Consider this scenario: A mother of three is trying to decide whether to vaccinate her kids – and she’s not getting her information from a government or scientific website.

Rather, she’s getting it from a woman she’s been following on Instagram for two years – someone who has shared her pregnancy journey, her postpartum struggles, her toddler’s food allergies, and her family’s approach to wellness. The influencer supports vaccines, mostly. But she also drinks raw milk, questions certain food additives, and occasionally promotes supplements with limited evidence behind them.

Does this woman lose her influence with this mother because she isn’t 100% aligned with public health orthodoxy?

She does not. In fact, she may have more influence precisely because she’s not.

What Influencers Have Figured Out That We Haven’t

Social media influencers have mastered something that traditional health communication has not – how to build trust at scale. And before we dismiss them, we should understand the mechanism, because it works whether the content is accurate or not.

They build trust through sustained relationships. Followers feel they know these creators after watching their lives unfold over months and years. We trust people we feel we know. We trust people who seem like us, who have faced what we’ve faced, and whose recommendations feel personal rather than prescribed.

They also tell transformation stories. Our narrative-wired brains find a personal story of experience and outcome far more compelling than a risk-benefit analysis. That’s not a failure of critical thinking. It’s simply how our brains process information.

They communicate in a way (visually, empathetically, personally) that most public health content simply doesn’t match.

And critically, the platforms reward them for it. Emotionally activating content – content that makes you feel something – gets amplified. Evidence-based information designed to inform, by contrast, tends not to generate the same engagement signals.

The result is a gap between where trust lives and where public health operates, which is something that we have been too slow to reckon with.

The Messiness Problem – And Why We Have to Get Over It

The current conversation has largely narrowed to science communicators in these online spaces. This is understandable – they are credentialed, accurate, reliable voices who can translate evidence into accessible language. These partnerships matter. We should absolutely cultivate them.

But they are not enough.

The people who hold trust with the largest and most skeptical audiences are often not the people who agree with us on everything. They support vaccines but also drink raw milk. They promote mental health awareness but question pharmaceutical interventions. They care deeply about their communities’ well-being while simultaneously holding beliefs that contradict specific public health recommendations.

Public health has invested in influencer partnerships before, and these have sometimes included everyday lifestyle influencers – but those efforts have been scattered and short-lived. And more often than not, when faced with a messenger who isn’t fully on board, our instinct is to disqualify them. If you won’t sign on to the full evidence-based platform, you’re not a messenger we can work with.

And this is costing us dearly.

The people who need to hear public health messages most – those who are skeptical, disengaged, or actively distrustful of institutions – are far less likely to be following science communicators. Rather, they are following these messier, more contradictory, more human figures. And those figures have already earned something we have not: a relationship.

Squaring the Circle

So how does public health work with a messenger who tells her followers to vaccinate their kids in the same breath that she talks about the benefits of raw milk?

We don’t think the answer is to pretend the contradiction doesn’t exist, or to quietly partner with her while hoping nobody notices the raw milk content. And we don’t think the answer is to require full ideological alignment as a condition of engagement.

We think the answer is to get genuinely comfortable with the messiness – and to reframe what we mean by alignment.

If a messenger believes in the importance of vaccines, builds genuine connection with a community that is vaccine-hesitant, and has the trust to move that conversation even incrementally – that is alignment enough to start. We don’t have to endorse everything they say to recognize the access they provide.

This requires something that does not come naturally to institutions built around credentialing and evidence standards: the willingness to meet people where they are, rather than where we want them to be. And it means not asking these messengers to become something they’re not in order to earn our partnership.

A Different Kind of Big Tent

The trust crisis in public health is not going to be solved by better infographics or more targeted PSAs. It requires a fundamentally different theory of change – one that starts with relationships rather than messages.

That means science communicators in the tent, yes. But it also means the wellness influencer who isn’t perfectly on message. The community leader who trusts traditional medicine and traditional healing. The podcast host who asks hard questions about institutional credibility even while directing her audience toward child well visits.

This is genuinely difficult work. It requires internal conversations about what we’re prepared to make room for in the name of meaningful engagement. It requires humility about the limits of credentialing as a proxy for trust. And it requires accepting that good will come from imperfect sources, which after all is, how public health has always advanced.

The trusted messengers we’ve been ignoring are already out there, already in conversation with the people we most need to reach. The question is whether we’re willing to show up in those conversations on terms that aren’t entirely our own.

---

Amelia Burke-Garcia, PhD, is a health communicator and Director of the Center for Health Communication Science at NORC at the University of Chicago.

 

 

Neha Trivedi, PhD, MPH, is a health communication researcher and behavioral scientist at NORC at the University of Chicago.