLIC HEALTH SETBACKS AND INNOVATIONS

Public health entities in Michigan understand all too well how the seeds of governmental distrust can flourish in the aftermath of a public health crisis. The city of Flint, Michigan has been distressed from decades of financial decline, and in 2014 the drinking water source was changed to the Flint River without the necessary corrosion control, resulting in lead leaching from pipes and exposing an estimated 140,000 individuals. ¹¹ The Flint water crisis ultimately caused largescale lead exposures particularly impacting children in vulnerable communities but also led to broad distrust in governmental entities.

Studies conducted in the years following the Flint water crisis showed that perceived trust in government officials was significantly lower after the water crisis, ¹² , ¹³ and demonstrated the potential for long‐term psychological sequelae, ¹⁴ including impacts on those not directly affected by the contaminated water. ¹⁵

In 2016, Michigan Governor Rick Snyder established a special commission to make public health recommendations in the wake of the water crisis. ¹⁶ The findings of this special commission were released in 2017 and included a recommendation to create a permanent advisory body, the Michigan Public Health Advisory Council, ¹⁷ which was established later that year and charged with providing guidance on public health matters, developing action plans, and monitoring the effectiveness of Michigan's public health response system. ¹⁸ The Council is made up of members representing the following professions: a physician, a registered nurse, a pharmacist, a veterinarian, a medical school faculty member, a school of public health faculty member, a local public health official, a hospital administrator, a local director of public works, an epidemiologist, a toxicologist, a food safety expert, an expert in environmental health and a representative of a nonprofit health or environmental organization. ¹⁸

Unfortunately, the COVID‐19 pandemic began while Michigan was still reeling from the after‐effects of the Flint water crisis. COVID‐19 also disproportionately impacted socially vulnerable urban communities like Flint, ¹⁹ and this time, distrust in governmental and public health entities spread coast‐to‐coast. In 2022, as Michigan was beginning to recover from the first catastrophic waves of COVID‐19 deaths, the Public Health Advisory Council sought to identify gaps in the public health response in Michigan, through a series of structured interviews with proponents as well as critics of public health agencies. ²⁰

One of the key recommendations that came from the subsequent analysis and report was a charge to improve public health communication by partnering with trusted messengers from diverse communities, and engaging in a robust social media campaign, in an effort to raise public awareness of issues impacting the state. ²⁰

REBUILDING TRUST: THE MICHIGAN PUBLIC HEALTH COMMUNICATIONS INITIATIVE

In January 2025 the Michigan Association for Local Public Health launched the Michigan Health Communications Initiative (MHCI) with support from The Public Good Projects (PGP), and in partnership with the Public Health Advisory Council as well as numerous community‐based organizations. Five critical public health topics are included in the MHCI: vaccines, contraception, mental health, STIs, and gun violence prevention—topics were chosen based on community needs, and public health awareness of misinformation around these topics in particular. The initiative includes a rigorous evaluation to understand its impact on health care knowledge.

The Michigan Health Communications Initiative is a growing network of organizations and partners across the state committed to providing timely, evidence‐based health messaging that meets the evolving information needs of communities. Educational materials ²¹ are provided through this initiative as part of a broader effort to standardize and scale health communications across the state. The MHCI's communications are created in response to trending health narratives and information gaps identified through analysis of community partner insights and publicly available media data, such as social media and news within the state.

TRUSTED MESSENGER APPROACHES TO REBUILDING TRUST IN SCIENCE

Though the MHCI itself is new, it is a system composed of validated parts. Media monitoring of health topics is increasingly common in health departments, driven by public health systems strengthening efforts such as infodemiology.com ²² and the Public Health Communications Collaborative. ²³ Community health programs already integrate with numerous cross‐sector stakeholders to conduct their work, employing frameworks such as the Collective Impact ²⁴ model. The social and behavior change evidence base for empowering a community's trusted messengers, be they organizations or individuals, is well‐established ²⁵ , ²⁶ , ²⁷ as are programs founded on this approach. ²⁸ , ²⁹ , ³⁰ What the MHCI offers in the current environment, one in which federal health communications have been gutted and at times unreliable, is a sustained and sustainable manner for states to send vital communications when and where they are needed.

The MHCI's network can be activated when its local partners require it, based on near real‐time data coming from the state's information ecosystem (Figure 1). Partners receive communications through a centralized email, with materials available at no cost from an online download center. In this way, public health in the state of Michigan has a means to inform impacted communities without relying exclusively on expensive media campaigns and other traditional strategies. The goal of health communications is to provide individuals with the information they need to make informed choices for their health. That information does not always need to come directly from a health authority.

Figure 1.

Michigan Health Communications Initiative System organizational and information flow.

CONCLUSION

Rebuilding trust in public health and the medical profession is essential to the nation's health. However, recent changes to websites and other public information at the Centers for Disease Control, the FDA and throughout the Department of Health and Human Services pose serious challenges to providing accurate, evidence‐based information to citizens throughout the country. These changes make it difficult for individuals to find a trusted source of information about critical and emerging health issues.

Despite the challenging federal landscape, all is not lost. States and local government still play a critical role in civic life in America. State and local government must now play a central role in disseminating fact‐based information about health.

Initiatives like the MHCI provide templates that other states can model to overcome the current challenges presented by health misinformation and disinformation. With trust at a generational low, public health can earn back its place in communities by sitting at the table with local organizations who are trusted. Empowering trusted messengers with the right information at the right time can be a means of fulfilling public health's mission during a time where it must do more, with much less. Now is the time for states and local communities to lead.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflicts of interest.

Udow‐Phillips M, Smyser J, Bagdasarian N. Rebuilding trust in public health and medicine in a time of declining trust in science. J Hosp Med. 2025;20:787‐790. 10.1002/jhm.70086