Harms of Public Health Measures Overlooked in COVID-19 Policy Reviews

Major retrospective policy reviews of the COVID-19 pandemic response were found to devote less than 1% of contents to the harms of public health measures, according to an SSM - Population Healthstudy arguing that harms must be weighed alongside benefits.¹

“The COVID-19 pandemic challenged public health and required timely responses despite incomplete evidence,” wrote authors of the analysis.¹ “In many respects, this was public health’s finest hour, with the rapid development and deployment of effective COVID-19 vaccines. However, other measures to combat the pandemic have received much criticism—some warranted and some not—which has undermined trust in public health officials.”

As childhood vaccine exemptions rise and measles makes a comeback, the analysis argues that pandemic reviews that failed to weigh the harms of COVID-19 measures may have deepened the public mistrust pharmacists now face at the counter, as well as patients’ overall distrust of public health.

READ MORE: CDC Opens Orders for COVID-19 Vaccines in Vaccines for Children

Evaluating the Cost of Overlooking Harms in Post-Pandemic Reviews

The SSM-Population Health analysis emphasizes that prominent retrospective pandemic evaluations in major medical journals virtually ignored the negative externalities of nonpharmaceutical interventions such as school closures, business disruptions, and social isolation.¹

By focusing almost exclusively on whether public health authorities underreacted, these high-profile reports failed to systematically account for policy overreactions or errors of commission where restrictions created substantial economic, educational, and psychological harms. When official public health inquiries omit these real-world trade-offs, they undermine the comprehensive evidence base required for future crisis planning and exacerbate public skepticism toward health guidelines.

This analytical gap leaves frontline health care professionals, particularly community pharmacists, bearing the operational brunt of growing public cynicism when recommending routine preventive measures.^1,2

A broader conceptual framework on public health errors notes that official decisions or omissions yielding health outcomes substantially worse than available alternatives compromise systemic credibility, regardless of whether those choices were intentional or culpable.³

This loss of trust is substantiated by national survey data across the US, which documented a dramatic drop in public trust toward physicians and hospitals from 71.5% in April 2020 down to 40.1% by January 2024. Researchers found that lower trust levels directly correlated with reduced uptake of COVID-19 vaccines and seasonal influenza immunizations, creating severe public health vulnerabilities that manifest daily in local pharmacy settings.⁴

Navigating Retail Barriers and Rebuilding Community Trust at the Counter

Qualitative investigations into vaccine decision-making reveal that patient hesitancy is rarely plain opposition but rather a reflection of deep-seated institutional distrust stemming from pre-existing negative experiences with health insurance, drug pricing, and medical access barriers.⁵

In community pharmacies, establishing strong interpersonal trust is further complicated by structural factors, including the retail business environment, opacity surrounding pharmacist remuneration, and limited public understanding of professional qualifications. Nevertheless, local pharmacies often function as critical hubs where accessible, approachable clinicians can address individual doubts and effectively bridge the gap between cautious patients and health institutions.^5,6

To overcome medical mistrust and improve long-term outcomes for patients with chronic conditions, public health frameworks advise pharmacists to deliver culturally competent care, screen for health-related social needs, and partner with community health workers.²

By practicing active listening, demonstrating personal respect, offering clear guidance on medication affordability, and fostering community linkages, pharmacists can transform daily counter interactions into pivotal opportunities to restore public confidence across the health care system.^2,6

“The fact that inquiries largely ignored policy trade-offs is discouraging. Diversity of thought, free from ideological bias, is key to assessing the adequacy of government responses to the pandemic,” concluded authors of the current report.¹ “To improve public health outcomes, to prevent the recurrence of policy mistakes, and to restore trust in public health authorities, accountability inquiries must assess the harms as well as the benefits from public health interventions and weigh them against each other. So far, this has not been done.”

READ MORE: COVID-19 Resource Center

REFERENCE

1. Bavli I, Sutton B, Bardosh K, et al. Incomplete assessments: including harms and trade-offs in assessing policy approaches to COVID-19. SSM - Population Health. 2026;36:101983. doi:10.1016/j.ssmph.2026.101983

2. Public health strategies for pharmacists to improve health for people with chronic disease. CDC. September 8, 2026. Accessed October 19, 2026. https://www.cdc.gov/cardiovascular-resources/php/public-health-strategy/index.html

3. Bavli I. When public health goes wrong: toward a new concept of public health error. J Law Med Ethics. 2023;51(2):385-402. doi:10.1017/jme.2023.67

4. Perlis RH, Ognyanova K, Uslu A, et al. Trust in physicians and hospitals during the COVID-19 pandemic in a 50-state survey of US adults. JAMA Netw Open. 2024;7(7):e2424984. 2024 Jul 1. doi:10.1001/jamanetworkopen.2024.24984

5. Casselman-Hontalas A, Adams-Santos D, Watkins-Hayes C. Discourses of distrust: how lack of trust in the U.S. health-care system shaped COVID-19 vaccine hesitancy. RSF. 2024;10(4):154-172. doi:10.7758/rsf.2024.10.4.07

6. Gregory PAM, Austin Z. Understanding the psychology of trust between patients and their community pharmacists. Can Pharm J (Ott). 2021;154(2):120-128. 2021 Feb 16. doi:10.1177/1715163521989760