It’s the trust, stupid

November 2, 2020 12:20 am

The U.S. Capitol Building. Photo by Samuel Corum/Getty Images.

Whatever happens on Tuesday, we know that there’s important, hard work to be done in the weeks, months, and years ahead. While a great deal of the focus will be on the merits of various policy proposals, Americans will also need to take a step back and take stock of a larger question about our politics. I’m talking about the role of trust in our institutions.

One of the great losses our country has endured over the past almost four years is the erosion of trust in the non-partisan aspects of our federal government. When President Trump took office in 2017 we began to hear of a shady operation that was supposedly conspiring against him and those who voted for him: the “deep state.” While there were of course government employees dismayed about much of what the Trump administration was promising to carry out, especially when they regarded those plans as illegal, Americans need to know that Trump was talking about hundreds of thousands of mostly civilian employees who have dedicated their professional lives to carrying out the day-to-day work of the federal government.

In the pre-COVID era I was in Washington D.C. quite often. I can report that there was after 2017 a palpable sense of frustration, even sadness, that the work of long-serving federal employees was being undermined and misrepresented. Americans love to trash “bureaucrats” and complain about “red tape.” But the truth is that while we may focus on presidents and members of Congress, much of the work, with some of the most important effects on Americans’ lives, is carried out by career professionals who serve the country and not a particular party. Almost to the person, these employees work hard not only to do their work, but to steer clear of partisanship or political appearances. By questioning their allegiance to their country, President Trump has done them — and us — a tremendous disservice.

Nowhere has the erosion of this trust been more acute than in those agencies tasked with helping us to find a way out of the COVID-19 pandemic. President Trump’s flouting of key recommendations made by the Centers for Disease Control are well-documented, especially as concerns consensus items such as wearing masks and social distancing. But more worrisome than the flouting is the open mockery and undermining, with President Trump encouraging audiences at campaign events to openly defy, reject, and dismiss those recommendations as somehow politically motivated. As Politico reported, Trump undermined CDC recommendations by empowering political appointees at the Department of Health and Human Services to interfere with CDC reports and findings. 

The problem we face now is that we desperately need the expert advice that those organizations have to offer. The need to restore trust in the Food and Drug Administration (FDA) will become particularly acute as as we enter into the next weeks and months, when and if a COVID-19 vaccine becomes available. The FDA, after all, will play a crucial role in the oversight of COVID-19 vaccine development and production. The FDA’s fundamental job will be not only to ensure that a vaccine is safe, having been subjected to impeccable scientific testing, but also that Americans can trust the FDA itself. 

There is no analogue in American history for the situation we find ourselves in. There are no instances of mass resistance to and distrust of a vaccine that does not yet exist. And there is certainly no historical analogue of a pandemic wherein the great hope of the end of suffering and death, as well as a return to normalcy, is dependent on a vaccine produced by institutions whose legitimacy has been systematically and actively eroded by the administration charged with overseeing them. This erosion has been sustained and pointed, with Trump all but accusing his FDA director of being a “deep state” operative aiding his electoral downfall, and taking unprecedented steps such as appointing a right-wing pundit to serve as FDA spokesperson, thereby undermining the agency’s longstanding dedication to advancing sober and science-based analysis. That the president seemed intent on turning vaccine discovery and production into an urgent campaign promise — disconcertingly titled “Operation Warp Speed” — made this about-face from science all the more troublesome.

In his important book, “Reputation and Power: Organizational Image and Pharmaceutical Regulation at the FDA,” the political scientist Daniel Carpenter argued that the FDA’s authority and legitimacy is based not only on the rigor of its methods and adherence to scientific principles, but it’s reputation. The FDA is only able to do its job if Americans trust it. Reversing Trump’s full-on attack on the agency’s legitimacy needs to be at the top of the next president’s to-do list. 

Whatever happens this coming Tuesday, it is clear that the next president is going to have his work cut out for him, not only in advancing policy ideas that can address our country’s ongoing public health crisis, but in restoring Americans’ trust in the institutions charged with overseeing the day-to-day measures to help us out of that crisis. While plans are underway, in Ohio as elsewhere, to prepare for the arrival of a vaccine, the biggest challenges are likely to concern trust.

If Joe Biden wins next Tuesday, he should prioritize repairing our relationships with career professionals — from scientists to accountants to postal workers to public health experts — and restoring the credibility of the agencies they serve. He should talk directly to them, and apologize on behalf of Americans everywhere for what they have been through. We are going to need them more than ever in the months and years ahead.



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Dan Skinner
Dan Skinner

Dan Skinner is Associate Professor of Health Policy at Ohio University’s College of Osteopathic Medicine, located on the Dublin campus. He is the host of Prognosis Ohio, a health care podcast produced in collaboration with WCBE, a Central Ohio NPR affiliate. Follow Dan at @danielrskinner.