Navigating distrust and competing priorities during the COVID-19 pandemic: insights from Florida to strengthen cooperation.

Introduction: Stopping an infectious disease outbreak relies on a coordinated set of actions across public and private institutions and the wider public. However, cooperation with public health recommendations was notably hindered during the pandemic by widespread distrust in science and government and the notion that public health competed with other priorities. This study aims to examine the factors driving distrust and competing priorities in Florida, and potential pathways to overcome these issues. Methods: We conducted an additional analyses of qualitative data from our original study involving 25 semi-structured interviews with Florida stakeholders from government, academia, and the private sector. We employed a deductive-inductive approach to qualitative content analysis, using themes from the initial study as a guiding framework while allowing for the emergence of additional insights. Results: Interviews revealed that inadequate transparency and data availability, politicization, and poor communication were perceived as undermining public trust in science and decision-makers during COVID-19. The economy and individual rights were discussed as priorities competing against public health during the pandemic. Objectives for building trust and balancing priorities included five essential areas: transparency, representation, communication, education, and balance. Discussion: These challenges and objectives reflect the need for a reimagined approach to public health policy and practice-one that is rooted in trust and respect for diverse value systems. By leveraging core collective values that cut across political ideologies, we may mitigate polarization and perceived stigmatization to build a more culturally resonant public health practice.