More of than a million people in the U.S. died from COVID-19 during the pandemic, but health officials acknowledge that another casualty was trust in the public health officials, particularly at the federal level.

The topic of yesterday’s opening plenary session of the 2024 ID Week meeting was preparing for the next pandemic and rebuilding the shattered trust was the first thing the three experts were asked about during the discussion part of the session.

“I worry a little bit sometimes when we talk about trust that we put it as a bin that we put everything that is too hard into and say, ‘Well it is about trust’” said Jennifer Nuzzo, Dr.P.H., S.M., a professor of epidemiology at Brown University School of Public Health and director of the pandemic center there.

But Nuzzo and the other panelists, Paul Friedrichs, M.D., the director of The White House Office of Pandemic Preparedness and Response Policy, and Nicole Lurie, M.D., M.S.P.H., the executive director for preparedness and response for the Coalition for Epidemic Preparedness Innovations (CEPI), shared some thoughts on why trust in public health decayed and what can be done to bring it back.

Nuzzo said that when the pandemic started, trust in a variety of institutions was high and then eroded over time. “I think that is really important to recognize that, because what it points to is that trust isn’t a thing you either have or you don’t. It’s the result of a process.”

From her conversations with people during the pandemic, Nuzzo said she came to see that trust ebbed partly people believed their needs weren’t being met or the response was against their best interest.

Healthcare providers remain trusted sources of information, Nuzzo noted, but people would tell her that they didn’t have a regular provider. She said the primary healthcare infrastructure in the U.S. need to be rebuilt partly because it would help the country cope with disease outbreaks.

“If you first show up in people’s lives in an emergency, you can say, ‘Trust us. We’re here to help you,’ but you’ve never been in someone’s life, day in and day out trying to help them, then, good luck having that conversation,” Nuzzo said.

Lurie referenced her eight years as the assistant secretary for preparedness and response HHS prior to her current position at CEPI. “One of the big takeaways for me is what a huge country it is and how different different parts of the country are. And I think there’s not a one-size-fits-all to trust,” Lurie said.

Trust, Lurie said, can’t be manufactured at the federal level. “We can certainly destroy it at the federal level, but we can’t manufacture it,” she said. As has been said about healthcare and politics, trust is local, Lurie added, she urged the members of ID Week audience to speak to people at the local level.

“You are known in your neighborhoods You’re known in your institutions. You are people who can go out there and apolitically explain to people what’s going on and to speak the truth,” she said.

Lurie also urged the audience to speak to elected officials at the local and state level” “Explain to them what infectious disease is. Explain to them what infectious clinicians do and explain to them why they should care about that and become a resource for them as well as develop a trust relationship so that when they have a question or when something happens, you’re a person they call and you can spread the trust.”

Friedrichs said he agreed with Lurie about speaking to elected officials and added an admonition to avoid “medicalspeak” and talk in plain English. He said that there had been communication successes during the pandemic including “novel partnerships with atypical communicators — people who didn’t usually serve as spokesman or spokeswomen [on] medical issues, reaching out to historically underserved communities.”

Friedrichs also said that trust must be anchored equity. “Trust means that every American has to believe that they have the same opportunities to access high quality care. Trust means that people around world have to believe that their children can get the care when they need it, not just because they live in a wealthy country but because that is the right thing to do.”