Polarized Public Opinion About Public Health During the COVID-19 Pandemic: Political Divides and Future Implications

In recent years, political polarization in the US has grown, and this polarization is being reflected in the public’s attitudes toward the field of public health, which was traditionally considered to be science-based and nonpartisan. Understanding the extent of polarization in public opinion is crucial to guide public health and policy leaders. We reviewed the results of 6 nationally representative polls of US adults (≥18 years old) conducted during the COVID-19 pandemic (2020 and 2021) on the US public health system^1-6 as well as a comparable poll conducted in 2009.⁷ We examined the gaps between Democrats’ and Republicans’ views and found stark differences in several areas with major implications for the future of public health.

In the midst of the COVID-19 pandemic, Democrats were generally trusting of recommendations made by key public health institutions, whereas Republicans generally were not. Polling in 2021 found large gaps (>20 percentage points) between Democrats and Republicans for their degree of trust in the Centers for Disease Control and Prevention (CDC; 76% vs 27%), the National Institutes of Health (NIH; 61% vs 21%), Food and Drug Administration (FDA; 47% vs 26%), and state health departments (59% vs 22%),¹ indicating that the public health establishment is not a well-trusted source of information for substantial majority of Republicans. This finding reflects broader trends of growing political divides over public trust in science and differences in public opinion regarding the role of scientific experts in making policy decisions.

When rating the performance of public health departments and agencies in 2021 during the COVID-19 pandemic, Democrats gave much higher ratings than Republicans across the board, with remarkably wide differences in positive ratings of the CDC (74% vs 32%), NIH (66% vs 28%), the FDA (58% vs 34%), and local (64% vs 40%) and state (56% vs 39%) health departments.¹ These findings were a marked change from 2009 when Democrats and Republicans gave generally similar ratings of the CDC, the NIH, the FDA, and state health departments⁷; and more than half of Republicans (56%) gave positive ratings to the nation’s public health system, compared with only 39% of Democrats. While Democrats’ views on the nation’s public health system have remained roughly stable (40% positive ratings in 2021), only 30% of Republicans gave positive ratings to the nation’s public health system in 2021, a 26 percentage-point decline from 2009.^1,7

Notable political divides are evident in Democrats’ and Republicans’ respective attitudes toward COVID-19 vaccinations and mask mandates, including support for President Biden’s employer vaccine mandate (82% vs 19%)²; face mask requirements for students, teachers, and staff in schools (95% vs 29%)³; and COVID-19 vaccination requirements for in-person return-to-school for children 5 to 11 years old (76% vs 15%)³ and 12 years or older (72% vs 40%).⁴ These findings also are reflected in the current partisan positions taken by governors on vaccine and mask mandates in their states.⁸

Beyond trust, when given a list of issues broadly identified by public health experts as being within the domain of public health agencies, Democrats have a more expansive view of the role of public health compared with Republicans.¹ Notably, major differences are evident between Democrats and Republicans on whether reducing racism (58% vs 24%) and preventing gun violence and deaths (57% vs 20%) are main responsibilities of public health agencies. Depending on which political party controls the federal and state governments, its view on the scope of public health will affect the public’s support for the agencies that are tackling these controversial issues and will ultimately influence the country’s funding priorities and the legislative authority of public health agencies.

Despite the political divisions over COVID-19 vaccination policies, large majorities of Democrats (75%) and Republicans (69%) report they have mostly positive views of physicians,⁵ and more specifically, most Democrats (93%) and Republicans (81%) trust their own physician or health care professional to provide reliable information on the COVID-19 vaccine.⁶ More broadly, nurses, physicians, and health care workers remain the most trusted sources of information to improve health for both Democrats and Republicans.¹ This finding suggests a potential major role for clinicians to play in the future to help their patients understand public health issues.

Wide political differences in public opinion will profoundly shape the future of public health in the US in the post−COVID-19 era, with the content, scope, and funding of public health policies and institutions likely to change dramatically as power shifts between Democrats and Republicans at both the federal and state levels. The COVID-19 pandemic has accelerated a shift in the public’s perception of the field of public health away from its historic reputation as a fact-based, science-centered discipline toward a politicized field whose role is defined very differently by those in each political party. In general, Democrats are expansive in defining the role of public health, and Republicans take a more restrictive view.

Great uncertainty persists in how to reduce polarization and restore trust in science and medicine. Public opinion data show that these concerns extend to the field of public health. Political polarization is generally a reflection of differences in core values held by partisans, more so than disagreements over facts. Thus, educating partisans about evidence on public health issues is unlikely to change the current divisions.

Barring substantial shifts in the values held by the public, public health and policy leaders must either communicate public health issues in ways that reflect the differences in these underlying belief systems or work to bridge the public’s core principles and values. A hopeful possibility exists with both Democrats and Republicans largely trusting their own physicians and nurses for health guidance and recommendations. In the future, these health care professionals could play a broader and more sustained role in discussing public health issues with patients.

Published: March 18, 2022. doi:10.1001/jamahealthforum.2022.0016

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Findling MG et al. JAMA Health Forum.

Corresponding Author: Mary G. Findling, PhD, ScM, Harvard Opinion Research Program, Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, 677 Huntington Ave, Kresge Room 417, Boston, MA 02115 (mgorski@hsph.harvard.edu).

Conflict of Interest Disclosures: Dr Findling reported grants from Robert Wood Johnson Foundation during the conduct of the study. Dr Blendon reported grants from Robert Wood Johnson Foundation during the conduct of the study. Dr Benson reported grants from Robert Wood Johnson Foundation during the conduct of the study.