American Antagonism Toward Public Health Officials Shifted Through COVID-19

The representation of who dissents against COVID-19 response has evolved over time, according to new data.

The general population’s trust in public health officials throughout the COVID-19 pandemic has shifted, in terms of the sociodemographic populations that have been antagonistic toward figures and public health messaging. In new research presented by a team of public health, population health sciences and public policy investigators, the observed trend of US residents who held negative views toward public health officials shifted toward those who earned above-average annual pay, those with some college education, those who identified as politically independent, and those who expressed greater trust in science.

The findings suggest the role of various factors—including economic effects, politicization of pandemic response and pharmaceutical development, and the “pandemic fatigue” phenomenon—in driving altered beliefs behind the antagonism of public health officials, a matter which investigators said “frustrated and perplexed the scientific community.”

Led by Rachel J. Topazian, BA, of the department of Health Policy and Management at Johns Hopkins Bloomberg School of Public Health, the team sought to examine the proportion of US adults who believed it was justified to harass or threaten public health officials due to COVID-19 business closures. They additionally wanted to identify the factors that would influence such beliefs.

Antagonism against public health officials reached “unprecedented levels” during the pandemic, they wrote, noting instances of harassment, threats, property vandalism, doxing, and armed protests reported by various figures. A survey last year showed approximately one-fourth of all public health workers reported feeling bullied, threatened, or harassed due to their work during the early stages of COVID-19.

“The targeting of public health officials has exacerbated the pressures of the pandemic and is likely contributing to increases in stress levels, depression, and anxiety,” they wrote. “More than 50% of public health workers experienced at least one adverse mental health condition in March and April 2021, and more than 50% of public health workers reported at least one posttraumatic stress disorder symptom between September 2021 and January 2022.”

Worry has increased that these developments, along with the further limitation of public health authorities at the state level, will negatively impact the capability of the public health workforce and therefore the country’s preparedness for future crises.

Topazian and colleagues used data from the Johns Hopkins University COVID-19 Civic Life and Public Health Survey, an online, nationally-representative questionnaire that was delivered in 4 waves from April 2020 through August 2021.

The team asked respondents separately how much they believed harassment and threats toward public health officials for business closures were justified during the survey’s wave in November 2020. They asked nearly identical questions to that prompt but in past-tense in July and August 2021, to acknowledge the COVID-19 outbreaks in 2020. A question regarding respondent trust in science was asked in the November 2020 wave as well.

A baseline panel was used to collect respondent characteristics and demographics including race and ethnicity, age, household income, education and political party affiliations. Differences in beliefs regarding antagonism toward public health officials were adjusted and examined by the sociodemographic factors, as well as in their reported trust in science.

A total of 1086 respondents completed both the 2020 and 2021 survey waves; mean age was 49.0 years old, 52% were women, and 64% were White.

Investigators observed that the share of adults who believed public health official harassment and threatening due to business closures increased from 20% to 25% from November 2020 to July and August 2021 (P = .046).

A multivariable regression analysis showed adults who did not trust science much or at all were five-fold more likely to view threatening public health officials as justified than those who trusted science in November 2020 (35% vs 7%; P <.001). By July and August 2021, that disparity decreased (47% vs 15%; P <.001).

The team additionally observed notable increased in the rate of negative perception of public health officials between November 2020 and July and August 2021 among specific populations:

• Those earning $75,000 or more annually: 7 percentage points (95% CI, 1 - 14; P = .03)
• Those with some college education: 6 percentage points (95% CI, 2 - 11; P = .03)
• Those who identify as politically independent: 9 percentage points (95% CI, 3 - 14; P = .01)
• Those who reported trusting science a lot: 8 percentage points (95% CI, 4 - 13; P <.001).

Topazian and colleagues wrote about the concerning politicization of public health, noting the very apparent and evidenced polarization of pandemic mitigation strategies such as social distancing, masking and vaccination production and rollout. However, these latest findings show “increasingly partisan attitudes” over the duration of COVID-19.

“We found that most respondents believing that attacks on public health officials were justified in November 2020 also believed that attacks on politicians were justified,” they wrote. “This finding aligns with the general politicization of the pandemic but could also reflect the conflation of public health officials and political leaders or the view that public health officials make inherently political decisions.”

The team concluded the outcomes highlight both conventional partisan and sociodemographic factors associated with public health perception, as well as the increasing level of antagonism toward officials even by those supportive of science and “better equipped to weather the pandemic’s adverse economic impacts.”

“Ensuring the safety and sustainability of the public health workforce will necessitate finding new and tailored strategies to build trust with these groups,” they wrote.

The study, “US Adults’ Beliefs About Harassing or Threatening Public Health Officials During the COVID-19 Pandemic,” was published online in JAMA Network Open.