The study’s timing is significant. Kazakhstan first piloted HPV vaccination in four regions during 2013 and 2014, but the effort collapsed amid low uptake, widespread parental refusal, negative media coverage, and persistent safety narratives. The national programme was relaunched in September 2024 for eleven-year-old girls, with catch-up vaccination for those aged twelve to thirteen and parental informed consent required. In May 2026, voluntary vaccination was extended to girls aged fourteen to seventeen. The researchers designed their survey to capture public sentiment in this renewed context, drawing on a validated bilingual questionnaire originally developed in France and previously adapted for Kazakh populations.

Participants completed an electronic questionnaire between 17 January and 28 February 2026, recruited through QR codes displayed in fourteen gynaecology offices at the City Center for Primary Health Care in Astana. The sample skewed young and educated: the largest age groups were eighteen to twenty-four (26.7 percent) and thirty-five to forty-four (25.3 percent), 73.3 percent held higher education, and 40.7 percent were healthcare workers. Nearly all participants (95.0 percent) had heard of the HPV vaccine, and 85.1 percent had actively searched for information about it. Despite this high engagement, factual knowledge remained strikingly low.

On a twelve-item knowledge test, the mean score was just 4.95 out of 12, with a standard deviation of 3.84. ‘Don’t know’ responses exceeded 40 percent for ten of the twelve items, indicating widespread uncertainty rather than confidently held false beliefs. Only 19.9 percent correctly recognised that cervical cancer can still occur after HPV vaccination, and just 29.9 percent knew the vaccine protects against genital warts. Even the highest-scoring item, recognition that HPV infection may remain unnoticed for years, was answered correctly by only 64.7 percent of respondents. These gaps matter because HPV is a necessary cause of nearly all cervical cancers, which accounted for approximately 660,000 new cases and 350,000 deaths worldwide in 2022.

Trust in information sources varied dramatically. Scientific researchers earned the highest mean trust score (3.47 on a five-point scale), followed by healthcare workers (3.29). Alternative media and social networks scored lowest at 2.36, with traditional media close behind at 2.48. This hierarchy suggests that clinicians and researchers remain the most credible voices in the Kazakh information environment, even as digital platforms dominate actual information-seeking behaviour.

To move beyond simple attitude measurement, the researchers applied exploratory psychometric analysis to sixteen perception items. Using polychoric correlations, parallel analysis, and principal-axis factor analysis with oblimin rotation, they identified a two-factor structure. One factor captured perceived effectiveness alongside social endorsement and service facilitation; the other reflected safety- and age-related concern. From this structure, the team derived two preliminary composite measures: a five-item safety concern scale (mean 2.34, Cronbach’s alpha 0.868, McDonald’s omega 0.901) and a three-item perceived effectiveness scale (mean 3.20, alpha 0.922, omega 0.948). Critically, the two scores correlated only weakly (Spearman’s rho 0.129, p = 0.055), confirming that believing in a vaccine’s benefit does not preclude harbouring safety fears.

Knowledge and trust shaped these dimensions in distinct ways. Higher HPV knowledge was inversely associated with safety concern (rho = -0.284, p < 0.001) and positively associated with perceived effectiveness (rho = 0.393, p < 0.001). In multivariable robust regression, each additional correct knowledge answer predicted a 0.061-point increase in perceived effectiveness (95% CI 0.010 to 0.111). But the strongest independent correlate of perceived effectiveness was professional and scientific trust: each one-point increase was associated with a 0.297-point higher effectiveness score (95% CI 0.114 to 0.480). Institutional trust, media trust, and anecdotal experience showed no independent association with effectiveness.

Safety concern told a different story. In a model accounting for 44.6 percent of outcome variance, three contextual beliefs emerged as significant predictors: spillover from COVID-19 vaccine controversies (B = 0.190, 95% CI 0.043 to 0.337), distrust attributed to Kazakhstan’s earlier HPV vaccination programme (B = 0.197, 95% CI 0.047 to 0.347), and preference for natural immunity (B = 0.137, 95% CI 0.040 to 0.234). Healthcare workers reported modestly lower adjusted concern than other participants (B = -0.225, 95% CI -0.449 to -0.001). Notably, the association between knowledge and safety concern was attenuated after contextual beliefs were included (B = -0.023, p = 0.269), suggesting that safety fears are driven more by narrative and historical context than by factual gaps alone.

The most striking finding came from a secondary exploratory analysis. Forty-nine participants (22.2 percent) reported refusal or intention to refuse HPV vaccination for a daughter. The strongest predictor of this response was knowing someone believed to have become seriously ill after vaccination, which raised the odds more than sevenfold (adjusted odds ratio 7.42, 95% CI 2.60 to 21.16). Having children was also associated with higher odds (aOR 3.71, 95% CI 1.40 to 9.81). The researchers caution that this outcome combines actual refusal among women with daughters and prospective intention among those without, so it cannot be interpreted as verified historical refusal prevalence. Nevertheless, the magnitude of the anecdotal-narrative effect underscores how personal stories, even when causally unverified, can override statistical safety data in vaccination decisions.

The findings carry clear programme-level implications. First, communication materials should address effectiveness and safety separately, since belief in benefit does not eliminate concern. Second, healthcare workers require standardised communication training and rapid access to evidence-based answers, because professional-scientific trust is a key asset and recent meta-analytic evidence shows that clinician communication training improves HPV vaccination uptake. Third, the history of the earlier national programme should be acknowledged directly through transparent safety surveillance rather than dismissed. Fourth, preference for natural immunity deserves targeted counter-messaging that contrasts the predictable protection of vaccination with the uncertain and potentially carcinogenic consequences of natural HPV infection. Finally, programme evaluation should measure actual first-dose and series-completion outcomes rather than attitudes alone. The study’s limitations, including convenience sampling at a single centre, a cross-sectional design that cannot establish causality, and preliminary psychometric measures requiring external validation, temper these conclusions. Yet the core message is unambiguous: in a post-COVID information environment marked by cross-vaccine narrative spillover, rebuilding confidence in HPV vaccination demands not just more facts, but a fundamentally different kind of conversation between clinicians, scientists, and the communities they serve.

Subject of Research: HPV vaccine knowledge, trust, and multidimensional perceptions among women attending primary care in Astana, Kazakhstan

Article Title: Knowledge, trust, and multidimensional perceptions of human papillomavirus vaccination among women attending a single primary care centre in Astana, Kazakhstan: a cross-sectional study

Article References: Umbetzhanova, A., Kusniyeva, A., Derbissalina, G., Abduldayeva, A., Safonov, N., & Koikov, V. (2026). Knowledge, trust, and multidimensional perceptions of human papillomavirus vaccination among women attending a single primary care centre in Astana, Kazakhstan: a cross-sectional study. Frontiers in Global Women's Health, 7, Article 1960252. https://doi.org/10.3389/fgwh.2026.1960252

Image Credits: AI Generated

DOI: 10.3389/fgwh.2026.1960252

Keywords: HPV vaccination, vaccine hesitancy, Kazakhstan, vaccine safety, vaccine confidence, cervical cancer, COVID-19 spillover, health communication, primary care, psychometrics, women's health, public trust

Living kidney donation is one of medicine’s most ethically charged procedures. The donor undergoes major surgery and assumes real physical risk with no direct medical benefit, while the recipient gains freedom from dialysis and, often, years of extended life. Because the stakes are so asymmetric, the entire legitimacy of the practice rests on the donor’s consent being genuinely voluntary and informed. In Singapore, this is enforced through the Human Organ Transplant Act, which requires every living-donor transplant to be reviewed by a national Transplant Ethics Committee, or TEC. Each committee meeting includes a layperson and two doctors uninvolved in transplant medicine, drawn from a national list overseen by the National Organ Transplant Unit. Donors and recipients are interviewed separately, and a rejection by the TEC effectively prevents transplantation anywhere in the country, placing enormous weight on the decisions made before a case even reaches formal review.

The authors argue that ethical judgment cannot be reduced to procedural compliance. Transplant teams themselves carry a broader responsibility to evaluate the relational dynamics that may undermine the voluntariness and authenticity of consent. Their three cases, involving candidates between 40 and 60 years old who voluntarily disclosed previously concealed intimate relationships during evaluation, illustrate how difficult this responsibility becomes when the information at stake is not medically relevant but is deeply morally significant.

In the first case, a recipient candidate disclosed to the transplant team a nearly decade-long extramarital relationship that had recently ended, but refused to tell the spouse who wished to donate a kidney to free them from lifelong dialysis and preserve the marriage. The team recognized that the donor’s offer rested on a presumption of mutual marital fidelity, and that knowledge of the affair might change the donor’s decision entirely. This created a direct conflict between the donor’s right to material information and the recipient’s right to privacy, particularly since the information had been shared in good faith. Some team members worried that the recipient’s decision to end the affair might itself have been implicitly coerced by the donor’s sacrificial gesture, raising questions about whether genuine informed consent was even possible under such emotional pressure. There was also concern that the donor might later use the gift as leverage to pressure reconciliation if the infidelity came to light. The team ultimately deferred, but did not prohibit, the transplant, hoping to give the recipient time for grief, reflection, or counselling. Notably, the recipient felt penalized for honesty, upset that candid voluntary disclosure had led to personal disadvantage.

The second case reversed the roles. Here, the donor disclosed a three-year extramarital affair that had preceded the recipient’s dialysis dependency, motivated by a desire to become a better spouse after witnessing the recipient’s fortitude during illness. The donor had ended the affair a full year before even raising the possibility of donation. The ethical concerns now centered on the recipient, whose consent would be obtained through ignorance of the donor’s infidelity. Yet the team reasoned that while emotionally significant, this information was not clearly material to the recipient’s evaluation of surgical risk, transplant prognosis, or expected clinical outcome. The recipient’s reason for accepting the kidney, escaping the burdens of dialysis, was independent of the donor’s past conduct. The team also acknowledged that some recipients might prefer not to know about spousal infidelity, exercising what ethicists call negative autonomy, and that preferences for disclosure vary widely across individuals. Crucially, they could not ascertain the recipient’s preference without revealing the truth itself. After deliberation, the team recommended proceeding, judging that deferral would not rewrite the marital history but could delay the recipient’s access to improved quality of life, potentially causing greater harm. The donation went ahead, and the donor made no subsequent disclosure of the affair.

The third case was the most complex. Both donor and recipient concealed an ongoing intimate relationship from their spouses and presented themselves as close friends. The donor claimed the offer was motivated by altruism, friendship, and compassion, while the recipient sought emancipation from dialysis. On the surface, the threshold for informed consent was met: both parties understood and accepted the risks and benefits, and both were voluntary in their decisions. Informed consent, the team noted, is owed to the donor and the recipient, not to their spouses, even if the spouses were misinformed about the nature of the relationship. But doubts emerged about whether the donor’s offer could be coerced as proof of devotion or driven by fear of abandonment, and whether the recipient might feel compelled to remain in the relationship because of the donation. The team also faced a deeper institutional bind: the transplant would be contingent on continued deception of both spouses, who would be placed in caregiving roles they had never agreed to, raising fairness concerns. The risk of exposure might not be high, but the reputational risk to a publicly accountable team was significant, particularly if marital breakdown or family conflict involving children followed. The team reached a unanimous decision on conditional deferral, giving the pair time to decide the future of their relationship before reconsidering the transplant. Both candidates, though disappointed, accepted the outcome.

What unites these cases is a common ethical question: should living-donor transplantation proceed when concealed intimate relationships materially affect the relational context in which donation occurs? The authors argue that spousal living donations are typically grounded in love, devotion, marital commitment, and preservation of the family unit. A decision to donate based on a material misunderstanding of the true nature of the donor-recipient relationship compromises autonomous decision-making. Because the donor alone assumes the physical risk, factors that undermine the donor’s ability to provide informed consent should carry greater ethical weight than those affecting the recipient. Privacy remains important, but it does not absolve transplant programs of their responsibility to safeguard the integrity of donor consent.

The authors also emphasize that conditional deferral, rather than outright prohibition, offers a proportionate response in many situations. Deferral provides time for relational instability to be addressed, for disclosure to be considered where appropriate, and for reliable post-operative support to be ensured. Since none of these cases involved urgent need for transplantation, and given that a TEC rejection effectively precludes transplantation anywhere in Singapore, deferral preserves the possibility of future transplantation once the identified concerns have been resolved. The authors frame this as proportional restraint rather than moral adjudication of private wrongdoing. They also point to Singapore’s Human Organ Transplant Regulations 2004, which statutorily require consideration of public interest and community values, concepts that may reasonably extend to preventing foreseeable harm to spouses, families, and marital relationships.

Ultimately, the authors conclude that transplant programs should not reject living kidney donation solely on the basis of moral discomfort with aspects of the donor-recipient relationship. But confidentiality and respect for autonomy alone are insufficient to justify proceeding when teams become aware of concealed extramarital relationships that materially affect the relational context of donation. Ignoring such relational realities risks reducing ethical oversight to procedural compliance rather than principled judgment. To the authors’ knowledge, this is the only known work discussing the impact of concealed intimate relationships in living-donor transplant, a gap they argue warrants further empirical and normative research to guide programs confronting these ethically complex situations.

Subject of Research: Ethical evaluation of concealed marital infidelity in living kidney donor and recipient consent

Article Title: Consent in the dark: Can living kidney donation proceed amid marital infidelity?

Article References: Lim, C., Voo, T. C., Chow, P. C.-L., & Krishna, L. K. R. (2026). Consent in the dark: Can living kidney donation proceed amid marital infidelity?. Transplant International, 39, Article 16580. https://doi.org/10.3389/ti.2026.16580

Image Credits: AI Generated

DOI: 10.3389/ti.2026.16580

Keywords: living kidney donation, informed consent, transplant ethics, marital infidelity, donor welfare, Transplant Ethics Committee, Singapore, Human Organ Transplant Act, institutional integrity, psychosocial evaluation, conditional deferral, public trust

The researchers examined two of the most prominent post-hoc evaluations of national Covid-19 responses, published between 2022 and 2024 by two leading medical journals: The Lancet and The BMJ. The Lancet Commission on lessons for the future from the Covid-19 pandemic, released in 2022, provided a comprehensive analysis of government responses and recommendations for future pandemics. The BMJ published three separate series—one informing the United Kingdom’s Covid-19 Inquiry, one on accountability for Canada’s response, and one on lessons for future health protection and preparedness in the United States—comprising 25 analyses, opinions, and editorials. These journals played a critical role in shaping global policymaking during the pandemic, publishing some of the most important studies on Covid-19 and evaluating the effectiveness of non-pharmaceutical interventions such as mask mandates and lockdowns.

What the team found was striking. Across all 25 articles in the three BMJ series, references to the harms of public health interventions accounted for less than 1 percent of the total content. In the Canadian series, only one article out of seven mentioned harm at all, and just two sentences—38 words out of 13,033 total words, or 0.29 percent of the text—addressed the issue. In the US series, four sentences in the series editorial indirectly described harms, representing 101 words out of 16,299 total words, or 0.62 percent. The UK series fared marginally better, with nine sentences totaling 207 words out of 25,003 words, or 0.83 percent. None of the BMJ articles incorporated any form of cost-benefit analysis. The Lancet Commission mentioned harms in a few sections—briefly noting effects on marginalized individuals, the poor, displaced children, and refugees—but did not discuss them systematically, made only a minor and cursory reference to policy trade-offs, and failed to incorporate them into its recommendations.

The authors argue that this omission is both surprising and consequential. The field of harm-benefit analysis is well established in public health, and the notion that interventions involve trade-offs between benefits and harms should be uncontroversial. Cost-benefit analysis is routinely employed in other fields—environmental, consumer, and financial regulation—areas that also impact the well-being of large populations. Yet public health scholars have largely avoided applying a benefit-harm framework to Covid, partly for moral reasons: such analysis often involves assigning a monetary value to life. The authors contend that this natural reluctance, while understandable, impedes sound policy analysis in a world of limited resources, and that acknowledging that interventions can cause harms—even if inadvertent—is essential for restoring trust in public health authorities.

The harms of pandemic interventions were real and increasingly documented. Lockdowns disadvantaged low-income populations and young people. Social isolation measures harmed those struggling with addiction and mental health disorders. School closures hurt children and their families, with evidence from the United States showing substantial learning losses associated with remote and hybrid schooling, with larger declines in districts serving more Black students and effects that may be long lasting. A comprehensive framework has recently been published identifying the range of harms of non-pharmaceutical interventions and reviewing their magnitude. Another framework focused on health inequalities shows that several interventions not only perpetuated and exacerbated pre-existing inequities but also created new ones. Policies designed to improve public health can disproportionately harm disadvantaged populations, contributing to unequal socio-economic outcomes.

Ignoring these harms and trade-offs, the authors argue, erodes public trust in health authorities. The history of epidemics teaches that overly paternalistic interventions can lead to conflict and mistrust. As historian of epidemics David Jones noted, epidemic responses such as quarantine or compulsory vaccination generally involve people with power and privilege imposing interventions on people without power or privilege—a dynamic that fuels social conflict. Trust is critical in public health because it facilitates consent, a necessary condition for widespread adoption of measures such as immunization programs. Lack of trust increases non-compliance and vocal opposition to health authorities. The erosion of trust may already be visible: in the United States and parts of Canada, routine childhood vaccination requirements are increasingly challenged, exemptions are rising, and outbreaks of preventable diseases such as measles have re-emerged.

The global dimension of this blind spot is particularly severe. Data from the World Bank and UN agencies showed that over 400 million people fell below their national poverty line in 2022, with low-income countries experiencing a disproportionate share of the drop. UNICEF estimates a 13 percent global increase in learning poverty—the share of children who cannot read a simple text with comprehension by age 10—disproportionately higher in low- and middle-income countries, essentially erasing all educational gains since 2000 and estimated to cost the current generation of students $21 trillion in lost earning potential. Millions of children missed essential vaccines, with nearly four million more unvaccinated children than in 2019. Country-level evidence illustrates the severity: in Uganda, lockdowns were associated with disruptions to family stability, housing, schooling, food security, and increased gender-based violence and child labour. In Angola, where 77 percent of the population worked in the informal economy, unemployment in September 2020 was 34 percent higher than in 2019, and a survey of informal-sector operators in Luanda found that 95.8 percent reported significant or marginal reductions in income. In India, the March 2020 nationwide lockdown abruptly disrupted migrant workers’ livelihoods, prompting large numbers to return to their home states.

To explain why these assessments failed, the authors draw on the disproportionate policy response literature from political science, which holds that governments can either over-react or under-react to situations requiring a policy response. Over-reaction occurs when a policy’s net cost exceeds its benefit—when the scale, stringency, or breadth of intervention is disproportionate to the problem. Under-reaction occurs when a policy’s net benefit is lower than the relevant status-quo counterfactual—when action is weaker or narrower than warranted by the risk. The BMJ and Lancet inquiries focused almost entirely on the under-reaction perspective, highlighting failures to act while largely ignoring the possibility of over-reaction. This narrow framing, the authors argue, prevents a thorough investigation of trade-offs and leaves policymakers with a flawed toolkit for future emergencies.

Recent scholarship offers explanations for why over-reaction may have occurred. National committees advising governments were dominated by public health officials who lacked the expertise to evaluate the costs of non-pharmaceutical interventions and had little inclination to do so. As Francis Collins, a member of the White House Coronavirus Task Force, commented, decision-makers attached infinite value to stopping the disease and saving a life, and zero value to whether measures actually disrupted people’s lives, ruined the economy, and kept children out of school. The media focused too heavily on disease spread and deaths rather than the costs of prevention measures. Academics willing to investigate trade-offs often found themselves subjected to invective, character attacks, and reputational damage. Political science literature also identifies conditions favoring major policy change: high issue salience, especially during crises when the public feels anxious and vulnerable, and a low number of veto players—during the pandemic, major decisions were taken almost exclusively by executive branches insulated from meaningful oversight by other government bodies.

The authors conclude that accountability inquiries must assess the harms as well as the benefits of public health interventions and weigh them against each other—something that, so far, has not been done. The need to address trade-offs should be made explicit in the terms of reference of any inquiry, and invitees to hearings should reflect a broad range of views, placing pressure on committee members to consider the appropriate balance in their recommendations. Diversity of thought, free from ideological bias, is key to assessing the adequacy of government responses. Low-income countries, which often have younger populations at lower risk of serious harm from Covid-19 and lack necessities like clean water and food, may benefit from less restrictive approaches, and the most appropriate national policies are conditional on national demographic, social, and economic conditions. To improve public health outcomes, prevent the recurrence of policy mistakes, and restore trust in public health authorities, the authors argue that future pandemic preparedness must begin by acknowledging that interventions involve trade-offs—and by building the systematic evaluation of those trade-offs into decision-making from the start.

Subject of Research: Public Health Policy

Article Title: Incomplete Assessments: Including Harms and Trade-offs in Assessing Policy Approaches to Covid-19

Article References: Bavli, I., Sutton, B., Bardosh, K., & Galea, S. (2026). Incomplete Assessments: Including Harms and Trade-offs in Assessing Policy Approaches to Covid-19. SSM – Population Health, Article 101983. https://doi.org/10.1016/j.ssmph.2026.101983

Image Credits: AI Generated

DOI: 10.1016/j.ssmph.2026.101983

Keywords: Covid-19, public health, policy trade-offs, harm-benefit analysis, lockdowns, school closures, The Lancet, The BMJ, public trust, health inequities, low-income countries, disproportionate policy response

The scale and ambition of modern health data research are difficult to overstate. Large-scale datasets drawn from electronic health records, administrative systems, disease registries, and digital technologies are transforming how researchers understand disease patterns, treatment outcomes, and population health trends. Instead of studying small groups of patients in isolation, scientists can now follow entire populations over time, spotting signals that would be invisible in conventional clinical trials. For children’s healthcare in particular, where rare conditions and long-term developmental outcomes make traditional studies slow and expensive, routinely collected data promises insights that could shape care for generations. Yet the same features that make big data powerful also raise concerns. Data collected for one purpose are often routinely reused beyond their original context, and critics have pointed to cases where information has been sold to commercial companies. Governance structures can be opaque, and participants are typically far removed, both physically and institutionally, from the researchers who analyse their information, creating a distance that can breed suspicion.

Much of what is known about public attitudes to health data sharing comes from studies of general adult populations, which have found broad but conditional support, particularly where there is perceived public benefit and trust in the organisations involved. Evidence specifically exploring the views of children and young people, especially those from groups underrepresented in research, has been far scarcer. That gap matters, because children’s data are used in research with decisions made on their behalf, and because today’s young people will become tomorrow’s adult participants in an increasingly data-saturated research environment. To address the gap, researchers from the Department of Psychiatry at the University of Cambridge carried out a systematic review of both qualitative and quantitative evidence, allowing them to combine findings from different types of research and identify common themes across the evidence base. The review included 17 studies involving 6,261 participants in total, including at least 4,710 children and young people and 1,443 parents and carers.

The overall pattern of attitudes was encouraging for the research community. Children and young people, along with their parents and carers, were broadly supportive of using health data for research where there was a clear potential benefit. Three kinds of benefit stood out in the evidence: improving healthcare directly, advancing scientific knowledge, and supporting other people with similar experiences of illness. In other words, participants were not opposed in principle to their records contributing to a larger good; they could imagine their own data helping a child they had never met receive better treatment. However, the review is emphatic that this support was conditional rather than unconditional. Participants wanted research to be carried out ethically, by trustworthy organisations, and with appropriate safeguards and transparency around how their data are used. Where those conditions were absent or unclear, support weakened considerably.

The conditions participants attached to their support reveal a sophisticated understanding of the risks involved. Respondents wanted strong protections to ensure their information is used safely and fairly, and they were concerned about the potential loss of privacy and the possibility of being identified even when data are supposedly anonymised. This concern reflects a technical reality: as datasets grow larger and more detailed, and as they are linked with other sources of information, the risk of re-identification from supposedly de-identified records increases. Participants were also worried about the misuse of data by organisations, particularly commercial companies. Trust emerged as a decisive factor in shaping attitudes. Young people were generally more comfortable sharing data when it was managed by trusted public organisations such as health services, universities, or non-profit researchers, and markedly less comfortable when private companies were involved in the chain of custody. For anyone designing data infrastructure for paediatric research, the implication is clear: who holds the data, and under what governance arrangements, matters as much to young people as what the data will be used for.

Perhaps the most striking finding concerned agency. Young people wanted a greater say in decisions about their data as they grow older. Some studies suggested that they should become increasingly involved in decisions about consent and data use as they mature, rather than having those decisions made entirely by parents or institutions on their behalf. This developmental perspective challenges the conventional binary of parental consent and child assent, pointing instead toward a graduated model in which young people’s decision-making role expands with their maturity. It also aligns with broader movements in paediatric medicine toward recognising children as active participants in their own care rather than passive subjects. Charlotte Burdge, a PhD student in the Department of Psychiatry at the University of Cambridge, who led the review, said that big data has the potential to unlock valuable insights into health and disease, but that the review shows we should not take for granted that everyone will give unqualified support for their data to be used. Young people, she noted, are generally in favour and can see the benefits, but they understandably want to ensure their data is used ethically and securely, that they have control over how it is used, and that their views are taken seriously.

The review also points toward practical measures that could build the trust and transparency young people say they need. Burdge suggests that making it clearer to participants how their data are being used and governed is one such measure. Understanding why data are being used, who may access them, and what safeguards are in place will be important as the use of data in healthcare research continues to expand. In practice, this could mean plain-language explanations of data flows, accessible governance information, and mechanisms through which participants can ask questions and raise concerns. The findings arrive at a particularly relevant moment for Cambridge itself, which is developing new approaches to using health data and other routinely collected information to improve children’s healthcare. Burdge’s work contributes to the Children and Adolescents Data Resource, known as CADRE, led by Dr Anna Moore, also from the Department of Psychiatry, which is helping to establish the digital foundations for the new Cambridge Children’s Hospital. Ensuring that children, young people, and families are involved in thinking about how data are collected, linked, and used is intended to be an integral part of developing data-driven approaches that are trusted and responsive to their needs.

Burdge also emphasised the importance of early engagement. For research such as ours, she said, it is important that we work with patients and members of the public from the outset to understand any concerns they may have and find out what would be meaningful for them, adding that this will help ensure that what researchers are doing aligns with public expectations. The researchers are careful to note, however, that their findings should not be interpreted as representing one uniform view among all underrepresented groups. People’s experiences and perspectives are shaped by their individual circumstances, backgrounds, and previous encounters with healthcare and research. A young person who has spent years in and out of hospital may view data sharing very differently from one with little contact with health services, and communities with historical reasons for distrusting medical institutions may need different forms of assurance. Treating children and young people as a single homogeneous bloc of opinion would itself undermine the review’s core message about the importance of listening to individual voices.

The research was funded by the UKRI Medical Research Council through Datamind, the Office for Life Sciences, and the National Institute for Health and Care Research Mental Health Translational Research Collaboration Mission, hosted by the NIHR Oxford Health Biomedical Research Centre, with additional support from the NIHR Cambridge Biomedical Research Centre and the NIHR Applied Research Collaboration East of England. The review, published under the title Perceptions, attitudes, and concerns of underrepresented groups regarding the use of big data in children and young people’s healthcare research, arrives as governments and health systems invest heavily in data infrastructure, from national secure data environments to hospital-scale platforms linking genomic, clinical, and administrative records. For the architects of these systems, the Cambridge findings offer both reassurance and a warning. Reassurance, because the next generation appears genuinely enthusiastic about the promise of data-driven medicine and can articulate its benefits with clarity. Warning, because that enthusiasm is contingent, and it can be lost. Young people are asking not to be excluded from the data revolution, but to be included in its governance, with safeguards they can see, organisations they can trust, and a seat at the table that grows as they do.

Subject of Research: Children's and young people's attitudes toward the use of big health data in healthcare research

Article Title: Children and young people broadly support health data research – but want safeguards

Article References: Children and young people broadly support health data research – but want safeguards. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: health data, big data, children, young people, systematic review, data privacy, consent, public trust, healthcare research, University of Cambridge, PLOS Digital Health, data governance

The study, carried out by Ahmed Mohamed Hassan of the Faculty of Social Sciences and Ahmed-Nor Mohamed Abdi of the Department of Public Administration, both at SIMAD University in Mogadishu, set out to answer a question that has long puzzled governance researchers: can digital participation mechanisms actually build trust in a post-conflict state, or are such tools meaningful only in countries where democratic institutions already function? Somalia, emerging from prolonged conflict with weak formal institutions and a rapidly growing digital culture driven by mobile technology, provided an unusually demanding test case.

To investigate, the researchers surveyed 301 residents of the Mogadishu municipality using a cross-sectional design. Rather than treating e-participation as a single undifferentiated concept, the study broke it down into three distinct dimensions drawn from the established e-governance literature. The first, e-information, covers the extent to which local government uses digital channels to publish data, announce decisions, and make its activities visible to the public. The second, e-consultation, refers to structured online mechanisms through which citizens can voice opinions, respond to proposals, and offer feedback before decisions are finalized. The third and most demanding dimension, e-decision-making, involves giving citizens genuine digital pathways to influence or co-determine municipal outcomes, moving beyond consultation toward shared authority.

The analytical backbone of the study was partial least squares structural equation modeling, or PLS-SEM, a statistical technique widely used in information systems and public administration research when relationships between latent constructs—such as trust or digital literacy—must be estimated from survey indicators. PLS-SEM is particularly suited to exploratory models in novel contexts because it does not require the strict distributional assumptions of covariance-based methods and performs well with complex predictive models. The researchers used it to test a conceptual model in which the three e-participation dimensions were hypothesized to have direct positive effects on trust in local government, while citizens’ digital literacy was modeled as a potential moderator of those relationships.

The results were striking in their consistency. All three dimensions of e-participation—e-information, e-consultation, and e-decision-making—showed positive and statistically significant direct associations with public trust in the municipal government. In other words, residents who perceived that Mogadishu’s local authorities were transparently sharing information online, actively soliciting citizen input through digital channels, and incorporating public participation into decision-making reported markedly higher levels of trust. This pattern held across the full model, suggesting that the trust-building pathway operates through multiple complementary mechanisms rather than a single channel.

The theoretical logic behind these associations draws on well-established ideas in governance research. Transparency, delivered through e-information, reduces the information asymmetries that breed suspicion in fragile states where rumors and misinformation often fill the vacuum left by unreliable official communication. E-consultation signals responsiveness and respect for citizen voice, which procedural fairness theories identify as a key driver of institutional legitimacy. E-decision-making goes further, transforming residents from passive recipients of governance into stakeholders with a measurable stake in municipal outcomes. In Mogadishu, where generations of residents have experienced government as either absent or predatory, even modest evidence of responsiveness may carry outsized psychological weight.

The study’s second major hypothesis, however, did not survive testing. The researchers expected that citizens’ digital literacy would moderate—either amplify or attenuate—the relationship between e-participation and trust, on the plausible reasoning that digitally skilled residents would be better positioned to access, interpret, and benefit from online participation platforms. Instead, digital literacy showed no statistically significant moderating effect. Within this sample, the trust-building benefits of e-participation remained consistent regardless of how digitally proficient respondents were. The authors are careful to interpret this null result with caution: their sample was predominantly digitally literate and well educated, which compresses the variation in digital skills and makes it statistically harder to detect moderation. In a more heterogeneous population, digital literacy might still act as a gatekeeper determining who can participate at all.

That caveat matters less than it might appear, however, because of what the sample itself reveals about urban Somalia. The image of Mogadishu as a technological wasteland is increasingly outdated. Mobile money, social media, and smartphone connectivity have spread rapidly across the city, and the study’s respondents—a group skewed toward digitally capable, educated residents—reflect a real and growing segment of the urban population. For this constituency, low-barrier digital platforms appear to function as genuine bridges to the state. The study describes how inclusive digital platforms can transform marginalized urban residents into active stakeholders, a shift that carries implications well beyond satisfaction with municipal services.

The findings are framed explicitly within the United Nations Sustainable Development Goals, particularly SDG 16, which calls for effective, accountable, and inclusive institutions, and its Target 16.7, which emphasizes responsive, inclusive, participatory, and representative decision-making at all levels. The authors argue that their results advance the literature on social sustainability by demonstrating how citizen-centric digital governance can be localized in post-conflict settings. They also connect the work to SDG 11 on sustainable cities, suggesting that digital participation contributes to institutional resilience and social cohesion in cities recovering from violence. In fragile states, where trust in government is both hardest to earn and most consequential for stability, e-participation may thus serve as a low-cost instrument of state-building.

The broader significance of the study lies less in its individual statistical estimates than in the territory it opens up. Most empirical work on e-participation and trust has been conducted in stable democracies with mature digital infrastructure, leaving scholars with little evidence about whether digital governance mechanisms transfer to environments marked by institutional fragility, security constraints, and histories of state failure. By extending the e-participation and public trust literature to an understudied post-war African urban governance setting, and by grounding it in a validated structural model, the research provides a template for future studies in comparable contexts—from other Somali cities to fragile urban centers across the Horn of Africa and beyond. The study received ethical approval from the Ethics Committee of the Center for Research and Development at SIMAD University and was funded through a SIMAD University research grant. Its central message is deceptively simple: even in the most difficult governance environments on Earth, the deliberate design of transparent, participatory digital platforms is statistically associated with something fragile states desperately need—citizens who believe their government can be trusted.

Subject of Research: The relationship between e-participation, digital literacy, and public trust in local government in post-conflict Mogadishu, Somalia

Article Title: Electronic participation, digital literacy and public trust in local government in the fragile context of Mogadishu, Somalia

Article References: Hassan, A. M., & Abdi, A.-N. M. (2026). Electronic participation, digital literacy and public trust in local government in the fragile context of Mogadishu, Somalia. Discover Sustainability. https://doi.org/10.1007/s43621-026-05045-0

Image Credits: AI Generated

DOI: 10.1007/s43621-026-05045-0

Keywords: e-participation, public trust, digital literacy, local government, e-governance, Mogadishu, Somalia, post-conflict governance, PLS-SEM, SDG 16, participatory governance, social sustainability

The timing of the argument is not accidental. The COVID-19 pandemic offered a stress test of how science reaches the public, and the results were sobering. Rapidly evolving evidence forced frequent updates to public health guidance, but inconsistent messaging and inadequate explanation of scientific uncertainty bred confusion. Social media amplified both accurate information and misleading claims at unprecedented speed, and simplified or sensational narratives frequently outran nuanced, evidence-based explanations. The authors argue that the pandemic did not create these weaknesses but exposed them, revealing that the institutions and incentives supporting science communication have not evolved at the pace required by a decentralized, algorithmically mediated information environment.

The first stage of breakdown occurs before a finding ever leaves the laboratory’s orbit. Peer-reviewed journals remain the gold standard for communication within the biomedical community, prized for their rigorous scientific and editorial oversight. Yet the path to publication is fraught. Manuscript submission fees can be prohibitive, rejection rates are high, and peer review and editorial processes are lengthy. The imbalance between available peer reviewers and the volume of manuscripts awaiting review has worsened since the pandemic, and it has been compounded as submission numbers climb, driven in part by researchers using large language models to draft manuscripts. Publishing incentives also favor positive findings and novel discoveries over the confirmatory studies and negative data that build a complete evidence base.

Access is the other half of the problem. Full-length journal articles often sit behind expensive paywalls, and even when they are readable, dense field-specific terminology and technical precision prioritized over clear storytelling can render them impenetrable to biomedical professionals outside a given specialty. Many journals have introduced remedies, including open access options, required plain-language summaries, and graphical abstracts, but adoption is inconsistent and enforcement is weak. Plain-language summaries remain relatively uncommon or overly technical, and graphical abstracts can themselves create accessibility barriers for some audiences. The result is a system in which even the professionals most likely to translate research for others struggle to obtain and understand it.

The authors propose a layered set of fixes for this first stage. Journals can use their own data on readership, citation metrics, and digital engagement to evaluate which editorial policies actually work and to refine guidelines for data sharing and plain-language summaries. Research institutions can retain department- and school-level support from in-house statisticians, graphic designers, technical writers, and communications specialists, and extend equitable access to those staff regardless of a research team’s size or funding. Researchers themselves are urged to write for the professional backgrounds of their intended audiences, to describe the conditions under which findings apply while acknowledging limitations and uncertainty, to develop fluency in accessible visual communication, and to use preprint outlets when publication costs are prohibitive. Philanthropic funders, meanwhile, can incentivize these practices among grantees; the authors cite the Misophonia Research Fund, which engaged a communications firm to strengthen grantees’ skills and hosted a virtual forum to share findings with both the biomedical community and the public.

The second stage, interpretation and distribution, is where the telephone game gets truly dangerous. Once research is published, findings are picked up, translated, and repackaged for different audiences, and every act of reinterpretation is an opportunity to introduce inaccuracy. Science journalism sits at the center of this relay, and it is struggling badly. As the advertising-based model that historically supported news platforms collapses, legacy media organizations have lost reporting capacity, particularly in specialized areas like science. The United States is losing an average of more than two newspapers per week, and the spread of news deserts, communities with few or no local news sources, matters because local news is highly trusted and has significant reach, making it a key vehicle for disseminating accurate scientific information. The contraction also means fewer opportunities for specialized training: most journalists are generalists, and fewer than 3 percent bring an undergraduate science major to their reporting.

As journalism recedes, other actors fill the vacuum, often without preparation. Clinical and research scientists increasingly post on social media, write for public audiences, and engage with reporters, but they are not typically trained in public communication and risk misrepresenting nuance or uncertainty in ways that inadvertently undermine trust. Misinformation compounds the problem. Although blame often falls on social media, the authors note that inaccurate scientific information stems from many sources, including corporations, government offices, entertainment media, press offices, individual scientists, healthcare professionals, and research institutions. AI platforms and large language model chatbots now serve as additional distribution channels, with the potential to amplify both accurate and misleading content. Because misinformation thrives in the absence of easily accessible, credible information, the authors argue that everyone participating in the ecosystem bears responsibility for sharing reliable science.

Remedies for the distribution stage already exist and can be scaled. Training programs and fellowships support specialized science journalism, exemplified by the Knight Science Journalism Academic-Year fellows who spend a year at MIT exploring research and honing technical skills. Scientific societies can train scientists to work with journalists: SciLine, developed by the American Association for the Advancement of Science, offers journalists free training, resources for evidence-based reporting, and a matching service that pairs reporters with scientific experts, while scientists in its network receive media training. Universities can embed communication skills in scientific training, as Stony Brook University does through a science communication certification offered with the Alan Alda Center for Communicating Science during doctoral study. Philanthropy has a distinctive opening here, exemplified by Press Forward, a national network led by the MacArthur Foundation that aims to strengthen local news and close coverage gaps by lowering barriers for new funders. Because much philanthropic giving is place-based and rooted in personal interests, the authors argue that science journalism, sitting at the intersection of those domains, can appeal to many funders.

The third stage, public engagement, is where the paradox of modern science communication becomes starkest. Polling from the Pew Research Center reported in April 2026 found that 85 percent of Americans obtain science and health information at least sometimes from healthcare providers, 66 percent from people with similar health experiences, and 60 percent from major health websites such as WebMD or Mayo Clinic. Journalists and news organizations were cited by 46 percent, government health agencies by 45 percent, social media by 36 percent, and AI chatbots by 22 percent. Yet despite this abundance of channels, global and US public confidence in the ability to find reliable answers and make informed health decisions has significantly declined in the past year, according to the Edelman Trust Barometer. The authors attribute this paradox to the multiple layers of reinterpretation in the current pipeline: different platforms deliver conflicting or oversimplified narratives, leaving audiences uncertain about what to believe and more likely to gravitate toward the most prominent or emotionally compelling voices.

The encouraging news is that trust itself is not the missing ingredient. Roughly 70 percent of Americans report at least moderate trust in scientists to act in the public’s best interest, and about 75 percent prioritize sources that demonstrate relevant medical expertise, disclose conflicts of interest, and present information clearly. Preferences vary across populations: people with lower incomes or less formal education are more likely to prioritize likability and relatability, while those without health insurance often emphasize convenience, including access through social media and AI platforms. The central weakness, the authors conclude, is a misalignment between trust, accessibility, and communication pathways. Their recommendations include having academic medical centers incentivize faculty and clinicians to engage in outreach and pair them with professional science communicators, as the Mayo Clinic has done by counting digital and social media scholarship among criteria for academic advancement. Community-level partnerships matter too: the Barbershop Talk with Brothers program, a collaboration between the Arthur Ashe Institute for Urban Health and SUNY Downstate Medical Center, trains barbers who are trusted advisors in Brooklyn to communicate evidence-based health information. Structural incentives, such as tying grants or accreditation to demonstrated public communication, and philanthropic support for programs like the ARVO Science Communication Training Fellowship could make outreach a core component of scientific careers. The challenge, in the authors’ framing, is not a deficit of public trust in science but the failure to ensure that accurate, transparent, and understandable information is easy to find, easy to engage with, and easy to trust, and philanthropy’s risk-tolerant capital may be the force best positioned to rebuild those connections.

Subject of Research: Redesigning the biomedical science communication ecosystem from publication to public engagement

Article Title: Bridging communication gaps across the biomedical ecosystem

Article References: Burke, E. A., Schumm, S. N., Jobe, A., Whelply, K., & Das, I. (2026). Bridging communication gaps across the biomedical ecosystem. Frontiers in Systems Biology, 6, Article 1939110. https://doi.org/10.3389/fsysb.2026.1939110

Image Credits: AI Generated

DOI: 10.3389/fsysb.2026.1939110

Keywords: science communication, biomedical research, peer review, misinformation, science journalism, social media, large language models, public trust, philanthropy, health information, news deserts, community health

The mechanism Krucke describes is deceptively simple. Institutional policies translate operational priorities into day-to-day expectations about productivity, access, documentation, communication, teamwork, and behavior. None of these expectations is inherently illegitimate. Hospitals must manage throughput, clinics must maintain access, and health systems must steward finite resources. But when those operational priorities are packaged as professionalism, the term begins to drift from its ethical foundations. A physician who raises concerns about unsafe staffing or unrealistic visit targets may find that the concern is redescribed as a problem of attitude, tone, or teamwork. The physician who adapts quietly becomes the model employee, and by extension, the model professional.

Crucially, Krucke’s argument is not a critique of employed physicians or of the compromises that real-world care demands. Doctors routinely choose among imperfect treatments, limited social supports, difficult discharge plans, and competing patient needs. Professionalism, as he frames it, is not an absolute demand for unconstrained or perfect care. It is a fiduciary obligation to exercise patient-centered judgment honestly and accountably under actual conditions. The Physician Charter, the landmark 2002 statement from the American Board of Internal Medicine Foundation, the American College of Physicians, and the European Federation of Internal Medicine, identifies the primacy of patient welfare, patient autonomy, and social justice as the fundamental principles of professionalism, embedded within medicine’s social contract with society. Those commitments require physicians to acknowledge scarcity, consider the needs of other patients, steward resources, communicate limitations, and participate responsibly in teams.

The ethical question, then, is where legitimate accommodation ends and moral compromise begins. Krucke offers a practical test. An accommodation remains professionally defensible when it protects safety to the extent reasonably possible, respects patient preferences, discloses meaningful limitations, considers justice, and permits escalation or review when serious concerns remain. A physician may appropriately accept a formulary restriction, a standardized workflow, or a less costly treatment when the decision is clinically defensible and honestly communicated. A poor discharge option may genuinely be the safest available option, and a physician may disagree with it while still helping the patient navigate it. Compromise, in other words, is not the enemy of professionalism. Concealment is.

The boundary is approached, he argues, when organizational priorities require concealment, misleading communication, disregard of patient preferences, or the transfer of unreasonable risk to patients and clinicians. It is also approached when an institution treats policy compliance as sufficient justification for overriding clinical judgment. The concern is not that physicians must resist every constraint placed upon them. It is that they may be expected to absorb unsafe contradictions without the authority or the opportunity to raise them. In that scenario, the ethical infrastructure of medicine is hollowed out from the inside: the vocabulary of professionalism survives, but its practical meaning shifts from fiduciary judgment to compliance.

These tensions are especially visible in general internal medicine, the specialty that anchors much of the American health care system. In ambulatory practice, panel size, inbox volume, prior authorizations, preventive care metrics, chronic disease management, and access expectations each serve legitimate purposes individually. Together, however, they can leave inadequate time for complex care. A physician who spends additional time coordinating care for a medically complicated patient may appear inefficient on a productivity dashboard even when acting squarely in the patient’s interest. In the hospital, expectations around throughput, length of stay, utilization review, coding, and discharge timing can conflict with clinical readiness, social circumstances, and safe follow-up. Krucke’s point is that neither speed nor delay is inherently professional. The ethical task is to judge what can responsibly be done for this patient, under these conditions.

The viewpoint names the phenomenon it describes as organizational capture. Capturing professionalism does not require institutions to reject its language; they may preserve the vocabulary while changing its practical meaning. The American College of Physicians has already recognized that physician employment and health care business practices can create conflicts involving professional integrity and patient interests. A broader framework of organizational professionalism, articulated in a 2017 charter published in Academic Medicine, likewise emphasizes that structural factors may impede physicians from fulfilling their professional commitments and that health care organizations bear responsibilities of their own to create cultures and operations consistent with professional values. Organizations, in this view, have professional obligations too: to support patient welfare, workforce well-being, honest communication, and meaningful accountability.

Krucke is careful to distinguish principled dissent from mere resistance to change, acknowledging that physicians can misuse autonomy to avoid teamwork or accountability. Dissent is professionally warranted, he writes, when it is grounded in identifiable duties to safety, autonomy, justice, honesty, or fiduciary responsibility; supported by relevant facts; communicated through appropriate channels; and open to review and correction. Institutions, for their part, should evaluate dissent by its ethical basis and evidence rather than simply by whether it creates friction. This distinction also clarifies the relationship between professionalism and physician distress. Not every difficult decision constitutes moral distress, and not every demanding expectation represents ethical conflict. Yet repeated pressure to recognize a problem without the time, authority, staffing, or institutional support to address it can produce genuine moral strain. Recent research has linked moral distress with occupational burnout, while scholarship on physician moral injury describes the corrosive conflict between professional obligations and systems that constrain action. Emotional support may help clinicians stay oriented, but it cannot substitute for examining the conditions that generate recurring ethical contradictions.

As an alternative to indefinite adaptation, Krucke proposes fortitude, a concept he developed in earlier work. Fortitude, in this framing, is the capacity to act responsibly before outcomes are known, amid uncertainty, and when principled action may carry personal cost. It is explicitly not endurance of institutional harm. It is moral agency directed toward honest judgment, accountable dissent, and repair. The question fortitude asks is not how much pressure a physician can absorb, but what the physician remains responsible for doing. This reframing shifts the burden of moral analysis away from individual resilience and toward the structural conditions under which judgment is exercised, placing responsibility on institutions to preserve credible avenues for physicians to identify and challenge unsafe or misleading practices.

The stakes extend well beyond physician morale. Professionalism matters, ultimately, because it supports public trust. Patients do not expect unlimited or perfect care, Krucke notes. They expect physicians to explain limitations honestly, exercise judgment responsibly, and remain accountable when institutional interests and patient interests diverge. If clinical recommendations begin to appear driven by productivity goals, payer requirements, patient-satisfaction incentives, or institutional convenience rather than clinical judgment, that trust erodes, and with it the social contract on which medicine’s authority rests. Employment structures will inevitably shape practice; the danger lies in allowing them to define professionalism so completely that ethical dissent itself begins to look unprofessional. If that happens, medicine may keep the language of professionalism while gradually surrendering the moral authority, and the public trust, that once made the term worth defending.

Subject of Research: The influence of physician employment structures on the definition and ethics of professionalism in general internal medicine

Article Title: When Employment Structures Define Professionalism in General Internal Medicine

Article References: Krucke, G. W. (2026). When Employment Structures Define Professionalism in General Internal Medicine. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10939-w

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10939-w

Keywords: professionalism, general internal medicine, medical ethics, physician employment, organizational capture, moral distress, moral injury, burnout, Physician Charter, organizational professionalism, fiduciary duty, public trust

The contrast with federal health agencies could hardly be starker. Confidence in the U.S. Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), and the National Institutes of Health (NIH) as sources of trustworthy public health information declined significantly from stable highs of 72 to 76 percent in 2024 to just 59 to 64 percent in 2026. The decline occurred during 2025, following the beginning of President Donald J. Trump’s second term and the February 2025 confirmation of Robert F. Kennedy, Jr. as Secretary of Health and Human Services, the cabinet position that oversees all three agencies. The timing of the drop, documented across successive waves of the Annenberg Science and Public Health (ASAPH) survey, points to a period-specific shock to institutional trust rather than a gradual, long-term drift away from science-based institutions.

The numbers behind the decline reveal how deeply the erosion has cut. In August 2026, 61 percent of respondents expressed confidence in the CDC, significantly below the 72 percent who did so in September 2024. The share of Americans who said they were very confident in the CDC fell from 29 percent to 13 percent over that period, less than half of its earlier level. Confidence in the FDA stood at 59 percent in August 2026, down from 73 percent in September 2024, with the very confident share dropping from 23 percent to 11 percent. The NIH followed the same pattern, falling to 61 percent from 74 percent, while the proportion expressing high confidence declined from 27 percent to 12 percent. In each case, the drop in the strongly confident category was far steeper than the overall decline, indicating that many Americans did not abandon these agencies entirely but downgraded them from institutions they trusted without reservation to ones they trusted only with reservations.

As a result, the gap between Americans’ confidence in their personal healthcare providers and their confidence in the three federal public health agencies has widened dramatically. Although a confidence gap has existed since APPC first began asking the public health trustworthiness question in June 2023, that gap grew significantly during 2025 and has not recovered. In August 2026, the difference between trust in one’s own provider and trust in each federal agency stood at 26 to 28 percentage points, nearly double the 14 to 16 percentage point gap recorded in September 2024. Patrick E. Jamieson, director of APPC’s Annenberg Health and Risk Communication Institute, which oversees the health surveys, described the trend as concerning, noting that the gap doubled over the course of 2025 and has remained elevated since.

The survey findings directly challenge assertions made by U.S. health officials that declining trust in federal agencies reflects a broader disillusionment with the medical community as a whole. In December 2025, then FDA commissioner Dr. Marty Makary, responding to a question about APPC’s previously reported decline in trust in the FDA, cited a 2024 study published in JAMA Network Open showing a decline in trust in hospitals and doctors from April 2020 through January 2024. That decline, however, occurred predominantly during the Covid-19 pandemic, and the inference that it signaled an ongoing trend of increasing disillusionment with medical institutions does not fit with the flat trend lines for trust in healthcare providers observed from 2023 onward in both the APPC dataset and the dataset underlying the JAMA Network Open study. The APPC data show that public confidence in one’s own provider has been both high and stable, undermining any claim that the agency trust decline is simply part of a generalized collapse in medical trust.

At the same time, Kennedy has publicly claimed that the administration is rebuilding confidence in the public health system. Speaking at a Tampa, Florida, elementary school on August 26, 2026, he told reporter Mitch Perry of the nonprofit Florida Phoenix that the administration is actually restoring faith in the public health agencies so that people will take their advice, adding that the advice is that people should get the measles vaccination. Laura A. Gibson, an APPC research analyst, responded that the survey data show no evidence that the Trump administration is restoring trust in the federal health agencies. The empirical record thus presents a direct tension between the administration’s rhetoric and the measured attitudes of the public it serves.

The period of declining trust coincided with significant upheaval in the leadership of the agencies themselves. In August 2025, CDC director Dr. Susan Monarez was fired and the CDC’s deputy director and chief medical officer, Dr. Debra Houry, resigned. More recently, the FDA lost both its commissioner, Dr. Marty Makary, who stepped down in May 2026, and the head of its vaccine and biologics division, Dr. Vinay Prasad, who resigned in March 2026 after a turbulent tenure. Since the completion of the current survey, President Trump nominated Dr. Heidi Overton, deputy director of the White House Domestic Policy Council, to become the new FDA commissioner. This cascade of departures at the highest levels of the public health bureaucracy provides visible context for a public that was simultaneously downgrading its assessment of the institutions those officials led.

The latest ASAPH survey was conducted August 4 through 17, 2026, among 1,904 U.S. adults, with an estimated margin of sampling error of plus or minus 3.2 percentage points at the 95 percent confidence level. Interviews were carried out by SSRS, an independent research company, using both web and telephone modes among a nationally representative probability sample drawn from the SSRS Opinion Panel, with data weighted to represent the U.S. adult population. The September 2024 comparison survey was conducted September 13 through 30, 2024, among 1,744 U.S. adults, with a margin of error of plus or minus 3.5 percentage points. Earlier waves provide important historical context: in 2023, when the question concerned trustworthiness on matters of public health, confidence in personal providers ranged from 87 to 90 percent, and in 2021 and 2022, when the question focused on information about preventing and treating Covid-19, confidence in providers was slightly lower at 82 to 87 percent, though still higher than for the federal agencies. Data from 2021 on the federal agencies, when the question concerned trustworthy information about means of preventing and treating Covid-19, showed confidence levels of 71 to 77 percent, similar to the 2024 figures.

Ken Winneg, APPC’s managing director of survey research, emphasized the practical significance of the provider findings, saying that it is critical for the public to have a reliable source for healthcare information, and that it is a relief to see high and consistent trust in personal healthcare providers. That relief is tempered by the institutional picture. Public health agencies depend on public confidence to carry out vaccination campaigns, communicate safety warnings, and coordinate responses to outbreaks, and a sustained 26 to 28 percentage point trust deficit relative to personal physicians means that official health guidance now reaches many Americans at a significant credibility discount. The persistence of the gap through August 2026, more than a year after the initial 2025 decline, suggests that the erosion is not a transient reaction to a single controversy but a durable shift in how Americans rank their sources of health information.

The APPC has been tracking American public knowledge, beliefs, and behaviors regarding vaccination, Covid-19, influenza, RSV, and other consequential health issues through the ASAPH survey and other national samples since April 2021, under the auspices of the Annenberg Health and Risk Communication Institute. The research team includes Jamieson, Winneg, and research analysts Gibson and Shawn Patterson, Jr. Taken together, the five years of data tell a consistent story: the American public’s trust in the people who actually examine them, answer their questions, and prescribe their medications has been a stable anchor throughout a period of pandemic, political turnover, and institutional churn. Whether federal health agencies can rebuild the confidence they held as recently as 2024 remains an open question, but the survey makes clear that the pathway runs through demonstrated competence and continuity rather than through any generalized collapse of trust in medicine itself.

Subject of Research: Longitudinal survey research on U.S. public confidence in personal healthcare providers versus federal public health agencies

Article Title: Public confidence in one’s own healthcare provider remains high

Article References: Public confidence in one’s own healthcare provider remains high. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: public health, healthcare providers, CDC, FDA, NIH, public trust, Annenberg Public Policy Center, survey research, HHS, Robert F. Kennedy Jr, health communication, vaccination

The team set out to answer a deceptively simple question: does the public view AI-driven care differently from human-centred care, and does that difference shift depending on where a person sits along the dementia care journey? To probe this, the researchers employed a repeated-measures experimental design, a technique in which each participant evaluates multiple carefully constructed scenarios rather than a single one. This approach allows researchers to isolate the effects of specific variables while controlling for individual differences in outlook. The scenarios, presented as short vignettes, varied along three dimensions. The first was the stage of care, aligned with the five stages of NHS England’s Dementia Well Pathway, which traces the trajectory from early awareness and prevention through diagnosis, living well with the condition, and ultimately dying well. The second dimension was what the authors call system centrism, contrasting an AI-based care system with a human-based one. The third was the level of involvement, distinguishing between moderate support, in which the system assists, and full control, in which it takes charge.

The choice of participants was itself a deliberate act of strategic targeting. Rather than sampling the general population, the researchers focused on adults aged 55 to 64, a cohort that faces an elevated risk of developing dementia within the coming decade and is also among the most likely to encounter these technologies as patients, carers, or family members in the near future. Their attitudes therefore offer something close to a preview of the real-world reception that AI care systems can expect as they move from prototype to deployment. Each participant rated every scenario on two separate scales: how acceptable the arrangement would be, and how plausible or likely they judged it to be in practice. This dual measurement is important, because acceptance and perceived likelihood can diverge in revealing ways. A technology might be seen as desirable yet improbable, or inevitable yet unwelcome, and such gaps shape both consumer behaviour and policy debates.

The results paint a nuanced picture in which the public’s verdict on AI care depends heavily on context. Across the board, acceptability was sensitive to both the stage of care and the type of system involved. The most striking statistical feature was a significant interaction effect between system centrism and level of involvement. In plain terms, scenarios involving full human involvement were consistently rated as more acceptable than any AI alternative, while AI involvement was viewed favourably only when it operated at a moderate, supportive level. When AI was framed as assuming full control of care, approval collapsed. This pattern suggests that the public is not rejecting the technology itself so much as rejecting the prospect of human replacement, a distinction that carries substantial weight for how AI products in this space are designed, marketed, and regulated.

Crucially, the interaction effect did not remain constant across the dementia care pathway; it intensified as the pathway progressed. The largest discrepancies between human-centred and AI-centred care emerged in the later stages, particularly those described as Living well and Dying well, where full-control AI scenarios received the lowest acceptability ratings of the entire study. This gradient makes intuitive sense once considered from the perspective of patients and families. In the earliest stages, when a person is still largely independent, an AI system offering reminders or monitoring may feel like a helpful convenience. But as dementia advances and the stakes of care decisions rise, the emotional and ethical weight of those decisions grows, and the public appears increasingly unwilling to see machines occupy the central role. End-of-life care, in particular, seems to be regarded as territory where human presence, empathy, and judgement are not optional extras but essential elements.

The second outcome measure, perceived likelihood of actualisation, followed a related but distinct pattern. Participants judged scenarios to be more likely under conditions of moderate involvement than under full control, suggesting that the public already senses, perhaps correctly, that the realistic future of AI in dementia care lies in assistance rather than autonomy. Human-centric scenarios were also rated as more likely than AI-centric ones, and this gap widened in the later stages of the pathway. In other words, respondents not only preferred human involvement as dementia progressed; they also expected the health system to deliver it. This alignment between preference and expectation may partly reflect public familiarity with how care currently works, but it also signals a potential credibility problem for any organisation promising fully autonomous AI care in this domain.

Underlying these findings are deeper psychological currents that the authors identify as trust, autonomy, and public understanding. Misconceptions about what AI can and cannot do continue to circulate widely, and concerns about losing user agency, the sense of being in control of one’s own life and care, remain a powerful brake on adoption. The study’s results suggest that these concerns are not irrational anxieties to be engineered away but legitimate value judgements that any acceptable care technology must respect. Acceptance peaked precisely when AI was positioned to augment human input rather than substitute for it, supporting what the researchers describe as hybrid models. In such models, AI handles scalable, routine tasks such as continuous monitoring, data collection, and early-warning alerts, while human carers retain authority over consequential decisions and provide the interpersonal dimension of care that machines cannot replicate.

The practical implications for NHS England and for digital health developers are considerable. With over half a million recorded diagnoses and pressures on health and social care systems intensifying, scalable solutions are urgently needed, and AI-enabled smart home systems offering cognitive support, real-time monitoring, and decision-making assistance are among the most promising candidates. But the study indicates that the route to adoption runs through augmentation, not replacement. Products that emphasise moderate involvement, that keep humans visibly in the loop, and that are tailored to the specific stage of care a patient occupies are far more likely to win public acceptance than systems promising full automation. Developers who ignore the stage-sensitivity of attitudes, deploying the same one-size-fits-all automation across the entire pathway, risk encountering the sharpest resistance exactly where care needs are greatest.

There are also implications for communication and public engagement. Because misconceptions about AI continue to limit acceptance, improving public understanding of how these systems actually work, what data they collect, and what decisions they can and cannot make could help close the gap between perceived and actual capabilities. The finding that participants rated moderate-involvement scenarios as more likely than full-control ones suggests the public’s intuitions are already broadly realistic, which gives communicators a foundation to build on. Framing AI as a tool that supports carers and preserves patient agency, rather than as an autonomous decision-maker, aligns with both the evidence and the values expressed by the very demographic most likely to use these services.

Ultimately, this study offers a measured but firm message: the future of AI in dementia care in England will be decided not by the sophistication of the algorithms but by the willingness of the public to accept them, and that willingness is conditional, stage-dependent, and firmly anchored in the preservation of human involvement. As AI-enabled care technologies mature, the organisations deploying them would do well to remember that the people they serve, particularly those approaching the age of greatest risk, want machines to lend a hand, not to take the wheel, and they want that human hand to remain steady through every stage of the journey, from the first worrying signs to the final days.

Subject of Research: Public acceptance of AI-enabled versus human-centred dementia care across NHS England's dementia care pathway stages

Article Title: Examining public acceptance of AI versus human-centric dementia care across NHS England’s dementia pathway stages

Article References: O’Fee, T., Vijaykumar, S., & Craig, M. (2026). Examining public acceptance of AI versus human-centric dementia care across NHS England’s dementia pathway stages. PLOS Digital Health, 5(10), e0001088. https://doi.org/10.1371/journal.pdig.0001088

Image Credits: AI Generated

DOI: 10.1371/journal.pdig.0001088

Keywords: artificial intelligence, dementia care, NHS England, public acceptance, digital health, smart home systems, care pathway, human autonomy, hybrid care models, health technology, end-of-life care, public trust

The research team, led by Wei Wang and Boyuan Lu of the University of Wisconsin-Madison and Peking University, together with colleagues at the University of Maryland and Peking University’s Department of Sociology, exploited a natural experiment embedded in the timing of the December 2015 alerts. Beijing’s red haze alerts, the most severe tier in the city’s emergency response system, were triggered by forecasts of sustained heavy pollution and came bundled with dramatic countermeasures, including restrictions on vehicle use, suspension of industrial production, and closures of schools and construction sites. Because the alerts arrived suddenly and applied citywide, the researchers could compare the pollution estimates of people surveyed before the alerts with those of people surveyed after, treating the intervention much like a randomized treatment in a laboratory setting.

The study combined two sources of data. The first was official air-quality monitoring information from the Beijing Municipal Ecological and Environmental Monitoring Center, which provided objective benchmarks for fine particulate matter concentrations, known as PM2.5, and for the frequency of yellow-level haze days, a milder pollution category. The second was a survey experiment involving 947 university students who were randomly assigned to report their perceptions of pollution conditions either before or after the red alerts. By asking participants to estimate pollution levels and then comparing those estimates against monitored values, the researchers could quantify the estimation gap with unusual precision for a social science study of environmental perception.

The headline result is striking. Among students who reported being aware of the red alert, mean overestimation of PM2.5 concentrations fell from 49.90 percent above monitored values to 30.53 percent. The correction was even more dramatic for yellow-level haze days, a category that most residents would find harder to judge from memory: overestimation collapsed from 178.89 percent to 87.43 percent. In other words, before the alerts, students believed mild haze days were nearly three times more common than the monitoring record showed; afterward, their estimates were less than twice the true figure. Multivariate statistical models that controlled for individual characteristics confirmed these reductions, estimating that the red alert cut PM2.5 overestimation by 19 to 27 percent and yellow-level haze-day overestimation by 92 to 147 percent.

These numbers speak to a well-documented puzzle in the literature on environmental risk perception. Decades of research, stretching back to foundational work on judgment under uncertainty by Amos Tversky and Daniel Kahneman, have shown that people rely on heuristics and salient memories rather than statistical records when assessing hazards. Air pollution is a particularly tricky case because its severity varies across space and time, is often invisible at low concentrations, and is filtered through media coverage, personal symptoms, and social conversations. Previous studies in China and elsewhere have found that self-reported pollution levels routinely diverge from station data, sometimes wildly, and that these mismatches can distort protective behavior, undermine trust in government statistics, and complicate emergency management. The Beijing study suggests that a single, highly salient official alarm can serve as an anchoring event that resets the reference point people use when making subsequent judgments.

The mechanism the authors propose is consistent with salience theory in behavioral economics. A red alert is not just information; it is a dramatic, citywide signal that makes pollution cognitively available and provides a concrete benchmark against which past and present conditions can be evaluated. Once residents know that a red alert corresponds to a specific, severe pollution state, they apparently recalibrate their internal scale, becoming more accurate not only about extreme episodes but also about milder yellow-level conditions. This spillover from high-severity signals to lower-severity judgments is one of the study’s most interesting technical contributions, because it implies that extreme warnings do more than communicate the immediate emergency; they teach the public where the whole pollution distribution sits.

Yet the alert’s effects were strikingly selective when it came to evaluations of government mitigation efforts. The researchers examined whether the red alerts changed how students assessed specific policy responses, including vehicle restrictions, factory shutdowns, urban greening programs, and restaurant regulations. Only the vehicle restriction policy showed a significant increase in recognition and evaluation. The authors attribute this asymmetry to measure visibility: odd-even license plate rules remove half the cars from the streets, an effect that any commuter can directly observe, whereas factory closures, tree planting, and restaurant oversight happen largely out of public view. Assessments of those less visible measures did not shift at all in response to the alert. For policymakers, this is a sobering result, because the measures that are hardest for citizens to see are precisely the ones whose public support may depend on deliberate communication rather than ambient visibility.

The study also probed whether the alerts changed self-reported protective behavior, such as wearing masks or limiting outdoor activity, and whether gender shaped the accuracy of pollution estimates. On both fronts the results were more muted. Changes in protective behavior were modest and statistically insignificant, and gender had no significant effect on overestimation, a finding that runs counter to some earlier literature reporting systematic gender differences in environmental risk perception and pro-environmental behavior. The authors are careful not to overclaim here; a survey of university students, however well designed, captures a specific population at a specific moment, and self-reported behavior is vulnerable to recall and social desirability biases that the study’s own framing acknowledges.

Those limitations are worth taking seriously, but they do not erase the central contribution. By pairing a randomized survey design with objective monitoring data and a genuine policy shock, the study moves the field beyond the correlational snapshots that have dominated perception research. It demonstrates causally, not just associatively, that high-severity environmental alarms function as reference signals that narrow the perception gap. It also identifies the boundary conditions of that effect: the correction applies to pollution estimates but not automatically to policy evaluations, and it operates through visibility, meaning that invisible mitigation work remains invisible even during a crisis. The practical implication is that warnings and transparency must travel together. An alert can teach the public what severe pollution looks like, but only visible, well-communicated policy action can convert that heightened attention into durable trust in the institutions managing the air.

As cities worldwide grapple with wildfire smoke, dust storms, and industrial smog in a warming climate, the Beijing red alert experiment offers a template for evidence-based risk communication. Emergency warnings are often evaluated solely by whether they prompt immediate protective action, a metric on which this study found only weak effects. But the research suggests a second, subtler function that has been largely overlooked: alarms as calibration devices that align public perception with scientific measurement. If subsequent studies replicate these findings in other cities and populations, environmental agencies may come to see their most severe alert tiers not just as sirens but as teaching moments, brief windows in which the public is unusually receptive to learning what the numbers on the monitor actually mean for the air in their lungs.

Subject of Research: The effect of high-severity air pollution alerts on public perception accuracy and policy evaluation during Beijing's 2015 red haze alerts

Article Title: High-severity environmental alarms as reference signals: Evidence from Beijing’s first red haze alerts

Article References: Wang, W., Lu, B., Zhang, X., Fan, X., & Zhang, W. (2026). High-severity environmental alarms as reference signals: Evidence from Beijing’s first red haze alerts. Air Quality, Atmosphere &amp; Health, 19(10), Article 228. https://doi.org/10.1007/s11869-026-02117-y

Image Credits: AI Generated

DOI: 10.1007/s11869-026-02117-y

Keywords: air pollution, PM2.5, red haze alert, risk perception, Beijing, environmental communication, survey experiment, public trust, protective behavior, salience theory, emergency response, environmental monitoring