Building Trust in Public Health Institutions : Consider This from NPR If you're confused about the new CDC Coronavirus guidelines, you're not alone.

In fact, this week, the American Medical Association released a statement saying, "The new recommendations on quarantine and isolation are not only confusing, but are risking further spread of the virus."

Adherence to public health guidelines is built on trust, and over the last few weeks, trust in the CDC seems to be eroding.

Jessica Malaty Rivera, a Senior Advisor at the Pandemic Prevention Institute and a science communicator, explains how we got to this point...and what steps need to be taken to ensure public trust in the CDC.

In participating regions, you'll also hear a local news segment that will help you make sense of what's going on in your community.

Email us at considerthis@npr.org.

How To Build Public Trust When Fighting A Pandemic

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MICHEL MARTIN, HOST:

The late-night talk shows have become a fairly reliable way to figure out what or who is getting on the nation's collective last nerve. Last week, they locked in on a new target - the CDC, specifically the latest CDC guidelines for controlling the coronavirus.

(SOUNDBITE OF TV SHOW, "THE DAILY SHOW WITH TREVOR NOAH")

DESI LYDIC: Remember this rhyme - it's symptoms again, the days are 10. If you're symptom free, the days are through five. If you still wear a cloth mask, you've already died.

MARTIN: That's Desi Lydic from "The Daily Show" on Comedy Central.

(SOUNDBITE OF TV SHOW, "THE DAILY SHOW WITH TREVOR NOAH")

LYDIC: I know it seems confusing, but by following these simple guidelines, we can finally beat smallpox.

UNIDENTIFIED PERSON #1: COVID-19.

LYDIC: COVID-19.

MARTIN: And it's not just late night poking fun at the organization.

MARTIN: Group chats, Twitter and TikTok are flooded with meals and skits, like this one from Joy Ofodu.

(SOUNDBITE OF VIDEO)

JOY OFODU: Welcome. The CDC says, your favorite game from your favorite play cousin. CDC says put on your mask. CDC says take it off. CDC said put it on.

MARTIN: Why not joke about it? That's better than tearing your hair out over guidance that in the kindest interpretation is not clear, and at its worst, makes no sense. Here's why. In a short press release put out on December 27, the guidance to isolate for 10 days after an onset of symptoms turned to five. And there was no requirement to test people who had COVID but are now symptom free. To end their isolation, just a directive to assess their own symptoms in order to re-enter society. Plus, at first, their guidelines did not come with a scientific brief explaining the changes. This week, they did update those guidelines to show some of their reasoning, but they still don't require a test to end isolation.

Confused yet? You're not alone. In fact, the American Medical Association released a statement saying, quote, "the new recommendations on quarantine and isolation are not only confusing, but are risking further spread of the virus," unquote. So there are a lot of questions about these guidelines and what's driving them. And some experts think it's not just the science.

(SOUNDBITE OF ARCHIVED NPR BROADCAST)

ROCHELLE WALENSKY: So, of course, we can't take science into a vacuum. We have to put science in the context of how it can be implemented in a functional society. So we always do that.

MARTIN: That's the CDC director, Dr. Rochelle Walensky, talking to my colleague Ari Shapiro last week.

(SOUNDBITE OF ARCHIVED NPR BROADCAST)

WALENSKY: We want to make sure that we can keep the critical functions of society open and operating.

WALENSKY: It's true - good public health guidelines balance multiple priorities, but confusing communication about them threatens their effectiveness. CONSIDER THIS - adherence to public health guidelines is built on trust, and over the last few weeks, trust in the CDC seems to be eroding.

MARTIN: So how did we get here and what do we do to fix it? That's coming up. From NPR, I'm Michel Martin. It is Saturday, January 8.

MARTIN: It's CONSIDER THIS FROM NPR. Despite President Biden's promises to put public health experts front and center and restore public trust, the CDC's scientists have remained out of the public eye during his tenure. Former CDC Director Tom Frieden, who served during the Obama administration, told NPR's Selena Simmons-Duffin that's a problem.

TOM FRIEDEN: The fact is there are dedicated scientists at CDC who are the world's experts in a lot of these issues, and they need to be speaking directly to the public along with Dr. Walensky.

MARTIN: In fact, during the Trump administration, career scientists led CDC press briefings on the coronavirus every few days in the early months of 2020, before it was officially declared a pandemic by the WHO. On February 25, 2020, CDC scientists signaled that things could get really bad, something President Donald Trump continuously downplayed. Trump sidelined those scientists and made COVID briefings a White House affair. And that practice continued during the Biden administration. But yesterday, after weeks of criticism...

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED PERSON #2: Good morning, and thank you all for joining us for today's telebriefing.

MARTIN: Finally, a CDC-led media telebriefing...

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED PERSON #2: We're joined by CDC Director Dr. Rochelle Walensky, who will provide opening remarks. Then we will be joined by Dr. Greta Massetti.

MARTIN: ...With CDC scientists...

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED PERSON #2: And Dr. Henry...

MARTIN: And there was clear relief from the reporters.

(SOUNDBITE OF MONTAGE)

UNIDENTIFIED JOURNALIST #1: Hi, Dr. Walensky. Thank you for doing this.

UNIDENTIFIED JOURNALIST #2: I'll second that I really appreciate this opportunity.

UNIDENTIFIED JOURNALIST #3: Especially for giving us access to agency experts.

MARTIN: Now, the briefing was supposed to focus on schools reopening today.

(SOUNDBITE OF ARCHIVED RECORDING)

WALENSKY: I want to provide you an update on keeping our children safe and protecting them from COVID-19.

MARTIN: But it quickly digressed into questions about the CDC's guidelines, messaging and silence.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED JOURNALIST #4: I wanted to ask whether you are aware that people are confused about the messaging from CDC.

UNIDENTIFIED JOURNALIST #5: I'm wondering, where is the science behind your isolation policy?

UNIDENTIFIED JOURNALIST #4: And if you could explain why you are doing this briefing today.

WALENSKY: Well, we have heard clearly over the last week that there was interested in hearing from us independently, and so that was the reason for today.

MARTIN: It seems Dr. Walensky has gotten that message. And she clarified that the guidance is trying to balance dual priorities - reducing enough transmission while keeping society open. But there's still a lot we don't know about how omicron will change those calculations.

(SOUNDBITE OF ARCHIVED RECORDING)

WALENSKY: I anticipate that this will be the first of many briefings, and I very much look forward to them.

MARTIN: Coming up, our next guest thinks the CDC should do more to regain public trust. This week, I had a chance to sit down with Jessica Malaty Rivera. She is a senior adviser at the Pandemic Prevention Institute, an infectious disease epidemiologist and a science communicator. Now, that's a lot of balls to keep in the air, but I focused on that last one. What does a science communicator actually do?

JESSICA MALATY RIVERA: Well, for the last at least two years of the pandemic, I've been helping translate a lot of the emerging data, the headlines, the trends that we're seeing in COVID-19 statistics and numbers, translating it so that it's accessible to wide audiences.

MARTIN: We asked Jessica Malaty Rivera if she agreed that the CDC communications with the public have been confusing.

MALATY RIVERA: Incredibly confusing. In fact, I was very pleased to see that the American Medical Association officially called them out to say that they were not only confusing, but that they were problematic and could cause more harm.

MARTIN: So you listened Walensky's media briefing. Do you think she made up for this confusion? Do you think she addressed it in an effective way?

MALATY RIVERA: No, unfortunately, I don't. And it's clear that that wasn't really even the intention of the teleconference, but it went there with the journalists. I'm glad it went there. But when pressed on where is the data and where is the science to justify this, I mean, she all but admitted that it's not based on omicron data. They said that they don't have that data, the detailed data for omicron, and they won't for weeks, so that they did decide this decision based on what they had from wild type and beta and delta, which don't have the same kind of transmission dynamics as we are seeing with omicron.

MARTIN: I think a lot of people are scratching their heads wondering what is going on with the CDC right now. I think a lot of people wonder, why is it still so confusing? Is that just endemic to this field or are there things that they're just doing wrong?

MALATY RIVERA: I think it's a little bit of both. I think the fact that it's really impossible to eliminate politics from a government agency and in a time when we're still recovering from a really botched response to the pandemic since Day 1, it's going to have to remain political because so many of the decisions are going to have to affect so many different industries.

MARTIN: Do you think that the CDC is still experiencing political interference from the current administration?

MALATY RIVERA: I do. I think that it's impossible to ignore that. Knowing the timing of when the president had a call with governors who put pressure on him about the burden, the economic burdens of 10-day isolations, and even knowing that there were letters sent from corporations on that particular burden as well, we know that the White House was pressuring the CDC respond in this way and that there was an effort to kind of get that message out fast so that it seems, you know, streamlined. Science and public health are political, but this politicization of it is where all of us are feeling a bit uncomfortable. And it's impossible to remove that from what's happening right now.

MARTIN: See, this is what I'm trying to understand is, what is the line between political judgments and political interference? Because as you're pointing out, public health is in part about balancing different priorities.

MALATY RIVERA: Right. Well, if you think about the outcry from public health professionals right now, we're asking for the data, we're asking for the evidence because that is what informs good policy. And so I think that's where the line is. I think when you are making policies in the absence of very, very clear and significant and peer-reviewed and quality data, that's a red flag.

MARTIN: I was wondering if there's any sympathy among public health experts like yourself for the CDC because things change so quickly. I mean, Dr. Walensky pointed out that new data is coming out all the time. Is that a factor here in why the CDC is struggling to communicate effectively with the public?

MALATY RIVERA: Absolutely. Their positions are not enviable. They have an enormous task in one of the most difficult times of our lives. This is exhausting, but what a time for all of us to kind of come in and step in and flex these muscles that we've been training for so long in a time where the American public needs us. But at the same time, it's not worth making rash decisions or decisions that are not based on very, very clear evidence or having messages that have to kind of continue to be corrected because they were done possibly in haste. I definitely have sympathy for them. And I think that a lot of people in this space are burnt out, tired and emotionally worn from this - the demands of this, you know, endless pandemic it seems like.

MARTIN: I mean, I'm sure you were aware of this history, but there have been times in the past when - because the job of the CDC is to weigh all these various factors - right - it's to weigh the science, and there have been times in the past, as I think, you know, people know, when maybe the CDC's call wasn't quite right. But even having said all that, I think there are those who worry the CDC has lost its way in some way or who perhaps feel that the CDC has become too politicized. Is this actually endemic to the field or is there something specifically wrong here right now?

MALATY RIVERA: I think COVID-19 was a lesson that we were unprepared for because of the kind of years of devaluing and defunding public health. You know, we had systems in place prior to COVID-19 many many years ago to do things like bio surveillance and tracking emerging threats for possible pandemics. And that funding dried up over time. And what we're seeing here is a consequence of that. You know, public health, when it works, it's invisible. It's really hard to see the value of a lot of public health systems when there aren't a bunch of public health fires going off.

And then you have an unprecedented, you know, once-in-a-century-type pandemic that brings us to our knees. And you realize, well, shoot, we probably shouldn't have devalued all of those resources and all of those industries. And so that's why you've seen a big outcry to public health and to even prioritize the communication of public health because oftentimes you're dealing with folks who don't understand the science or who don't have context on how to normalize it so that people can make informed choices.

I mean, the thing about public health too is that it's layers. It's it's not a black-and-white space. It's just multiple shades of gray. And to have messages that seem very black and white creates a bunch of false dichotomies on what mitigation efforts cancel out the next. And that's what we've been dealing with. We've been dealing with this kind of yo-yo effect, taking one step forward, one step back and back-and-forth messaging. And it's because of this lack of prioritization. And I think COVID-19 is probably going to be one of the most horrifying lessons learned for our country.

MARTIN: So how should the CDC go about regaining the trust of the public, which some segments of the public, let us say, are so distrustful of any utterances by authority figures that do not come from, say, their own political orientation. I'll just put it that way. What should they do?

MALATY RIVERA: I think Dr. Walensky even said that they were hearing that people wanted to have direct contact, you know, hearing from them alone. And I think that that's going to be a way to build trust, not the only way, but a way to hear their tone, to hear the nuance and the gray areas that are not always reflected in the updates of the website and, you know, updates on Twitter. But I think it's going to take a while to do that. And I think that part of the process of regaining trust is also admitting when they've done wrong or admitting that things were bad or that they haven't been communicated well.

I mean, I think one of the most poignant questions was when Walensky was asked if they would acknowledge that the CDC has done a bad job with messaging. And I think that's a necessary acknowledgement because it has been confusing. When you have groups of medical doctors like the AMA saying this is harmful to the public and can cause more risk, that should be responded to. And I think it shows ownership. I think it shows the humanity of people that are actual humans behind these personas online to kind of say, hey, this is a really difficult job. I mean, she said that to a degree. She did say that this is difficult. We're evolving with real time data as it emerges. And it's hard to kind of aggregate it all and have streamlined messages. But there's got to be more of that.

MARTIN: That was infectious disease epidemiologist and science communicator Jessica Malaty Rivera. It's CONSIDER THIS FROM NPR. I'm Michel Martin.

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