Decline in Trust in the Centers for Disease Control and Prevention During the COVID-19 Pandemic

Photo by James Gathany/CDC

The U.S. Centers for Disease Control and Prevention (CDC) is a federal agency tasked with protecting public health and safety. The coronavirus disease 2019 (COVID-19) pandemic presented the CDC with a challenge that was initially met with technical problems in the development of testing kits (Patel, 2020), mixed messaging about the pandemic and mitigation strategies (Schnirring, 2020), and extended public commentary and interference by the Trump administration (Weiland, 2021). As vaccine dissemination campaigns ramp up, trust in the vaccines themselves and in public health procedures more broadly may pose a significant challenge to effectively combating the pandemic—particularly among groups that have had general medical mistrust stemming from historical experience, such as among people of color (Bogart, Takada, and Cunningham, 2020; Bogart et al., 2021). This report examines changes in levels of trust in the CDC between May and October 2020 in light of these concerns.

As part of a nationally representative RAND American Life Panel (ALP) survey fielded in early May 2020 that assessed how Americans are coping with COVID-19,^[1] we asked more than 2,000 individuals to report their levels of trust in a variety of federal institutions, including the CDC, the United States Postal Service (USPS), and the Federal Emergency Management Agency (FEMA). In October 2020, we resurveyed a random sample of 1,892 of the original respondents and asked them to report their levels of trust again.^[2] In this report, we compare individual-level changes in trust in the CDC, USPS, and FEMA between May and October 2020. Responses are weighted to match a range of population distributions in the Current Population Survey and voting behavior.^[3]

Figure 1 presents the mean level of trust reported for each institution in May and October on a scale of zero (complete distrust) to ten (complete trust). Overall, the surveys show that there was a statistically significant^[4] decrease in trust in the CDC, while trust in the USPS and FEMA increased significantly over the same period. We further identified how the level of trust in the CDC changed within subgroups that were defined by rural or urban status, race or ethnicity, age, and intended voting behavior in the 2020 Presidential election.^[5] Changes in trust are presented in Table 1.

	May 1–6	October 5–22
CDC	7.6	7.0
USPS	6.9	7.7
FEMA	6.4	6.8

SOURCE: Authors' calculations that used 1,891 responses from RAND ALP surveys conducted May 1–6, 2020, and October 5–22, 2020. The exact wording of the question was, "Attitudes towards various government and private institutions can range from distrust to trust. Using a scale from 0 to 10, where 0 indicates complete distrust and 10 indicates complete trust, please indicate your level of trust in . . . ." The order of institutions was randomized.

Declines in trust in the CDC were widely observed across groups: The average was roughly 0.7 points, or about a 10-percent decline from the original score. Non-Hispanic White and Hispanic respondents reported significant declines in trust, while the changes were not statistically significant for non-Hispanic Black or respondents of other races. Respondents who reported an intention to vote for Joe Biden showed a small and nonsignificant decline in trust in the CDC, while those who intended to vote for Donald Trump, vote for someone else, or not vote at all in the 2020 Presidential election showed significant and substantial declines in trust. Respondents of all ages reported similar levels of decline in trust, as did rural and urban individuals. In the end, there is remarkable consistency and convergence in reported levels of trust in the CDC across these subgroups after the declines, with the exception of the vote intention comparisons.

The convergence in trust across race or ethnicity highlights a key challenge that the CDC now faces. Lack of trust among Black Americans has been a well-publicized concern regarding the COVID-19 vaccine rollout. However, trust in the CDC did not decline significantly among Black respondents; instead, trust among non-Hispanic white and Hispanic respondents fell to the same lower level of trust that was already prevalent among Black Americans. Indeed, overall population-level trust in the CDC fell to the same lower level as that of Black respondents (Table 1). Trust among respondents who intended to vote for someone other than Biden in the 2020 Presidential election or among those who did not intend to vote at all fell even further, suggesting that views of the CDC are now strongly politicized. Similar politicization was not observed for FEMA or the USPS, which was the focus of heavy political and legal pressure subsequent to contentious policy changes implemented by postmaster general Louis DeJoy in June 2020 (Mak, Dreisbach, and Temple-Raston, 2020). In fact, trust in the USPS increased across all political groups identified in our survey (by 1.0 points for Biden voters, 0.7 points for Trump voters, and 0.6 points for others; all of these changes are statistically significant).

These surveys show that the CDC will need some perception rehabilitation, particularly among those who reported intending to vote for someone other than Biden or not vote at all (who had low levels of initial trust that declined even further). Although we know that the Black community has had low trust in the CDC, it is now similarly low across all of the groups.

The Biden administration will have an uphill battle in rehabilitating trust in the CDC at this critical junction in the pandemic response. A key challenge will be to identify people who will be viewed as trusted messengers regarding the vaccine and public health policies during the pandemic, and not just among the groups that previously expressed mistrust. Public trust in federal government agencies has never been as important as it has been during the COVID-19 pandemic, yet public suspicions of scientific experts and levels of distrust of government institutions are increasing for a variety of reasons, including a blurring of the line between opinion and fact and access to more sources of conflicting information (Kavanagh and Rich, 2018). A recent Kaiser Family Foundation survey on the public's views regarding COVID-19 vaccination highlights the implications of public mistrust of federal agencies (Hamel et al., 2020). The authors found that 27 percent of the public remains vaccine-hesitant, saying that they probably or definitely would not get a COVID-19 vaccine; vaccine hesitancy is highest among Republicans (42 percent), which is consistent with our results.

Four factors that determine whether an audience perceives the messenger as trusted are transparency and honesty, empathy and care, dedication and commitment, and competence and expertise (Covello, 1992; Covello, 1993). The CDC and its messengers should convey these factors to rebuild and maintain trust, communicating in appealing and transparent ways to counter the way that information is currently disseminated.

One way that trust in the CDC might be rebuilt is by ensuring that the public understands the scientific rationale for policy changes and guidance during the COVID-19 pandemic. In October 2020, the Food and Drug Administration opened advisory committee meetings on vaccine approvals to the public to increase transparency (Lovelace, 2020). This type of openness also might benefit the CDC. The Kaiser Family Foundation survey also found that about 40 percent of adults in the United States felt that the CDC was paying too much attention to politics when issuing guidelines and recommendations for COVID-19 policy (Hamel et al., 2020). Thus, a clearer and more explicit focus on the science that is driving decisions also might build trust in the CDC's competence, expertise, and commitment to protecting public health and safety.

References

• Bogart, Laura M., Lu Dong, Priya Gandhi, Samantha Ryan, Terry L. Smith, David J. Klein, Luckie-Alexander Fuller, and Bisola O. Ojikutu, What Contributes to COVID-19 Vaccine Hesitancy in Black Communities, and How Can It Be Addressed? Santa Monica, Calif.: RAND Corporation, RR-A1110-1, 2021. As of March 22, 2021: https://www.rand.org/pubs/research_reports/RRA1110-1.html
• Bogart, Laura M., Sae Takada, and William E. Cunningham, "Medical Mistrust, Discrimination, and the Domestic HIV Epidemic," in Bisola O. Ojikutu and Valerie E. Stone, eds., HIV in U.S. Communities of Color, Cham, Switzerland: Springer, 2020, pp. 207–231.
• Carman, Katherine Grace, and Shanthi Nataraj, 2020 American Life Panel Survey on Impacts of COVID-19: Technical Documentation, Santa Monica, Calif.: RAND Corporation, RR-A308-1, 2020. As of June 4, 2020: https://www.rand.org/pubs/research_reports/RRA308-1.html
• Covello, Vincent T., "Trust and Credibility in Risk Communication," Health and Environment Digest, Vol. 6, No. 1, 1992, pp. 1–4.
• Covello, Vincent T., "Risk Communication and Occupational Medicine," Journal of Occupational Medicine, Vol. 35, No. 1, 1993, pp. 18–19.
• Hamel, Liz, Lunna Lopes, Cailey Muñana, Samantha Artiga, and Mollyann Brodie, Race, Health, and COVID-19: The Views and Experiences of Black Americans—Key Findings from the KFF/Undefeated Survey on Race and Health, Washington, D.C.: Kaiser Family Foundation, October 2020. As of March 5, 2021: https://www.kff.org/racial-equity-and-health-policy/report/kff-the-undefeated-survey-on-race-and-health/
• Kavanagh, Jennifer, and Michael D. Rich, Truth Decay: An Initial Exploration of the Diminishing Role of Facts and Analysis in American Public Life, Santa Monica, Calif.: RAND Corporation, RR-2314-RC, 2018. As of March 5, 2021: https://www.rand.org/pubs/research_reports/RR2314.html
• Lovelace, Berkeley, Jr., "FDA Opens Private COVID Vaccine Meetings to the Public in Bid to Gain Trust as Trump Pressures for Fast Approval," CNBC, October 22, 2020. As of March 4, 2021: https://www.cnbc.com/2020/10/22/fda-goes-public-on-private-covid-vaccine-approval-process-in-bid-to-gain-trust.html
• Mak, Tim, Tom Dreisbach, and Dina Temple-Raston, "Who Is Louis DeJoy? U.S. Postmaster General in Spotlight Ahead of 2020 Election," NPR Morning Edition, August 21, 2020. As of March 22, 2020: https://www.npr.org/2020/08/21/904346060/postmaster-general-faces-intense-scrutiny-amid-allegations-of-political-motives
• Patel, Neel V., "Why the CDC Botched Its Coronavirus Testing," MIT Technology Review, March 5, 2020. As of March 4, 2021: https://www.technologyreview.com/2020/03/05/905484/why-the-cdc-botched-its-coronavirus-testing/
• Pollard, Michael S., and Matthew D. Baird, The RAND American Life Panel: Technical Description, Santa Monica, Calif.: RAND Corporation, RR-1651, 2017. As of May 29, 2020: https://www.rand.org/pubs/research_reports/RR1651.html
• Pollard, Michael S., and Joshua Mendelsohn, Methodology of the 2016 RAND Presidential Election Panel Survey (PEPS), Santa Monica, Calif.: RAND Corporation, RR-1460-RC/UCLA, 2016. As of February 18, 2021: https://www.rand.org/pubs/research_reports/RR1460.html
• Schnirring, Lisa, "Mixed Messages Hamstring U.S. COVID-19 Response," Center for Infectious Disease Research and Policy, webpage, 2020. As of March 4, 2021: https://www.cidrap.umn.edu/news-perspective/2020/09/mixed-messages-hamstring-us-covid-19-response
• Weiland, Noah, "'Like a Hand Grasping': Trump Appointees Describe the Crushing of the C.D.C.," New York Times, January 15, 2021.

Notes

• [1] The ALP is a nationally representative, probability-based panel of more than 5,000 participants who are regularly interviewed over the internet. A technical description of the baseline survey, which includes details about the ALP, the objectives of the survey, and information about the fielding of the survey, is available in Carman and Nataraj, 2020. Additional information on the technical aspects of the ALP is provided in Pollard and Baird, 2017.
• [2] One original respondent did not provide trust assessments during the October survey.
• [3] Standard ALP demographic weights are further adjusted to match known 2016 vote behavior distributions (Pollard and Mendelsohn, 2016).
• [4] The bounds of a 95-percent confidence interval around the change score did not include zero.
• [5] Respondents were asked "If the 2020 presidential election were being held today, would you vote for . . . ?" Response options were Joe Biden, Donald Trump, other, will not vote, and not sure. The order of response options was randomized.

Topics

• Coronavirus Disease 2019 (COVID-19)
• Health Literacy
• Media Influences on Health
• Public Health Preparedness
• U.S. Postal Service
• Vaccination