Katelyn Jetelina MPH PhD
Trust in public health is eroding, and the implications are far reaching. We, as a field, have to fix this.
Over the weekend
Any forward-facing scientist can tell you that receiving dangerous messages has been a common occurrence throughout the pandemic. But the hate, resentment, frustration, and anger was crystallized in one instance over the weekend: Elon Musk—the world’s richest man and new owner of Twitter—wrote the post below.
My pronouns are Prosecute/Fauci
Five words, that were wrong on so many levels, garnered more than 1.17 million “likes,” 177,000 retweets, and international attention in mass media. Anyone who dared to disagree received a wave of truly grotesque comments. Even Musk noticed as he followed up on his original tweet with: “Truth resonates…”
Of course, the viral reaction is due to many things: social media algorithms, a polarized country, politics, misinformation, disinformation, opinions about Twitter, opinions about Elon. I also think Musk is trying to deflect negative attention from himself. It’s also a reflection of humans’ difficulty coping with randomness—people need someone to blame for the pandemic, the fear they experienced, the people they lost, or the jobs and livelihoods that were changed. The viral reaction was also an indication that people finally felt heard.
But all of the above also overlap with public health. And, their accumulation has been funneled into one sentiment towards our field: distrust.
Change in trust
Every year, the Pew Research Center conducts a survey with Americans on public confidence in certain groups. Overall, trust in scientists has decreased throughout the pandemic, but ever so slightly. Interestingly it remained higher than public confidence in business officials, the military, public school principals, religious leaders, police officers, and elected officials.
If we compare the responses based on political affiliation, though, the story becomes jarring: confidence in scientists among Republicans dropped significantly. In fact, 1 in 3 Republicans have no confidence at all.
Furthermore, declines in trust in science were most pronounced among White adults. Americans with higher levels of education expressed more positive views of scientists than those with lower levels of education.
This is a huge problem, as trust equals lives
An Oxford report continually assesses country-level factors that most strongly predict COVID-19 deaths. The answer? Not pandemic preparedness. Not government. It was interpersonal trust—a measure of how much people think they can trust another citizen who they don’t already know. In other words, public health worked better in high-trust countries.
We cannot have one group trust public health and another not. This is not how viruses work. Infectious diseases violate the assumption of independence—what one person does directly impacts the person next to them. This is unlike cancer or diabetes, for example. Everyone has to be against a virus, or the virus thrives.
Perhaps most concerning is that this isn’t going to be our last pandemic. Since the 1918 flu, we’ve seen diseases emerge faster and faster. Public health also touches on our daily lives beyond infectious diseases: what we eat, social problems, gun violence, and all other acute and chronic medical problems. We need the trust of the community to move the needle for any of these.
What to do?
As the field of public health copes, self-reflects, and digests the past three years and weighs how to build for a better future, we have to make it our goal, our opportunity, to improve trust. As one scientist said, “You earn public confidence in small drops and you [lose] it in buckets.”
Bottom-up engagement is absolutely necessary. We need to enter conversations with humility. A conversation about false dichotomies (lock down vs. throwing caution to the wind) is necessary. A conversation about disease vs. the needs of a community is necessary. An honest conversation on what we (CDC, state epi, local epi, leaders, communicators) got wrong, got right, and why.
What does this look like? I have a few ideas:
Listening sessions. Not hearing and not telling, but listening to people and trusted messengers who are not in “our world.” Bringing them into the solution. It will be painful. It will be time consuming. But it has to be done.
A COVID-19 commission that is congressionally mandated, like the 9/11 commission. There is text in the PREVENT Act, but it’s not clear if PREVENT will pass.
Preparation for the future. Putting communication at the center of pandemic preparedness. This is still not being done. Building capacity for effective scientific communication needs to be a core of our national strategy. As I’ve written before, a lot needs to be done in this area.
I’m sure there are more and even better ways. And I would love to hear your thoughts in the comments. But the fact of the matter is there is no one solution. And this is going to take a whole lot of time.
We need to understand why five words in a Tweet carry so much weight in public health and threaten our entire profession. Will trust in science survive the pandemic? Maybe. It depends on what we, as a field, do next. If we don’t win hearts and minds, we won’t win against this virus or the next. Trust is key in public health. Our scientific work depends on it. Our health depends on it. Our lives depend on it. Now everyone needs to act like it. That includes, you, Mr. Musk.
“Your Local Epidemiologist (YLE)” is written by Dr. Katelyn Jetelina, MPH PhD—an epidemiologist, data scientist, wife, and mom of two little girls. During the day she works at a nonpartisan health policy think tank and is a senior scientific consultant to a number of organizations, including the CDC. At night she writes this newsletter. Her main goal is to “translate” the ever-evolving public health science so that people will be well equipped to make evidence-based decisions. This newsletter is free thanks to the generous support of fellow YLE community members.
Either Musk is just stirring up controversy because he is worried about Twitter losing money, or he really is an idiot, or both. And I once thought I would buy a Tesla. Not any more.
I sort of doubt Mr. Musk will be tallying your vote
or take notice of it.
You can't swing a cat in these parts without hitting a Tesla,
so I imagine there is a waiting list of eager buyers.
@BDair I don't shop at Hobby Lobby or eat at Chick-fil-a either.
Musk only just recently took over Twitter. Let's see what effect his bonehead policies have on Tesla sales. It's still very early...
@BDair I just heard about one from a German company that has photovoltaic cells embedded in body's outer surfaces. It's something I have been waiting to see. But I think hydrogen will ultimately lead the field.
@Spongebob The presenter spends a lot of of time comparing hydrogen to fossil fuels, or discussing generation of hydrogen using fossil fuels. But in the future all hydrogen will be produced with wind, photovoltaic, geothermal, tidal, wave, or nuclear fission or possibly even fusion energy. In any case, fossil fuels have no place in any future where we truly address climate change. So we can just ignore all discussion of fossil fuel use.
The presenter also holds up the tiny fraction of hydrogen tech in our current energy system as somehow indicative of the future. She implies that hydrogen is not widely used now because it simply can't compete. But this is patently false. In fact, we would be much farther along in developing and implementing all green technologies, including hydrogen, were it not for the the extremely successful disinformation campaign waged by the fossil fuels industry over the last few decades. But that is about to change.
The lady does bring up some important limitations to hydrogen, i.e. tank life and rarity of platinum and iridium. The pressure problem in itself is not a big deal; nor is the weight. If weight were really an issue, they wouldn't be using hydrogen fuel cells in space. Relatively rare iridium and platinum may be, but there is enough of these elements on Earth to make many millions of fuel cells. And we may someday find new deposits on Earth, the moon, or even on Mars.
The water effluent freezing in cold climates should not pose an unsurmountable problem. We can always insulate the tailpipe, and direct a small fraction of the energy generated in the fuel cell to heating it if necessary. And remember, we are looking at a much warmer future world. Hell, just look at the European ski resorts with no snow this winter. The future is here.
Finally, no single technology will fullfil all our energy needs. We will always be using a variety of green technologies, the specifics of which will be determined by local conditions and resources. Hydrogen is bound to be one of those.
PS: I own no stock in any hydrogen fuel cell-related companies; I'm just an objective observer.
@Flyingsaucesir I am just not that optimistic about it. I think it is a distraction held up by the fossil fuel industry
@Spongebob You are certainly right to suspect the fossil fuel industry; distraction and misdirection, along with outright lying, are important parts of their playbook. But green hydrogen really does have great potential for storing energy. There are already solar energy arrays that can produce more electricity while the sun shines than they can sell. Electrolysis of water to produce hydrogen is a great way to store that excess energy. And large fuel cells that can run factories, ships, trucks, and trains are actually more efficient than the small ones in cars and pickups.
Fauci did nothing to be prosecuted for. So, if you are a non-mask wearing person that is your choice and just leave it alone. Don't billionaires have something better to do than this?
Other than overseeing an agency that was financing a BSL4 lab
in Wuhan China with US tax dollars that was carrying out Gain of Function research
on Horseshoe bat derived corona viruses that Ralph Baric had tweaked
in his work at UNC Chapel Hill in 2015 to make them more
transmissible to humans. A then perjuring himself in Senate hearings.
@BDair You're living in a dystopian nightmare world of disinformation and conspiracy theory. Wake up, man!
It's not science, unless 2 or more sides is exposed to every story. Not top scientists with another perspective eliminate to the compliance theory narrative. That being banned, careers ruined or assassinate. I have a hard time trusting billionaires, or people who claim they are science or and claim they are very intelligent.
Well reasoned remarks from Michael DAmbrosio in the comments section.
Katelyn - Curious where you side in the debate on viral Gain of Function research?
Do you support the views of Ralph Baric, Peter Daszak, Shi Zengli, and Anthony Fauci that it is useful to create chimera viruses which don't exist yet in nature in case someday they do exist in nature? Should we increase in the transmission and/or pathogenicity of potential pandemic pathogens in labs in order to potentially develop therapeutics as they argue?
I think this is where the "prosecute/fauci" tweet comes from, as each day more evidence comes to light that the lab leak is likely, and while Fauci was only tangentially involved (funding a small amount of money), off camera he was shoring up opposition to even exploring this hypothesis which we only learned of years later through FOIA requests.
He was duplicitous in 2020 when in his public facing role he acted like this was an absurd conspiracy theory for quacks, but behind the scenes was organizing the very people involved in this research to get their ducks in a row and publish papers guaranteeing it was natural origins (just look at the history of how the Proximal Origins paper came about) - then back in public facing pretending he had no involvement in those studies and they were just a product of science.
Then, Fauci, with the support of our government, got social media companies to suppress and censor any discussion of the lab leak hypothesis for over a year. He likely perjured himself in May of 2021 (though I truly believe he was ignorant of what was initially going on - he's high level and can't always be in-the-weeds).
I assume Musk got even more details on how the sausage was made in suppressing the lab leak through acquisition of Twitter and prompted this tweet.
What I don't understand is how the left (which I am a part of) is giving Fauci a complete pass on this when every FOIA request, every new piece of information, continues to make it very likely the virus was created in a lab, it did accidentally leak (as is somewhat common), Fauci realized our ties to the lab, realized he was on record for supporting this type of research, and did everything he could to shift focus to natural origin and halt any discussion considering a lab leak.
EVEN if it was natural origin, his actions behind the scenes in 2020 were unethical and not in the spirit of science.'
I'm curious. What specifically did he do that was "unethical"? In all seriousness, I want specifics, not some B.S. from an unknown or unreliable source.
@GrooshStar In relation to Musk and Twitter,
he worked with social media and the government
to have all dissenting opinions silenced
Or, we the listeners could wait, probably not terribly long, for enough deniers/naysayers to drop dead.
Too bad, so sad but i have Never thought that "saving everyone" is a good goal.
We need Natural Selection, Now!
And they are generally against all vaccines.
Measles can be deadly or life altering.
And can you imagine if Polio or small pox comes back?
@BufftonBeotch I think NY had a smallish up tick in polio earlier this year, which sorta un-nerved a bunch of folks.
@BufftonBeotch If some are more against all vaccines now, more so than in the past, it is partly due to the medical establishment calling flu and covid medicines vaccines. They are not vaccines, people smell bullshit, trust is lost.
Vaccines used to equate immunity eg stop catching and transmitting. They were an easy sell as they were effective and sold themselves. The very small fraction of the people who refused to take...........so be it. No need to mandate.
But now when a new "vaccine" is announced, it could mean anything unfortunately. Seasonal.
It is not a loss of trust in science, it is a loss of trust in medical science. And as a member of the scientific community, the author of this paper needs to define ie be finite ie name the boundaries of exactly what a vaccine is as it seems to me that she considers covid medicines to be vaccines, lumping them together with measles and polio vaccines. People may be stupid, but they are not that stupid mostly. They can tell the difference between covid and polio/ measles medicines.
Covid and flu shots are not vaccines as immunity is not provided for the individual. If individuals are not immune, a herd immunity will not be attained.
Now if establishment scientists admitted this, that if no immunity is provided a medicine cannot be classed as a vaccine, then trust may begin to be restored. Call it an effective pre-emptive medicine for the vulnerable, which it is.
I denied government and the super rich when doctor told us tobacco was healthy. And marrijana was our society, number one criminal enemy. Here we go again, tobacco still kills annually fives time greater than covid, yet no alarm bells. And marrijana is returning back to the number one medicine. I trust nature's medicines, nature has everything I need for my continued good health.
@Castlepaloma Nature gives not One rat's ass about your health. Everything is fodder for something else (in our case nowadays mostly bacteria/virus/germs and our (and every single thing on the planet's) Only function is to propagate.
Get a grip!
How does what Musk does with Twitter impact your
car purchasing decision?