Building Public Trust in Public Health Emergency Preparedness and Response (PHEPR) Science

In March 2022, the National Academies of Sciences, Engineering, and Medicine hosted a two-day workshop, Building Public Trust in Public Health Emergency Preparedness and Response Science. The workshop examined issues of building knowledge of and trust in public health emergency preparedness and response science enterprise—the institutions, the research process, and the researchers and practitioners. The workshop highlighted opportunities and aimed to:

Learn

LEARN about the public’s current knowledge of and attitudes towards PHEPR science

Explore

EXPLORE empirical evidence on effective strategies to create and maintain public confidence and trust in PHEPR science

Understand

UNDERSTAND how public confidence and trust in PHEPR science can be lost and how it can be rebuilt

Discuss

DISCUSS the role that key stakeholders have in creating and maintaining public confidence and trust in PHEPR science

INFOGRAPHIC Why is Public Trust Important in PHEPR Science?

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Reflections on Trust during the Covid-19 Pandemic

The COVID-19 pandemic highlighted issues related to public trust in PHEPR science. Participants at the workshop discussed actionable strategies and approaches to (re)build and maintain trust that are applicable to various levels of the public health system and different emergency types.

Case Studies

Case Studies

CASE STUDY Confidence and Trust in PHEPR Science

Anne Zink, Chief Medical Officer of Alaska, described how trust comes from building relationships with communities over generations. Many Alaskan Native tribes and communities were severely affected by the 1918 pandemic, and the memory of that experience lives on. This impacted the way in which Alaskan tribes and the state responded to Covid-19.

In Alaska, both state and tribal partners collaborated and researched with one another, and hosted a weekly echo series to hear it back from the public. Zink partnered with Alaskan tribes and local community leaders to promote testing and the COVID-19 vaccine.

Trust does not come from a series of Zoom calls, and information meetings and pamphlets handed out. It comes from generations of working together and acknowledging uncertainty.
We have 229 sovereign tribes in the state of Alaska. And the influence of the 1918 pandemic was powerful and palpable. And so we went to a couple of the communities early on when they had shut everything, communities that shut their doors to the 1918 pandemic actually stood there with gunpoint, kept their community, kept their language, kept their culture. And that history stayed strong, and that memory stayed strong and definitely influenced the way that community as well as the state responded to this pandemic.
Just in that previous speaker acknowledging the past, but also looking toward the future, we had to have a two-eye view on this pandemic. We had to both acknowledge that history, and I am incredibly grateful for the tribal leaders of this state and the Alaskan native people for helping me to see the past, as well as being able to move into that future.
We had a whole series of meetings led by the whaling captains where they talked about Covid-19 and how to mitigate Covid-19. They could ask us any question they wanted, but they shared it with the community because they were the trusted leaders in that community.

Stephen Thomas, Director for Health Equity, University of Maryland, described the significance of barber shops and beauty salons in the Black community and how these professionals are seen as trustworthy messengers.

Thomas discussed his role in leading Shots at the Shop, a program that trains Black barbers and hair stylists on COVID-19 information with the intent they can convince others in their community to get vaccinated.

We pivoted our hair network health advocates in recent research which was focused on health disparities into a Covid-19 vaccination campaign with rapid response training of barbers and stylists using our online platform.
And to date, we have recruited more than 1,000 barbershops and beauty salons across the nation into the network.
Nobody wants to go back to normal because back to normal means far too many Black and Brown people live sicker and die younger.
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INFOGRAPHIC Confidence and Trust in PHEPR Science Among Demographic Groups

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CASE STUDY The Infrastructure and Workforce to Build and Maintain Public Trust

Venus Ginés, President of Día de la Mujer, discussed the importance of community-health workers (promotores) in the Latinx community during public health emergencies, such as Hurricane Harvey, and pandemics such as COVID-19.

According to Ginés, community-health workers can serve as:

  • telehealth community navigators
  • patient navigators
  • clinical trial community navigators
  • behavioral health community navigators
  • medical providers
  • personal-care navigators
  • school-based navigators

During the pandemic, the community health workers established a call center and hotlines to tackle issues such as domestic violence, substance abuse, teen suicide, and other health related issues.

If the problems are in the community, then solutions are with your community health worker.

To move this forward, there is a need to not only address the existing health disparities, but to utilize the expertise and knowledge that the community-health workers have by looking at them as key opinion leaders.

If we are committed to trust and bringing trust back into public health then [community health workers] need to be integrated into all of the strategic plans early on.
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Jefferson Ketchel, Executive Director, Washington State Public Health Association, addressed instability in public health funding and the de-centralized health system in Washington state.

The Washington State Legislature made an investment to fund the foundational public health services and are currently looking at priorities for the public health workforce development in Washington State.

According to Ketchel, these priorities include:

  • Strengthen the school-to-work pipeline in the public health and environmental fields (e.g., internships, practicums, job shadowing)
  • Assess incentives for workers in rural environments
  • Upscale opportunities (e.g., working with high schools and community colleges to incorporate this into the system)
  • Public health worker protection
Functional infrastructure and a trained workforce are of value. Those things ultimately require resources. Is that something your jurisdiction values? If we trust things that we value, did public health have the trust before the pandemic? And has the pandemic either earned or lost trust in public health.
From 2000 to 2021 in Washington State, the public health system had unpredictable, unstable, and undedicated funding much like the rest of the United States […]. In 2021, the Washington State Legislature recognized that the public health system did not have the resources it needed to prevent disease and promote health.
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INFOGRAPHIC Building the Necessary Infrastructure and Skilled Workforce

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CASE STUDY Addressing the Information Environment

Ulie Seal

Ulie Seal, Fire Chief for the Bloomington (MN) Fire Department, mentioned how he and his fire and police teams handled issues with mixed messages during the pandemic. He indicated that it’s crucial to provide reasoning as to what communications and recommendations are based upon.

And first responders, especially in the fire world, are rather direct and like clear direction. [There] was some of that lacking initially and there was a lot of fear initially as well with how to respond, and especially on the part of some of my law enforcement partners. Because sometimes, they were thrust into situations where they did not have the opportunity or time to put PPE on.

As a Fire Chief and not a public health professional, “[you] not only find yourself trying to explain the message but also define some of the terms that are in the message […]”

Even with more readily, recognizable dangers […], people tend to need to feel like they’re in danger before they’re willing to take action. And trying to convince people that there is a danger […] becomes compounded when nobody can see it, nobody can really define it, and there’s a struggle even amongst the experts on deciding exactly how to proceed.
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Mitch Stripling

Mitch Stripling, Director, Pandemic Response Institute at the Mailman School of Public Health, Columbia University, discussed how storytelling can support public health guidance and recommendations.

I want to integrate this idea of storytelling into the guidance development process itself […].
If we can tell a better story, it makes [public health] more operationally nimble, which I think builds trust.
If we entrust those community ambassadors to go out and do the work as they know it in the community […], that helps us to stay operationally nimble. We can also listen to what they’re saying and so that lets us dial our operations up and down. And that’s all based on the idea that this question of building trust, telling the story of the response is not separate or distinct from epidemiology or public health expertise, but it’s really the same piece.
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INFOGRAPHIC Key Elements of PHEPR Science Community Strategies

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CASE STUDY Translating and Communicating PHEPR Science Information

Lindsey Leininger

Lindsey Leininger, Clinical Professor of Business Administration at Tuck School of Business at Dartmouth University, co-founded “Nerdy Girls”, a public education campaign turned sustainable, non-profit science translation campaign.

“Nerdy Girls” has 200,000 readers across various social media channels and wrote over 2,000 evidence based posts about pandemic-era living. This non-profit connects female scientists with clinicians in order to hold important conversations and draw from different disciplines and experiences.

I started writing about data on my personal Facebook page […]. I quickly found a group of other women scientists and clinicians on Facebook who were similarly inundated with questions from their friends and family. So what we decided to do was to join together to answer these questions more efficiently on one evidence based Facebook page that we called Dear Pandemic […].Our audience grew beyond friends and family.

“We have involved over three dozen women clinicians and scientists in the work.” The “Nerdy Girls” hold a special place because they are community-ambassadors and can even consider themselves “micro-influencers”. They play an instrumental role in crisis communication and connect female scientists with lay audiences to hold conversations with one another.

“How do we build and scale science and translation patterns for future emergencies?”

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Mitch Stripling

Supriya Bezbaruah, Team Lead, Science, and Knowledge Translation at the World Health Organization, worked to build the WHO Epidemic Information Network (EPI-WIN) to make public health information more accessible and understandable during the COVID-19 pandemic.

WHO Epidemic Information Network established three global networks:

  • Faith leaders and inter-faith leaders
  • Employers (Health in the World of Work)
  • Youth Council

Going forward, they are working to create the EPI-WIN Science Translation that will include a variety of professionals ranging from scientists, media professionals, health professionals, and others. By establishing field guides, documenting good practices for science translation, and engaging with decision-makers, this will be crucial in moving toward the next steps.

Resource: IUF launches new COVID-19 safety guide for hotel workers

“There’s no-one better to understand the communities concerns than the community leaders themselves. We’ve worked with them to co-develop scientific facts to then re-distribute to the communities.”

INFOGRAPHIC Addressing the Information Environment

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