Trust is Public Health - This is not how you restore trust in public health

Public health requires public trust. The current regime is seemingly doing everything to destroy it. 

Article discussed: https://www.kff.org/health-information-trust/trust-in-cdc-and-views-of-federal-childhood-vaccine-schedule-changes/

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Transcript

SPEAKER_01 0:05

Welcome back to Everything is Public Health. I'm MJ. And I'm Cass. How much do you trust the CDC before 2025 and after 2025?

SPEAKER_00 0:13

Oh man. We're just like automatically off the bat wading into the deep.

SPEAKER_01 0:19

Yeah, well, the thing is, we've done a few fun episodes, and true to form, we have to do a depressing one.

SPEAKER_00 0:24

So Okay. I will say, even in the midst of the current administration, I know there are many, many people who work at CDC who are doing their very best to do right by the country and their health and well-being. So I need to caveat and say the core staff who work at CDC, I trust as much before and after 2025.

SPEAKER_01 0:48

Absolutely.

SPEAKER_00 0:49

The things publicly coming out of CDC and what we're hearing from Health and Human Services Secretary, I trusted much more before 2025, and I basically trust not at all now because it's all feels and vibes, not science.

SPEAKER_01 1:06

I feel the same way. I am also of the opinion that there are a lot of good people within the CDC that is trying their best to duct tape everything together for lack of a better term. And all the corruption is very much top-down. As an institution, I trust it less because of its leadership. But in terms of the people actually doing the work, obviously, shout out to the scientists holding things down with duct tape. Nothing but duct tape at a prayer, it seems like, is they're holding that institution together. And we do need them to continue to do so because were they to leave, I think they'll just get replaced by worse people. So shout out to them.

SPEAKER_00 1:40

Yeah. And well, one of the things I shared in April of last year when I officially started my term as the president of Saver, which is the Society for the Advancement of Violence and Injury Research. I talked about how there will be an other side. We will come out of what is happening right now. And we need researchers, people who understand the evidence to be able to help us get back to what we know works. And I know how hard it is for the folks who have been in lots of agencies, not just CDC, feeling frustrated. And are they working? Are they not working? And, you know, all of the things that are happening. And it takes a lot of courage to work in a space and keep talking about evidence when it's not being received well. And so again, you know, props to the folks who are there. And gosh, I hope they can minimize as many harms as possible until we come out on the other side.

SPEAKER_01 2:36

Yeah, we have lost a lot, but we will lose more if we give up. So it's important that we don't. And it's important that we continue to do the things that keep science alive. So unfortunately, things are still bleak in the US, if you can't tell already, but we must persist because that is the first step in being part of the resistance, simply existing. For listeners perhaps outside of the US or simply avoiding the news, let's do a quick rundown of a few things that's been happening. I've always thought about doing a timely news style show where we give updates on what's happening, but obviously that takes a lot of time and effort to do. So this is a small sample of that hypothetical podcast that I will never make, I suppose. So go ahead.

SPEAKER_00 3:14

All right. So for folks who haven't heard this or who need a little refresher, the food pyramid has been reintroduced as the dietary guidelines upside down. The health secretary is openly advocating for eating more meat and saturated animal fat, counter to all medical understanding. Also, alcohol is good for you again, magically.

SPEAKER_01 3:33

Wild. That part is what pisses me off the most, actually.

SPEAKER_00 3:35

Casey Means, a wellness influencer, is nominated as Surgeon General. Multiple states are reversing course on school vaccination requirements, just in case it's not clear, that's real bad. We are on pace to far outpace 2025's measle record, which is already absurdly high at over 2,200 cases. Less than three months into 2026, we have surpassed 1,000 cases. Millions of dollars of health research funding has been gutted. More than 5,800 NIH grants and almost 2,000 NSF grants were canceled or suspended at some point in 2025, including cancer clinical trials and infectious disease research. Only about half were recovered. Several public health programs at CEC have been abolished, including lead poisoning programs, pregnancy risk assessment programs, intimate partner in sexual violence surveys, HIV and STD prevention, Office of Health Equity, and so much more. Man, I'm so much more depressed now. We started this session talking about how amazing the last few days have been for me and how like I've just been living my best life.

SPEAKER_01 4:43

And now you are just in my cereal bowl.

SPEAKER_00 4:47

Thank you.

SPEAKER_01 4:48

Sometimes you have to confront reality. And I'm sorry that you were on a high and I had to bring you back down, but that is the topic of today, unfortunately. I did not do this on purpose. Anyway, needless to say, these actions by the current administration are detrimental to all of our health. However, on top of all the direct harms these actions have, there's a much more insidious effect that I want to discuss today, which is all this disruption, to say the least, erodes the public's trust in these public health institutions like the CDC.

SPEAKER_00 5:20

Right. And this is really concerning because we need the general public to trust the guidance and advice that public health and larger institutions are making, because one of the things we do is make policy, we educate people. And if folks don't trust the information that they're getting, they're unlikely to make the choices that are best for their health, but also the health of the population. Right. If we think back to COVID flashback, people not believing that masks were important. And we've had a whole conversation about masks, go back to the peeing your pants episode that we talked about a little while ago. But the lack of belief in the system that they were giving out accurate information just made COVID way much worse than it needed to be.

SPEAKER_01 6:03

Anytime you sort of had these nonsense going on, it just gives the impression that, oh, maybe, maybe I couldn't trust the CDC because of all this nonsense that RFK Jr. is doing. And you sort of touch on this already, but that's explored this a little bit better. We got to ask the obligatory question: why is public trust a part of public health? And I think we can show this by showing examples of like how public health works and why trust is a part of it.

SPEAKER_00 6:28

Yeah. So I mentioned COVID, but COVID's not the only outbreak that we've had. So the public trusting that the CDC has their best interest in mind and notifying them on outbreaks and providing guidance on how to avoid getting infected is really important. The public trusting NOAA and the National Weather Service to monitor impending weather events and provide appropriate evacuation guidance if necessary. And the public trusting law enforcement agencies to spend their effort on actually tackling dangerous criminals and not just focusing on frivolous issues is also important, right? These are all ways that both the individual well-being and the public well-being can be impacted by whether or not people trust the information that they're getting.

SPEAKER_01 7:09

And you can think of a society where there's no trust in these institutions, then you have people sort of having to fend for themselves at best or just doing things that are dangerous at worst. The inspiration of today's episode is an article from KFF, which is their preferred name now, as their previous name gives people the impression that they are affiliated with a popular HMO healthcare system. What is your impression of the KFF, Cass?

SPEAKER_00 7:33

I generally think that they are doing good work trying to gather information to answer pressing issues. They do some polling on similar topics that we do. They've done some funding, sort of calls for proposals and funding in the space. And I think they're really working hard to think about how they can continue to give people accurate information to inform decisions when perhaps what's coming out of the administration is less accurate.

SPEAKER_01 8:02

I also generally have a pretty positive impression. I think when I was in school, their health policy summaries were very helpful to sort of see what's going on, especially when they have like 50 states breakdowns on a particular policy. Those are always very helpful. So this is the article. KFF tracking poll on health information and trust. Colon, trust in the CDC and views of federal childhood vaccine schedule changes. Let's go over some parts of this article and we'll sort of discuss at large what this means in terms of trust.

SPEAKER_00 8:32

So the first sentence says, quote, in the weeks following the Trump administration's announcement of changes to the recommended childhood vaccine schedule, the public's trust in the CDC remains at its lowest point since the COVID-19 pandemic, including a nine percentage point drop among Democrats in recent months saying they trust the CDC for reliable vaccine information.

SPEAKER_01 8:53

And that is pretty much the thesis. There's a decline in trust that they're noticing. And I guess we never directly talked about this, or maybe we have, but why do you think the public's trust dipped during COVID?

SPEAKER_00 9:03

I mean, I think there were a few things. So one, the pandemic started under Trump, and the administration didn't give perhaps the best information. They were talking about fringe to say the least quote unquote treatments like ivermectin or hydroxychloroquine. Trump even suggested bleach at one point. In general, the US response was slow and poor. Part of that, I think, was evolving information. And one of the most challenging things in communicating in something like this that is at least not seen in our general lifetime is that people perceive evolving information as misinformation. And so one of the challenges was every day we were getting new information. And the way that was communicated was perhaps not always handled as well as it should have been to make it clear why things were changing. And I think that, along with in general, a general decline in the public's understanding of how science works, right? We change policy when new evidence becomes available, and like there's a spectrum of certainty and how we should or shouldn't respond to things. That doesn't mean that the information is wrong. It's just we're making the best decisions on the best available information and that will change over time.

SPEAKER_01 10:17

Yeah. And you see this with the whole iveromectin and hydroxychloroquine debacle, in which in the early days they were truly trying everything because they just didn't know like whether this was going to work. So there was a moment in time where they're like, well, you know, let's just try this and see what happens. And when they found out that it didn't work, a lot of people interpreted that as the government is hiding something rather than we tried it, it didn't work, we have to move on to something else. So that became a big part of it. And I do want to mention this again because there's a lot of revisionist history about COVID of like, well, Biden did X, Y, and Z. And I cannot stress this enough. It happened in 2020. Trump was the president when COVID happened. And I think just because he only did seven months.

SPEAKER_00 10:56

Well, the first year-ish.

SPEAKER_01 10:58

Even though he only did like the first year of it, you know how like the first hour is the most important when it comes to stroke or heart attack. Like the same thing with the pandemic. Like the first few months is the most important. And he said so many weird things. And I think that just ruined it.

SPEAKER_00 11:13

Well, he also he pushed really hard on one hand to get a vaccine developed, and then publicly said, don't get vaccinated. Which was like it was hard to keep up.

SPEAKER_01 11:24

Anyway, so there's many reasons why the public trust in these institutions dipped in COVID, gradually recovered over time, but the bulk of the article addressed polling showing the dip in public trust again. For example, when asking people if they have trust in the CDC to provide reliable and information about vaccines, in 2023, 63% said they trust them a fair amount or more. In 2026, that number has dipped below half. Only 47 said a fair amount or more trust.

SPEAKER_00 11:52

Well, and there's a heavy partisan difference, as there is with many things. In 2023, Democrats started at 88%, saying fair amount of trust or more in CDC, compared to only 40% of Republicans. In 2025, the Democratic number dipped to 55%, and Republicans' numbers didn't really move all that much, raised up a little bit to 43%.

SPEAKER_01 12:14

And one thing I want to note with this is how the lines did not cross. In other words, when the new administration came in, there was no dramatic flip of and now all Democrats don't trust the CDC, and all the Republicans embraced the CDC. There was no crisscross. Republican trust in the CDC never broke 50%, despite essentially Maha's full takeover of our public health institution. So what does that tell you? The fact that Democrats trust dipped, but Republican trust stayed the same.

SPEAKER_00 12:40

I mean, I think it signals to me that the trust on the Republican side of CDC has less to do with who is in the administration and more to do with a perception of the agency overall. And the significant dip among Democratic support in 2025 is likely because of who's now overseeing the agency and they don't have faith in the information that's coming out. I would have been shocked had the lines crossed because I feel like on the conservative side, there is just a distaste for CDC and NIH in general. Again, painting with a broad brush, but that's a key perception there.

SPEAKER_01 13:23

So the polls say, yeah. I draw the similar conclusion that for them it's not about who is giving the message. Like their general distrust is sort of baseline to their ideology, and it's not like a, you know, who is in the administration, which says a lot. Anyway, this pattern continues. Although there are still strong partisan difference, neither political leaning shows trust in the CDC or federal health agencies. And we go to figure three. Go ahead. Cass, describe what you're seeing.

SPEAKER_00 13:49

Sure. So this figure is showing a cross-partisanship. Generally, less than half of respondents are confident in government health agencies to act independently or to make decisions based on science. So looking at those who say they have a lot or some confidence in federal health agencies, overall it's 46% for ensuring safety and effectiveness of vaccines, 38% for making decisions based on science rather than personal views of agency officials, and only 34% for acting independently without interference from outside interests. When you look at Democrats and Republicans, there's about a 10-point split between them with a slightly smaller gap on making decisions based on science. But still in general, there's a pretty big partisan divide.

SPEAKER_01 14:37

Yeah, pretty big partisan divide. However, neither trust the CDC or federal government, which is what the previous graph also showed, where the lines did not cross. And obviously, this is bad. It just shows that there's a complete lack of public trust in these public health institutions, and we'll get to the implications of that later. A sharper partisan difference returns when the question is regarding IFK Jr.'s performance specifically, with Democrats overwhelmingly disapprove and Republicans overwhelmingly approve.

SPEAKER_00 15:07

There's also sharp partisan differences when asked about whether the recent changes to childhood vaccine schedule will have negative or positive impacts among people who have heard of the changes. For Democrats, overwhelmingly, 83% says that the change is negative versus Republicans saying 23% negative, and 47% say the change is positive among Republicans.

SPEAKER_01 15:29

Yeah. So when you get down to these focus on the individual topics, the partisan difference is so much more stark. And I guess what's your take on this? Because we've seen this in other areas too, where, for example, in your bailiwick, right? Generally people think when you ask specifically about certain policies, people tend to have very different views than if you just add, like, here's a broad thing about how you feel about this. And I think we see that here, although the directions may be a little different.

SPEAKER_00 15:54

Well, I think one important consideration is how siloed people's news sources have become. So that whether you're doing it through social media or more traditional media, I think it's pretty rare for people to read, you know, stories or to get their news from a media outlet that doesn't align with their political ideology. And so if a news media organization or social media algorithm isn't showing you the good things that an organization is doing and it's only focused on the bad things, or it's ignoring things that people are doing entirely, right? It's really hard to get the full picture. And I think people assume that their news media is going to give them all of the information, but the way we have made this so much more partisan and siloed than it ever has been, it's just you're never gonna get all of the information from just one resource.

SPEAKER_01 16:51

I'm not gonna comment too much upon it, but this is just funny to me how Republicans don't trust the CDC and federal agencies, but love RFK Jr.'s performance. Kind of wild.

SPEAKER_00 17:00

I mean, again, it's like the what's getting covered.

SPEAKER_01 17:02

Yeah. Uh right.

SPEAKER_00 17:04

And how are things being characterized, right? One of the things that has shifted so monumentally from watching news as a kid to watching news now, it used to be people would tell you what happened. Now they tell you what happened and what they think about it. Even more so now it's I'm gonna tell you what happened, what I think about it, and what you should think about it, because now it's like we've removed some of the critical thinking that people have ingesting information so that people are just like, oh yeah, I feel X way. Like I remember one day Aaron had come home from school and their teacher had made some statement. And Aaron had sort of parroted back the statement. And I said, Why do you think that? And Aaron said, Well, my teacher said, Okay, fine. That your teacher said that, but why do you you're now telling me this statement, why do you think that? Oh, I don't know. I said, Maybe it would be good to get some information to inform why you think something, as opposed to just, you know, whatever. I think Aaron was maybe like 14 at the time.

SPEAKER_01 18:05

So Yeah, you're putting a lot of pressure.

SPEAKER_00 18:07

My point was more like, but this is an important thing to learn at an early age. Trust but verify.

SPEAKER_01 18:14

Yes, absolutely.

SPEAKER_00 18:15

Go out and get information that you need to double check. Go to the source. If there's a story saying somebody said something about blah, blah, blah, go find it. Don't just trust that somebody actually said the thing.

SPEAKER_01 18:27

I definitely feel this way too, where there are more opinion pieces or reactions than there are news. News.

SPEAKER_00 18:33

We have to fill up a 24-hour news cycle and there are just not that many things happening.

SPEAKER_01 18:37

Now there's a lot of things happening, but that's sort of by design.

SPEAKER_00 18:40

But God, do you remember the outrage when Obama wore a tan suit? Oh my god.

SPEAKER_01 18:44

Or when he wore mom jeans. People are like, How dare the president? I'm like, is that really okay, I can't get into this. But yeah, there's a lot of opinions and reaction content instead of actual news content. And I think a lot of people take that as a shortcut to be like, oh, this is my opinion now. Anyway, we're getting a little bit off track. The point is.

SPEAKER_00 19:02

Sorry. Reeling it back in.

SPEAKER_01 19:04

This is all part of the conversation about why public trust is eroding and why public trust is so critical to public health, right? And another fact to point out, uh, this just be a quick factoid, I guess, from the poll of similar question. Republicans are three times more likely than Democrats to be not sure about the impacts of these vaccine changes. Take that what you will. One slight positive silver lining, more people are aware of childhood vaccination policies than before because there's so much more attention on it. Previously, people probably don't think about these things because if public health is done well, no one notices anything.

SPEAKER_00 19:38

Yep, that's the hard part about public health.

SPEAKER_01 19:40

And now a lot of people are thinking about it. The rest of the article breaks down more questions they ask people regarding trust, which of course declined overall. Democrats have lost a lot of trust. Republicans, strangely, unmoved. Uh, what irritates me the most is that perhaps how all of these changes to childhood vaccine schedule, the CDC, the FDA, are all under the guise of like rebuilding trust in public health. RFK Jr. said this explicitly that they're doing all this to quote unquote rebuild trust in public health, whatever that means.

SPEAKER_00 20:07

Right. And not only are they failing to rebuild trust, they're also failing to understand the last time public trust in public health was low was during Trump's first term. So it seems like perhaps the current administration was part of the problem in the lack of public trust in public health.

SPEAKER_01 20:26

The last trait I want to cover from this article that I find fascinating is figure eight of this article, which is linked in the show notes. Figure eight, partisan divide on confidence in flu, COVID-19, and hepatitis B vaccine safety for children, semicolon, large majorities are confident in MMR polio vaccine safety. And we're not going to go over each row, but I just want to point out the general trend, which is people generally, even Republicans and Maha supporters, generally people trust polio, MMR, and hepatitis B vaccines. The numbers really dip in the flu and COVID vaccine category, which I don't know. I'll I'll listen to your thoughts first.

SPEAKER_00 21:04

So one thought I have on this is generally, and it may be, you know, you have to get a couple of shots in a sequence, but polio, MMR, and hepatitis B, you get vaccinated against those things and you are generally protected. You don't have to maintain for a long time, yeah. Yeah, either for a very long time or forever. Flu and COVID, you have to get every year. And then people will say, Well, I got sick anyway. Sure, you might have gotten sick anyway, because guess what? It doesn't cover all strains. So there's like a messaging issue, right? Get this flu or COVID-19 vaccine. It's likely to make you less sick if you do get a protected strain, if sick at all. But you can still get sick if you get some other strain, right? Because mutations and whatever. But so I think the fact that you have to get them annually and people claim rightly or wrongly that they still get sick, I think that leads to some lower levels of support for those annual vaccines.

SPEAKER_01 21:59

Yeah. Yeah, definitely. And the key is you got sick, but you didn't end up in a hospital, right? Or you end up in a hospital, but you didn't die, right? Those are the protective effects of the flu and COVID vaccine. And I think anytime public health or indeed medicine has to deal with probabilities, the general public tend not to understand what that means. When they designed the flu vaccine, I hesitate to use this word, but it's kind of like an educated gamble. They don't have a crystal ball. They can't see the future of like, oh yeah, definitely this is a strain that it's gonna infect people. So they they took an educated gamble using statistics, which is a part of science. That uncertainty is a part of science, but it's just a lot harder to sell that of like we are certain amount confident that this flu vaccine will be protective. And I think that's probably the reason. And then COVID-19 vaccine got really politicized, as is very evident in this chart. Democrats trust the COVID-19 vaccines. Republicans, while trusting the polio MMR vaccine, do not trust the COVID-19 vaccines at all. So what can we do about this right now? The current administration has fully compromised our public trust in our public health systems. So how do we trust? Who do we trust, and how can we trust?

SPEAKER_00 23:06

So we've been talking a lot about this lately. I think there are a couple of things that a couple of places that we can go for good information. So there are professional societies made up of experts in the field, ranging from the American Medical Association, the American Public Health Association, the Society for the Advancement of Violence and Injury Research. There are organizations that do work in the public health space that they are centered and anchored in evidence-based policy recommendations, evidence-based health behaviors. Going to those places for sources of information is a really good strategy. So if you're unsure what to do about your child's vaccine schedule, go out to the American Academy of Pediatrics. What do they recommend? Stick with that, not necessarily what's coming out of the administration. There are also institutions of higher education that produce the research that is used by these professional organizations to guide what they're doing. So well-respected institutions, obviously Johns Hopkins being one, but there are lots of great institutions where the researchers are producing information, writing op-eds, writing policy briefs, doing media interviews to make sure that people have that information. Those are the folks that you could trust, I think, more than what we have in the current administration.

SPEAKER_01 24:26

These institutions of higher learning, like universities and large research centers, like they oftentimes are the ones doing the actual research. Actually, most of the times, the government is a funding instrument rather than a research instrument. So these institutions are one layer removed from the current administration. So there is still that level of integrity left.

SPEAKER_00 24:44

Yeah, academic independence.

SPEAKER_01 24:46

Hopefully, fingers crossed. Every day we gotta fight because these things are important. So yeah, I will end on this. Whenever I hear someone bring up an example of like bad science, it's always an example of not science. You know what I mean?

SPEAKER_00 25:00

Yeah. The word science gets thrown around a lot. The word research gets thrown around a lot. The number of times I get an email from somebody who says, Oh, I did some research and blah, blah, blah. I'm like, okay, you spent time on Dr. Google. Like, that's not research.

SPEAKER_01 25:13

That is reading at best.

SPEAKER_00 25:14

Yeah. So that that can be challenging. But there are places that you can trust. Like if you're interested in gun violence prevention, our center, the Center for Gun Violence Solutions, has tons and tons of information on evidence-based solutions. There are other institutions who do similar work and have similar resources available that are free. Checking those out is a good source.

SPEAKER_01 25:34

Trust real science, trust real experts. And, you know, real experts, don't try to sell things, is what I will say again. If someone is trying to sell you something, think twice. Why are they selling a supplement?

SPEAKER_00 25:46

For just four monthly payments of$49.99, you too can be cured of blah, blah, blah. Whatever.

SPEAKER_01 25:52

I think hopefully we demonstrated that public trust is a very important component of public health and how currently the current actions of the administration is eroding the public trust in these institutions, which is very bad because when people don't know who to turn to, they will not make optimal public health decisions. Uh vaccine being the obvious examples, but you can extrapolate this to every field essentially. Microgood time, like we just sort of went over trust real science, trust real experts. I would also say we can vote with our ballot, we can vote with our money, but we could also vote with our time. A lot of these algorithms are based on attention and how long you stay on a particular video for. So if you know something is rage bait, don't watch it. It's for your own mental health. And also, the more you watch, the more money they make. So vote with your time and attention as well. Don't give things that don't deserve your time, don't deserve your attention, any of your time and attention. That's my microgun. What about you?

SPEAKER_00 26:45

Wash your hands, soap water 20 seconds vigorously. Turn the water off if it's not automatic with your forearm or the back of your hand. When you dry your hands, save that paper towel and use it to open the door handle because door handles are some of the dirtiest parts of the bathroom, not the toilet seat, contrary to popular belief. And just don't wash your hands and then touch the doorknob. So wash your hands and then use the paper towel to open your doorknob or use hand sanitizer when you leave the bathroom.

SPEAKER_01 27:15

I advocate for every bathroom door to be opened with your feet. Like they sometimes they have those hook things.

SPEAKER_00 27:21

I love those. Those little claw thingies. I don't have to open the door. Love that so much.

SPEAKER_01 27:28

Thank you for listening to Everything is Public Health. New episodes every other week. If you like the show, please tell everyone you know about the show. That helps us immensely. Commenting, subscribing, and leaving us a review helps us a bunch as well.

SPEAKER_00 27:38

If you have any questions or think we missed an important perspective, you can reach out to us at everything ispublichealth at gmail.com. Follow our website, everything is publichealth.com, for all show updates and bonus material. And remember, everything is public health.

SPEAKER_01 27:51

Everything is public health.