Losing the Public, for Better or for Worse: A Lesson from John Everett Gordon (1890-1983) and John Rodman Paul (1893-1971).

The Covid-19 pandemic has laid bare a tension around scientific expertise that has major implications for the effectiveness of health systems. Critical engagement with this tension, however, is largely missing from the lessons and programs consolidating in the wake of the emergency. Lacking good frameworks for discussing the tension, the vague term "public trust" has proliferated into a buzzword that stands in for more articulate discussion. The tension between experts and the public is not new, however. It is useful to look back to the 1930s, when health experts identifying as "new epidemiologists" imagined a new modern science of epidemiology that, some believed, would resolve evident failures in public cooperation. Historical analysis of different approaches to the production and use of epidemiological knowledge in these years reveals a debate about power at the heart of epidemiology, and a critical framework for discussing the tension around epidemiological expertise in public health.

Vaccine confidence in the time of COVID-19.

In the early months of the COVID-19 epidemic, some have wondered if the force of this global experience will solve the problem of vaccine refusal that has vexed and preoccupied the global public health community for the last several decades. Drawing on historical and epidemiological analyses, we critique contemporary approaches to reducing vaccine hesitancy and articulate our notion of vaccine confidence as an expanded way of conceptualizing the problem and how to respond to it. Intervening on the rush of vaccine optimism we see pervading present discourse around the COVID-19 epidemic, we call for a re-imagination of the culture of public health and the meaning of vaccine safety regulations. Public confidence in vaccination programs depends on the work they do for the community-social, political, and moral as well as biological. The concept of public health and its programs must be broader than the delivery of the vaccine technology itself. The narrative work and policy actions entailed in actualizing such changes will, we expect, be essential in achieving a true vaccine confidence, however the public reacts to the specific vaccine that may be developed for COVID-19.

The first concussion crisis: head injury and evidence in early American football.

In the early 21st century, sports concussion has become a prominent public health problem, popularly labeled "The Concussion Crisis." Football-related concussion contributes much of the epidemiological burden and inspires much of the public awareness. Though often cast as a recent phenomenon, the crisis in fact began more than a century ago, as concussions were identified among footballers in the game's first decades. This early concussion crisis subsided-allowing the problem to proliferate-because work was done by football's supporters to reshape public acceptance of risk. They appealed to an American culture that permitted violence, shifted attention to reforms addressing more visible injuries, and legitimized football within morally reputable institutions. Meanwhile, changing demands on the medical profession made practitioners reluctant to take a definitive stance. Drawing on scientific journals, public newspapers, and personal letters of players and coaches, this history of the early crisis raises critical questions about solutions being negotiated at present.

An assessment of the Francois-Xavier Bagnoud poverty alleviation program in Rwanda and Uganda.

OBJECTIVES: We evaluate the three-year community-based FXBVillage poverty-alleviation model, which provides extremely poor families with sustained social support and graduated material support for education, healthcare, housing, nutrition, and income-generation. METHODS: We combine a pre/post analysis of participant households in Rwanda (n = 912) and Uganda (n = 628) with construction and assessment of a combined multivariable household wealth index comparing FXBVillage data with national Demographic Health Surveys. RESULTS: Many FXBVillage households shifted to higher household wealth quintiles. This shift was particularly strong in Rwanda. Increases among relevant household characteristics included (in Rwanda/Uganda): ≥3 meals/day (5-88%)/(44-86%), school attendance 5-17 years (79-97%)/(64-89%), adequate school supplies (7-97%)/(4-71%), and communal financial support if needed (27-98%)/(29-87%). Universal bednet ownership and water treatment was nearly attained; vaccine coverage was not, especially in Uganda. CONCLUSIONS: The model likely supports poverty-alleviation among participants. The variability of improvements, across indicators and countries, highlights the need for better understanding of interactions within programs and between programs and implementation settings, as well as how these interactions matter to poverty-reduction strategies.