Not Ready: The Trust Stockpile Is Bare

Everyone is sick and tired (literally and metaphorically) of worrying and talking about COVID-19. It disrupted daily life for more than three years and tore the social fabric. Globally, there have been 768 million confirmed infections and nearly 7 million deaths. Here in the U.S., those numbers are 103 million cases and more than 1.1 million deaths.

The threat posed by COVID is far less now, though it is still a reality. Nearly everyone has some level of immunity; more than 96% of Americans have either had the coronavirus, been vaccinated for it, or both. COVID infections, hospitalizations, and deaths are all small fractions of what they were at the peak of the pandemic. It is a relief that the United States and the World Health Organization (WHO) both recently declared an end to the COVID-19 public health emergency.

Will we be ready — or not — for the next pandemic? And another pandemic is quite possible. The outgoing director of the Centers for Disease Control and Prevention (CDC) recently wrote: “I want to remind America: The question is not if there will be another public health threat, but when.” The WHO director-general recently warned: “the threat of another pathogen emerging with even deadlier potential remains.” Some disease forecasters predict a 27% chance of pandemic as deadly as COVID within the next 10 years.

I’ve written before about how woefully unprepared our public health system was to meet the moment during the COVID-19 pandemic; we’ve chronically underinvested in public health, and we’ve paid a terrible price for it.

Will we be any better prepared the next time around? My answer is both yes and no.

The biggest reason for optimism is in the scientific arena. It is stunning that a COVID vaccine progressed to phase 1 clinical trials in just 66 days; safe and effective vaccines were in people’s arms in less than a year. In the past, vaccines took years or decades to develop and test. Before COVID, the fastest vaccine ever developed was for mumps and that took four years. The virus that causes AIDS was identified in 1984; it’s 39 years later and we still don’t have a vaccine.

Looming large among the reasons for no: a massive breakdown of trust. Lack of trust — in government and other public institutions, in public health professionals, in the media, in our neighbors — sets us up to be less healthy and even more vulnerable to the next pandemic. Technical missteps, bungled communications and messaging, the deliberate spread of misinformation and conspiracy theories, and deep political polarization have eroded trust. Consider the facts:

  • In 2021, according to Gallup, only 39% of Americans had a great deal or a fair amount of trust in the federal government to handle either domestic or international affairs.
  • Pew Research Center survey in 2022 found that fewer than half of the respondents said the country had “given the right amount of priority to the needs of K–12 students, public health, [and] quality of life.”
  • In an NBC News poll taken last year, just 44% of Americans said they trusted the CDC, compared with 69% at the start of the coronavirus outbreak.
  • Here’s the clincher: a study of 177 nations found that “low levels of government and social trust, as well as higher levels of government corruption, are strongly correlated to higher COVID-19 infection rates around the world.” Meanwhile, indicators like pandemic preparedness, democracy, universal health care, and hospital capacity weren’t significantly related to COVID outcomes.

Trust is easy to lose and hard to earn. It’s even harder to regain. Pandemic preparedness has many dimensions. Certain things — like rebuilding the stockpiles of personal protective equipment — are relatively straightforward. But the “trust stockpile” is bare and refilling it will be difficult.

There are ways to build up trust in public institutions and government officials. Better communication could go a long way: clear and consistent messaging, upfront acknowledgements that the landscape is changing rapidly and guidance may be updated as more is learned; and honesty and humility in quickly communicating mistakes. But it will take a long time to restore the trust that was lost during COVID, and it’s baked into our politics at this point to be mistrustful of elected officials who don’t share our views.

We must look beyond public institutions. The same NBC poll found that Americans are more likely to trust people they know or people with whom they have direct contact. For instance, the group that ranked highest was “your employer.” And there was some consistency across the political spectrum; about 70% of Democrats and 53% of Republicans said they trusted their employers. Parents trust their local schools. The takeaway: the public is more likely to trust the people who employ them and those who teach their children than they are to trust the experts. Working with messengers within communities — from religious leaders to community health workers to barbershop and beauty salon staff — to deliver public health information is one promising approach. Shoring up our health care systems could also make a difference; Americans tend to trust their own doctors, but those without a usual source of care don’t have the opportunity to build those trusting relationships.

As tempting as it is to forget about COVID and its lessons, doing so is guaranteed to be deadly. Rebuilding trust and social cohesion may be the hardest task of all. And right now, we are nowhere near ready on that score to meet the challenges of another pandemic. But there is time to change that; we should get started.

By David Sandman, President and CEO, New York Health Foundation
Published in Medium on June 29, 2023

Mental Health of New Yorkers Stagnates Overall, Worsens for Some New Yorkers

Contact: Arica VanBoxtel,

June 21, 2023, New York, NY – More than three years after the onset of the COVID-19 pandemic, rates of depression and anxiety among New Yorkers remain highly elevated. One in three New Yorkers are experiencing one or both conditions—a rate that has not budged since May 2021. Mental health distress is more common among some groups of New Yorkers than others, disproportionately affecting young people, people of color, people with low income, those who lost employment income during the pandemic, and those experiencing food insufficiency.

The findings come from a New York Health Foundation (NYHealth) analysis of U.S. Census Bureau survey data on self-reported symptoms of anxiety and/or depression from the beginning of the pandemic through March 2023.

“Even with the worst of the pandemic behind us, it’s obvious that New Yorkers are still struggling,” said David Sandman, Ph.D., President and CEO of NYHealth. “As other parts of life return to a version of normal, we’re essentially treading water when it comes to mental health in New York.”

Key findings include:

  • More than three in ten (31.5%) New Yorkers reported poor mental health in March 2023, the most recent date for which data are available. That proportion shows no improvement from May 2021, when 32% of New Yorkers reported poor mental health.
  • Rates of poor mental health among New Yorkers have fluctuated throughout the pandemic. They peaked in February 2021, when two in five (40.2%) New Yorkers said they experienced anxiety and/or depression. The most recent spike (37.2%) occurred in September 2022.
  • Some groups of New Yorkers were more likely to experience depression and/or anxiety. In the first quarter of 2023:
    • One in two (50.0%) New Yorkers with very low incomes (less than $25,000 per year) reported anxiety and/or depression, more than twice the rate of those with annual household incomes of $100,000 or more (22.1%).
    • Younger adults had poorer mental health rates than other age groups; two in five (40.0%) New Yorkers between the ages of 18 and 34 reported poor mental health.
    • Poor mental health increased most for Asian New Yorkers and Hispanic New Yorkers; two out of five (41.0%) Hispanic New Yorkers reported anxiety and/or depression.
    • One in two (50.7%) New Yorkers who lost employment income since the onset of the pandemic reported anxiety and/or depression.
    • More than half (57.4%) of food-insufficient New Yorkers had poor mental health—nearly twice the rate of food-sufficient New Yorkers (29.2%).

“Mental health is a persistent challenge across the board in New York, but some people are struggling more than others,” said Mary Ford, Director of Policy and Research at NYHealth. “As policymakers and others consider opportunities to expand and improve mental health services, they should prioritize New Yorkers who are facing economic hardship, young people, and New Yorkers of color.”

The researchers and mental health providers will explore the findings in-depth and discuss how to improve mental wellbeing in an upcoming NYHealth webinar on Wednesday, June 28.

View the full data brief here.


The New York Health Foundation (NYHealth) is a private, statewide foundation dedicated to improving the health of all New Yorkers, especially people of color and others who have been historically marginalized. The Foundation is committed to making grants, informing health policy and practice, spreading effective programs to improve the health care system and the health of New Yorkers, serving as a convener of health leaders across the State, and providing technical assistance to its grantees and partners.