In the wake of the COVID-19 pandemic, a profound shift in public confidence toward health institutions in the United States has emerged, revealing an unsettling erosion of trust that persists to this day. A groundbreaking longitudinal study, led by Amyn A. Malik and colleagues at UT Southwestern Medical Center, meticulously tracks this decline in trust over a four-year span from 2020 through 2024. Published on June 26, 2025, in the open-access journal PLOS Global Public Health, the analysis draws on four discrete, census-matched surveys of US adults to deliver an unprecedented glimpse into evolving public perceptions of key health organizations during this tumultuous period.
The study’s central finding highlights a striking drop in high confidence levels among US adults in the Centers for Disease Control and Prevention (CDC), a cornerstone institution for public health guidance and outbreak response. Confidence in the CDC plunged from an initially robust 82 percent in February 2020—the very dawn of the pandemic—to a concerning nadir of just 56 percent by June 2022. This nearly 30 percent relative decline underlines an erosion of trust in one of the country’s most critical public health bodies during an era when reliable information was arguably more vital than ever.
Yet the CDC was not alone in this downward trajectory. Comparable confidence deteriorations were documented across multiple public health entities, including the National Institutes of Health (NIH), the Department of Health and Human Services (HHS), state health departments, and professional medical organizations. Relative drops ranged from 13 to 26 percent between 2020 and 2022, a broad and systemic decline reflective of widespread skepticism affecting various facets of the public health infrastructure. These institutions traditionally act as authoritative sources for scientific guidance and pandemic mitigation, making this loss of trust particularly alarming from a public health policy perspective.
An intriguing contrast within this general decline was observed in public confidence toward more localized health sources. While national entities lost ground, respondents reported a rebound of confidence in their personal doctors and local health departments from 2022 to 2024. Notably, confidence in personal physicians increased by five percent, while trust in local health departments surged by an impressive 19 percent during the same period. This divergence suggests that the broader distrust in large federal agencies did not necessarily extend to frontline healthcare providers or local health officials who maintained direct community engagement throughout the outbreaks.
Exploring the dynamics underlying these trends is critical to understanding the societal fracture in trust. The study’s period encompasses not only the initial reaction to COVID-19 but also the later emergence of mpox outbreaks in 2022 and 2024, situations that required sustained public health responses amid heightened scrutiny and politicization of health measures. Such events likely contributed to fluctuating confidence patterns, as public health messaging and intervention strategies faced intense media and political scrutiny, influencing public sentiment.
Another noteworthy observation is the increase in public confidence in the White House over the four-year period, rising from 29 percent in early 2020 to 39 percent by late 2024. While far from a majority, this uptick may reflect shifting political landscapes and perceptions of federal leadership’s role in pandemic management. It also underscores the complex interplay between governance and public trust, where political considerations can intersect with health communications in shaping public opinion.
The methodology employed in this research warrants emphasis. Utilizing four separate cross-sectional surveys, each matched to the US adult population in terms of census demographics, the researchers ensured that the findings accurately echoed the evolving perspectives of Americans from diverse backgrounds. Sample sizes for these surveys—ranging between 672 and 856 participants—provided sufficient statistical power to draw meaningful longitudinal comparisons. The surveys probed multiple dimensions: confidence levels in public health entities, perceptions of who should lead responses to infectious disease outbreaks, and assessments of the entities’ credibility.
Data interpretation revealed critical insights for public health strategy in the United States. As overall trust in major federal health institutions declined, the relative resilience of confidence in personal healthcare providers signals an opportunity to leverage these relationships in rebuilding public trust. The study’s lead co-author, Hannah Melchinger, stresses the urgency of addressing this trust deficit, emphasizing that preserving the credibility of public health bodies is indispensable for effective disease control and community protection in future health crises.
Senior author Amyn A. Malik underlines the pivotal role healthcare professionals play as trusted intermediaries who can reestablish public confidence. Doctors, nurses, and healthcare staff, he notes, are among the most reliable sources of health information for many Americans. Harnessing these trusted communicators could prove integral in overcoming misinformation, vaccine hesitancy, and skepticism toward public health recommendations that have intensified during the pandemic era.
The implications of this research extend beyond immediate pandemic response frameworks, shedding light on the broader challenges faced by public health institutions in a post-pandemic world. Restoring public confidence is not merely a question of effective communication but also involves transparency, accountability, and meaningful community engagement. Policymakers and health leaders must reckon with the long-term consequences of eroded trust and develop strategies that can reinforce the social contract between the public and public health authorities.
Moreover, this study underscores a vital methodological advancement: reliably assessing public confidence over multiple years through longitudinal surveys offers a template for ongoing monitoring. This approach enables the early identification of trust erosion, allowing for timely interventions rather than reactive measures. Such surveillance is crucial as the United States, and indeed the world, face emerging infectious disease threats and seek resilient health systems capable of rapid, credible responses.
In conclusion, the research by Malik and colleagues marks a critical contribution to understanding how perceptions of public health organizations have evolved in the US from 2020 to 2024. While confidence in federal health agencies notably declined during this period, increased trust in personal physicians and local health departments provides a beacon of hope and a tactical avenue for rebuilding public engagement. This study not only illuminates the challenges inherent in maintaining public trust during protracted health emergencies but also points toward the essential role of trusted healthcare providers in shaping future health narratives and policies.
As the pandemic’s immediate waves recede, the US public health community faces a stark imperative: to address the fractures in trust laid bare during these years and emerge with stronger, more resilient connections to the communities they serve. It is an endeavor that requires both reflection on past missteps and a concerted commitment to elevating the voices of healthcare providers as frontline ambassadors of scientific integrity and compassionate care.
Subject of Research: People
Article Title: Change in confidence in public health entities among US adults between 2020–2024
News Publication Date: 26-Jun-2025
Web References: https://doi.org/10.1371/journal.pgph.0004747
References: Melchinger H, Omer SB, Malik AA (2025) Change in confidence in public health entities among US adults between 2020–2024. PLOS Glob Public Health 5(6): e0004747.
Image Credits: Melchinger et al., 2025, PLOS Global Public Health, CC-BY 4.0
