Challenging world leaders amid medical populism

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The Lancet COVID-19 Commission Statement warned about medical populism, and I would like to underscore a couple of points about this framework. First, medical populism describes the style—not the content—of political actors' responses to health crisis. In Jair Bolsonaro's Brazil and Donald Trump's USA, dramatic displays of defiance to public health guidelines would have resonated among libertarian constituencies, but not in Rodrigo Duterte's Philippines, where no such movement exists. It is thus unsurprising that Trump's reaction to his own illness mirrored his Brazilian counterpart's: both used their own illness to vindicate their having downplayed the pandemic. Second, if, as the medical populism framework suggests, “simplification of the pandemic” is a familiar response, then one can anticipate the further emergence of vaccines as a populist trope in the coming months. Whereas the first phase of the pandemic was marked by claims of fake cures and dramatic lockdowns, the ongoing situation involves a vaccine messianism that echoes the “culture of optimism” in previous outbreaks. In response to medical populism, the Lancet COVID-19 Commission Statement recommend that leaders “prioritise advice from the professional public health community”, but, as Donald Trump illustrates, the subordinate position of public health officials makes such fiscalisation difficult. How effectively global health institutions can advise or challenge political leadership is a question that demands urgent reflection amid the sustained popularity of medical populists, regardless of their countries' successes in suppressing the pandemic.