The coronavirus disease 2019 (COVID-19) pandemic completely disrupted daily life in the United States (U.S) and created an unprecedented level of anxiety and uncertainty in recent times. This study presents a longitudinal evaluation of Americans’ shifting trust in various public health organizations between 2020 and 2024. A particularly concerning trend during the public health crisis was a sharp decline in confidence in these organizations.
During health emergencies, trust in the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC) is essential for effective communication and public cooperation. Estimates of age, gender, and race from the American Community Survey (ACS) 2022 were used to calculate the data. According to findings, local organizations, including personal physicians and local health departments, may leverage the trust they have built with their communities to help restore confidence in national public health organizations.
The main objective of this study was to monitor and examine shifts in public trust towards important health agencies over a four-year period. These recorded patterns were observed during the COVID-19 pandemic and the following monkeypox (mpox) outbreak. Between February 2020 and October 2024, the researchers conducted four cross-sectional surveys among U.S. adults aged >18 years or older. These surveys were conducted via Qualtrics and delivered through the well-established online survey platform CloudResearch.
CloudResearch provided census-matched panels of U.S. adults gathered through word-of-mouth and advertisements. A small incentive of ~$2 in cash, subscription credits, and some donations was given to each participant for their participation. In 2020, the first survey was carried out from February 4 to 7, followed by the second from May 6 to 7. In 2022, the third survey was held from June 8 to 13, while in 2024, the fourth survey was from September 20 to 27. Surveys from 1 to 4, the corresponding sample sizes were 718, 672, 856, and 828, respectively. Regarding generic questions about trust in public health organizations, surveys 1 and 2 include questions about COVID-19, while surveys 3 and 4 include questions about the mpox outbreak.
A scale of 1 to 5 was used by participants to rate their level of confidence towards various public health organizations. A score of 4 or 5 was considered to indicate “high confidence.” To correct for demographic representation, the responses were weighted appropriately during analysis using STATA SE 18.5. Calculations were made for mean, ratios, and 95% confidence interval (CI), with a threshold of p < 0.05 for statistical difference.
The proportion of respondents who express high trust in the CDC dropped from 82% in February 2020 to 68% in May 2020, and further declined to 56% in 2022. Confidence in personal physicians decreased by 6% from 2020 to 2022, but it rose again by 5% between 2022 and 2024. From February 2020 to October 2024, confidence in the White House increased by 10%, while public trust in the FDA remained relatively stable throughout the period.
Despite some recovery in trust after 2022, the continued low confidence in key institutions poses a significant challenge for public health communication in view of emerging health risks. To ensure effective public health responses now and in the future, it is important to eliminate misinformation and engage reliable community leaders.
Reference: Melchinger H, Omer SB, Malik AA. Change in confidence in public health entities among US adults between 2020–2024. PLOS Glob Public Health. 2025;5(6):e0004747. doi:10.1371/journal.pgph.0004747
