Building trust in public health for the next time: ‘If a pandemic can’t bring us together around the common purpose, what can?’

By Sarah Ladd
Kentucky Lantern

Even as Kentucky reels and recovers from Covid-19 in what some have touted as the “new normal,” experts say there are systemic steps we could take now to prepare for the next big health crisis.

Chief of all, experts told the Kentucky Lantern, is building trust between the general public and health officials, the shortage of which during this pandemic has led to a myriad of misinformation spread through social media and otherwise.

At the 100-year anniversary of the 1918 flu pandemic, the Centers for Disease Control and Prevention issued a report examining gaps in pandemic preparedness. Those gaps included scarce surveillance of birds and pigs, not enough access to ventilators, worries that the health care system would be overrun in a flu-like pandemic, lack of a universal vaccine, shortage of pandemic plans in many countries, and more.

Two years later, when the Covid-19 pandemic hit, those predictions held true.

Though vaccines were produced relatively quickly, roughly 2,000 Kentuckians died from the virus before the lifesaving shots came out in late 2020. Even after they arrived, many Kentuckians were reluctant to roll up their sleeves. Covid-19 deaths in Kentucky as of last week totaled 17,555 people.

Supplies like personal protective equipment, ventilators and masks were in short supply in the early months. Hospitals were overrun with sick people, field hospitals went up to handle overflow, and National Guard members were deployed to help stretched medical staff.

During all this, Kentucky contended with a nursing shortage exacerbated by pandemic-induced burnout.

“One of the difficult lessons that we have learned in this pandemic is that the public-health infrastructure of this country has been under tremendous stress and they have suffered, I think, through this pandemic, in a number of different ways,” said Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky.

Kentucky is also vulnerable to pandemics because of our high rates of comorbidities, when two or more diseases or medical conditions are present in a patient at the same time, Chandler added. The state ranks high for risk factors such as diabetes, kidney disease and cancer, and “all of those things cause people to be much more vulnerable to viruses.”

Pandemic politics

In addition to a lack of resources early on in the pandemic, Chandler added, public-health experts had to battle constant misinformation and distrust.

“When you have a pandemic, it’s a pandemic generally because whatever you’re facing is novel, it’s new,” Chandler explained. “And there will always be questions and uncertainties about exactly how to handle it. It’s not always clear what the right thing is because the science isn’t yet entirely clear on what the society is dealing with.”

Partisan politics added to the problem, said Chandler, a Democrat who served in Congress in 2004-12 and was Kentucky’s attorney general in 1996-2004.

“We have sort of … retreated to armed camps,” he said. “And we’ve got to somehow figure out how to bridge those gaps, and I don’t know what it will take because you would think that if anything could cause you to bridge the gaps and have people come together, it’d be a pandemic. If a pandemic can’t bring us together around the common purpose, what can?”

Jennifer Hancock, president and CEO of Volunteers of America Mid-States, agreed. “By design, public health is political,” she said. But, there’s a need going forward, she added, to make sure those decisions are transparent and all voices have a chance to sit at the decision-making tables.

“If you feel like you’re not at the table, then you’re on the menu,” Hancock said. “Then, it immediately promotes defensiveness and mistrust.” (Republicans who run the legislature criticized Democratic Gov. Andy Beshear for not consulting them about his anti-pandemic measures.)

Historical racism has also exacerbated mistrust of the medical community. Oluwasegun Abe, a member of the Kentucky Nurses Association who works in Louisville as a hospitalist, said “the first thing” we need to work on “is to repair the distrust between the health-care system and the different races.”

Abe spent more than a year of the pandemic volunteering with the Louisville Metro Department of Health and Wellness. As he vaccinated people all over the city, he repeatedly heard people’s mistrust, much of it based on the notorious study in which medical researchers and providers withheld treatment from about 400 Black men in Tuskegee, Alabama, from 1932 to 1972 in order to study the course of untreated syphilis.

“We continue to just distrust each other,” Abe said. One solution to that distrust is investing in more diversity, he said, so people can see themselves represented in health-care professions.

Delanor Manson, CEO of the Kentucky Nurses Association, said, “What we’ve learned over the last three years is that the community must trust the professionals that are providing the information” in order for it to be effective. That means showing up for people, listening to their concerns and answering the hard questions.

“I think a lot of the ways to build that trust include being present,” said Manson. “And what I mean by that is being present when there isn’t a pandemic, when there isn’t an epidemic, but being present in the community to establish the relationship that there is support, caring, and we have that all the time, not just when there’s a problem.”

She added: ‘If you’re not there when things are stable, then you don’t have that relationship to build on when things are not going well.”

Fear breeds distrust

“My experience has been: whether it’s someone in Eastern Kentucky or someone in West Louisville,” mistrust is “really based in fear,” Hancock said.

Manson said another way to build trust, particularly when thinking about vaccinations, is to normalize that in childhood, a job that often falls to parents.

Hancock, who required vaccines for VOA workers early in the pandemic, said the model of internal quick and clear communication about the shots and the risk factors of Covid-19 can be of use for employers in the future.

“The fear and anxiety we had regarding people being pushed out of our organization or feeling pushed out of our organization because of that decision (to require vaccines) was never realized,” Hancock said, pointing out her 95% employee-retention rate.

Manson said Kentucky must also prioritize not just recruiting nurses to fix the current shortage but also strive to retain staff. Nurse retention starts with including nurses in the decision-making process, from the shifts they work to the laws that impact them, she added.

“What most nurses want more than anything else,” Manson, herself a nurse, said: “They want to be heard.”

Hancock said authentic conversations are a must.

“If we have that same spirit and approach where we are really seeking to have the most inclusive table where all voices get to be respected and represented, then it diffuses some of the rhetoric that otherwise gets the headlines,” she said. “And that’s what we’ll continue to do. And we’re very, very committed to that.”

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