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Rebuilding trust in public health


At her news briefing yesterday, CDC Director Dr. Rochelle Walensky responded to criticism that the guidance issued by her agency has been confusing to the public. She noted that for the past two years, the coronavirus pandemic has been throwing curveballs at the CDC as new data is collected on the virus and its variants. But she insisted that the agency's guidance is always based on the science.


ROCHELLE WALENSKY: Every day, I am proudly joined by thousands of scientists at this agency as we continue to closely monitor all of the available data about COVID-19 and advise the country as to what we know works to protect them in this very moment.

MARTIN: Dr. Walensky began the briefing saying it would focus on schools reopening, but many reporters wanted to talk about the confusion caused by CDC guidance issued in the past few weeks. That's relevant because, setting aside other factors like partisan political agendas, the willingness of the public to follow the agency's advice rests on whether the public understands, believes and is motivated to follow what the agency says.

So we wanted to learn more about what makes for effective public health communication and how the CDC can do better, so we called Jessica Malaty Rivera, an infectious disease epidemiologist and science communicator. She's also a senior adviser at the Pandemic Prevention Institute. Jessica Malaty Rivera, welcome. Thank you so much for talking with us.

JESSICA MALATY RIVERA: Thanks for having me.

MARTIN: So I'm going to put you on a spot and ask, do you agree that the CDC's messaging has been confusing?

MALATY RIVERA: Incredibly confusing. In fact, I was very pleased to see that the American Medical Association officially called them out to say that they were not only confusing, but that they were problematic and could cause more harm.

MARTIN: So you listened Walensky's media briefing. Do you think she made up for this confusion? Do you think she addressed it in an effective way?

MALATY RIVERA: No, unfortunately, I don't. And it's clear that that wasn't really even the intention of the teleconference, but it went there with the journalists. I'm glad it went there. But when pressed on where is the data and where is the science to justify this, I mean, she all but admitted that it's not based on omicron data. They said that they don't have that data, the detailed data for omicron, and they won't for weeks, so that they did decide this decision based on what they had from wild type and beta and delta, which don't have the same kind of transmission dynamics as we are seeing with omicron.

MARTIN: I think a lot of people are scratching their heads wondering what is going on with the CDC right now. I think a lot of people wonder, why is it still so confusing? Is that just endemic to this field or are there things that they're just doing wrong?

MALATY RIVERA: I think it's a little bit of both. I think the fact that it's really impossible to eliminate politics from a government agency and in a time when we're still recovering from a really botched response to the pandemic since Day 1, it's going to have to remain political because so many of the decisions are going to have to affect so many different industries.

MARTIN: Do you think that the CDC is still experiencing political interference from the current administration?

MALATY RIVERA: I do. I think that it's impossible to ignore that. Knowing the timing of when the president had a call with governors who put pressure on him about the burden, the economic burdens of 10-day isolations, and even knowing that there were letters sent from corporations on that particular burden as well, we know that the White House was pressuring the CDC respond in this way and that there was an effort to kind of get that message out fast so that it seems, you know, streamlined. Science and public health are political, but this politicization of it is where all of us are feeling a bit uncomfortable. And it's impossible to remove that from what's happening right now.

MARTIN: Well, see, this is what I'm trying to understand is, what is the line between political judgments and political interference? Because as you're pointing out, public health is in part about balancing different priorities.

MALATY RIVERA: Right. Well, if you think about the outcry from public health professionals right now, we're asking for the data, we're asking for the evidence because that is what informs good policy. And so I think that's where the line is. I think when you are making policies in the absence of very, very clear and significant and peer-reviewed and quality data, that's a red flag.

MARTIN: I was wondering if there's any sympathy among public health experts like yourself for the CDC because things change so quickly. I mean, Dr. Walensky pointed out that new data is coming out all the time. Is that a factor here in why the CDC is struggling to communicate effectively with the public?

MALATY RIVERA: Absolutely. Their positions are not enviable. They have an enormous task in one of the most difficult times of our lives. This is exhausting, but what a time for all of us to kind of come in and step in and flex these muscles that we've been training for so long in a time where the American public needs us. But at the same time, it's not worth making rash decisions or decisions that are not based on very, very clear evidence or having messages that have to kind of continue to be corrected because they were done possibly in haste.

MARTIN: I think there are those who worry that the CDC has lost its way in some way, who perhaps feel that the CDC has become too politicized. Is this actually endemic to the field or is there something specifically wrong here right now?

MALATY RIVERA: I think COVID-19 was a lesson that we were unprepared for because of the kind of years of devaluing and defunding public health. You know, we had systems in place prior to COVID-19 many many years ago to do things like bio surveillance and tracking emerging threats for possible pandemics. And that funding dried up over time. And what we're seeing here is a consequence of that. You know, public health, when it works, it's invisible. It's really hard to see the value of a lot of public health systems when there aren't a bunch of public health fires going off.

And then you have an unprecedented, you know, once-in-a-century-type pandemic that brings us to our knees. And you realize, well, shoot, we probably shouldn't have devalued all of those resources and all of those industries. And so that's why you've seen a big outcry to prioritize public health and to even prioritize the communication of public health because oftentimes you're dealing with folks who don't understand the science or who don't have context on how to normalize it so that people can make informed choices.

I mean, the thing about public health too is that it's layers. It's not a black-and-white space. It's just multiple shades of gray. And to have messages that seem very black and white creates a bunch of false dichotomies on what mitigation efforts cancel out the next. And that's what we've been dealing with. We've been dealing with this kind of yo-yo effect, taking one step forward, one step back and back-and-forth messaging. And it's because of this lack of prioritization.

MARTIN: So how should the CDC go about regaining the trust of the public, which some segments of the public, let us say, are so distrustful of any utterances by authority figures that do not come from, say, their own political orientation. I'll just put it that way. What should they do?

MALATY RIVERA: I think Dr. Walensky even said that they were hearing that people wanted to have direct contact, you know, hearing from them alone. And I think that that's going to be a way to build trust, not the only way, but a way to hear their tone, to hear the nuance and the gray areas that are not always reflected in the updates of the website and, you know, updates on Twitter. But I think it's going to take a while to do that. And I think that part of the process of regaining trust is also admitting when they've done wrong or admitting that things were bad or that they haven't been communicated well.

I mean, I think one of the most poignant questions was when Walensky was asked if they would acknowledge that the CDC has done a bad job with messaging. And I think that's a necessary acknowledgement because it has been confusing. When you have groups of medical doctors like the AMA saying this is harmful to the public and can cause more risk, that should be responded to. And I think it shows ownership. I think it shows the humanity of people that are actual humans behind these personas online to kind of say, hey, this is a really difficult job. I mean, she said that to a degree. She did say that this is difficult. We're evolving with real time data as it emerges. And it's hard to kind of aggregate it all and have streamlined messages. But there's got to be more of that.

MARTIN: That was Jessica Malaty Rivera, an infectious disease epidemiologist and science communicator. Jessica Malaty Rivera, thank you so much for joining us.

MALATY RIVERA: Thank you so much for having me. Transcript provided by NPR, Copyright NPR.