How the CDC Can Rebuild Trust

The CDC has recently acknowledged that it badly mismanaged not just the COVID-19 pandemic, but monkeypox as well. Its director, Dr. Rochelle Walensky, promised reforms, most notably to increase transparency in the data it collects and in its public messaging.

By admitting there is a need for reform, the CDC is taking a crucial first step toward restoring trust. After two years of missteps—including flip-flops about masking, keeping schools closed even as bars and restaurants reopened, ineffectual lockdown rules, and incomplete and often confusing vaccine rollouts—it’s not surprising that trust in the U.S. healthcare system plummeted. Many have been asking: What took so long?

As a behavioral economist who spent the past two decades studying how organizations apologize, I have answers—not only on why it took so long for the CDC to admit its missteps but also on what else needs to be done to restore trust. The pandemic was a vivid demonstration of just how critical trust is. A Lancet study found that one of the best predictors of which countries had the lowest COVID-19 fatality rate wasn’t public health preparedness; it was trust.

An Apology Begins With Admitting Your Mistake

The path to restoring trust begins with an apology. My research focuses on why many find it costly to apologize, but also on why we need apologizers to pay a cost.

When we see an organization is willing to pay a cost for its mistakes, we interpret that admission as a signal that it will do better in the future—the costlier the apology, the more effective the signal. In an experiment conducted with Uber, my co-authors and I randomly sent different apologies to 1.5 million customers who experienced a late ride and found apologies were only effective if the firm paid a cost.

An apology that was too "cheap" was often worse than no apology at all. Cheap apologies include banal expressions of empathy, “I am sorry you were offended,” or attempts to make excuses or shift blame. A more costly apology could be monetary, either a simple coupon for future service or an acceptance of legal liability. Our research finds that taking responsibility for mistakes could be even more costly and thus more effective than a monetary payment alone.

In my research, I break down the non-monetary cost of an apology into the cost of being accountable for the past, and the cost of promising a better future. Admitting to mistakes is hard because we often hold someone accountable by replacing the offending parties with somebody new.

Furthermore, acknowledging past mistakes is risky because it damages public perceptions of your competence. Organizations that apologize are seen as having more integrity but are also seen as being weak and incompetent. For an institution like the CDC, that perception of incompetence could mean less adherence to future recommendations.

One study conducted during Bill Clinton’s presidency used two different videos containing footage of Clinton talking about Monica Lewinsky: one where Clinton sounded angry, the other where he sounded apologetic. While subjects found apologetic Clinton to be more likable than angry Clinton, they perceived apologetic Clinton to be less competent and less deserving to be president.

My co-authors and I found similar patterns in corporate apologies. Firms that apologized for chemical spills by taking responsibility experienced worse stock market performance compared to those that offered “cheap” expressions of empathy.

An Effective Apology Must Also Commit to a Better Future

Still, taking responsibility is a key first step that the CDC has commendably begun. A full apology from the CDC would clearly articulate past mistakes and identify their root causes. The next step would be to lay out a clear plan for the future with clear and transparent benchmarks for success. But making such promises for the future entails costs and risks as well.

In our experiment with Uber, we found that when Uber made a promise to a customer to do better (even in the context of a simple email) and then failed to live up to its promises, customers were more likely to stop using Uber compared to the control condition where there was no apology at all. For an organization like the CDC, clear benchmarks help to restore trust but risk doing even more damage if the organization fails to live up to them.

Distrust of Public Health is Part of a Larger Pattern

The recent downturn in trust in the medical establishment is part of a larger trend of growing distrust in public institutions that began decades ago. Even though the proximate causes of distrust in the CDC may be pandemic related, they were exacerbated by a trend of growing partisan divides.

A recent Pew survey better unpacks conservative distrust of science, finding that while conservatives generally trust scientists to do science, they have less trust in the ability of scientists to make unbiased policy decisions. Much of the distrust of the CDC stems from disagreements about trade-offs that reasonable people might disagree upon:

• How do you balance the need for clear messaging, with the need to acknowledge the ambiguity of current science?
• How do you balance the needs of public health against the social and health-related benefits of in-person school?
• How do you balance the urgency of the vaccine rollout with the need for the public to trust the safety of those vaccines?

People who share the same fundamental values may still disagree on how to handle these tradeoffs. But we have a hard time appreciating the perspectives of others when those values lead us to different conclusions.

There is a growing sense that government institutions do not reflect the people they represent. Increased diversity at those institutions could help. Americans should be able to see themselves in the institutions that serve them. Greater diversity and greater transparency in how those decisions are made could help us better recognize the complexity that underlies the decisions and be more likely to accept the legitimacy of the decisions that are ultimately made.

Restoring Trust is a Long Game

Public trust is a long game; an apology is just the first step. In lab experiments, my co-authors and I found that one session of untrustworthy behavior required three sessions of trustworthy behavior to repair. Transparency by a public institution gives the public the chance to observe more examples of positive behavior which will help rebuild trust so long as the institution lives up to its promises.

Despite the trends and underlying challenges, I remain optimistic we can overcome them. The same Gallup polls that showed long-term declines in trust showed an uptick in 2020 (that quickly reversed as the pandemic abated). At a time of crisis, Americans were still able to come together. It is essential that the CDC succeeds in rebuilding its reputation. We’re all going to need it for the next pandemic.