The problem, as the authors describe it, sits at the intersection of science, politics, economics, misinformation, and public trust. During the pandemic, health leaders were asked to contain a fast-moving virus while simultaneously minimizing economic disruption, educational loss, restrictions on individual freedom, and damage to health equity. Choosing one course of action almost always created harm somewhere else, yet leaders were expected to defend those choices as if they were purely scientific determinations with no values embedded in them. The commentary argues that this framing was unsustainable and, in many cases, destructive to public confidence in health institutions.

The human cost of that unsustainable framing is measurable. The authors cite a survey of 583 United States health departments which found that 36 percent of public health officials left their positions during the first year of the pandemic, and that more than one-third of those departures were associated with workplace harassment, bullying, or threats. When experienced leaders exit in this way, institutions lose more than personnel. They lose relationships, institutional memory, community trust, and the accumulated capacity to navigate future crises. Ige and Fakuade argue that this leadership turnover should be treated not as an administrative inconvenience but as an indicator of system instability and a direct measure of emergency preparedness.

Central to the authors’ argument is the observation that public health leaders are already diplomats in everything but name. Diplomacy is conventionally associated with foreign ministries, but its core functions, including communication, negotiation, facilitation, consensus building, and the management of competing interests, are also the daily work of local and national health officials. These officials routinely negotiate with elected politicians, hospital systems, businesses, educators, community organizations, journalists, scientists, and residents, each of whom may hold sharply different definitions of acceptable risk during a crisis. The commentary draws on leadership experience in Chicago and New York to make the point that it is often easier to get the science right than to navigate the consequences of acting on it. Decisions about schools, mass gatherings, scarce resources, and protective measures demand epidemiologic expertise, but they equally demand the ability to explain uncertainty, negotiate disagreement, understand power dynamics, and maintain working relationships with people who may vehemently oppose the final decision.

International case studies reinforce the argument. In South Africa, the COVID-19 response was built around coordinated, transparent, science-based, and agile leadership, supported by relationships spanning government, academia, the private sector, non-governmental organizations, and international partners. In New Zealand, crisis leadership was communicated through the collective narrative of a “team of five million,” which emphasized shared responsibility, care, trust, and cooperation. The authors suggest that these examples demonstrate a consistent principle: effective crisis leadership is not merely a question of what leaders know, but of how institutions create the conditions for collective action. At the continental level, the commentary also highlights African leadership during COVID-19 as evidence of the value of regional cooperation, locally informed decision-making, and a stronger African voice in global health governance.

From this evidence base, the authors propose three institutional practices to strengthen what they describe as the diplomacy infrastructure. The first is making decision transparency a standing institutional practice rather than an improvisational gesture. Agencies should establish permanent frameworks for weighing health risks alongside economic harm, educational disruption, individual autonomy, and equity, and those frameworks should be public. Leaders cannot always provide certainty, but they can always explain process: what evidence was considered, which values were prioritized, what tradeoffs were recognized, and who participated in the deliberation. Transparency of this kind does not eliminate disagreement, the authors acknowledge, but it creates the conditions for disagreement to be managed constructively. When people can see that decision-making recognizes their realities rather than reducing complex social choices to a bare invocation of “the science,” trust becomes genuinely possible.

The second proposed practice is the systematic use of predefined reassessment checkpoints. Crisis measures, the authors argue, should be treated as time-bound and revisable from the outset rather than as open-ended impositions. Before implementing a major intervention, agencies should identify the time horizon, the specific data to be monitored, and the conditions that would trigger modification or termination. A measure might be announced with an explicit commitment to review transmission and hospitalization data weekly and to decide whether to extend, modify, or end it at a fixed date. This reframing has a subtle but powerful psychological effect: changing course in response to new evidence becomes responsible decision-making rather than an admission of failure. Predefined checkpoints also transform public disagreement from a contest over who was originally “right” into a shared discussion about what the accumulating evidence is revealing.

The third practice is the establishment of cross-sector structures for shared decision-making. The commentary is explicit that public health decisions should not be negotiated solely behind the walls of the health department. Business, education, government, community, and health leaders need standing mechanisms through which competing priorities can be discussed both before and during crises. South Africa’s experience illustrates both the value of coordinated cross-sector relationships and the damage that top-down communication and weak institutional links can inflict on trust. The authors are careful to define what shared decision-making does not mean: it does not give every stakeholder an equal vote on scientific questions. Rather, it ensures that the consequences of decisions are understood by the people who will experience and implement them, a condition that becomes especially critical when misinformation is competing with credible information for public attention.

That competition for attention is itself a defining feature of the modern crisis environment. The authors describe the contemporary information landscape as an infodemic, in which credible evidence contends with misinformation, political narratives, commercial interests, and rapidly shifting social media content. In such an environment, trust cannot be built through information alone. It is built through relationships, consistency, listening, acknowledgment of uncertainty, and accountability. This is why, they argue, public health diplomacy requires a broader competency set than traditional risk communication: skills in facilitation, negotiation, consensus building, conflict management, understanding power, and applying equity and ethical reasoning. These competencies, the commentary insists, belong in graduate education, executive development programs, and emergency preparedness exercises, not in the personal skill sets of a fortunate few leaders.

The conclusion the authors reach is deliberately blunt. Public health leadership during crisis requires navigating competing interests, managing uncertainty, building trust, and helping societies make difficult collective choices, and that, simply put, is diplomacy. The field should stop trying to train individual leaders to communicate better and start building institutions that are better prepared to negotiate. Transparent decision frameworks, predefined reassessment checkpoints, cross-sector advisory structures, and deliberate investment in leadership stability together can make difficult decisions more understandable, more inclusive, and more adaptable. Introducing new leadership in the midst of an emergency erodes community trust precisely because the foundational relationships required for an effective response have not yet been established. If the world expects public health leaders to serve as diplomats in the next crisis, the authors conclude, it must first give them the structures and institutional protection to succeed, distributing the burden of impossible decisions across resilient systems rather than leaving it on individual shoulders until they break.

Subject of Research: Institutionalizing public health diplomacy to strengthen crisis communication, trust, and leadership resilience

Article Title: Institutionalizing public health diplomacy: building trust in crisis

Article References: Ige, O., & Fakuade, D. (2026). Institutionalizing public health diplomacy: building trust in crisis. Public Health Reviews, 47, Article 1610349. https://doi.org/10.3389/phrs.2026.1610349

Image Credits: AI Generated

DOI: 10.3389/phrs.2026.1610349

Keywords: public health diplomacy, crisis communication, COVID-19, leadership turnover, decision transparency, risk communication, health equity, misinformation, emergency preparedness, cross-sector collaboration, institutional resilience, trust