Almost four years ago, Dhruv Khullar wrote an essay for The New York Times on a growing distrust of the medical profession.
“In 1966, more than three-fourths of Americans had great confidence in medical leaders,” he wrote. “Today, only 34% do. Compared with people in other developed countries, Americans are considerably less likely to trust doctors, and only a quarter express confidence in the health system.”
The article appeared in January 2018, more than two years before the first American life would be lost to COVID-19.
Khullar is a physician and an assistant professor of health policy and economics at Weill Cornell Medical College. In the essay, he identified a crisis that soon would lead to thousands of deaths.
Since the beginning of the pandemic, the coronavirus has claimed more than 764,000 American lives, more than half of those since public health professionals began administering vaccines late last year.
The virus has killed more than 7,000 people in the United States in just the last week.
The good news from the U.S. Centers for Disease Control and Prevention is that 194 million Americans are now fully vaccinated against COVID-19. That represents nearly 60% of the population.
The bad news is that more than four in 10 Americans are still unprotected, many of them because they doubt that these lifesaving vaccines will actually work or, worse yet, because they fear the vaccines will do them harm.
Such skepticism is nothing new.
“During some recent disease outbreaks,” Khullar wrote in that 2018 article, “less than one-third of Americans said they trusted public health officials to share complete and accurate information. Only 14% trust the federal government to do what’s right most of the time.”
This sort of mistrust, he said, could lead people to skip their annual flu shot or forego the measles vaccine for their children.
“Perhaps most concerning is evidence that low levels of trust can weaken the ability of governments and public health agencies to respond to epidemics,” Khullar wrote.
What explains this lack of faith? Part of the problem, Khullar acknowledges, is the perception that those involved in public health are more concerned about profits than about the welfare of patients.
“All institutions are imperfect, and some are plainly corrupt,” he wrote. “A degree of skepticism is inevitable and important. But when doubt becomes pervasive, it can erode the glue that binds society together and the medicine that keeps us healthy.”
Nicholas Christakis, a physician and sociologist at Yale University, wrote a book titled “Apollo’s Arrow” about the consequences of the current pandemic. He spoke to Khullar for an article in The New Yorker last spring.
“We have a thinned-out intellectual culture,” Christakis said. “We’ve lost our capacity for nuance. Everything is black or white. You’re either with me or against me. Masks are a sign of virtue or totalitarianism.”
During the pandemic, Khullar wrote, Americans have been among the most divided people on the planet.
“What can be done to ensure that we’re more united when the next plague strikes?” he asked. “Good policy might make our health system more pandemic-proof, but technocratic solutions can do only so much to address a lack of social cohesion. Beliefs about science, freedom, individual responsibility and collective action are profoundly influenced by one’s community and sense of identity. For some Americans, pandemic denialism has become a misguided form of patriotism.”
As we’ve already witnessed, the result of this lack of trust can be deadly.
Public health officials and the medical profession must begin work immediately to rebuild the trust that has been so lacking in the current crisis. Thousands of lives are depending upon their success.