More Transparency Would Limit Distrust.

• Position: PUBLIC HEALTH ETHICS

Distrust and, at times, outright dismissal of public health's evolving pandemic guidance might have been minimized by relying more heavily on input and guidance from ethicists, argue the authors of a new perspective piece in the New England Journal of Medicine.

"Policymaking always involves tradeoffs based on evolving evidence and values, and public health ethics is particularly good at identifying and working through conflicts between the two with the best interest of the broader community in mind," says Amy Fairchild, dean of Ohio State University's College of Public Health, who cowrote the piece with Efthimios Parasidis, a health law and bioethics specialist in the Colleges of Law and Public Health.

The authors acknowledge public health's missteps, including oversimplifying messaging by characterizing policy as "following the science," and the repercussions of that approach. They write that public health decisionmakers often failed 'to adequately explain the reasoning behind their decisions about interventions, such as mask mandates, quarantine and isolation policies, mandatory testing, and transitions to remote work and learning... without acknowledging that the data models they were relying on have varying degrees of accuracy and reliability, that the available evidence would evolve and require reevaluation, and that reasonable people could disagree about how to translate data into policy.

"In fact, officials sometimes relied on 'noble lies,' intentionally misrepresenting facts in order to support their decisions, simplify communications, or maintain calm. These tactics eroded public trust, hindered adoption of COVID mitigation measures, and fueled social movements opposing health policies and officials. Once follow the science' was exposed as an overly simplistic mantra, various segments of the public chose for themselves what guidance they would follow."

Public health ethicists, who concern themselves with the balance between individual freedom and community good, are too few and were not called upon often enough to help sort...