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.

The post Why the ivermectin myth persists, and what It teaches us about systems, power, and public health first appeared on Tina Purnat.

We say: “People don’t trust the system.” “We need trusted messengers.” “We have to combat misinformation.”

But we rarely ask the harder question: Are we acting in ways that are actually trustworthy?

Trust is not an emotion. It’s a judgment.

In a recent negotiation class at the Harvard T.H. Chan School of Public Health, Linda Kaboolian discussed a powerful framing: trust isn’t a vague feeling. It’s made up of four components, each of which we evaluate, often subconsciously, when deciding whether to believe, follow, or rely on someone (or something).

These apply in relationships and in systems:

1. Motive – Do they care about me?
2. Competence – Can they actually do what they say?
3. Reliability – Do they follow through consistently?
4. Respect – Do they treat me with dignity?

Let’s break that down with real-life examples, and like our lecturer did, first personal, then public health.

1. Motive: Do they care about my outcome?

In life: Imagine a friend giving you career advice. You listen closely, if you believe they want the best for you. But if you sense they’re competitive or self-serving, even great advice feels manipulative.

In health: Imagine a person newly diagnosed with infertility. They’re told to start a specific hormone protocol, but they’re also being upsold on expensive add-ons. If they sense the clinic’s main motive is financial gain rather than their wellbeing, trust erodes, no matter how good the medicine. Similarly, if people feel that the reason vaccination campaigns are taking place is to make profits for the pharmaceutical companies or a corrupt Ministry of Health, they will not trust the vaccine, no matter how effective it is.

In communities that have experienced neglect, exploitation, or indifference from health systems in the past, this is foundational. If the motive isn’t right, no message will land.

2. Competence: Can they do what they say?

In life: You may love a family member dearly, but would you trust them to fix your car if they’ve never held a wrench? Probably not. We don’t equate good intentions with ability.

In health: A person living with cancer is promised “comprehensive care.” But the oncology nurse doesn’t return calls, the referral process is broken, or pain relief is delayed. Even if individual clinicians care, the system shows low competence, and trust fades fast.

Health systems need to communicate not just that they care, but that they can actually deliver. That includes accurate diagnoses, clear treatment pathways, and accessible support.

3. Reliability: Do they follow through, every time?

In life: A friend might be capable of helping you move, but if they’ve bailed the last two times how likely are you to ask again?

In health: Take nutrition programs promoting lifestyle change. Many ask people to “eat better” or “move more.” But if someone shows up for a community exercise group and the trainer is late (or worse, never shows) why would they return? Or if a healthy food subsidy is available only during complicated hours or runs out, people stop believing it’s worth the effort.

Reliability is the pattern, not the one-off. Public health programs that aren’t reliably funded, staffed, or consistent in delivery cannot expect sustained trust.

4. Respect: Do they treat me with dignity?

In life: Respect is what makes you feel safe being honest. If your colleague interrupts you constantly or talks down to you, you’re less likely to speak up, even if they’re competent.

In health: A woman seeking contraception gets rushed through a visit, judged for her relationship status, or not informed of all options. Even if the service is technically available and free, disrespect makes the system untrustworthy.

This is especially true in marginalized communities where historical mistreatment has left deep wounds. Respect isn’t performative; it’s about listening, sharing decision-making, and recognizing lived experience.

Trustworthy systems, not just trusted messengers

We often invest in trusted messengers: community leaders, influencers, health workers. This matters. But if the system behind the message isn’t trustworthy, the messenger is put in an impossible position.

Public health doesn’t just ask people to take action. It promises things in return:

• A treatment will help.
• A service will be available.
• A prevention step will protect.
• A health product will be safe and useful.

If we ask people to show up, change behavior, or trust science, we must deliver as a system.

This is why I always return to repeating that health communications need to be aligned and delivered in support of health systems and public health programs, not in parallel to them.

So, what would a trustworthy public health system look like?

Especially in communities with past trauma or ongoing inequities, it would:

Demonstrate motives rooted in equity and care, not politics or profit

Build competence through training, infrastructure, and responsiveness

Be reliable in programs, appointments, communication, and follow-up

Treat people with respect across race, gender, age, ability, and identity

The bottom line

If we want to rebuild public trust, we need to stop treating trust as a communications issue and start treating trustworthiness as a systems issue.

Trust isn’t just about how we talk. It’s about how we show up—again and again.

Let’s stop asking, “Why don’t people follow our guidance?” and start asking, “What would make us worthy of their trust?”

The post Trust building isn’t just about communication: What public health often misses first appeared on Tina Purnat.

Other speakers in the webinar were Nandita Thatte, DrPH , Dr James Kiarie , Åsa Nihlén , Chelsea Polis, PhD, Innocent Grant , Amanda Cordova-Gomez., PhD. and Tigest Tamrat.

The challenge of sexual and reproductive health misinformation

Misinformation about sexual and reproductive health is spreading quickly online. This false information is not just a nuisance. It shapes health outcomes, tilts decision-making, and even influences laws and policies. Our research covered 254 studies and articles, published between January 2019 and December 2024. We used rigorous database searches and explored grey literature from reliable sources. Our aim was to understand how digital SRHR misinformation affects individuals, communities, health workers, and policymakers.

The data shows that false information directly impacts everyday decisions. People base their health choices on what they read online—often without realizing the source may be untrustworthy. This gap leaves them vulnerable to poor-quality health advice.

Thinking about SRH misinformation through human rights lens

We framed our study using key human rights principles. These include equality and non-discrimination; availability, accessibility, acceptability, and quality; informed decision-making; privacy and confidentiality; participation and inclusion; and accountability. Here’s what we found:

• Equality and non-discrimination: False narratives limit informed choices. They add to fear and stigma. For example, misleading information about pregnancy and LGBTQ+ health reinforces harmful biases. This not only makes people feel excluded but also prevents them from accessing the information they truly need.
• Availability, Accessibility, Acceptability, and Quality: When low-quality apps and misleading online content replace trusted advice, people suffer. Many menstrual and fertility tracking apps promise accurate data but are not backed by rigorous evidence. In places where services are scarce, such apps become a desperate resource. The result is a gap between what users expect and the reality of the information provided.
• Informed decision-making: Every individual deserves access to clear, evidence-based information. Instead, misinformation steers people toward decisions based on bias and incomplete facts. When false information about fertility treatments or abortion safety circulates, it skews the decision-making process and can even lead to harmful health outcomes.
• Privacy and confidentiality: Privacy is a major concern. Users worry about how menstrual cycle data and other sensitive details might be tracked. Many fear that their information could be sold for advertising or even used against them in regions with strict reproductive laws. This worry can prevent people from seeking the help they need.
• Participation and inclusion: Digital misinformation silences marginalized voices. When inaccurate and stigmatizing content dominates online discussions, those most affected by SRHR issues often withdraw from the conversation. This lack of participation hinders the development of inclusive policies that truly represent everyone’s needs.
• Accountability: When misinformation gains ground, accountability weakens. False narratives can become codified into law. For instance, restrictive abortion laws sometimes rest on misrepresented statistics. When policymakers rely on inaccurate data, efforts to reform or improve services are stifled.

Real-world examples

I shared several (not exhaustive) concrete examples from our research to illustrate these points:

An example of a complex issue are fertility trackers and menstrual cycle apps that are rapidly gaining popularity, but they come with complex challenges that go far beyond simple technology use. Many apps lack evidence-based references and provide unreliable algorithmic predictions, contributing to misinformation about reproductive risks. In the UK, mistrust in hormonal contraception drives some women to adopt these tools, whereas in Brazil, limited access to health services and contraceptives fuels their reliance. In the Netherlands, 77% of women have accessed web sites for health information and 61% have used pregnancy and childbirth apps, even though digital sources were perceived as less trustworthy and less useful compared to health professionals as health information sources. Healthcare workers also often distrust the accuracy of these apps themselves and lack the skills to assess their credibility, while users worry about data privacy, particularly in settings where reproductive healthcare may face legal restrictions.

Then, online health information seeking follows a clear gendered pattern, with most of the reviewed research on SRH misinformation centered on women’s health, LGBTQ+ topics, or youth. Much less attention has been paid to how misinformation impacts men’s health. Meanwhile, online profiteers exploit these patterns through ads, deceptive websites, and questionable direct-to-consumer products that cater to gender-specific needs, beliefs, and identities. You’ll see above, for example, that nonevidence-based women’s health products are a lucrative business under the flag of girl power. And there are plenty of men’s health clinics that do this type of direct-to-consumer marketing for dubious treatments for men.

While improving digital literacy helps people scrutinize dubious claims, health systems also bear responsibility. Individuals often turn to unreliable sources because they fear or feel judged or misunderstood by their healthcare providers or health workers. There’s a pressing need for stronger consumer protections since wellness influencers and commercial clinics escape the professional accountability demanded and expected in traditional medical settings.

Healthcare professionals traditionally rank among the most trusted sources of health information (see US, several other countries globally). However, younger generations now turn to an abundance of online alternatives like TikTok or YouTube where influencers with no medical qualifications can be just as, if not more, persuasive. This shift undermines the monopoly that healthcare workers once held in guiding health decisions. Studies show that videos made by health professionals often reach smaller audiences than those from popular influencers. Meanwhile, providers receive little organizational backing or training for engaging in online discussions. They’re expected to adapt, absorb new responsibilities, and expose themselves to greater risks, all without a comprehensive support system or amendments to occupational health and safety policies.

The absence of information can be just as harmful as the presence of misinformation. Recent reports show that misinformation is increasingly woven into policies and laws, reinforcing false narratives and legitimizing them. In the United States and several African countries, it has been reported that legislative or strategic litigation tactics incorporate misinformation and nonvidence-based practices into official frameworks, which amplifies and normalizes these misleading claims.

At the same time, major internet platforms apply inconsistent content moderation that can block or throttle accurate SRHR information in certain regions or languages, while allowing harmful misinformation elsewhere (see 2025 article, and 2024 report). These twin forces reshape online spaces and heighten disparities in digital information. Addressing this requires filling information voids with accessible, localized, and discussion-friendly resources, especially where credible material and services are missing or heavily restricted.

What this means for us

SRHR misinformation is not an isolated phenomenon; it reflects deep, systemic asymmetries in how people access health information and care. The big takeaway from our scoping review is that improving access to quality health information and care will go a long way toward mitigating the harms of misinformation. However, simply chasing after individual misinformation narratives and improving communications through tailored and culturally appropriate delivery is not enough. Sexual and reproductive health is deeply intertwined with individual, community, and social identities and values, which means that addressing it requires systemic, people-centered solutions.

We must apply a human rights lens when strengthening our systems. This approach demands new partnerships, the creation of healthier digital spaces where accurate SRHR information is freely available and openly discussed, and empowered healthcare providers and systems that are better equipped to handle the inevitable impact of the digital information ecosystem.

To protect and promote human rights in sexual and reproductive health, we must align our policies and practices with the real-world needs of people. This means pushing for evidence-based communication, better digital literacy, and stronger safeguards for privacy. When accurate information is delivered hand in hand with quality services, support and products that people need, we can reduce the detrimental power of misinformation.

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In Uganda, the impact is unfolding in real-time, and it is devastating—not just financially but in the erosion of trust in healthcare itself.

US development aid has been so important to Uganda’s healthcare system that the USAID funding freeze has forced Uganda’s Ministry of Health to reassure its citizens that hospitals will remain open. The anxiety runs so deep that the government had to publicly affirm that its own health system is still functioning.

And at the same time, a nurse at one of Uganda’s top medical institutions died of Ebola after first seeking care from a traditional healer.

This is not just a tragic personal story. It is a warning sign of the unintended, cascading effects of aid cuts and how they collide with local perceptions and trust of the healthcare system and the government. When a healthcare system loses funding, it does not simply lose medicines, doctors, or facilities. It loses something more fragile and harder to restore: public trust.

When health workers stop trusting the system, what happens next?

Infodemic management, RCCE and humanitarian response expert Obol Sunday Jimmy notes that the late nurse was a trained medical professional working at the country’s leading hospital. And yet, when he fell ill, he did not trust the system he worked for.

His hesitation—his decision to turn to a traditional healer instead—raises a deeply troubling question: If healthcare workers themselves do not have confidence in the system, why should ordinary citizens?

And now, misinformation is spreading like wildfire. On WhatsApp and social media, some Ugandans claim that the Ministry of Health fabricated the Ebola outbreak as a ploy to secure emergency funds after the USAID cut. The logic is cynical but predictable: If people see their government struggling to keep the system afloat, they become skeptical of any crisis that suddenly demands resources.

This is how trust collapses—not in a single moment, but in layers. First, health workers begin to doubt the system. Then, the public watches them retreat. And finally, conspiracy theories rush in to fill the void.

Aid cuts are never just about money

In high-income countries, foreign aid is often framed as an act of generosity, a charitable contribution that can be withdrawn at will. But in reality, aid is not a bonus, but a pillar of stability that has been woven into the fabric of many national health systems.

USAID funds have supported disease surveillance, maternal health programs, HIV treatment, vaccine distribution, and health worker training. When that support disappears overnight, it is not just a budget shortfall—it is a fracture in the entire health infrastructure.

And that fracture is more than logistical. It is psychological.

When donor funding disappears, it signals instability. And instability breeds doubt. Doubt, in turn, breeds mistrust. And in healthcare, trust is everything.

The ripple effects of mistrust are long-term

Uganda has battled Ebola before, and it has built capacity over years to contain outbreaks. But what happens when an outbreak occurs in a moment of financial and institutional uncertainty?

Misinformation thrives—If people suspect the government is fabricating outbreaks for financial gain, public health measures become harder to enforce.

Vaccine hesitancy increases—Uganda has successfully rolled out vaccines for Ebola and other diseases in past outbreaks. But if citizens do not trust the motives of health authorities, even lifesaving interventions may be rejected.

Future outbreaks become deadlier—When people delay seeking care or turn to unregulated alternatives because they don’t have access to services or treatment, diseases spread faster and kill more people.

This is not just about Uganda. Other countries (see Malawi, Zambia, Africa CDC) have been forced to reassure their citizens that their national health services are still functioning and will be funded domestically.

It is a warning for any country where donor funding plays a key role in healthcare delivery. When aid is abruptly withdrawn, the damage is not just in statistics. It is in narratives, in perceptions, in how people feel about the institutions meant to protect them.

A wake-up call for the US and the global health community

The US government may frame its aid freeze as a financial decision, but it is, in reality, a decision about human lives.

Health systems do not exist in isolation. They are ecosystems of trust, and trust does not recover overnight.

If the US wants to be a global health leader, it must recognize that cutting off funding does not just save American taxpayers money—it destabilizes the very systems meant to prevent the next pandemic.

And when the next global health crisis emerges, the cost of mistrust will not be paid by Uganda alone. It will be paid by all of us, including Americans.

The post The unintended fallout of USAID Cuts: Erosion of trust in health systems first appeared on Tina Purnat.

A new think piece for the upcoming conference organized by the Public Health Association of BC in November 2024 discusses how commercial activities influence public health in profound ways—both directly and indirectly.

For public health professionals, reflecting on these commercial determinants isn’t just an academic exercise; it’s deeply personal.

From the products marketed to us daily, to the types of healthcare available, to the way urban spaces are developed, commercial forces are woven into the very fabric of our lives. CDoH encompasses practices and policies of companies and industries that impact health outcomes, for better or for worse. While certain sectors, like tobacco or fast food, may pose clear health risks, other industries and commercial actors may contribute positively—consider companies that prioritize sustainable practices, offer fair wages, or support health-focused research and development.

Why is it important for public health professionals to reflect on CDoH?

First, recognizing the influence of CDoH can help practitioners understand the invisible factors that shape health trends and disparities in their communities. For example, while many of us focus on addressing lifestyle diseases, we might overlook the role of aggressive marketing by processed food companies that drives unhealthy food consumption patterns. This reflection isn’t just about seeing what’s harmful but understanding how to harness positive commercial practices to improve health outcomes.

Secondly, CDoH are not confined to our workplaces—they permeate our personal lives. The products we consume, the media we engage with, and even the neighborhoods we live in are shaped by commercial forces. Reflecting on these influences helps us recognize the complexity of our role as public health advocates. It encourages us to advocate for policies that protect vulnerable populations, create healthier environments, and foster transparency around commercial influences on health.

The Path Forward

This think piece invites us all to reconsider how we view public health and our role within it. When we reflect on CDoH influences, we can better advocate for structural changes that promote equitable health outcomes.

As you explore this think piece, consider the ways commercial forces impact your own life and your work in public health.

How can we, as a community, drive the change from harmful practices to those that support health and well-being?

Reflecting on CDoH isn’t just an exercise; it’s a step toward shaping a healthier future for everyone.

Guided self-reflection

Consider the following as a starting point:

1. Which commercial determinants of health across the sectors discussed are of particular concern or interest to you?
2. How do these topics interact with CDoH in your community or area of work?
3. Specifically, how do these issues impact healthcare providers, public health professionals, health advocates, and public health researchers?
4. How do these areas interact with commercial actors at the local, provincial, or national level?
5. What competing motivations and objectives do different commercial actors have in this space?
6. Are there any examples of successful action taken in your community or workplace regarding CDoH?
7. Who would you consult to better understand this topic and how it relates to CDoH?

Consider these across different sectors:

Trade

• Health-harming Impact: Trade agreements that prioritize corporate interests over public health, such as allowing the import of unhealthy processed foods and tobacco products into low- and middle-income countries, can contribute to rising rates of noncommunicable diseases.
• Health-promoting Impact: Fair trade initiatives that ensure ethical labor practices and promote sustainable agriculture can improve the livelihoods and health of workers and communities involved in the production process.

Social Sector

• Health-harming Impact: When private companies take over essential social services, such as housing or elder care, profit-driven models can lead to reduced quality of care, affordability issues, and unequal access to services, disproportionately affecting populations experiencing inequities.
• Health-promoting Impact: Social enterprises that focus on providing access to clean water or affordable healthcare in underserved areas help reduce health inequities.

Economy

• Health-harming Impact: Economic policies that prioritize corporate profits over public health, such as deregulating industries that pollute the environment, can lead to poor health outcomes, especially in disadvantaged communities.
• Health-promoting Impact: Economic policies that promote living wages, paid parental leave, and access to healthcare can improve both mental and physical health for workers and their families.

Education

• Health-harming Impact: Corporations marketing unhealthy foods in schools, such as sugary drinks and snacks, contribute to childhood obesity and poor nutrition.
• Health-promoting Impact: Partnerships between businesses and educational institutions that promote health literacy and wellness programs can help children and adults make healthier choices and improve overall health outcomes.

Competition

• Health-harming Impact: Monopolies or dominant market players in industries like pharmaceuticals can lead to inflated drug prices, limiting access to essential medicines for many people.
• Health-promoting Impact: Policies that foster competition in the healthcare market, such as encouraging generic drug production, can lower costs and increase access to necessary treatments.

Transport

• Health-harming Impact: Car-centric transport policies that prioritize the automobile industry lead to increased air pollution and sedentary lifestyles, which contribute to respiratory diseases and obesity.
• Health-promoting Impact: Investments in public transport systems and bike-friendly infrastructure promote physical activity and reduce pollution, leading to better overall health outcomes.

Energy

• Health-harming Impact: The fossil fuel industry contributes to air and water pollution, leading to respiratory diseases and other health issues, particularly in communities near extraction sites.
• Health-promoting Impact: The renewable energy sector reduces reliance on polluting energy sources and helps mitigate climate change, which is beneficial for both public health and environmental sustainability.

Health

• Health-harming Impact: Pharmaceutical companies that aggressively market opioids without adequate warnings about addiction risks contributed to the opioid crisis, which has had devastating health consequences.
• Health-promoting Impact: Pharmaceutical companies that work with governments and nonprofits to make essential medicines affordable and accessible improve public health, particularly in low-income regions.

Environment

• Health-harming Impact: Deforestation driven by commercial agriculture or logging leads to the spread of vector-borne diseases, such as malaria, due to the destruction of natural habitats and breeding grounds for disease-carrying insects.
• Health-promoting Impact: Corporate environmental sustainability initiatives, like reducing plastic waste or supporting reforestation efforts, help protect ecosystems and improve community health by maintaining cleaner air and water.

Labor

• Health-harming Impact: Labor exploitation in industries like garment manufacturing can lead to poor working conditions, mental health issues, and occupational injuries, particularly in low-income countries.
• Health-promoting Impact: Companies that offer safe working conditions, fair wages, and access to health benefits promote the well-being of their workers and create healthier work environments.

Agriculture

• Health-harming Impact: Industrial farming practices that rely on pesticides and antibiotics contribute to antimicrobial resistance and environmental degradation, both of which have negative health impacts on communities.
• Health-promoting Impact: Organic farming and sustainable agriculture practices improve food safety and reduce exposure to harmful chemicals, leading to better long-term health outcomes for consumers and agricultural workers.

Science

• Health-harming Impact: Corporations that suppress or manipulate scientific research to protect their profits, such as tobacco companies or industries that deny climate change, hinder public health efforts to address critical health and environmental challenges.
• Health-promoting Impact: Investments in health innovation by the private sector, such as research and development for vaccines or new medical technologies, lead to major advancements in disease prevention and treatment.

Security

• Health-harming Impact: Arms manufacturing and trade can destabilize regions, leading to violence and conflict, which has severe impacts on mental health and increases the risk of injury and death.
• Health-promoting Impact: Companies that invest in cybersecurity or develop products to protect critical health infrastructure help ensure that health services can operate without disruption, improving overall community safety and health.

Media

• Health-harming Impact: Media companies that prioritize sensationalism and clickbait over responsible health reporting contribute to the spread of misinformation and public confusion about health issues, such as during the COVID-19 pandemic.
• Health-promoting Impact: Media campaigns that promote public health initiatives, such as those focused on smoking cessation or promoting vaccination, play a vital role in encouraging healthier behaviors and improving health literacy.

Local governments

Health-harming Impact:

• Unhealthy zoning decisions: Allowing fast food chains and liquor stores to dominate low-income areas contributes to food deserts and increases rates of obesity, diabetes, and heart disease.
• Weak environmental enforcement: Poor regulation of industrial pollution leads to higher rates of respiratory diseases and cancers, especially in communities near industrial zones.
• Car-centric infrastructure: Prioritizing cars over active transport options like biking or walking fosters sedentary lifestyles and worsens air pollution, contributing to obesity and respiratory conditions.
• Partnerships with health-harming industries: Collaborating with industries promoting sugary drinks, fast food, or alcohol undermines public health efforts and reinforces unhealthy behaviors.
• Urban design and lack of green spaces: Focusing on commercial development over green space limits opportunities for physical activity, increasing rates of lifestyle-related diseases like obesity and mental health issues.
• Inadequate regulation of alcohol and tobacco: Failing to regulate sales of alcohol and tobacco makes these products more accessible, especially to youth, raising addiction rates and long-term health consequences like liver disease and cancer.

Positive Impact:

• Zoning and land use: Encouraging grocery stores, farmers markets, and urban farms in underserved areas improves access to fresh food, helping reduce diet-related diseases like obesity and diabetes.
• Environmental protections: Enforcing environmental regulations on pollution helps lower rates of respiratory illnesses and cancers caused by industrial emissions.
• Public infrastructure and transportation: Investments in public transit, bike lanes, and walkable spaces promote physical activity and reduce pollution, addressing conditions like obesity and cardiovascular disease.
• Health-promoting partnerships: Collaborating with businesses to promote healthy and well-being initiatives, such as immunization campaigns or smoking cessation programs, aligns commercial incentives with public health.
• Green Spaces: Developing parks and recreational areas encourages physical activity and social interaction, reducing the risk of lifestyle-related diseases and improving mental health.
• Regulation of alcohol and tobacco: Strict regulation of alcohol and tobacco sales reduces consumption, particularly among young people, lowering addiction rates and related diseases.

The post Why commercial determinants of health matter for us all first appeared on Tina Purnat.

From one perspective, the answer might seem clear. “Health is a political choice”. Health outcomes are always influenced by political decisions, and ignoring this reality doesn’t make it disappear. The social medicine perspective, for example, has long argued that health inequalities are driven by systemic political and economic forces. From inadequate social safety nets to structural racism, political systems create barriers to equitable healthcare. For advocates of this view, political engagement is necessary to address the root causes of poor health—meaning that, in this sense, health must be political to ensure justice.

But there is another viewpoint worth considering: many people—and even health professionals—might prefer to see health services and prevention efforts as apolitical. This is not because they are unaware of the political dynamics at play but because they believe that health services, prevention and systems should transcend politics. In moments of crisis, like a global pandemic or a natural disaster, health professionals are often expected to set aside political affiliations and focus on delivering care based on need. Humanitarian organizations, for instance, operate under the principle of neutrality, focusing on health as a basic human need that should be addressed regardless of the surrounding political context.

Then there’s also instances when health services, health guidance, health products, access, and policies are politicized. Politicized health is detached from the moorings of health evidence and commonly held values. This can fuel distrust in the entire enterprise of supporting and advancing people’s health and well-being. Moreover, when health is politicized in this way, health-related narratives can be hijacked by mis- and disinformation. Such hijacking is difficult to dislodge, because it hooks into people’s existing perceptions that health is devalued and misused for political gain and not beneficial to them.

Consider this: Ensuring that pregnant women have adequate medical care during their pregnancy and in delivery is close to universally accepted norm across the world. All countries have health systems that provide antenatal care to women. In theory, provision of such basic health services should be considered apolitical. Unfortunately, in the US, pregnancy and maternal health are politicized. The consequences are that in many US States, women and their healthcare providers have their healthcare decisions leally circumscribed. This is done to support a particular political and moral perspective on what a pregnant woman can and cannot do with her pregnancy.  Women’s health has been politicized in the United States (ignoring, for a moment, LGBT+ rights, racism, and other structural issues, also affecting health), and thus affected their human rights.

So where does this leave us? Do people really want the health services they receive to be political, or do they long for a world where health is treated as a universal human right, separate from political battles? On the one hand, viewing health as political is necessary to confront the root causes of inequality and systemic failures and make social commitments in favor of social investment into health and wellbeing. But on the other, an apolitical stance demands that we focus on the shared human need for health and well-being, trusting that care is provided based on need, not political agendas.

“Health is political.”

“Health is a political choice.”

“Health is apolitical.”

“Health is politicized.”

… these all mean different things and relate to different domains of policymaking, decision-making, service and programme delivery, and expression of universal societal values.

We should be precise and thoughtful when operating with this language.

Ultimately, it’s not about denying the political nature of health. The way our health systems function—and who they benefit—is deeply shaped by political decisions and other structural determinants. But it’s also about recognizing that people seek health services for care and support, not for a political debate. Perhaps the real question is how we balance these perspectives, how we understand them and how we talk about them. Can we keep politics at the forefront of how we structure systems while ensuring that healthcare delivery and public health programs remain evidence-based, equitable, and human-centered?

Health policies and management of health system may never be truly apolitical, but the aspiration for health services, products and programmes to be delivered focused on human rights, equity, and evidence should guide the political decisions that influence them.

The post Do people want health to be political? first appeared on Tina Purnat.

The recent hurricane response described in The Atlantic (see Charlie Warzel’s I’m running out of ways to explain how bad this is) illustrates a profound breakdown of trust and information. Emergency responders, battling both the storm and misinformation, faced physical threats as conspiracy theories took hold in communities, stoking fear and distrust. The chaotic spread of falsehoods about government conspiracies and weather manipulation exposed just how vulnerable some populations are to misinformation. When trust in emergency and health responders collapses in real-time, it becomes nearly impossible to correct narratives or restore faith in the response while the responders are working hard to help the affected communities.

This breakdown of trust reveals that the layers of misinformation are deeply entrenched by prior experiences, information bubbles, and shared beliefs and world views in communities. By the time a crisis hits, communities make sense of circulating information about the response through their own worldview lens, making it difficult to communicate facts about the response.

This scenario highlights the urgent need to build resilient communities—ones that can withstand the barrage of misinformation before and during emergencies, especially when information ecosystems break due to infrastructure and connectivity failures. Rather than reacting in the heat of a crisis, we must proactively foster trust, improve information ecosystems, and build digital literacy so that communities can be prepared, informed, and united in the face of misinformation.

Here’s what a community resilient to misinformation would look like in the context of health emergencies and the key steps we can take to support and develop these critical systems.

1. Easy access to quality health information

No strategy can succeed if credible, accurate health information isn’t readily available. During COVID-19, even the most well-crafted and wide-reaching campaigns struggled to shift vaccine hesitancy because they raised more questions than they answered. When people can’t easily find reliable information from trusted sources, or have a negative experience with a healthcare provider, all the outreach in the world won’t inspire people to take action. Access to accurate, credible health information must be the foundation for any resilient community.

2. High levels of health literacy across the life-course

A community resilient to misinformation nurtures health literacy across the entire population, from childhood through old age. Health literacy isn’t just about understanding the facts and health information; it’s about applying that understanding in real life and critically evaluating new health information. When people can interpret health information effectively, they are better equipped to make informed decisions, whether about vaccines or navigating a new health crisis.

3. Knowing where to find credible, accurate health information

Beyond just institutions and influencers, a resilient community is one where health information is discussed in various social spaces, both within and outside the healthcare system. This connectedness enables people to share, validate, and interpret health information in ways that align with their cultural and social experiences. Social networks, both online and offline, act as valuable channels for distributing reliable information, creating a network of trust and credibility that misinformation struggles to penetrate.

4. Sharing and remixing health information

An indicator that health communication has resonated with the community is when people start to mirror and remix the messages. During COVID-19, many social media users created funny, engaging content promoting vaccines and public health messages in ways that felt authentic to their community—without using official logos or government language. This grassroots adaptation of health information shows that the message has not only been received but also embraced and repackaged in a way that is culturally relevant and engaging.

5. Digital literacy and active participation of individuals and health workers

Digital literacy goes beyond the ability to spot misinformation. It also includes understanding how to navigate the broader information ecosystem, protect personal privacy, and engage in discussions about health information in a safe and constructive manner. In a resilient community, people know how to search for, consume, and share health information responsibly, supporting one another in identifying misinformation while also addressing online harassment or misinformation attacks in real-time.

6. Community norms that promote healthy behaviors

Social norms that encourage health-promoting behaviors are a critical defense against misinformation. In a resilient community, behaviors like getting vaccinated or following public health guidelines are woven into the social fabric. These norms make it harder for misinformation that contradicts these actions to take hold, as individuals are influenced by the positive behaviors of those around them.

7. Trust in health service delivery, products, health guidance, and health workers

Trust is the cornerstone of a resilient health system. When communities trust their health services, products, and healthcare providers, they are far more likely to follow guidance, receive vaccinations, or comply with public health and social measures. Building and maintaining this trust requires transparency, responsive communication, and a demonstrated commitment to community well-being. Without trust, even the most well-intentioned public health campaigns will struggle to make an impact.

8. Sharing positive health experiences

A resilient community doesn’t just follow health advice—they share their positive health experiences with others, creating a ripple effect of trust and confidence. When individuals talk about how vaccines, treatments, or public health and social measures have benefited them, they provide powerful counter-narratives to misinformation. These personal stories help to reinforce the value of evidence-based health practices and can inspire others to take similar actions.

Withstanding shocks and maintaining trust

Communities resilient to misinformation are also better able to withstand shocks—whether that’s an emergency, a new health threat, or vaccine-related incidents that may erode public trust. These communities rely on their strong information networks, high levels of health literacy, and trust in health systems to navigate uncertainty. By fostering social norms that support health and building a culture of informed, critical engagement, resilient communities can maintain their trust in health services, even in the face of crises or disinformation campaigns.

It’s also important to note what it truly takes to build resilience

Resilient communities cannot be built through paternalistic approaches by health authorities. Instead, they require deep engagement with the community, creating spaces where people feel heard, valued, and understood. Trust is built through the consistent presence of social, health, and other essential services that reinforce people’s confidence in their government, health workers, and emergency responders. It’s this trust, earned through collaboration and transparency, that forms the backbone of a community’s resilience against misinformation.

We can start by asking people in noncrisis periods, “Do you have everything you need to live a healthy, happy life in your community?” listening to their responses and then designing and delivery social, health, and other services that meet community member needs.

Best way to build trust in the government and health authorities? Reflect on what it means to be trustworthy and then act on the learning.

Co

The post What does a community resilient to misinformation and infodemics look like? first appeared on Tina Purnat.

We make meaning of our lives and the world through the spaces where we live, work, pray, play, study, and gather. But these spaces are no longer just analog. The digital information environment has changed this. Today, we form bonds, communities, and identities not only in our neighborhoods, workplaces, or schools, but also in virtual spaces that transcend geographical and cultural boundaries. We concurrently live and trust “glocally”. People now engage online, build relationships through platforms, and participate in global conversations that influence their behaviors as strongly as face-to-face interactions.

Digital spaces blur the lines between personal and public life, creating new opportunities for connection and collaboration, but also new vulnerabilities. These online communities have become crucial for how people exchange information, seek support, and organize around common goals.They’ve also transformed how commercial actors market products and provide services. However, digital spaces are still shaped by the same structural determinants of health—commercial, social, ecological, normative, and political factors—that influence physical communities, often in more complex and accelerated ways than we can fully grasp.

We’ve spent thousands of years adapting to the structural determinants of health in our physical environments, but we’ve only had around 20 years to adapt to the digital worlds we’ve created. At this scale, it’s hard to fully understand how innovation, shifts in commercial practices, and constant advancements in digital technologies are reshaping how we access, consume, and amplify information.

Consider this: at the dawn of the internet, it took the World Wide Web seven years to reach 100 million users. Fast forward to today, and it took ChatGPT just two months to reach the same milestone.

This rapid pace of adoption isn’t just about more people being online or owning digital devices. It’s about how quickly our digital environment is transforming—and with it, the way we interact with information, subscribe to narratives, shape our identities, express belonging, and make decisions.

Online communities form and dissolve, change and redefine themselves relatively rapidly – in ways we do not experience in our physical world.

The consequences are profound. The faster information flows—and the more fragmented it becomes—the harder it is for us to keep up. And public health systems are even slower to understand and address this.

Although we talk about digital divide and equity, we really haven’t even begun to define or address the structural determinants of health in digital spaces.

Unchecked commercial and fraudulent activities, deceptive marketing, and the constantly shifting digital landscape often go unnoticed at the individual level. This strains the systems of governance and accountability we’ve built that are too geographically constrained to put a dent on geographically unconstrained digital interactions and environments.

Just one example is how we rely on social cues to assess the trustworthiness and relevance of information, but the digital environment has distorted our perception of what is socially valued. This distortion reinforces beliefs and shared identities in ways that can mislead and harm public health efforts.

Because the digital information environment changes so rapidly, public health research, policies, and approaches are struggling to keep up. And that’s dangerous. We are falling behind in addressing the harmful impacts of this evolving space, while also missing opportunities to promote health in positive ways. I can’t help but feel this gap is increasing.

As someone who has spent time thinking about how information environments influence how we relate to each other, the kind of information we seek, how we understand it, and how we feel about it, I believe we must embrace a pluralistic understanding of knowledge and evidence.

But we need to embrace the complexity of people’s lived experiences and the environments they inhabit—how they relate to the natural, physical, and digital world, what they encounter, what they value, and what they trust.

If centering equity in research means creating knowledge systems that respect and engage with people’s lived realities and knowledge systems, we must also consider that for many, these realities are increasingly digital.

Life happens everywhere humans are—whether in the physical or digital world.

The post Diving deeper into structural determinants of health in digital environment first appeared on Tina Purnat.

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Vaccine demand promotion is more than just about boosting confidence in vaccines. It’s about implementing a broad set of strategies that address the behavioral and social drivers behind vaccination decisions. From community outreach to social marketing and tailored health communication, from suporting health worker confidence in vaccines and improving quality conversaiton about vaccines through interpersonal communication, to ensuring positive vaccination experiences, the approaches are as diverse as the challenges they aim to solve.

But what does this mean for vaccine demand research? Behavioral and social drivers of vaccine demand require different interventions across all levels of society. While researchers often focus on a specific intervention within their area of expertise, public health practitioners are tasked with the enormous challenge of creating a comprehensive health program that addresses vaccine demand among high-priority populations, tackles broader issues of vaccine hesitancy, and does all of this within the constraints of limited budgets, high staff turnover, and numerous political and institutional barriers. Practitioners have to problem-solve on the fly, navigating these obstacles to deliver the best possible program.

“evidence-informed” is not a dirty word

Between scientists and policymakers, there can sometimes be confusion between “evidence-based medicine” and “evidence-informed policy.” The latter doesn’t mean policies are less grounded in evidence. Rather, it means policy decisions incorporate evidence alongside other factors like resource constraints, competing priorities, expert insights from practitioners, gaps in available data, and even the political climate. While (especially quantitative) researchers seek to find “the facts that characterize the truth,” policymakers need to act quickly, often making decisions in the face of uncertainty, but always with the public’s well-being at heart.

Different perceptions of what makes research useful

One of my own key takeaways from the summit was the recognition of how differently researchers and practitioners perceive what makes research useful or actionable in the field or for policy. Public health practitioners—whether in ministries, health facilities, or community organizations—are often understaffed and overburdened. For research to truly serve them, it must directly address the pressing issues they face and offer practical solutions. Whether it’s providing data for decision-making, contributing to skill-building, or offering evidence that can be fed back to donors or supervisors, research needs to bring tangible value.

Do we understand what makes an intervention affordable, scalable, implementable, and acceptable?

I think that regardless of what type of research design they use, researchers need to understand the operational, capacity, and political context in which they are doing their research and evaluating their interventions—and document this context when reporting on the results. How else can we even begin to discuss what is needed to understand whether tested interventions can scale, whether they are affordable to implement, and whether they are acceptable in different settings? This kind of reflection is key to ensuring that interventions don’t just work in theory but can be adapted and sustained in real-world environments where resources are limited and demands on practitioners who need to implement them are immense. Without this contextual understanding, even the most promising intervention risks being impractical for the settings that need it most.

Tension between the business of research and the business of public health

A more radical approach to doing research serves the needs of public health practice and policy is one where researchers would design implementation and evaluation studies to directly serve the current needs of immunization programs. In theory, this would be a powerful way to align research with the operational realities on the ground, making it immediately actionable for public health programs (implementation research, anyone?). However, in reality, this is rarely achievable. It often clashes with current funding models, which prioritize academic independence and long-term research goals, and with university systems that require researchers to focus on publishing and meeting academic metrics for promotion. This disconnect highlights the structural challenges that prevent research from being fully integrated into public health practice in the most immediate and practical ways.

The trap of research partnerships to reproducibility and scalability

Research is often too slow or not reproducible because it relies heavily on specific partnerships to achieve its goals. These partnerships, while valuable, can limit the scalability and timeliness of research outcomes. The reliance on select collaborations can lead to delays or challenges in replicating the approaches in other contexts or regions, making it harder for practitioners to apply research-based interventions swiftly or across broader geographies. To serve public health better, we need to create more flexible, scalable research models that can adapt quickly to different contexts and allow findings to be generalized, transferred and implemented without being overly dependent on specific partnerships.

Are we making space for local researchers?

When it comes to international research collaborations, particularly between high-income and low- or middle-income countries, there must also be an intentional focus on ensuring equity and sustainability. Are high-income country researchers mindful and self-reflective of the power dynamics in these partnerships? Are they ensuring that their local partners benefit in a way that strengthens their decision-making capacity and builds their research expertise for future projects?

The bottom line…

At the end of the day, the true success of research isn’t just measured by publications or findings. It’s about how well it helps those on the ground—health practitioners and policymakers—do their jobs better, faster, and more effectively. Vaccine demand research, in particular, must be adaptable, interdisciplinary, and mindful of the pressures on those implementing public health programs. The key question for the research community remains: How can they better support public health professionals, ensuring that the findings we produce are not only relevant but also actionable in the real-world environments they navigate daily?

The post From Research to Reality: Aligning Vaccine Demand Studies with Public Health Needs first appeared on Tina Purnat.