The statement “follow the science” is much more complicated than it first appears when it is applied to drafting and implementing policy decisions in health fields. In health science and policy, the stakes are high, as lives can hang in the balance. Health scientists and policy makers face many challenges in ensuring the best possible evidence is used in making decisions. In this blog post, we highlight a few key challenges discussed in the literature and reflect on some important enablers that can improve health policy in the future.
The challenges in following the science is demonstrated in a Bozeman (2022) case study of the response to COVID-19 in the United States. This study centres on scientific and technical information (STI) and shows the complicated relationship between STI and policymaking. The complex nature of science-based policy making is especially critical in quickly developing situations, like the COVID-19 pandemic, which require quick and decisive implementation of policy decisions. The pandemic tested both health policy and the public perception of health systems. It exposed the fragility of public trust and brought important insights into the interpretation and communication of health science research.
Bozeman identified a significant challenge in the response to COVID-19 in the United States, namely, that policymakers rarely interact directly with science in its most raw format. “Very few policymakers, have any routine exposure to formal scientific knowledge, except as curated by others” (Bozeman, 2022, p. 809). Instead, policymakers receive much of the research through secondary lenses like advisors, agencies, journalists, news articles, and social media. These conditions can be an issue for policy development because the curation of scientific information can change the focus, the emphasis, and even the conclusions of scientific studies, resulting in policy that may be less “science-based” than it appears.
This issue of the curation and framing can also affect public perception of the uptake of evidence into public policies. Bell (2014) examined the history of the concept of “thirdhand smoke” to illustrate the ways that science can be reframed to serve particular policy agendas. Thirdhand smoke refers to the tobacco chemicals that linger on surfaces, such as furniture, walls, or cars, after smoking has taken place. Through a case study of thirdhand smoke, Bell (2014) shows that this issue is not simply driven by strong scientific evidence but is socially constructed as a public risk. Bell suggests that its rise as a public health concern was shaped by several key factors, including media framing, which helped popularize the concept; public health discourse, which emphasized potential risks; and policy interests, which supported expanding smoke-free regulations.
Media framing/curating of this health risk had a strong influence on how the public understood the problem. First, thirdhand smoke was presented as an extension of second-hand smoke, which is a well-established and widely accepted health risk. By associating thirdhand smoke with an already recognized danger, its perceived harmfulness was amplified, even though direct evidence of its effects remains limited. Second, the issue was often discussed around vulnerable demographics, such as babies and children. They are seen as more likely to be affected, because of their developing bodies and in danger of exposure to their surroundings. This focus made the issue feel more urgent and easier to justify policy attention. In addition, the media helped to spread the idea through powerful and sometimes emotional stories, which also increased public attention. At the same time, the concept of thirdhand smoke also supported broader tobacco control efforts, which gave policymakers another reason to promote stricter regulations.
The same underlying issues of perceptions and fear of risk are highlighted in another core challenge identified by Bozeman (2022): the misalignment between the time scales needed for policy-making and scientific research. For science, the timeline included acquisition of physical tools needed for scientific research, which required policy about shipping and manufacturing. For example, COVID-19 diagnosing and testing relied on logistics and pipelines for the tools to conduct the work just as much as it relied on immunization and vaccine synthesis research. These tools were needed quickly, but policy preparedness to deliver the tools was low, resulting in delays to important research. From another perspective, science was often slow in providing concrete answers for policy questions in a timely way. This longer interval led to uncertainty and inconsistency in how scientific findings were applied to policy questions like masking mandates, booster shots, and information regarding virus transmission. These scenarios and inconsistencies contributed to mistrust by the global public, who sometimes perceived decisions as intentional deception or a failure of science to meet public needs, as opposed to an adherence to the “best possible advice” in the moment.
Communicating risks and uncertainty openly with the public while also acting swiftly in cases of immediate urgent needs is a challenge reported across the literature on health science communication (e.g., Bell et al., 2014). In these instances, public discourse can sometimes overtake STI in the public sphere of influence, leading to conflicting narratives. This outcome can lead to the promotion of specific ideological and political agendas, as Bozeman (2022) highlighted. During the 2024 US election campaign, which occurred during the COVID-19 pandemic, rhetoric around the COVID-19 response was deeply influenced by political agendas. Bozeman focused on the United States, but this challenge played out in other countries around the world. Bozeman’s paper illustrates how significant the curation and framing of STI can be, and how quickly trust can be eroded in highly politicized arenas.
For Toledo and Larson (2026), the issue of trust has significant knock-on effects in the creation of effective and successful health policy. They argue that when trust is eroded, the image and effectiveness of health systems are affected. Their research looked at how trust factors into the organ donation system in the USA. At the time of their study, concerns were being voiced in the public about the ethical practices that were being followed. Toledo and Larson noted a major concern was “donor hospitals and organ procurement organizations putting patients forward for organ removal prematurely, with ‘signs of life’ still present” (Larson & Toledo, 2026, p. 31). This narrative led to a negative public reaction, which in turn prompted a decline in donor registrants, with 20,000 people withdrawing from the system. Given that less than 10% of potential organ donations occur globally (p. 31), any disruption to the donation systems triggers major impacts. In this case, the decline in public trust and perception of the donor program resulted in a significant impact on the success of the donor program.
Larson and Toledo (2026) also discussed how vaccine programs can be significantly affected when there are limited lines of communication between researchers, policy makers, and the public. During the COVID-19 vaccine rollout “the scientific and policy community failed to communicate widely that, although the mRNA platforms were a new approach to making vaccines, there had already been decades of mRNA research” (p. 31). This lack of communication led to unfounded suspicion and fear about mRNA vaccines that affected uptake in many segments of the population. Similarly, Larson and Toledo (2026) found in a case study of the Dengvaxia vaccine rollout in Brazil and the Philippines how different approaches elicit different reactions. The dengue vaccine posed risks to individuals who had no prior exposure to the dengue virus. The vaccine offered protection to those who had been previously infected, but the risk was a higher likelihood of severe dengue in individuals who had never contracted the virus. In the Philippines, communication about the risks was essentially nonexistent, leading to massive distrust and politicization of not just the Dengvaxia program but also in other, unrelated health programs. Distrust led to declines in vaccination uptake, which resulted in increased deaths in preventable conditions. In Brazil, policy makers were able to adjust their rollout plans and policies. They offered the vaccine to people who had been previously exposed, thereby maintaining public confidence and stability throughout their programs. These studies show the importance of careful and consistent communication about health policies. When communication is deficient or there is a lack of understanding of political and social contexts within health systems, further rifts in public trust occur that become politicized events.
Together, these articles point to the need for clear communication, careful messaging, and trust building for health policy. Careful balance between transparency and effective communication are required, because simply producing better scientific evidence may not be enough to guide policy or build public trust. If health risks can be shaped through analogy, framing, and altered focus, then evidence is not fully objective, as it is influenced by social and political contexts. While risks must be acknowledged, poor communication about risks can lead to misinformation and panic. Trust is also a collective matter, where consistent policies and coordination across healthcare are necessary. Trust must be actively managed through proactive risk management and communication. The scientific facts are extremely important, but understanding communication and social contexts is equally important to avoid the politicization of people’s health. This combination helps to explain why “following the science” is not always as straightforward as it sounds, and that trust in health expertise may be affected not only by misinformation, but also on how evidence is presented and communicated.
References
Bell, K. (2014). Science, policy and the rise of “thirdhand smoke” as a public health issue. Health, Risk & Society, 16(2), 154-170. https://doi.org/10.1080/13698575.2014.884214
Bozeman, B. (2022). Use of science in public policy: Lessons from the COVID-19 pandemic efforts to “Follow the Science.” Science and Public Policy, 49(5), 806-817. https://doi.org/10.1093/scipol/scac026
Larson, H. J., & Toledo, A. H. (2026). Lessons in public trust. Nature Medicine, 1-3. https://doi.org/10.1038/s41591-025-04056-0
Authors: Jacob Varner, Riley Stephenson, and Jiayu Yu
This blog post is part of a series of posts authored by students in the graduate course “Information in Public Policy and Decision Making” offered at Dalhousie University.
Tags: Information Use & Influence; Science-Policy Interface; Scientific Communication; Student Submission
