The Dalai Lama once said, “A lack of transparency results in distrust and a deep sense of insecurity.” It’s a warning that feels especially relevant today, as public health institutions around the world face growing scrutiny and criticism.
Since the COVID-19 pandemic, confidence in national health authorities has steadily declined. Many people experienced lost education and employment opportunities during those years, often with little acknowledgment—or compensation—from those responsible for managing the crisis, leaving them frustrated and distrustful. Consequently, they increasingly turn to apps and social media for guidance, sceptical of advice from established bodies such as the World Health Organization (WHO) or the U.S. Centers for Disease Control and Prevention (CDC).
As science is drawn into political and ideological battles, traditional methods of communication no longer suffice. Public health faces a crisis of trust and regaining it will require more than fresh messaging. Officials must acknowledge that institutions have not always been transparent or necessarily provided the best counsel. Owning past missteps, including those made during the pandemic, is essential to rebuilding credibility.
Yet debates over transparency and trust should not remain confined to what happens ashore. On the world’s oceans, a quieter but equally consequential information gap shapes how cruise ship health risks are reported; and it too merits its own public conversation.
The Transparency Gap at Sea
Cruise passengers may expect the highest standards of hygiene, but few realise how little public information exists about ship sanitation inspections or disease outbreaks. Fewer still are aware of how sharply the approach to port health inspections can differ, even between Europe and the United States. Despite advances in digital reporting and data collection, the information available to the public still depends largely on where, and whether, a ship is inspected.
In Europe, the EU SHIPSAN Association oversees port health inspections of cruise ships, applying standards from its ‘European Manual for Hygiene Standards and Communicable Disease Surveillance on Passenger Ships’. At the time of writing, the results of 35 inspections conducted so far this year have been published, with every vessel receiving the highest grade: A.
Passengers, however, see only that letter grade—if they see it at all—not the findings behind it. An “A” offers no way to distinguish between a ship with minor administrative lapses and one with more substantive food or water safety violations. (Some social media posts even claim several ships recorded no areas of non-compliance during SHIPSAN inspections.) Likewise, when outbreaks occur, no public record or notification follows.
Across the Atlantic, the picture is strikingly different. The CDC operates the Vessel Sanitation Program (VSP), which openly publishes inspection scores, full reports, corrective actions, and summaries of outbreak investigations. For context, the VSP has already conducted more than four times as many cruise ship sanitation inspections this year (152 to date).
Such a disparity prompts a simple question: why should the same industry be transparent in Miami but opaque in Mykonos? And what does that mean for passenger safety—and for public trust in the cruise industry’s health standards?
Europe’s Partial Picture
The VSP was established in 1975 and issued its inaugural operations manual in 1989. By comparison, SHIPSAN is relatively young: its cruise ship hygiene guidelines were first published in 2011, with the most recent update in 2016. Even accounting for its comparative infancy, this does not excuse the European system’s continued shortfall in publishing actionable public health data.
Posting inspection grades without context leaves passengers and other stakeholders guessing how a single letter correlates with actual hygiene standards. And by not publicly disclosing outbreaks of gastrointestinal illness or other communicable diseases—even in aggregate form—it is impossible to assess whether the recent increase in acute gastroenteritis outbreaks on ships sailing in U.S. waters is mirrored in Europe. This opacity denies health authorities, researchers, and cruise lines the opportunity to learn from incidents and strengthen preventive practices.
The broader healthcare evidence is instructive. A recent study in The Journal of Philosophy, Ethics, and Humanities in Medicine synthesized decades of evidence demonstrating that “information transparency affects healthcare performance and public trust.” Similarly, a JAMA Health Forum article concluded that public reporting fosters continuous improvement: when performance data is visible, organisations tend to correct deficiencies faster and sustain higher standards.
These lessons apply directly to cruise operations. Freely accessible information would help travellers make informed choices, enable regulators to identify trends, and encourage operators to benchmark and improve. Without such visibility, confidence in the industry’s public health systems inevitably erodes.
Hesitance within the EU to share inspection and outbreak data is partly cultural. Privacy norms and fragmented authority across member states make data sharing politically sensitive, while harmonising inspection procedures across dozens of ports is operationally challenging. Nevertheless, the cost of ambiguity for a global industry is high: it fuels misleading media coverage and uneven perceptions of onboard public health standards.
Lessons from the U.S. Playbook
The CDC’s Vessel Sanitation Program offers a proven alternative. Each VSP inspection yields a detailed report and a numeric score out of 100, posted online within weeks.
Reports itemize violations, cite the relevant code sections, and list the corrective actions proposed by the cruise line. If an outbreak—such as norovirus—affects more than 3% of passengers or crew, the VSP publishes an investigation summary including case counts, laboratory results (where available), and the control measures taken.
This openness creates accountability. Cruise lines know that low inspection scores or outbreaks will be visible to passengers, competitors, and the media. And while publicity should never be the primary motivator, it undeniably compels senior management to prioritise corrective action. No operator wants headlines announcing a failed VSP inspection or an outbreak affecting numerous passengers onboard.
Although our own recent analysis suggests some aspects of the program’s influence may be plateauing—similar deficiencies recur year after year—the VSP’s decades-long combination of rigorous inspections and candid reporting has nonetheless driven measurable gains in sanitation and outbreak prevention.
The feedback loop is clear. It is transparency, not secrecy, that strengthens both performance and public trust.
Sailing Toward a Global Standard
The remedy need not be radical. SHIPSAN could start by publishing full inspection reports—detailing findings and corrective actions—modelled on the VSP approach. Outbreak data should also be made available, anonymously if necessary, but with enough detail to reveal trends and guide preventive measures.
Currently, information on SHIPSAN’s activities is scattered across multiple websites, limiting public awareness. Consolidating this material into a single, accessible platform would allow passengers, operators, and researchers to track performance more effectively. Even modest steps, such as publishing summary statistics on outbreaks or routine inspection findings, would signal a meaningful commitment to accountability and continuous improvement.
Inspection standards within the EU also warrant attention. Cruise lines rarely approach a SHIPSAN inspection with the same urgency as a VSP visit because the rigour of evaluations varies significantly from port to port and external scrutiny is limited.
This is not a criticism of the competence of European port health inspectors; rather, it highlights a difference in emphasis. SHIPSAN inspections often appear more focused on verifying general public health practices than on ensuring strict compliance with the standards outlined in the EU SHIPSAN manual.
Consider the example of Water Safety Plans (WSPs). While the VSP’s newly released ‘2025 Environmental Public Health Standards’ manual has drawn criticism for not requiring them, SHIPSAN guidance has referenced WSPs since 2011; yet implementation on cruise ships sailing in EU waters remains minimal. SHIPSAN deserves credit for introducing the requirement, but without robust enforcement the rule remains largely symbolic. (Were a WSP mandated under the VSP, it would almost certainly be universally adopted given the program’s stringent inspections.)
Cruise passengers should not have to adjust their expectations for health transparency—or sanitation standards—based on geography. The industry already operates under international safety codes; public health should follow a similar global standard.
A Case for Transparency
As the journalist Glenn Greenwald observed, “Transparency is for those who carry out public duties and exercise public power. Privacy is for everyone else.”
Public health thrives in the sunlight, yet across the EU we remain largely in the dark about cruise ship hygiene inspections and disease outbreaks. The U.S. experience shows that openness is both achievable and a proven driver of safety, accountability, and continuous improvement.
But transparency on ships is only part of a broader challenge. Globally, trust in science and public health hinges on trust in authority itself—gone are the days when credentials alone can command confidence. History reminds us that political tides will ebb and flow, yet long-term trust thrives in societies that remain free and open. Building that confidence requires sustained investment in education, deeper community engagement, and stronger partnerships among governments, industry, academia, and civil society.
Cruise health is a microcosm of this wider reality. Publishing inspection reports and sharing illness data is essential not only for building trust in cruise ship health systems, but also for giving regulators and operators the information they need to prevent outbreaks more effectively. These measures carry symbolic weight as well: they signal that public health is not a closed system, but a shared responsibility.
Transparency should not be seen as a lofty ideal but as an operational tool—one that protects travellers today and strengthens the foundations of trust tomorrow. By embracing openness, the EU can show that passenger and crew safety is not merely a line in a manual, but a visible, verifiable commitment, and in doing so set a benchmark worthy of a truly global industry.