The association between populist-aligned views and engagement with public health interventions: a systematic review of longitudinal studies

BACKGROUND: Population-level engagement with public health interventions is needed to achieve impact. Recently, however, there has been evidence of increasing resistance to government-led public health interventions in areas such as vaccination, climate change mitigation, sexual and reproductive healthcare, and non-pharmaceutical-based infection control measures. The rise in populist attitudes that has taken place in many countries over the last two decades may be one potential explanation for this phenomenon, given the importance placed on individual freedom and national sovereignty, and a distrust of scientific, government and other elites within much populist discourse. METHODS: To understand how populist-aligned views might subsequently influence the receipt of public health interventions, we systematically reviewed quantitative, longitudinal evidence across thirteen bibliographic databases and relevant websites, published between 2008 and 2024. All studies were set in Organisation for Economic Co-operation and Development (OECD) countries and results were synthesised narratively. RESULTS: Across 16 included studies, much of the evidence focused on COVID-19. We found evidence that prior populist-aligned attitudes have a negative impact on subsequent receipt of public health interventions, such as the COVID-19 vaccine and non-pharmaceutical-based prevention measures against COVID-19 (i.e., engaging in masking and social distancing) through both existing and increasing distrust in elite institutions and actors over time. We also found preliminary evidence about the potentially negative role of populist-aligned attitudes on the receipt of other vaccinations before and during the COVID-19 pandemic. CONCLUSIONS: From a policy perspective, the findings from this review suggest the need for proactive efforts by political, scientific and medical establishments to build and maintain trust, thereby strengthening the reputation of both the public health leaders and institutions that engage with those more likely to be resistant to public health interventions to increase overall acceptance and uptake. TRIAL REGISTRATION: PROSPERO registration number CRD4202451312.