Has the public lost faith in public health officials, who continue to communicate with so much confusion and ambiguity? During the COVID pandemic, when trust should be the coin of the realm, physicians, researchers, and bureaucrats in the public health community seem unwilling or unable to articulate their message clearly and concisely. Because COVID presents a unique set of problems and continuously evolving circumstances, it is especially important to avoid certain pitfalls when talking to the public.
The most important of these priorities is “thou shalt not mislead the public.” It does not surprise us when politicians lie, but we don’t expect mendacity from our doctors – nor should we. Case in point: Dr. Anthony Fauci, the country’s recognized COVID authority. In a December 24 interview with The New York Times, Fauci admitted he deliberately understated the figures needed for herd immunity, partly based on new science but also on his sense the country was not prepared to hear his true feelings.
No matter his paternalistic good intentions, this was a lie. It cost him the trust of many, particularly in light of his statements early in the pandemic about masks being unnecessary: “Right now in the United States, people should not be walking around with masks.” In his defense, his comment about masks preceded research that pronounced masks somewhat effective. But when experts shade the truth or project unwarranted certainty, they risk having subsequent discoveries undermine their credibility.
A related pitfall public health experts should have avoided: appearing to be inflexible know-it-alls even as situations evolved. Consistency is a virtue, dogmatism is not. Everybody has been wrong about COVID (I predicted we would be through the pandemic last summer), and it behooves us to admit our mistakes, rather than cling to them. This recalls a famous quote attributed variously to among others, John Maynard Keynes, Winston Churchill, and Paul Samuelson, “When events change, I change my mind. What do you do?” Be consistent, but not inflexible.
All of us have heard more than a year’s worth of predictions about the future course of the pandemic. Some experts engage freely in these projections, without allowing for uncertainty. They predict surges or huge waves of cases that never occur and then those prognostications are quickly forgotten. This is the medical equivalent of the economists who have successfully predicted “nine of the last five” recessions. A term exists for any COVID prediction that projects out more than six weeks – it’s called a “guess.”
Another lesson not easily learned is don’t overextend expertise. During the first wave of the pandemic, epidemiologists, virologists, and experts such as oncologist Ezekiel Emanuel, strongly advised tight lockdowns without realizing the substantial social and economic costs, which themselves had terrible health consequences, especially for schoolchildren who’ve been isolated for more than a year. Lockdowns have a place in controlling viral spread in certain situations for a limited time. But imposing them requires the input of experts other than just physicians, who are rarely experts in matters financial or social. Dr. Fauci admitted as much after the fact in a congressional hearing. Venture out of your lane – and don’t be surprised if you crash into a wall.
Finally, while personal bias is inevitable, scientific opinions should not be compromised by political concerns. One important goal of science is to minimize personal bias in the search for objective truths. When experts become political, they quickly undermine the very thing they seek to advance. In the case of COVID, a large outdoor gathering carries the risk of becoming a superspreader event whether it is a Black Lives Matter protest or a Sturgis motorcycle rally. When public health experts ignore their own warnings and approve of one but not the other based on their politics, it is obvious they are betraying the very scientific rigor they claim to represent. Why should anyone trust their subsequent statements, policy recommendations, and public mandates? Politicized science is invariably a recipe for the erosion of public trust.
Finally, like their military counterparts, public health officials have an unfortunate tendency “to fight the last war”, with a reluctance to learn from history. A prime example was in 1976, when public health officials predicted that a new strain of swine flu would cause a pandemic in the United States. A mass immunization campaign for the country was recommended to President Gerald Ford, which he attempted to implement in good faith. The pandemic never materialized but the vaccine was associated with severe neurologic reactions in several hundred patients.
Two years after the swine flu debacle, President Jimmy Carter’s Secretary of Health, Education and Welfare commissioned a report by two prominent scientific policy analysts on the entire episode with special attention devoted to the role of the public health officials in charge of the campaign. The analysts found in the public health response: “overconfidence by specialists in theories spun from meager evidence; conviction fueled by a conjunction of some preexisting agendas; zeal by health professionals to make their superiors do right; premature commitment to deciding more than had to be decided; failure to address uncertainties in such a way as to prepare for reconsideration; insufficient questioning of scientific logic and of implementation prospects; and insensitivity to media relations and the long-term credibility of institutions.”