From public health to public distrust

✍️ By Lynne Kristensen, IMA Senior Director of Communications & International Fellowship Program

Public health is not the same as the doctor-patient relationship.

By definition, public health is the field of medicine and policy focused on protecting and improving the health of entire communities or populations, rather than treating one patient at a time. It is the organized effort to protect and improve health through disease prevention, health education, safety standards, outbreak response and policies that affect the conditions in which people live. [1]

That definition and distinction are important.

Clinical medicine begins with the person in front of the physician. Public health begins with the population. Both can serve human health, but they do not carry the same moral risks. A doctor can recommend. A public health agency can influence policy. A physician can counsel one family. A public health mandate can affect millions of families at once.

That is why public health has always been a double-edged sword.

At its best, it can help communities understand risk, prevent disease, respond to outbreaks, improve sanitation, strengthen food safety and organize large-scale health responses. At its worst, it can become a vehicle for coercion, political power, institutional self-protection and medical decisions made far from the patient.

The question for American Medicine at 250 years is not whether public health should exist.

It should.

The question is whether public health can be restored to its proper role: guidance grounded in honest science, transparent data, informed consent and respect for the physician’s role in individual patient care.

What Public Health Is Supposed to Do

Public health has historically focused on problems too large for one physician or one household to solve alone.

Clean water systems, sewage treatment, food safety, workplace safety, maternal and infant health efforts, infectious disease surveillance and public education all changed the conditions in which Americans lived and died. The Centers for Disease Control (CDC) has listed vaccination, motor vehicle safety, safer workplaces, control of infectious diseases, safer and healthier foods, healthier mothers and babies, and recognition of tobacco use as a health hazard among the major public health achievements of the 20th century. [2]

Those achievements deserve to be part of the record.

But they do not give public health a blank check.

A public health agency may study population-level risk and it may offer guidance. It may warn about outbreaks. It may support research, collect data and help coordinate emergency response.

But public health becomes dangerous when guidance becomes a command, when uncertainty is presented as settled science, and when the rights of individuals are treated as obstacles to be managed rather than liberties to be protected.

The public is not a spreadsheet.

A population is made of individuals. Each with a unique health history.

When Population Policy Forgets the Person

Public health often speaks in broad categories: age groups, risk groups, exposure groups, vaccination status, case counts, hospitalization curves and disease burden.

Those categories can be useful. They can also flatten human reality.

A policy that appears logical at the population level may still be harmful to a particular patient, family, child, worker or community. A recommendation may be appropriate for one person and not another. A product may carry a different risk-benefit profile depending on age, prior infection, pregnancy, immune status, comorbidities, religious conviction or medical history.

This is why the doctor-patient relationship must not be displaced by public health bureaucracy.

The physician’s role is not merely to repeat agency guidance. It is to apply medical knowledge to the individual patient. The patient’s role is not merely to comply. It is to receive full information, ask questions and make decisions through informed consent.

When public health loses sight of that, trust begins to fracture.

The Money and Power Problem

Public health does not operate in a vacuum.

It exists inside a system shaped by pharmaceutical companies, federal agencies, academic institutions, professional associations, nonprofit organizations, media outlets, technology platforms, school systems, employers, courts and elected officials.

That system requires transparency because conflicts of interest can be real, perceived or both.

Pharmaceutical companies contribute millions of dollars to federal lawmakers through political action committees and other political channels, and KFF Health News has tracked those contributions as part of what it describes as a multipronged effort by drugmakers to influence health care lawmaking and spending priorities. [3] The pharmaceutical and health products industry has also been a major lobbying force in Washington, with OpenSecrets reporting that the industry has consistently ranked among the top sectors for federal lobbying and campaign contributions. [4]

A campaign contribution does not prove that a lawmaker will vote a certain way. A stock holding does not prove that a policy decision is corrupt. An advisory role does not prove improper influence.

But the public is right to ask questions and absolutely should. Historical patterns and connections should be reviewed.

When public health recommendations can create enormous markets for medical products, the people writing those recommendations must be held to the highest standards of disclosure and independence. When policymakers, advisers or institutions have financial ties to industries that benefit from public health policy, those relationships must be visible, limited and subject to scrutiny.

Trust requires more than expertise.

It requires independence.

COVID and the Breaking Point

No modern event did more to damage public trust in health institutions than the COVID era.

COVID was a real disease that caused real suffering. Families lost loved ones. Hospitals were overwhelmed. Physicians, nurses, respiratory therapists and emergency responders worked through fear, exhaustion and uncertainty. Many patients died alone. Many healthcare workers carried emotional and moral burdens that will not easily fade.

That must be acknowledged.

But acknowledging the seriousness of the virus does not require treating every policy response as wise, scientific or ethical.

COVID was not only a public health crisis. It became a crisis of institutional trust.

It revealed how quickly emergency guidance could become coercive policy. It showed how easily science could be politicized. It demonstrated how fragile civil liberties can become when fear is high and authority is centralized.

It also raised questions that still have not been fully answered.

What did officials know? What did they assume? What did they overstate? What did they suppress? What did they get wrong? Why were dissenting physicians attacked? How were injured patients handled? How much damage was caused by policies meant to protect the public?

Those questions are not anti-science.

They are necessary. And they are just starting to be revealed.

What Was Different About COVID

America had faced infectious disease outbreaks before. During the 1918 influenza pandemic, communities used measures such as quarantine, school closures and restrictions on public gatherings, but responses varied widely by city and state and were not centrally directed by the federal government.

What made COVID different was the reach of the response.

For the first time in many people’s lives, public health policy entered their homes, classrooms, workplaces, hospitals, houses of worship, military service, universities, restaurants, travel, media platforms and family decisions. It did not merely advise people about risk. In many cases, it determined what they were allowed to do.

Some workers were required to receive a COVID vaccine or face losing their jobs. Some students faced restrictions. Some travelers were subject to vaccination requirements. Non-U.S. citizen, nonimmigrant air travelers were required to show proof of COVID-19 vaccination to enter the United States by air beginning in November 2021, with limited exceptions. [8]

The Supreme Court eventually blocked OSHA’s vaccine-or-test mandate for large employers, while allowing the CMS vaccine mandate for many healthcare workers to proceed. [9]

That split reflected the deeper conflict.

How far can public health authority go before it becomes government overreach?

At what point does a recommendation become coercion?

Where does population guidance end and individual medical freedom begin?

COVID forced those questions into American life.

What Public Health Got Wrong

The central failure of the COVID era was not that officials made mistakes. Mistakes are inevitable in any crisis.

The deeper failure was that uncertainty was too often communicated as certainty.

Several claims and policies that were treated as settled later proved more complicated than the public was originally told.

The six-foot distancing rule became one of the most recognizable policies of the pandemic. Later congressional testimony from Dr. Anthony Fauci drew scrutiny when he said he was not aware of studies supporting the six-foot rule and described the distance as an empirical decision that “sort of just appeared.” [10] That does not mean distance was irrelevant. It means a highly specific rule was applied across schools, workplaces, churches and public spaces without the level of evidence many Americans assumed existed.

School closures are another example. Early caution may have been understandable. But prolonged closures carried serious costs. A JAMA Pediatrics systematic review found that school closures and broader lockdown measures during the first COVID wave were associated with adverse mental health symptoms and health behaviors among children and adolescents, including distress, anxiety, increased screen time and reduced physical activity. [11]

The messaging around vaccination and transmission also shifted. Early public messaging often suggested vaccination would stop transmission, then they said it would sharply limit the spread, but breakthrough infections were documented. During the Delta wave, the CDC’s Barnstable County investigation found breakthrough infections among vaccinated people and reported similarly high viral loads among vaccinated and unvaccinated people infected with Delta, contributing to updated masking guidance. [12]

The debate over COVID’s origin became another trust issue. The possibility of a laboratory-associated origin was widely dismissed by many voices early in the pandemic. Later reporting and government assessments showed that U.S. intelligence agencies did not agree on a single origin, with some agencies favoring natural exposure and others assessing a laboratory-associated incident as plausible or more likely. [13]

The lesson is not that every alternative claim was correct.

The lesson is that public health cannot afford to confuse legitimate scientific uncertainty with misinformation.

Anthony Fauci, Public Trust and the Question of Accountability

Dr. Anthony Fauci became the most visible public health figure in America during COVID.

For many Americans, he was presented as the steady voice of science. How many times did you hear “trust the science” without any true science being presented? For others, he became a symbol of centralized authority, shifting guidance and unanswered questions.

That tension has only deepened as congressional inquiries, released documents, diary entries, hearing transcripts and media reporting have continued to revisit the pandemic response. [15]

In 2026, Fauci invoked his Fifth Amendment right during a Senate hearing led by Sen. Rand Paul and declined to answer questions about the COVID response and origins debate. [14] Invoking the Fifth Amendment is a constitutional right and does not itself establish wrongdoing. But the moment intensified public frustration among those who remember when physicians, scientists and citizens who questioned COVID policy were never granted the same protection from public accusation, censorship or professional consequence.

That is precisely why this issue belongs in the public health trust conversation.

The question is not whether one man alone caused distrust.

The question is why Americans were repeatedly told to trust public health leaders while so many legitimate questions were treated as dangerous to ask.

The Independent Medical Alliance, which was founded during the COVID area because of the silencing of frontline doctors, has been direct in its own response. Recently, IMA argued that the “irony is impossible to miss” when a public health figure associated with censorship concerns invoked the right to remain silent, while physicians who raised questions during COVID faced professional, media and institutional pressure. [16]

IMA’s perspective comes from the experience of the frontline founding physicians who saw a need for truth and science-backed information to be available to the public.

Doctors on the frontlines saw patients. They tested treatments. They observed patterns. They asked questions. Some were praised early in the pandemic and later punished or smeared when their observations did not fit the official narrative.

A public health system that cannot tolerate frontline questions cannot claim to be fully scientific.

Mandates and the Loss of Consent

Perhaps the most damaging shift during COVID was the move from recommendation to mandate.

Informed consent requires more than access to a product information sheet. It requires freedom from unreasonable pressure. It requires honest discussion of known risks, possible benefits, alternatives, uncertainties and individual circumstances. It requires the ability to say no.

During COVID, many Americans felt that ability was taken from them.

A medical decision became tied to keeping a job, attending school, serving in the military, traveling, entering certain spaces or remaining in good professional standing. Some people accepted vaccination willingly. Others did so reluctantly because the social, financial or professional cost of refusal was too high.

That is not the same as trust.

It is compliance under pressure.

Public health leaders may argue that mandates were necessary in a crisis. But mandates carry moral costs. They place the state, employer or institution between the patient and physician. They can override medical nuance. They can harden public resistance. They can make people feel that their body is no longer their own.

For IMA, that is where public health crossed a line.

The public health role should be to inform and guide, not to coerce people into medical decisions through fear of exclusion, termination or loss of liberty.

Vaccine Injury and the Patients Left Behind

A trustworthy public health system must be able to hold two truths at once.

Medical products may help some people. Medical products may harm some people.

COVID vaccination was promoted with extraordinary confidence. Yet adverse events were real and deserved honest attention from the beginning. The number of reports to the federal Vaccine Adverse Event Reporting System (VAERS) rose dramatically after the COVID vaccine rollout, from about 49,000 reports in 2020 to more than 752,000 in 2021, more than a fifteenfold increase.[19] VAERS is an early-warning system, so a report does not by itself prove that a vaccine caused the reported illness or injury.[20] But an increase of that size should not simply be brushed aside. It is the kind of signal that warrants careful investigation, transparent reporting and continued study.

These facts do not prove that every patient faced the same risk or that there was a potential benefit for high-risk groups.

But they do prove that the injury was not imaginary.

Patients who experienced serious adverse events should not have been dismissed, mocked or treated as threats to public health for telling their stories. Families who believe a loved one died after vaccination deserve serious investigation, not reflexive denial. They deserve clinical care, transparent data and a compensation system capable of responding with dignity.

The federal Countermeasures Injury Compensation Program was created to compensate people who suffer serious injuries or deaths from covered medical countermeasures, including COVID vaccines. But the pandemic overwhelmed the system. The program received about 27 times more claims related to COVID than it had received during its entire first decade, with more than 11,000 claims alleging COVID vaccine injury or death. By September 2026, only a small fraction of those claims had been found eligible for compensation, raising questions about whether the system is equipped to respond to people who believe they were seriously harmed.[21][22]

Identifying and tracking these patients has been difficult. As recently as March 2026, there was still no specific U.S. medical diagnosis code for adverse health conditions attributed to COVID vaccination. Physicians instead had to document the individual condition and use a broader vaccine adverse-effect code. Federal health officials acknowledged that a dedicated code could make it easier to identify cases, study patterns and better understand what these patients are experiencing.[23]

Even the language around vaccination became part of the trust problem. CDC materials show that on September 1, 2021, the agency revised its definitions of “vaccine” and “vaccination,” moving away from language about producing “immunity” and toward language about stimulating an immune response and producing “protection.” CDC later argued that the change reflected normal scientific revision, but the timing during the COVID vaccine rollout contributed to public concern and distrust. [24]

The public does not trust institutions that cannot say, “This happened, and we are going to study it honestly.”

That is the bare minimum owed to the injured, the grieving and the physicians trying to understand what happened.

Physicians, Dissent and the Silencing of Clinical Judgment

The COVID era also placed physicians in a position many had never experienced.

Doctors were told to follow guidance that changed repeatedly. Some were discouraged from discussing early treatment observations, natural immunity, vaccine injury concerns, risk stratification or alternative interpretations of emerging data.

Professional pressure was not theoretical. In 2021, the Federation of State Medical Boards warned that physicians spreading COVID-19 vaccine misinformation or disinformation could face disciplinary action by state medical boards, including suspension or revocation of their medical licenses. [25]

That warning occurred in a climate where the line between false claims and evolving scientific disagreement was often unclear.

Ironically, a 2024 JAMA Network Open study found that medical board discipline for physician-spread misinformation was rare in the states studied and identified no misinformation-related license revocations. [26] Many of the physicians who founded the IMA (formerly FLCCC) were attacked for speaking out, the very reason an independent organization focused on conflict-free science is needed.

The issue was not only how many doctors ultimately lost licenses. It was the chilling effect created when physicians understood that questioning official guidance could put their livelihoods and reputations at risk.

California’s AB 2098 made that concern concrete by classifying certain COVID-related misinformation or disinformation by physicians as unprofessional conduct. The law was challenged and later repealed, effective in 2024.[27]

Science needs boundaries against fraud.

But it also needs room for disagreement. And disagreement should lead to meaningful discussions.

Doctors must be able to say what they are seeing without repercussions.

Childhood Vaccines and the Post-COVID Trust Crisis

COVID did not create all distrust in public health.

But it accelerated, exposed and amplified it.

After years of shifting guidance, mandates, censorship concerns, vaccine injury dismissal and institutional defensiveness, many parents began looking back at the entire childhood immunization schedule with new questions.

That does not mean every vaccine is the same. It does not mean every recommendation is unjustified. It does not mean infectious disease risk should be ignored.

It means public trust has changed.

In the early 1980s, the routine U.S. childhood immunization schedule was far smaller and centered on vaccines such as DTP, oral polio vaccine and MMR. [28] By 2025, the CDC child and adolescent immunization schedule included a much broader list of vaccines and immunizing agents across birth through age 18, including hepatitis B beginning at birth, rotavirus, DTaP, Hib, pneumococcal, polio, influenza, COVID-19, MMR, varicella, hepatitis A, HPV, meningococcal, RSV-related products and others depending on age and circumstance. [29]

For many parents, the question is no longer whether one vaccine ever had a public health rationale.

The question is whether the schedule, as a whole, has been studied with enough independence, transparency and long-term follow-up.

That concern is not unreasonable. A 2013 Institute of Medicine report found that while substantial literature exists on adverse effects of individual vaccines, few studies had focused on elements of the recommended childhood immunization schedule all together. The report identified ways existing systems such as the Vaccine Safety Datalink could be used for ongoing safety research. [30]

That is the conversation most parents are begging for.

Not slogans.

Not shaming.

Not “the science is settled.”

A real examination.

The Hepatitis B Birth Dose Question

The hepatitis B birth dose has become one of the clearest examples of why parents are asking for individual risk-based discussion.

Hepatitis B can be a serious infection, and preventing mother-to-child transmission has been a legitimate public health goal. For infants born to mothers who are hepatitis B positive or whose status is unknown, immediate intervention can be important.

But many parents question why a newborn should receive a hepatitis B vaccine on the first day of life when the mother has tested negative and the infant is not in a high-risk household. They ask whether a universal birth dose reflects the needs of the individual child or the convenience of a population-level policy designed to capture all infants before they leave the hospital.

With new leadership and frontline doctors at the helm of the Advisory Committee on Immunization Practices (ACIP), in December 2025, the CDC adopted individual-based decision-making for hepatitis B immunization, including the birth dose, for infants born to mothers who test negative for hepatitis B. The CDC described this as shared clinical decision-making in which parents and healthcare providers weigh vaccine benefits, vaccine risks and infection risks together before deciding when or if a child should begin the series. [31]

That shift is significant.

It suggests that public health can move back toward individualized care when enough pressure, evidence and public concern demand it.

HPV, Teenagers and the Need for Honest Risk Discussion

HPV vaccination also shows how public health messaging can become complicated.

Gardasil, manufactured by Merck, was licensed in 2006 for females ages 9 through 26 and recommended for routine vaccination of girls ages 11 or 12. ACIP later recommended routine use of quadrivalent HPV vaccine in males in 2011. [32]

The public health rationale was cancer prevention, especially cervical cancer. Over time, messaging expanded to boys as well, emphasizing prevention of HPV-related cancers and transmission.

But HPV vaccination also became a flashpoint because it was promoted for young adolescents, often through school and public health messaging, and because parents raised concerns about adverse events, autoimmune conditions, menstrual changes, fertility and pregnancy outcomes.

Those concerns should not be dismissed.

We again find the “science” as conflicting from public health perspectives and real-world experiences. For instance, the CDC states that CDC and FDA have not found proof that HPV vaccines cause reproductive problems in women, including primary ovarian insufficiency. [33] A published analysis of U.S. females ages 18 to 33 found no evidence of increased infertility among women who received HPV vaccination. [34]

That does not end the trust conversation. Especially when frontline physicians see different outcomes in their clinics and hospitals every day.

It shows why transparent monitoring, adverse-event reporting, long-term study and informed consent are essential. Parents deserve full information, including what is known, what is uncertain, what has been studied, what has not been studied enough, and how decisions should be individualized.

The public health answer cannot be, “Do not ask.”

The answer must be, “Here is the evidence, here are the limitations, and here is how we continue to look.”

Autism, Chronic Disease and the Questions Parents Are Asking

The rise in autism diagnoses has become another major point of public concern, as it should.

CDC data from the Autism and Developmental Disabilities Monitoring Network estimate that about 1 in 31 children age 8 in monitored U.S. communities were identified with autism spectrum disorder in 2022. [35]

That alarming number has changed how parents think about childhood health.

For some families, the concern is vaccines. For others, it is environmental exposures, toxins, food, genetics, immune dysregulation, medication exposures, microbiome disruption, maternal health, screen use, diagnostic expansion or multiple overlapping factors.

IMA’s position is that the question should be studied honestly and broadly.

Public health should not fear investigation into potential harms. It should not treat parental concern as ignorance. It should not assume that because one hypothesis is disputed, every question has been answered.

America’s children are not well served by institutional defensiveness.

They are served by serious research, transparent data and the willingness to ask difficult questions about the total environment in which children are developing.

Public Schools, Parental Rights and Medical Freedom

The childhood vaccine debate is not only medical.

It is also about access, authority and parental rights.

In many states, school attendance is tied to vaccination requirements. California’s SB 277 eliminated the personal belief exemption for currently required vaccines for school and childcare entry, while later laws SB 276 and SB 714 changed the medical exemption process by requiring new medical exemptions to be issued through the California Immunization Registry Medical Exemption system. [36]

California law also allows minors age 12 and older to consent to certain medical care related to the diagnosis or treatment of reportable communicable diseases and to medical care related to the prevention of sexually transmitted diseases. [37]

Supporters of these policies often frame them as necessary for public health, disease prevention and adolescent access to care.

Concerned citizens, and angry parents, see something very different.

They see the state stepping between parents and children. They see public health authority displacing family authority. They see schools becoming enforcement arms for medical policy. They see a system where refusal can mean exclusion from education and where parental consent may be weakened in areas that involve deeply personal beliefs and medical risk.

That is the public health dilemma in its most personal form.

When public health policy reaches into childhood, education and family decision-making, it must be especially careful. Parents are not obstacles to their children’s health. They are the primary protectors of it.

A New Review of the Childhood Schedule

The post-COVID public health conversation has now moved into formal policy review.

In 2026, HHS announced that CDC had acted on a presidential memorandum directing a review of U.S. childhood immunization practices compared with peer developed countries. HHS said the assessment examined vaccine uptake, public trust, clinical and epidemiological evidence, knowledge gaps, mandates and next steps. [38]

The White House later stated that the review found the United States recommends more childhood vaccines than peer nations, including more than twice as many doses as some European nations, and called for updates while emphasizing parental authority, religious liberty and informed consent. [39]

Those official statements are part of a political and scientific debate, and they should be interpreted as such.

But the underlying issue is larger than any administration.

For years, parents who questioned the childhood schedule were often dismissed. Now, federal agencies are acknowledging that the schedule itself, public trust, mandates, knowledge gaps and comparison with other countries deserve review.

That is a meaningful development.

The next step should not be another politicized fight.

It should be transparent science.

Where Public Health Has Helped and Where It Has Failed

Public health is not one thing.

It can be sanitation, food safety, disease surveillance, emergency response, maternal health, tobacco education, workplace safety, school policy, drug regulation, immunization recommendations, mental health campaigns, nutrition guidance or pandemic orders.

That is why it must be evaluated honestly, not defended reflexively.

Where public health has tangibly helped, the evidence should be acknowledged. Clean water, safer food, reduced workplace hazards, improved maternal and infant care, infectious disease surveillance and nutrition programs can contribute to better health and longer life in America. [2]

Where public health has failed, the harm should also be acknowledged. Tuskegee, eugenics, coercive sterilization, institutional abuse, opioid policy failures, COVID mandates, school closure harms, censorship pressure, conflicts of interest and one-size-fits-all medical policy all belong in the same broad conversation about what happens when authority overruns humility.

The lesson is not that public health should be abolished.

The lesson is that public health must be restrained by ethics.

What Public Health Must Learn

Public health must return to its proper role.

It should guide, not dominate. It should inform, not shame. It should persuade, not coerce. It should admit uncertainty before trust collapses. It should disclose conflicts before the public discovers them. It should protect the vulnerable without treating individual liberty as a nuisance or obstacle to overcome.

Maybe the most important, it must also remember the physician.

A public health agency can issue guidance for a population. It cannot know the full story of the individual patient. It cannot replace the doctor who understands a child’s medical history, a mother’s pregnancy risk, a patient’s prior injury, a family’s religious conviction or a person’s lived experience.

That is why informed consent should never be treated as a threat to public health.

It is the moral boundary that keeps public health from becoming medical control.

Remember the Roots, Restore the Trust

American medicine cannot move into its next 250 years carrying the same patterns forward.

Disease outbreaks will come again. Unknown pathogens will emerge. Hospitals will face pressure. Communities will need accurate information. Scientists will need to study, test and respond. Agencies will need to coordinate.

But the next crisis must not repeat the same mistakes.

Public health must never again ask Americans to surrender trust without transparency. It must never ask physicians to silence clinical judgment for institutional unity. It must never treat patients as populations first, and persons second.

Trust is not created by fear. It is not created by censorship. It is not created by mandates.

Trust is created when institutions tell the truth, respect the patient, protect the doctor-patient relationship and admit what they do not yet know.

That is the public health that America deserves for the next 250 years.

Source Notes

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