Before the 2024 election, fears loomed about the fate of evidence-based health policymaking. Today, those fears have materialized. The U.S. has withdrawn from the World Health Organization, frozen billions of dollars in biomedical research and terminated thousands of employees at the National Institutes of Health, the Centers for Disease Control and Prevention and the National Science Foundation.
This is not just a political matter. It is a public health emergency. With the systemic erosion of evidence-based decision-making, it is urgent for the research community to be skilled health diplomats and to redefine tools of knowledge translation.
Scientific evidence has shaped innovative and transformative health policies. Evidence has served as a moral tool to counteract self-interests and biases, and to support fairer, more effective decision-making. While no data is ever entirely impartial, rigorous methods, transparent data collection and triangulation across sources can mitigate distortions and strengthen the credibility of findings. But even the best evidence is powerless if ignored.
Evidence-based policies have historically led to vital improvements in public health. The RAND Health Insurance Experiment of the 1970s proved that increased cost-sharing lowered healthcare spending, helped shape national health insurance debates and led to major reforms. Similarly, laws have been implemented to lower blood alcohol limits for motor vehicle drivers and to inform the United States Food and Drug Administration’s ban of partially hydrogenated oils. These regulations have in turn saved countless lives.
Ignoring the evidence would be a catastrophic decision. It would normalize the abhorration of scientific and academic freedom, strengthen the threat to human health and destroy the principles of integral human development. Disregarding the evidence creates a thriving environment for public health crises to persist, to exacerbate the existing emergency and to create new ones.
Consider the measles double-dose vaccinations: They are 97% effective, but vaccination rates have declined drastically over the years. Consequently, measles has spread to 22 states, infected more than 600 individuals and killed two of them. Despite overwhelming evidence from the COVID-19 pandemic and other infectious diseases, no strong public endorsements of the MMR vaccine have been issued from the people that matter.
Similarly, veterinary experts have opposed proposals to let the H5N1 bird flu spread naturally through poultry flocks to identify immune birds. This unscientific strategy creates countless opportunities for the virus to mutate and potentially jump to humans — yet it’s being seriously considered. How many more lives must be lost before evidence is taken seriously again? The discordance between what ought to be done and what is actually done is not only devastatingly striking — it is dangerous.
It is an emergency then, for the research community to strategically and creatively engage in health diplomacy and to become expert storytellers. Scientists, researchers and their teams must be prepared to enter into the convoluted dynamics of health policymaking. They need to be capable of navigating complex political bureaucracies and negotiations. If the best evidence-based solution lacks support, researchers must ask: What is second best to gain momentum? They must also invest the time to build relationships with policymakers, listen to opposing views and engage in the frictional drag of democratic disagreement. Researchers must wear multiple hats: as academics, advocates, coordinators and reformists.
Most critically, they must redesign how they communicate evidence. Conventional policy briefs and memos are not enough. Behavioral psychology shows us that people make decisions based on values, emotions and perceived consequences — not just data, rationality and logic. We must stop asking only, “What does the evidence show?” and start asking, “What story does the evidence tell?” What’s at stake if policymakers ignore it? What will they and their constituents lose? What could they gain by acting now?
Policymaking divorced from evidence is policymaking that endangers lives. As we question what role will evidence play in health policy making, we cannot abandon the principle. In fact, it means that we need to fight harder for it when no one else is.
Jailene Castillo
second-year Master of Global Affairs student
April 4
