Healing Trust in Medicine in a Fractured Post-Pandemic Landscape

As it turns out, developing vaccines and treatments for COVID-19 wasn’t the health care industry’s greatest challenge of the 21st century. The real test lies in addressing the profound human impact the pandemic left behind. By the time the first vaccine rolled out in January 2021, many of the cognitive and behavioral factors that drove traditional patient and physician choices had shifted—along with perceptions of medicine itself.

Pharmaceutical companies and health care professionals (HCPs) face a health care landscape plagued with the ongoing anxieties and inner battles of patients who are looking to find comfort and safety post-pandemic. Put simply, the pandemic changed people—HCPs and patients alike.

Vaccine Hesitancy and Distrust in Health Care

A patient receives a vaccination. Image Credit: © insta_photos - stock.adobe.com

In 2023, we found the growing polarization of the anti-vaxxer movement, where skepticism towards pharmaceutical companies, science, and vaccines became mainstream. The CDC reported that by late 2021, 42% of unvaccinated adults said they “don’t trust the COVID-19 vaccine.”¹ A 2024 study involving African, Caribbean, and Black populations in the United States revealed the lowest willingness to become vaccinated.² These data highlighted that vaccine hesitancy stems from a complex array of issues—not just physical barriers. These include “knowledge, psychological, and socioeconomical barriers at the individual, organizational, and systematic level.” For HCPs, it is crucial to understand these individual and systematic struggles on a deeper level and address them through tailored communication and acknowledgement of these diverse barriers, as well as by continuing to work to address social disparities and build trust in medicine.

Alarmingly, distrust in vaccines and institutions like CDC persists in 2024, even among HCPs. A recent study showed that a quarter of HCPs harbor vaccine skepticism, despite a rise in COVID-19 vaccinations (2021-2023) within this group (vaccination mandate for HCPs began in July 2021 for 88 organizations, and November 2021 for all Medicare workers).^3-5 HCPs recommending all types of vaccines have decreased, as has their trust in CDC. Given that HCPs “have long been the most frequently used and credible source of vaccine information,” pharmaceutical companies now face the challenge of trying to reassure HCPs of vaccine credibility and efficacy and diversifying their outreach channels to get in touch and address anxieties surrounding vaccines.

Fighting Fiction: Tackling the Misinformation Crisis

A post-pandemic poll showed that 78% of respondents believed in, or are uncertain about, at least one COVID-19 falsehood, underscoring the prevalence of misinformation in algorithm-defined echo chambers.⁶ However, a recent analysis of COVID-19 misinformation found that it was being spread not only via social media but also through traditional outlets, such as major TV stations.⁷

Misinformation is found across various regions and demographics, with vulnerable populations being disproportionately affected. Key themes of misinformation include the origins of the COVID-19 virus, ineffective treatments, and misunderstandings of public health measures.

A 2024 poll revealed that while two-thirds of Americans still say that the benefits of COVID-19 vaccination outweigh its risks, there has been a 10% increase of those who believe that it is safer to contract COVID-19 than get vaccinated, with this group rising to 22% by August 2024.⁸ This builds on a 2022 poll which illustrated that “sizable numbers of Americans who believe in COVID misinformation know they’re at odds with scientists and medical experts.”⁹ This is particularly concerning, as it suggests educating people about misinformation will not change their beliefs. The analysis from 2024 suggests that counter strategies include enhancing health and digital literacy, engaging with communities, and targeted health campaigns.⁷

Telehealth Soars, But Who’s Left Behind?

The pandemic fundamentally changed how people access health care, driving a surge in virtual patient-physician interactions—from just 0.3% in 2019 to 24% in 2020. The 2023 mandated report to Congress on Medicare states both clinicians and recipients favor the continuation of telehealth—with 90% of beneficiaries being very or somewhat satisfied with virtual visits.¹¹ Telehealth is valued for improving access to care, reducing the burden on certain patients, and is generally well-received.

On the other hand, a 2024 study involving high-risk veterans revealed that although 83.4% of high-risk patients remained telehealth users, “access barriers may limit initial telehealth engagement” for those with high hospitalization risk.¹² Patients who overcame these barriers and sustained telehealth use were disproportionately from racial or ethnic minority groups. In contrast, those with lower illness burdens tended to engage with telehealth only briefly, if at all, before returning to in-person visits and were less likely to belong to minority groups.

A 2024 Digital Health Readiness screener also highlighted inequities in readiness for digital health care, indicating that those with lower readiness scores need additional support.¹³ Despite the significant investment in telehealth, and widespread agreement that it should continue post-pandemic, HCPs must focus on supporting initial access and use, particularly among racial and ethnic minorities and high-risk patients. The benefit of telehealth is clear, but equitable access remains a challenge that requires targeted attention.

Burnout and Beyond: Who’s Caring for Caregivers?

As we move beyond the pandemic, calls for better care for HCP have faded, even though COVID-19 remains a “uniquely traumatic experience for the health workforce and for their families.”¹⁴ Research revealed that health care support workers experienced significantly higher rates of inadequate sleep and depression during the pandemic, and were 21% more likely to suffer from anxiety compared to the general population.¹⁵ Among all HCPs, support workers were 39% more likely than clinicians to experience mental health struggles.

A CDC report comparing 2022 to 2018 data showed a sharp rise in burnout among HCPs, increasing from 32% to 46%. By 2022, 44% of HCPs say they intended to look for a new job, up from 33% in 2018.¹⁶ In response, the National Institute of Occupational Safety and Health under the CDC has been running the Impact Wellbeing initiative, offering evidence-based solutions to reduce burnout, sustain wellbeing, and build a system where health care workers can thrive.¹⁷

Additionally, smaller interventions have shown promise. For instance, a recent study demonstrated that 9 months of minor digital engagement through automated mental health messages and resources reduced the mean Generalized Anxiety Disorder 7-item anxiety score from 5.79 to 4.18.¹⁸ Though modest, this improvement was consistent, with follow-ups showing significant decreases in depression.

In a post-pandemic health care landscape, we must not overlook the mental health crisis the pandemic both highlighted and accelerated among HCPs. This essential workforce continues to bear a tremendous mental burden and requires specialized, ongoing support to address the daily emotional labor they face.

Vaccines: Public Health or Personal Choice?

In 2021, 77% of vaccinated adults believed those refusing COVID-19 vaccines were harming the country.¹⁹ Now in 2024, concerns about the virus as a public health threat have decreased across the political spectrum, with a gap between Democrats and Republicans shrinking to just 16%, down from 37% in 2022.²⁰ Despite this, 40% of Americans remain somewhat or very concerned about unknowingly spreading COVID-19, though only 28% have received the updated vaccine. The report reflects a resistant undercurrent of COVID-19 concerns.

Meanwhile, since 2020, we have seen a rise in negative attitudes toward childhood vaccinations, with growing parental skepticism about their necessity.²¹ While 70% of Americans still agree that healthy children should be required to be vaccinated in public schools, this is a drop from 82% in 2019. Notably, Republicans support for vaccine mandates in schools have fallen sharply, from 79% between 2016 to 2019 to just 57% in 2023, while Democrat supports remain steady—demonstrating the growing political tension in public health opinions. More concerning, 40% of parents now believe they should be able to opt out of vaccinating their children, even if it poses health risks to others. In particular, support for vaccine requirements among White evangelicals plummeted from 77% in 2019 to just 20% in 2023.

A Fractured Health Care Landscape

From trust issues to shifting medical practices, mental health challenges to evolving public health priorities, today’s health care landscape is undergoing profound transformation. Vaccine hesitancy, driven by a breakdown in trust toward health care institutions and the widespread influence of misinformation, places immense pressure on HCPs. They must navigate an ever-changing landscape shaped by systemic inequalities, personal fears, and the polarizing beliefs of diverse communities.

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