After two years of pandemic fatigue, trust in healthcare is at an all-time low, according to Edelman’s Trust Barometer Special Report on Trust in Healthcare. 

Trust is a key determinant of both health behaviors and outcomes, but COVID-19 has greatly influenced how the public makes healthcare decisions, according to the February online survey of more than 10,000 people in 10 countries around the world.

“We saw swings in trust since January 2020, which speaks to the volatility of the pandemic,” said Kirsty Graham, Edelman global chair of health. “This may be because so many people were interacting with the healthcare system in very stressed times. The volatility may also reflect what was happening directly around them – the prevalence of Covid-19, availability of vaccines and other localized factors.”

More than half of respondents say the pandemic reduced their confidence in the healthcare system, and only 61% say they are confident in their ability to find answers about healthcare and make informed decisions for themselves and their family, a 10-point decline over five years.  

The report also found trust in the healthcare sector directly impacted not only personal health behaviors but a person’s likelihood to change their health decisions based on how they affect others. 

Those with higher levels of trust in healthcare are more likely to be proactive about their general health, vaccinated against COVID-19, supportive for public health measures over personal freedom and accepting of changing recommendations from healthcare officials than are low-trusting respondents. 

Vaccination status also correlates to where the public received their medical advice. The unvaccinated rely on the internet and peer voices, not health experts, for information on vaccinations, while the vaccinated turn to doctors and national health experts. 

The divide stems from a mixture of economic, geographic, cultural and political factors. Of those surveyed, 71% of high income earners were more likely to trust healthcare compared to 55% of low income earners, while 62% of white people had high trust compared to 55% of Black.

More than half of those surveyed (55%) worry medical science has become politicized, and survey results split along party lines. Only half of Independent or third-party voters had high trust in healthcare compared to 60% of Republicans and 70% of Democrats. 

Rebuilding the public’s trust in healthcare will take time and a dedication to breaking through the information barrier and building trust across the entire health ecosystem.   

Employers and businesses would be ideal platforms for reaching employees about health information, according to Graham.

“Businesses also need to elevate the voices of doctors and experts, who are trusted in health, but recognize that the message, the messenger and the mode must meet all audiences where they are,” she said, adding that those with lower trust like to hear from local voices most. “If we learned one thing from the pandemic, it was that hyper-local messaging broke through trust barriers.”

Only half of those surveyed said they consume health information regularly, but cost and information play nearly equal roles in determining a person’s ability to take care of their health. 

This article originally appeared on PRWeek US.