Richard Lu

Building Trust and Confidence: An Essential Foundation for Biden’s Public Health Interventions


As Joe Biden and Kamala Harris step into office in a few short weeks, they will inherit a weary healthcare system that has been stretched to its core and an American populous that has been taken to its limits of flexibility and resilience. With the United States experiencing more daily COVID cases and deaths than any part of the pandemic, the need for decisive, cohesive action is long overdue. Against this context, the new administration should prioritize restoring both confidence and trust in the scientific community and its own scientific agencies (e.g., CDC, FDA).

Confidence and trust are two distinct, yet closely related, ideas that form the basis of trustworthiness. Confidence embodies the idea that a person or entity is capable of a positive outcome given its characteristics (e.g., competency, past success), whereas trust is a belief that a person or entity is acting in pursuit of another’s best interests despite knowledge of their vulnerabilities.

The trustworthiness of the healthcare community has always waxed and waned, even before the COVID-19 era. For instance the Tuskegee Syphilis Study conducted by the CDC and US Public Health Service exploited poor, rural, Black men for over four decades. Falsified experimental data from a now-debunked 1998 study implying a link between MMR vaccines and autism has fueled mistrust over vaccines in the decades since.

These two historical examples are relevant for the COVID era in which we live today. This pandemic has disproportionately affected Black, indigenous, and people of color (BIPOC) in the United States, and we are on the cusp of a mass vaccine rollout in the hopes of ending a pandemic that is currently claiming over 3,000 lives per day. Any public plan to successfully end the pandemic at this stage must confront our government's historical and contemporary acts of distrust.

It is important to mention here that it is not the responsibility of the public to become more trusting. Rather, the onus is on health systems to become more trustworthy. The outgoing administration has unfortunately damaged the reputation of its own federal agencies and public advice through contradiction, untimely insincerity, and outright denigration of leadership. Instead, trustworthiness will need to be rebuilt through a consistency of clear communication and follow-though. This follow-through means both delivering on COVID policy decisions and taking ownership of shortfalls and changes in decision-making in light of new or updated information.

Public health interventions are only as effective as their trustworthiness. When a crisis strikes, it is not surprising that opaque communication and inconsistency are met with suspicion, resistance, and anger. The new administration has a tantalizing opportunity to reset with our nation with clarity and empathy. The administration’s success – and our health – depends on it.