The COVID-19 pandemic introduced significant uncertainty among Americans, and eroded trust in US health entities and institutions. This study describes a longitudinal assessment of Americans’ change in confidence in these public health entities from 2020 to 2024. We conducted four surveys assessing confidence in public health entities among US adults conducted between February 2020 and October 2024. Surveys were hosted by CloudResearch and administered to a representative sample of US adults (18+). Data was weighted using age, gender, and race estimations sourced from the American Community Survey (ACS) 2022. From February 2020 to June 2022, Americans’ confidence declined for all entities asked about, most notably the Centers for Disease Control and Prevention (CDC, 26%). Despite slight increases between 2022 and 2024, levels of confidence have not recovered to pre-pandemic values. In contrast, Americans’ confidence in their own doctor and their local health department increased from 2022 to 2024 (5% and 19%, respectively), as did confidence in the White House (7%). Our study saw a marked decrease in confidence in public health institutions among US adults, a finding which has implications for the effectiveness of public health communication. Our results highlight the potential for local entities, including personal doctors and local health departments, to leverage the existing trust between them and their public to provide essential public health information and address low confidence in national entities.