Why the ivermectin myth persists, and what It teaches us about systems, power, and public health

Several recent articles have brought ivermectin back into public conversation. One, from New York Times, explored how conservative influencers continue to promote it despite the lack of evidence. Another, from STAT news, examined how the MAHA (Make America Healthy Again) movement is now influencing state legislatures across the country, both through food additive bans and “medical freedom” bills, and through efforts to expand over-the-counter access to ivermectin, even as credible evidence of its ineffectiveness for these purposes has accumulates.

Reading these made me reflect on how belief in ivermectin has become a durable feature of the U.S. health information landscape. It also reminded me how limited the US institutional responses have been. This moment feels like a good opportunity to examine where the assumptions about ivermectin, as a problem of misinformation, have failed us. I think it’s a moment to consider what we might gain by stepping back and taking a systems view.

Because ivermectin belief isn’t a messaging problem. It’s a systems problem.

The problem isn’t just misinformation, it’s the system that sustains it

When ivermectin first exploded as a supposed COVID-19 treatment, many in public health jumped to respond. And for good reason: the science didn’t support it. Clinical trials didn’t show a benefit. People were self-medicating with veterinary versions of the drug, sometimes landing in the hospital from poisoning. Health departments needed to step in.

There were some reactions, like warnings from the FDA and CDC, corrections in the media, debunking videos, and public statements. Communication campaigns kicked into gear.

But the belief persisted. And in some places, it deepened.

Ivermectin didn’t fade like responders expected it to. It morphed, adapted, and it was no longer just a fringe remedy as it became symbolic. In the hands of figures like Joe Rogan and Mel Gibson, ivermectin became part of a broader story: about medical freedom, distrust in government, and the power of alternative paths. Mel Gibson’s January 2025 podcast clip, in which he claimed that ivermectin and fenbendazole cured his friends’ cancer, spread to millions in days. For many viewers, this wasn’t just a story about treatment, because it carried the story of truth and betrayal.

We’ve seen bills proposed to sell ivermectin over-the-counter. We’ve seen mothers form communities around wellness and “natural healing” narratives. We’ve seen people dismiss public health warnings and the institutions behind them.

The problem isn’t only about what people believe. It’s what those beliefs are doing for them, and what kind of system makes those beliefs feel like the best option.

When communication hits its limits

To be fair, public health communication has come a long way. Today’s practitioners understand that behavior doesn’t change with facts alone. They consider tone, context, emotion, and identity. They use audience research, human-centered design, behavioral insights.

But even so, we often default to a narrow frame: get the message right, get it to the right audience and at the right time, and then behavior changes.

We tell ourselves that better segmentation, precision, or tailored messaging will be enough to make the change. But too often, these efforts still operate within a linear logic, as if the problem is a knowledge gap and the solution is the right narrative or story.

What this misses is the systemic feedback that keeps beliefs like ivermectin alive long after the facts are clear.

That’s why I turned to systems thinking, because I’ve realized communications couldn’t do all the work alone. We needed to understand the system we were speaking into.

From lines to loops: What the system shows us

When I started mapping the ivermectin belief system using causal loop diagrams, two main reinforcing feedback loops stood out.

You can see them visualized in the loop diagram below, but I’ll walk through them here with examples.

The first loop is what I call the anecdote amplification loop.

This is the echo chamber of experience. Someone hears that ivermectin helped a neighbor, a cousin, or a celebrity. They try it. Maybe they were getting better already, or maybe it’s the placebo effect, but they feel better. They share that story online or at church or in their parenting group. Now more people believe in ivermectin, more people try it, and the cycle intensifies.

When Joe Rogan announced that he took ivermectin during COVID and recovered, millions took that as confirmation. Not because Rogan is a virologist, but because he’s a trusted voice in his circle and his personal story carried weight.

These stories accumulate in community spaces, creating a local reality that feels more trustworthy than results of any clinical trial. The absence of harm becomes proof of benefit. Dismissals by scientists or public health officials often just reinforce the sense that “they don’t understand people like us.”

The second loop is the distrust-defiance loop.

Here, the starting point is mistrust of government, of pharma, and of experts. That distrust pushes people toward alternative information channels: Telegram groups, YouTube shows, Substacks. These channels promote ivermectin as the suppressed cure. The more people engage with this narrative, the more it deepens their distrust in official information sources. That mistrust then becomes the frame through which they interpret all new information.

We saw this with Robert F. Kennedy Jr., who has publicly argued that ivermectin was being unfairly suppressed to protect pharmaceutical profits. For those already inclined to mistrust “the system,” this wasn’t a fringe theory. It was a perfectly logical explanation. And every time the FDA pushed back, it was seen not as science, but as censorship.

These loops explain why so many linear interventions have failed. When you don’t see or interrupt the loops, your fixes get absorbed and sometimes weaponized by the system itself.

The archetypes we’re reenacting

As I looked deeper, I realized that ivermectin belief also mirrors several classic systems archetypes, patterns of behavior that show up across complex systems.

• We’re stuck in Fixes That Fail when our corrections inadvertently reinforce the problem. A well-meaning debunking effort gets interpreted as more evidence of suppression. The more we insist, the more tightly the loop coils.
• We’re enacting Shifting the Burden when we rely on communication as the primary solution instead of addressing the deeper drivers, like lack of accessible care, or the trauma of past medical harm. We chase the symptom (belief in ivermectin) instead of the cause (systemic failure to provide trustworthy care).
• We see Limits to Growth when early success stories and adoption hit saturation, but the underlying dissatisfaction with the health system keeps demand alive. Even when evidence accumulates, belief doesn’t disappear, because the root conditions haven’t changed.
• And perhaps most striking is the Escalation dynamic: public health warnings increase; alternative media double down. Each side intensifies, trying to out-claim the other. The system polarizes further.

We can use these archetypes as signals and not just clever metaphors to explain things. They tell us that we need different kinds of interventions and different mental models to design them.

So where are the leverage points?

Donella Meadows identified leverage points in systems – places where small shifts can create significant, systemic change. Many of our current efforts sit at the low end of this scale: adjusting parameters, like what the message says, who delivers it, or how often it’s repeated.

In complex social systems, the most powerful changes often come not from forceful targeted messaging or awareness campaigns, but from altering the structures and feedback loops that sustain belief. Jay Forrester, the founder of system dynamics, argued that real leverage is usually counter-intuitive. It’s found in the flow of information, in the goals of systems, or in the mindsets and relationships that shape how people act.

In the ivermectin ecosystem, the most obvious strategies, like debunking, deplatforming, fact-checking, have done little to unwind the loops. But systems thinking helps us see deeper interventions.

If we take ivermectin seriously as a systemic challenge, we need to consider higher leverage points. Those are the ones that don’t just aim to correct individual beliefs, but help reshape the underlying system dynamics that sustain them.

• We need to shift information flows, not simply broadcasting “the truth,” but diversifying who gets to speak, whose experiences count, and what kinds of knowledge are trusted. Instead of national, top-down campaigns, imagine community-led health literacy circles or church-based health dialogues, where people like a local nurse or pastor co-host forums to help residents make sense of competing health claims. In these settings, questions are welcomed, not dismissed, and knowledge is co-created rather than delivered.
• We need to change the rules of the system, particularly the policies and incentives that enable misinformation to flourish. During the pandemic, some doctors and telehealth platforms profited from off-label ivermectin prescriptions. Regulatory boards and agencies can tighten accountability for commercial actors using deceptive marketing. At the same time, social media platforms can be pushed to refine algorithms so that searches for “ivermectin cure” surface nuanced, evidence-based content delivered by peers, not just officials.
• We should rethink the goals of our interventions. Are we trying to eliminate a false belief? Or are we trying to create an environment where people feel heard, respected, and supported in making health decisions so that future misinformation takes root less easily? A trust-building effort between rural health officials and MAHA-aligned community members won’t erase belief in ivermectin overnight, but instead it can open space for dialogue and shift long-term norms around who is trustworthy and why.
• We need to redesign health systems and product experiences so they generate their own reinforcing loops of trust and value. One of the reasons people turn to ivermectin is that it offers something they feel traditional healthcare doesn’t: accessibility, affordability, agency, or simply being taken seriously. If people have repeatedly experienced rushed, expensive, or dismissive care or if they’ve been excluded from early treatment options altogether, it’s not surprising that they might place more faith in peer-validated alternatives. The real leverage lies in offering credible, responsive alternatives before desperation and mistrust sets in. That might mean ensuring early care is available without judgment, or designing touchpoints where people feel listened to and empowered. Instead of trying to out-argue misinformation, we need to outcompete it by creating better, more meaningful health encounters that stick in memory and circulate through networks in their own stories of “this worked for me.”
• And at the highest level, we must challenge the paradigms that shape our work. What if we stopped assuming that public health’s authority is self-evident or that people should comply because we are right? What if we led with humility and relationship-building, acknowledging past harms and inviting participation? Instead of viewing belief in ivermectin as irrational, we might begin to see it as a rational response to a system that hasn’t shown up for people when they needed it.

Moving beyond communications

Let me be clear: I’m not against health communication approaches. They need to be complemented because they are critical but insufficient to address wicked public health problems. I’ve worked on improving communication campaigns to raise awareness on health topics. I know how vital they are. But when we treat communication as the main intervention, it’s easy to blame health communication when it fails to deliver, and we’re doing what systems thinkers call “shifting the burden.” Often, that can mean shifting the burden to the individual, and that is unfair and incorrect.

Ivermectin belief goes beyond failures to persuade otherwise. We should see it and other narratives as a social response to deeper failures of presence, care, and trust. People are reaching for something, anything, that feels responsive, respectful, and within reach and is meaningful to them.

So we can use systems thinking to help us design better messages and better systems. Systems that listen, adapt, andco-create with the people they serve.

If we’re willing to act on that, the options expand. We might invest in long-term community partnerships instead of short-term campaigns. We might train health workers in narrative facilitation in addition to health information delivery or interpersonal communication. We might redesign how policies are communicated along with paying attention to what they say.

We might, in other words, begin to earn the trust we wish we had.

What the ivermectin story reveals

We should see the persistence of ivermectin belief as a mirror. It reflects how people make sense of uncertainty when trust has eroded. It shows us how simple narratives can gain power in complex systems. And it challenges us to look at what’s said and why people are ready to hear it.

If we treat it only as a misinformation problem, we’ll keep running in circles while the social relationships and narratives shift norms and social dynamics.

But if we see it as a systems problem, like a set of reinforcing loops, structural incentives, and narrative gaps, then we might start doing things differently, because we’re finally seeing more of the whole.

PS: End note on systems thinking and digital ecology, if you want more:

I’ve written this as a reflection on ivermectin, but what I’m really suggesting is bigger: we need to apply systems thinking to how we understand information ecosystems, beyond channels, influencers or platforms.

Systems thinking can help us start seeing these environments differently. It invites us to pause and examine our assumptions, not only about what “works,” but about how people make meaning in complexity. It encourages us to move beyond simple fixes and become more comfortable working in nonlinear, adaptive ways.

This is especially important when we’re dealing with digital ecologies that vary across topics, platforms, and communities. What circulates in one group as “common sense” may be dismissed in another. The design challenge becomes about how do we minimize the reinforcement of problematic loops, and instead cultivate balancing loops that stabilize trust, shared meaning, and responsiveness?

Naive interventions in such complex systems can have counterproductive results, and practitioners need to use systems tools to anticipate those effects. Before launching another campaign, we should pause to simulate or map how that intervention might ripple through the ecosystem, and ideally understanding relationships and power, and using tools like causal loop diagrams to identify potential feedback effects before they take hold.

That’s the kind of systems literacy we need more of in public health. It doesn’t promise control of health behaviors. But it does offer orientation toward humility, toward learning, and toward designing with, rather than against, the complexity we face.

Haynes, A., Rychetnik, L., Finegood, D. et al. Applying systems thinking to knowledge mobilisation in public health. Health Res Policy Sys 18, 134 (2020).

Lee BY, Greene D, Scannell SA, McLaughlin C, Martinez MF, Heneghan JL, Chin KL, Zheng X, Li R, Lindenfeld L, Bartsch SM. The Need for Systems Approaches for Precision Communications in Public Health. J Health Commun. 2023 Apr 7;28(sup1):13-24.

Ammara, U., Bukhari, H., & Qadir, J. (2020). Analyzing Misinformation Through The Lens of Systems Thinking. Conference for Truth and Trust Online.

Márton, A. (2021). Steps toward a digital ecology: ecological principles for the study of digital ecosystems. Journal of Information Technology, 37(3), 250-265.