The Trust Gap: What the Fauci Hearings Reveal About Public Health

Posted on September 1, 2026 by Justin B. Moore Leave a comment

As my colleague Dr. Shafer mentioned in the first post, the recent interrogation of Dr. Anthony Fauci by the US senate was, in many ways, a travesty. It epitomized many of our current problems in America, including a belligerent ideology that attacks expertise and a broader backlash against public health and public health officials. However, it is important to unpack this situation if we are going to learn from it. Some aspects reflect larger societal trends, while others point to failures within the public health system itself and continued efforts to optimize the public health workforce.

On the first issue, we are witnessing an attack on the intellectual elite, a term that has somehow become negative when being intellectually gifted should be viewed as assets. This concept is not new and was expertly captured in Tom Nichols’ excellent book The Death of Expertise. The vitriol directed at academics, scientists, and other experts has reached a new fever pitch. There are many possible reasons for this, but it often appears that people with less aptitude for the sciences, medicine, or public health resent being told that they do not know as much as they think they do about those disciplines. As a result, some lash out at those who are recognized experts in fields outside their own. This is obviously dangerous and counterproductive, but there is relatively little that can be done about it. We have been dealing with this phenomenon for quite some time. Still, I think it is related to a second issue: the widespread lack of trust in public health that reached a breaking point during the COVID pandemic.

Here, the public health and scientific communities also bear some responsibility. In my opinion, having Anthony Fauci become the face of public health during the pandemic represented a significant mismatch between expertise and job responsibilities. While Dr. Fauci was clearly a brilliant virologist, he was not ideally suited for the role he was ultimately given and was not especially well suited to be the face of the government response to the pandemic. At the same time, he appeared to embrace the attention, visibility, and admiration that came with that position, which contributed to the appearance that he was perhaps fear mongering to extend his 15 minutes of fame.

More broadly, this reflects a pattern we see across many intellectual fields and one that, in my view, has contributed to some of the backlash we now face. In academia, for example, we have a long history of taking people who excel in research, teaching, and service and placing them in administrative positions for which they have little formal preparation. For example, I am currently an interim department chair despite never having received formal training to be a department chair, even though many universities offer doctoral degrees in higher education administration, which would have better prepared me for the position and its responsibilities. If you look across comprehensive universities in America, most administrative positions are held by people much like me. They may be outstanding professors of public health, law, engineering, humanities, or another discipline who then become department chairs, associate deans, deans, provosts, and eventually presidents. Not all of them perform poorly. Many learn and adapt remarkably well. Still, there is a certain irony in working at an institution that offers degrees specifically designed for these roles while most of the people occupying them do not hold those credentials.

A similar pattern has existed historically in public health. Directors of public health departments at the county, city, and state levels have often held medical degrees despite the fact that the MD curriculum alone typically includes little, if any, coursework in population health, surveillance, epidemiology, health education, health behavior, health services, or many of the other foundational elements of public health practice. To be clear, an MD combined with specialized public health training, such as a Master of Public Health degree, can be an outstanding combination. However, I would venture that many public health leaders do not have that additional training, and the lack of it is a detriment to the field.

This is particularly noteworthy given that there are doctoral degrees specifically aligned with the competencies required for these positions, such as the Doctor of Public Health degree, as well as degrees in health care administration and related fields. As a result, we have seen many high performing health directors from a variety of professional backgrounds. At the same time, we have also seen lower performing leaders whose struggles may be attributable, at least in part, to a mismatch between preparation, experience, and job responsibilities. Everyone can learn on the job, but it would be better to begin with foundational skills that are directly relevant to the position.

This brings us back to Dr. Fauci. Despite his distinguished career at the NIH, he found himself in a role that involved public communication and public relations as much as, if not more than, infectious disease research. In hindsight, one could argue that he would not have been the ideal spokesperson for the government’s pandemic response. While he undoubtedly consulted with individuals whose expertise aligned more closely with those responsibilities, one could also argue that the relative absence of communication experts and, later, implementation scientists, contributed to some of the challenges that followed. While he undoubted was hindered by a president who was openly hostile to outside experts who might challenge his power and influence, and a decentralized national public health system, I cannot be convinced that a seasoned metropolitan health director (for example) could not have done a better job.

What we now accept as true is that there was a remarkable acceleration of vaccine technology and discovery that resulted in a very rapid, very safe, and very effective COVID vaccine. Dr. Fauci had a large role in advancing this discovery. However, even the most sympathetic public health professionals would likely agree that the vaccine rollout was suboptimal. I would go further and argue that it was the worst executed vaccine rollout of my lifetime, as distribution was fragmented, prioritization strategies varied widely, public health messaging lacked consistency, and implementation differed substantially across locations. Again, it is also fair to note that the president in 2020 undermined the process by repeatedly suggesting that COVID was not a serious threat and would disappear quickly. Anyone with a basic understanding of epidemiology knew that the virus would spread widely in the United States and have significant consequences.

My broader point is that when individuals are placed in leadership roles without adequate preparation in the relevant discipline, organizations become vulnerable to poor decision making and diminished public trust. Whether that is a health director without sufficient epidemiological training, a population health leader lacking a public health background, or another example entirely, the risk is the same. Even highly intelligent and capable people may struggle when their preparation does not align with their responsibilities.

As a result, I would advocate for several things. First, those of us who possess expertise in a particular field should think carefully before stepping into conversations outside our area of competence. Put simply, we need to learn to stay in our lane. When a dentist offers opinions on COVID transmission, the public may not realize that the individual lacks formal expertise in infectious disease epidemiology. Similarly, an MD without specialized public health training often knows relatively little about epidemiology. I say this as someone who has taught epidemiology to medical students at two different universities, and I can assure you that the rudimentary epidemiology instruction they receive disappears from consciousness following the USMLE Step 1 exam.

Ultimately, we need as much humility as confidence in our skills. Second, we need to practice what we preach when building and supporting the workforce. In academia, leadership development programs have become increasingly common. While obtaining an additional master’s degree in higher education administration may not be practical for many leaders, intensive mentoring and leadership training represent important steps in the right direction. Likewise, the growing number of public health leaders with specialized public health training is a positive development.

Third, at the federal level, once we recommit to public health, we should elevate the visibility and influence of professionals at the Centers for Disease Control and Prevention who are specifically trained to communicate with the public and work through local health departments. These individuals are often better positioned to build trust with the communities they serve. As in the end, our goal is to protect and serve all individuals through our respective professions. This includes people who may not share our academic background, specialized knowledge, experience, or expertise. That does not mean they lack expertise altogether. Their expertise is simply different from ours. It is important that we acknowledge that and show them the respect we hope to receive.

In a world where successful people increasingly assume that excellence in one domain translates automatically into competence in every domain, humility becomes essential. This can be seen in sports when wealthy owners believe that business success makes them effective general managers despite years of disappointing results. It can be seen closer to home when leaders assume that accomplishments in one field automatically qualify them to lead in another. Regardless of the field, the underlying lesson is the same: If we are to be trusted and followed, we must model the behavior we wish to see. We must also align our training and experience with our roles and clearly articulate why we should be trusted in the first place before making authoritative proclamations and demanding deference. It’s true that we cannot bestow the requisite knowledge on the public to understand the miracle that discoveries such as mRNA vaccines truly are; however, we can build a bridge to trust early and maintain it often so that, when the moment comes, we might come to an understanding that we’re all on the same team.

About the Author

Justin B. Moore: Justin B. Moore, PhD, MS, FACSM, is a Professor and Interim Chair in the Department of Implementation Science in the Division of Public Health Sciences at Wake Forest University School of Medicine. He serves as the Editor-in-Chief of the Journal of Public Health Management and Practice.