Healthcare professionals' trust in health authorities throughout COVID-19: a social media analysis

Healthcare professionals' institutional trust in health authorities is important for effective crisis response, as these professionals serve as both implementers of health directives and trust intermediaries influencing public confidence. Despite extensive research on public trust during COVID-19, studies examining healthcare professionals' trust in health authorities remain limited. Traditional survey methods face declining response rates and provide only cross-sectional snapshots. Social media platforms offer longitudinal data enabling analysis of trust expressions over extended periods. We analyzed 50,308 tweets from 9,442 healthcare professionals mentioning WHO, CDC, and FDA from January 2019 through March 2023. Large language models assessed trust levels using a 5-point scale. WHO showed the highest mean trust score, followed by FDA and CDC. Trust patterns varied by authority: WHO showed a pronounced early-pandemic decline with subsequent recovery, CDC showed sustained trust erosion throughout 2022-2023, and FDA remained relatively stable. Topic modeling identified 10 major themes, with integrity concerns dominating low-trust discourse across all authorities. Social media analysis demonstrates feasibility for continuous monitoring of healthcare professionals' trust dynamics, enabling early detection of authority-specific trust erosion patterns.