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In Basics of the U.S. Healthcare System, Fifth Edition, I included a discussion on how both the administrations of Donald J. Trump and Joseph R. Biden implemented the COVID-19 public health policies of COVID-19 vaccinations and masking and how politics impacted policy effectiveness.       

In January 2020, during the Trump Administration, the World Health Organization declared the COVID-19 virus a public health emergency of international concern and in March 2020, declared the virus a pandemic.

The United States declared a state of emergency in March 2020 and COVID-19 became the fifth documented pandemic since the 1918 flu epidemic. In April 2020, WHO issued guidance on mask wearing, indicating it was an effective measure against contracting the virus. In May 2020, President Trump announced Operation Warp Speed, with its main goal of developing a COVID-19 vaccine as soon as possible, a goal which typically takes years to create.

He authorized $10 billion to contractors to develop vaccines. In March 2020, the pharmaceutical company, Moderna, began trials on COVID-19 vaccines. In November 2020, Pfizer vaccine trials determined the vaccine as 90 percent effective.

In April 2021, 1 billion vaccine doses were administered globally. By May 2023, there were 103 million confirmed COVID-19 cases in the United States, with 1.13 million deaths, and 766 million cases worldwide, including 6.9 million deaths.

This narrative summarizes the impact COVID-19 had on the health of individuals worldwide. However, these statistics only tell part of the story of how the U.S. COVID-19 public health policy was impacted by politics.

The Costs of Downplaying a Pandemic

According to FactCheck.org, during the early days of the pandemic, the Trump administration downplayed the risk of the virus spreading even after WHO had declared it a pandemic. In several different speeches, President Trump continued to downplay the public health issue, indicating it was similar to the flu, only the elderly are at risk, and continued to hold rallies which had thousands attending, even though the number of cases continued to increase nationally among all demographics.

While the president was downplaying concerns about the pandemic, the government health agencies and scientists were indicating it was a major public health crisis. The Centers for Disease Control and Prevention recommended using masks to lower the risk of contracting the virus but the president recommended governors keep their states open and for the public to use ultraviolet rays and disinfectants to treat the disease. These recommendations were not fact-based.

When the term "fake news" became part of society’s vernacular, it was difficult to change people’s minds about the public health policies. Also, these mixed messages confused the general public who turned to social media to find answers which often had not been verified as truthful, which is how misinformation and disinformation began spreading during the administration and how mistrust became an ongoing issue during the pandemic.

The Important Distinction Between Misinformation and Disinformation

Misinformation refers to false and inaccurate claims about a health topic. Misinformation, as an example, occurs typically when there is a new disease and people are looking for answers about the disease and treatment. The information is typically posted on different social media platforms which makes the information difficult to verify as true in a timely manner. By the time the information is verified as false, it has spread across many social media sites believing this false information is true.

Disinformation, a subset of misinformation, occurs when false information is targeted at a certain group. It is used to achieve a political purpose. For example, the COVID-19 virus was characterized in derogatory terms around the fact that it originated in China, which resulted in an increase in discrimination against Asians in the U.S.

An infodemic occurs when facts are mixed with fears and rumors, which creates distrust of public health officials. This concept was developed in 2003 during the SARS (severe acute respiratory syndrome) outbreak. This also occurred during the AIDS epidemic and the most recent COVID-19 epidemic.  

COVID-19 mortality data was higher in areas when misinformation occurred, even though there were vaccination programs available. Interestingly, during the 1918 flu epidemic, misinformation about the disease and how clinicians could help them, resulted in the creation of an anti-vaccination movements because of distrust, similar to what occurred in the 2019 pandemic.

The Trump administration’s public health policy perspective was different from the Biden administration’s perspective. President Trump was uncomfortable wearing a mask, because he felt it portrayed him as weak, which resulted in many of his supporters doing the same. President Trump was not proactive in encouraging and educating his followers with the importance of getting a vaccine. He was also interested in nontraditional cures for COVID-19, which he publicly discussed, which were not science-based, resulting in the negative impacts on effective public health policy compliance set by the CDC and the National Institutes of Health. Senior Trump administrators also publicly contradicted the government health officials, further creating an atmosphere of distrust of their expertise.

After Biden became president, he was emphatic about the importance of mask wearing and wore masks himself. He implemented federal employee masking mandates, which the previous administration did not. He also was adamant about the protection vaccines provided against the virus.

In general, how to protect oneself from the virus became a political issue, creating a divide in the United States. The approval ratings for both administrations, regardless of COVID-19 case and mortality rates in states, fell along party lines. Research indicates the trust in the federal government regarding COVID-19 public health policies and science varied based on political party. The percentage of the population who trusted the Food and Drug Administration, the CDC, Anthony Fauci, formerly the director of the National Institute of Allergy and Infectious Diseases and effectively the public face of the public health response to COVID-19, and President Biden has decreased since December 2020, although Democrats’ trust has remained high (over 80 percent) for each of these entities.

Republicans’ trust in the FDA dropped from 62 percent to 43 percent, trust in the CDC dropped from 57 percent to 41 percent, trust in Fauci trust dropped from 47 percent to 25 percent, and President Biden’s trustworthiness dropped from 22 percent to 16 percent.

According to the Pew Research Center, as vaccinations became more available, those counties which supported Trump had much lower vaccination rates, resulting in higher death rates. The lower vaccination rates were the result of misinformation broadly disseminated across social media sites. These statistics reflect the use of misinformation and disinformation strategies in public health which ultimately impacts how the general population trust in how public health policies can protect them.

Battling Misinformation and Disinformation Going Forward

History indicates there will be additional pandemics and there will be nonbelievers in effective public health policies which can save lives. It is important that public health campaigns are developed to combat the use of misinformation. It is important that public health officials collaborate with social media sites to ensure the information is correct. This is, and will continue to be, a huge challenge. 

To learn more about this topic, download a review copy of Fifth Edition of Basics of the U.S. Health Care System, Fifth Edition.

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About the Author:

Nancy J. Niles, PhD, MS, MBA, MPH, is in her 19th year of full-time undergraduate teaching. She is in her 8th year of teaching undergraduate and graduate healthcare management courses at Rollins College in Winter Park, Florida. Prior to Rollins College, she taught 8 years of undergraduate business and healthcare management classes in the AACSB-accredited School of Management at Lander University in Greenwood, South Carolina, and 4 years teaching in the Department of Business Administration at Concord University in Athens, West Virginia. She became interested in health system issues as a result of spending two tours with the U.S. Peace Corps in Senegal, West Africa. She focused on community assessment and development, obtaining funding for business and health-related projects. Her professional experience also includes directing the New York State lead poisoning prevention program and managing a small business development center in Myrtle Beach, South Carolina.

Her graduate education focused on health policy and management. She received a Master of Public Health from the Tulane School of Public Health in New Orleans, Louisiana, a Master of Management with a healthcare administration emphasis and a Master of Business Administration from the University of Maryland University College, and a Doctor of Philosophy from the University of Illinois at Urbana-Champaign in health policy.