In a crisis of public health trust, patients still rely on their doctors

A multi-year study tracking Americans’ trust in public health institutions reveals a significant loss of confidence in health agencies like the U.S. Centers for Disease Control and Prevention (CDC) and National Institutes of Health (NIH) during the COVID-19 pandemic — a shift researchers say could have lasting implications on public health communication and policy.

Published Thursday in PLOS Global Public Health, the study surveyed more than 3,000 U.S. adults between February 2020 and October 2024. Researchers found that the percentage of Americans expressing high confidence in the CDC dropped from 82% in early 2020 to just 56% in 2022. The NIH saw a similar 25-point decline over the same period.

“Even though overall trust in health care institutions has decreased, health care providers remain one of the most trusted sources of health information in the U.S.,” said Amyn A. Malik, M.P.H., Ph.D., M.B.B.S., senior author and assistant professor at UT Southwestern Medical Center. “As trusted communicators, doctors, nurses and other health care staff will play an essential role in rebuilding Americans’ confidence in their public health organizations.”

Confidence in local vs. national institutions

The study, led by researchers at UT Southwestern, analyzed responses from four nationally representative, census-matched online surveys conducted in 2020, 2022 and 2024. Confidence was measured on a five-point scale, with responses of 4 or 5 categorized as “high confidence.”

While trust in national institutions fell steeply through 2022, some entities saw modest recovery by 2024. Confidence in the CDC rose slightly to 60% but remained lower than pre-pandemic levels. Trust in state health departments and the U.S. Department of Health and Human Services (HHS) followed a similar arc. The FDA’s confidence ratings remained largely flat.

In contrast, local health department and personal physicians fared much better. After an early dip, confidence in personal doctors increased by 5% between 2022 and 2024, nearly returning to baseline. Trust in local health departments jumped 19% over the same period.

“Our study saw a marked decrease in confidence in public health institutions among U.S. adults,” the study authors wrote. “… this study highlights the potential of local health entities, including physicians and local health departments, to act as those messengers and effectively communicate about public health.”

The White House and professional organizations

Notably, confidence in the White House — though historically low — also ticked upward during the study window, from 29% in 2020 to 39% in 2024. Meanwhile, professional medical organizations experienced a 26-point drop in public confidence between 2020 and 2022, with no significant rebound recorded by 2024.

Data highlights a growing public preference for decentralized, localized communication around health crises.

Researchers say the findings should prompt a shift in how public health guidance is delivered. With federal institutions still grappling with reputational damage, trusted local figures — especially physicians — may be best positioned to lead communication around emerging health threats.

Co-author Hannah Melchinger adds: “We need to take this decline seriously if we want to preserve the credibility of these entities and their public health recommendations.”