An operational model developed in Algeria may show a way that countries can make childhood vaccines more effective, more acceptable and more economical. It is a model that may provide a framework for middle-income countries across the globe, including many across the rest of Africa.

Six-in-one (or hexavalent) vaccines are cutting the number of clinic visits needed to prevent multiple life‑threatening infections and easing pressure on already stretched health systems. Growing economic evidence from Algeria and several Latin American countries suggests that while these vaccines may cost more upfront, the investment may be largely or entirely recovered through fewer appointments, streamlined logistics, and a reduction in cases of vaccine-preventable diseases and potential adverse events from vaccination. Yet the children who could benefit most – those living in low‑ and middle‑income countries are still the least likely to receive them, widening an avoidable gap between what modern vaccines can do and the protection children actually receive.

Most hexavalent vaccines save money in another way: they reduce the number of adverse events – side effects – that require treatment in a hospital or clinic. Acellular hexavalent vaccines include a type of protection against pertussis, or whooping cough, which is the gold standard for immunization in higher-income countries but has not yet been widely adopted beyond them.

With more than a decade of historical data supporting safety and efficacy, these acellular pertussis vaccines have a notable track record of improving vaccination coverage rates (VCR) and parents’ willingness to have their children protected, as they cause fewer painful adverse events [1].

Acellular pertussis (aP) vaccines are formulated using isolated antigens, which are purified and detoxified, thereby removing most of the components of the bacterium that cause undesirable reactions [2].

Most low- to middle-income countries still use whole-cell pertussis vaccines, which include a suspension of the entire inactivated Bordetella pertussis organism – some 3,000 antigens. Although the inclusion of far more antigens can result in a marginally higher immune response, the complexity of the vaccine leads to varying amounts of reaction-causing components between batches of vaccine and varying levels of protection [2].

The combination of more adverse events and variable efficacy means that developing countries bear a disproportionate share of the burden incurred through side effects. The side effects in children lead to an increased reluctance among parents to agree to future vaccines for their children and higher costs for the healthcare system. These problems often arise in healthcare systems that are inadequately equipped to deal with them.

Expert opinion from Algeria indicates that acellular hexavalent vaccination has improved vaccination coverage levels and simplified the vaccination schedule by reducing the number of appointments. It reduces the required number of immunization visits from ten to six. This eases pressure on overstretched health services, simplifies logistics and cold-chain management, and reduces indirect societal costs, including the time parents spend away from work.

Algeria is the third WHO African region country to adopt the acellular hexavalent vaccine into its national immunization schedule. Economic data from those countries and several in Latin America demonstrate that a rollout of the vaccine across African countries is not only possible but also economically advantageous [3,4,5,6].

Algeria’s vaccination metrics: an operational model for success

Vaccines have transformed child health in Algeria, as they have across the world. Since the initial introduction of vaccination in Algeria, followed by sustained efforts to expand the vaccination schedule, infant mortality rates have dropped dramatically from 163 per 1,000 live births in 1966 to 20 per 1,000 in 2023, a reduction of around 87% [7].

The percentage of children protected in Algeria has exceeded the targets set by the World Health Organization (WHO) for decades, with diphtheria, tetanus toxoid and pertussis (DTP) coverage consistently above 90% [8]. As in many countries, the COVID-19 pandemic disrupted healthcare systems, leading to a decline in vaccination rates, with DTP-3 coverage, a key measure of childhood vaccination, reduced to 77% in 2022 [9]. This situation was quickly improved, with coverage increasing to 92% by 2024 [9].

In 2022, three cases of polio caused by circulating vaccine-derived poliovirus type 2 were reported [10]. Rarely, the circulating vaccine-derived virus causes polio, highlighting the necessity of timely vaccination with IPV, with which these vaccine-derived cases do not occur [11].

The shift to hexavalent vaccination

Algeria’s shift from its former schedule to hexavalent vaccination was not a straightforward process. Initially, the five-in-one (or pentavalent) vaccine was replaced by a combination of the tetravalent vaccine (DTP-Hib) and the monovalent Hepatitis B vaccine (HBV), administered across 10 separate healthcare visits, necessitating additional appointments [12].

The change in the vaccination schedule resulted in delays in dose administration and a decrease in vaccination coverage. This issue was resolved with the introduction of the new schedule, which integrated an acellular hexavalent vaccine in 2023, reducing the number of required healthcare visits to six [13].

While polio vaccination was present in the previous schedule (with one IPV dose at 3 months and 3 OPV doses at 2, 4, and 12 months), inclusion as part of a hexavalent vaccine simplified the schedule (giving three doses of IPV at 2, 4, and 12 months associated with three OPV doses), helping to maintain the global strategy for polio eradication. The WHO recommends that all countries using OPV adopt a vaccination schedule with at least two doses of inactivated vaccine, which gives individual protection without the risk of vaccine-related polio [14].

The financial metrics of the switch

A recent whitepaper conducted a pharmacoeconomic analysis of the budgetary impact of transitioning from a whole-cell tetravalent vaccination schedule to an acellular hexavalent schedule. While the switch was associated with an increase in annual program expenditure of approximately 26 million Euros (around a 58% rise in upfront costs), this was substantially offset by nearly 19 million Euros in annual savings generated through the management of adverse events, improved logistics and transportation, and increased parental productivity [13]. Overall, roughly 73% of the upfront cost was offset by these savings.

Algeria is the latest in a series of examples where this is the case. The nominal, upfront cost of acellular hexavalent vaccines is typically higher than that of whole-cell vaccines; this has, in many cases, deterred countries from adopting them. However, there are many benefits at both the economic and systemic levels that recoup much of the costs of acellular hexavalent vaccines. In many instances, these costs are hidden and not factored into initial value calculations.

Similar experiences have been seen in other countries. In Argentina, Peru, and South Africa, the switch to hexavalent vaccines led to higher initial costs, but these were substantially offset by savings from fewer adverse events, lower programmatic expenses, and improved logistics. For example, in data from Argentina, roughly 90% of the initial investment into acellular hexavalent vaccines was recovered through fewer adverse event-associated costs and lower programmatic costs [15]. Peru reported a reduction in logistical costs by nearly 60%, with roughly 44% of the initial increase in costs recovered [16]. South Africa achieved overall savings of about 10 USD per child [3].

These calculations overlook benefits that are more difficult to quantify. For example, what costs are generated because of vaccines missed and infections caused by increased vaccine hesitancy on the part of parents. Across these settings, the higher upfront investment in hexavalent vaccines has proven to be economically viable, with much of the cost recouped through broader system efficiencies.

Programmatic benefits of hexavalent vaccination

Hexavalent vaccination offers the potential for simpler systems and higher levels of acceptance among patients. For the child, integrating six antigens into a single injection drastically reduces the number of needle sticks, alleviating injection-related anxiety and the prevalence of local reactions. This increases parental acceptance and helps to improve vaccination coverage.

Parents are relieved of the burden of coordinating multiple medical appointments, covering travel costs, and dealing with lost workdays. By reducing parental anxiety and the strain of repeated visits, combined vaccines help mitigate vaccine hesitancy within communities. This has been demonstrated in multiple studies across Africa, with investigations in Gambia and South Africa documenting concerns among parents about a child receiving more than two injections in a single visit [17,18]. Limiting the number of healthcare visits is also a crucial factor in increasing vaccine coverage in areas with limited healthcare infrastructure, such as those in rural southern Algeria.

For healthcare professionals, particularly in resource-limited settings such as rural areas in Africa, the adoption of combined vaccines helps to ease the administrative burden of multiple appointments. These formulations optimize consultation efficiency by drastically reducing the required administration time and simplifying inventory management [19].

The use of ready-to-use liquid vaccines, such as the hexavalents, has been shown to simplify and enhance the safety of the vaccination procedure when compared to vaccines that come as a powder that has to be reconstituted [20]. The preference for this approach among frontline workers is overwhelming: one study indicated that 97.6% of healthcare providers favored these liquid, combined formulations in their daily work [21]. Evidence supports this preference, demonstrating that the switch led to a dramatic reduction in administration errors (from 42.8% to 4%) and needlestick injuries (from 42.3% to 9.5%), while also yielding an average time savings of 1.1 minutes per dose [22].

The case for Hexavalent vaccination across Africa

Across the WHO Africa region, VCR has improved significantly over the last few decades; however, unfortunately, this improvement has stalled. The level of coverage for the third dose of DTP-containing vaccines, a standard benchmark for immunization system performance, has sat in the mid-70s for over a decade, with a current coverage of 76% [23].

This stagnation of the VCR is reflective of the ongoing issue of inequality. The gap in vaccine access runs not only between Africa and higher‑income regions, but also within the continent itself, where some countries consistently outperform others. Diseases, however, do not recognize borders; any outbreak that affects one country is likely to increase the risk to surrounding countries. Air travel enables a disease case to be spread to virtually any country in the world within just two days [24].

The COVID-19 pandemic was a clear example of the rapid spread in today’s world. Within a period of weeks, the virus spread from its origin in China to the entire globe, despite public health measures and lockdowns. With this in mind, any country that is falling behind on vaccination coverage becomes a weak link in a global chain where diseases can flourish and form reservoirs of cases that can allow diseases such as polio to spread unchecked.

Bringing vaccine equity to lower- and middle-income countries is therefore vital to addressing global health concerns. Hexavalent vaccination has demonstrated its ability to increase vaccine coverage in these countries. Among the WHO Africa region, Mauritius, which adopted hexavalent vaccination in 2017 [4] currently stands notably above the average for the region, with 96% coverage for the first dose of inactivated polio vaccine, and 93% for the benchmark based on DTP-containing vaccines [25].

Vaccine coverage translates into increased prosperity. Vaccination cannot be viewed as an inconvenient expense but as an investment. The WHO estimates that for every dollar spent, vaccination can yield a return on investment of around 54 USD – provided, of course, that the vaccines actually find their way into the arms of children [26].

As the Algerian case study demonstrates, higher upfront costs for acellular hexavalent      vaccines are often paid back by improvements in logistical efficiency, reduced healthcare burdens, and improved parental compliance. By bridging the gap between high- and low-income immunization standards through this investment, the life-saving benefits of gold standard vaccinations can become more than a privilege of geography, but a universal foundation for human health.

[This consensus paper is based on the findings of a white paper discussing the findings of a group of vaccination experts focusing on paediatric immunisation, supported by Sanofi. Intended for professional use.]

Reference list

1. Boisnard, F., Manson, C., Serradell, L., & Macina, D. (2023). DTaP-IPV-HB-Hib vaccine (Hexaxim): an update 10 years after first licensure. Expert Review of Vaccines, 22(1), 1196–1213. https://doi.org/10.1080/14760584.2023.2280236
2. World Health Organization (2017) The immunological basis for immunization series: module 4: pertussis, update 2017. Available at: https://www.who.int/publications/i/item/the-immunological-basis-for-immunization-series-module-4-pertussis-update-2017
3. Batson A, Glassman A, Federgruen A, et al. The world needs to prepare now to prevent polio resurgence post eradication. BMJ Global Health. 2022;7(12):e011485. doi: https://doi.org/10.1136/bmjgh-2022-011485
4. ReliefWeb. Hexavalent vaccine: less injections and more protection babies. Available at: https://reliefweb.int/report/mauritius/hexavalent-vaccine-less-injections-and-more-protection-babies
5. Olivera, I., Grau, C., Dibarboure, H. et al. Valuing the cost of improving Chilean primary vaccination: a cost minimization analysis of a hexavalent vaccine. BMC Health Serv Res 20, 295 (2020). https://doi.org/10.1186/s12913-020-05115-7
6. Romero M, Góngora D, Caicedo M. Cost-Minimization and Budget Impact Analysis of a Hexavalent Vaccine (Hexaxim®) in the Colombian Expanded Program on Immunization

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7. World Bank Data. Available at: https://data.worldbank.org/indicator/SP.DYN.IMRT.IN?locations=DZ
8. World Health Organization. Immunization data: African region. Available at: https://immunizationdata.who.int/dashboard/regions/african-region/DZA
9. World Health Organization.  DTP vaccination coverage. Available at: https://immunizationdata.who.int/global/wiise-detail-page/diphtheria-tetanus-toxoid-and-pertussis-(dtp)-vaccination-coverage?CODE=DZA&ANTIGEN=DTPCV3&YEAR=
10. GPEI – Algeria. Available at https://www.archive.polioeradication.org/where-we-work/algeria/
11. Global Polio Eradication Initiative. GPEI-OPV. polio global eradication initiative . Published 2016. Available at: https://polioeradication.org/polio-today/polio-prevention/the-vaccines/opv/           
12. Practical Implementation Guide for the 2016 National Immunization Schedule in Algeria. Available at: https://cnpm.org.dz/wp-content/uploads/2024/01/Guide_Pratique_de_Mise_en_Oeuvre_du_Nouveau_Calendrier_Natio-1.pdf
13. Laichour A, Kihel M, Aissaoui A, Olivera G. Pharmacoeconomic evaluation of national immunization program realisation in Algeria: cost-minimization analysis of switch from DTwP-Hib + HBV + IPV to an acellular hexavalent (DTaP-HBV-Hib-IPV) vaccine. Poster presented at: ISPOR Europe 2023; November 2023; Copenhagen, Denmark. Value in Health. 2023;26(Suppl 2):S2-EE134.
14. WHO Polio Position Paper 2022. Available at: https://www.who.int/publications/i/item/WHO-WER9725-277-300  
15. Olivera, I., Pérez, C.G., Lazarov, L. et al. Cost minimization analysis of a hexavalent vaccine in Argentina. BMC Health Serv Res 23, 1067 (2023). https://doi.org/10.1186/s12913-023-10038-0
16. Seinfeld J, Rosales ML, Sobrevilla A, López Yescas JG. Economic assessment of incorporating the hexavalent vaccine as part of the National Immunization Program of Peru. BMC Health Serv Res. 2022 May 16;22(1):651. doi: 10.1186/s12913-022-08006-1. PMID: 35570278; PMCID: PMC9109284.
17. Idoko OT, Hampton LM, Mboizi RB, et al. Acceptance of multiple injectable vaccines in a single immunization visit in The Gambia pre and post introduction of inactivated polio vaccine. Vaccine. 2016;34(41):5034-5039. doi: https://doi.org/10.1016/j.vaccine.2016.07.021
18. Hanani Tabana, Dudley L, Knight S, et al. The acceptability of three vaccine injections given to infants during a single clinic visit in South Africa. BMC Public Health. 2016;16(1). doi: https://doi.org/10.1186/s12889-016-3324-2
19. Pelissier JM, Coplan PM, Jackson LA, May JE. The effect of additional shots on the vaccine administration process: results of a time-motion study in 2 settings. Am J Manag Care. 2000 Sep;6(9):1038-44.
20. Al-Bashir L, Ismail A, Aljunid SM. Parents‘ and healthcare professionals’ perception toward the introduction of a new fully liquid hexavalent vaccine in the Malaysian national immunization program: a cross-sectional study instrument development and its application. Front Immunol. 2023;14:1052450.
21. De Coster I, Fournie X, Faure C, Ziani E, Nicolas L, Soubeyrand B, Van Damme P. Assessment of preparation time with fully-liquid versus non-fully liquid paediatric hexavalent vaccines. A time and motion study. Vaccine. 2015;33(32):3976–82.
22. Esteve IC, Fernández PF, Palacios SL, Rodrı́guez MJ, Vino HP, Ortega BR, Nieto Nevot ML, Manch´on GD, L´opez-Belmonte J-L. Health care professionals’ preference for a fully liquid, ready-to-use hexavalent vaccine in Spain. Prev Med Rep. 2021;22:101376.
23. World Health Organization. Immunization data: African region. Available at: https://immunizationdata.who.int/dashboard/regions/african-region
24. Findlater A, Bogoch II. Human Mobility and the Global Spread of Infectious Diseases: A Focus on Air Travel. Trends Parasitol. 2018 Sep;34(9):772-783. doi: 10.1016/j.pt.2018.07.004. Epub 2018 Jul 23. PMID: 30049602; PMCID: PMC7106444.
25. World Health Organization. Immunization data: Mauritius. Available at: https://immunizationdata.who.int/dashboard/regions/african-region/MUS
26. World Health Organization (2025) Fully funded Gavi, the Vaccine Alliance, is a lifeline for child survival, says WHO. Available at: https://www.who.int/news/item/28-03-2025-fully-funded-gavi–the-vaccine-alliance–is-a-lifeline-for-child-survival–says-who

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Behind every budget shift lies a ripple effect, and today, global healthcare is at the receiving end. The result is shrinking access, rising costs, and widening inequities. The impact of geopolitical decisions is rarely confined to borders, it now extends into clinics, hospitals, and communities. What we are witnessing is not just a funding gap, but a structural shift in how the world values health.

The silent reallocation

Over the past years, global defense spending has surged to record levels. According to the Stockholm International Peace Research Institute (SIPRI), global military expenditure rose by 9.4% in real terms to $2718 billion in 2024, the highest global total ever recorded by SIPRI and the 10th year of consecutive increases. The total military expenditure accounted for 2.5% of the global gross domestic product (GDP) in 2024. These figures are expected to climb further following the June 2025 commitment by North Atlantic Treaty Organization (NATO) members to increase defence and security spending to 5% of GDP by 2035, more than twice the earlier 2% benchmark.

Meanwhile, public health budgets are being trimmed or stagnating. The World Health Organization (WHO) has raised serious concerns about the strain on global health systems, pointing to shrinking international aid and ongoing funding shortfalls. In February, Director-General Tedros Adhanom Ghebreyesus highlighted that abrupt and significant reductions in bilateral assistance have severely disrupted healthcare services across multiple countries, describing 2025 as “one of the most challenging years” in the organization’s history.

As per the WHO, an estimated 4.6 billion people worldwide still do not have access to essential health services, while around 2.1 billion experience financial strain due to healthcare expenses. Compounding this challenge, the global health workforce is projected to face a shortfall of 11 million professionals by 2030, with nurses accounting for more than half of this gap. When 4.6 billion people lack access to essential services, this is not only a development failure, but also a global stability risk – translating into fewer vaccinations, delayed disease surveillance, and weakened emergency response systems.

The global policy conversation increasingly treats defence spending as essential security investment. Health spending, however, is still framed as social expenditure rather than strategic infrastructure. This shift is particularly devastating for LMICs, where international aid often fills critical gaps.

Conflict and the collapse of care

Conflict has long been a stress test for health systems, but the consequences today are deeper and more far-reaching. As the Russia–Ukraine war entered its fifth year in 2026, Ukraine’s health system faced unprecedented strain, with attacks on healthcare rising nearly 20% in 2025 alone. Since the full-scale invasion began, the WHO has documented at least 2,881 attacks targeting hospitals, health workers, ambulances, and medical infrastructure, severely disrupting care delivery. Health outcomes have deteriorated sharply, with 59% of people in frontline areas reporting poor health, alongside surging mental health issues, cardiovascular conditions, and widespread lack of access to essential medicines. Intensified attacks in 2025, including a spike in strikes on medical warehouses, have further crippled supply chains.

In the aftermath of the war in Gaza, the region’s health system remains on the brink of collapse despite months of humanitarian efforts and intermittent pauses in fighting. Widespread damage to hospitals, severe shortages of medicines, and a surge in patients continue to overwhelm already fragile services. Many facilities operate at drastically reduced capacity, with critical treatments, including cancer care, meeting only a fraction of demand, while rising cases of skin and respiratory illnesses place further strain on the system. Healthcare workers, operating under extraordinary pressure and with limited resources, are struggling to manage overwhelming caseloads each day amid ongoing supply constraints and infrastructure damage. The crisis extends well beyond acute injuries, as patients with chronic illnesses face dangerous interruptions in care and deteriorating living conditions, turning access to healthcare into a daily struggle for survival.

Meanwhile, after three years of conflict, the Sudan war has evolved into the world’s largest humanitarian and health crisis, with 34 million people in need of aid and 21 million lacking access to basic healthcare. The system is collapsing under the combined weight of widespread disease outbreaks, acute malnutrition affecting over 4 million people, and relentless attacks on healthcare infrastructure—37% of facilities are now non-functional. As infectious diseases surge and funding falls short, Sudan’s health crisis continues to deepen, turning basic healthcare access into a matter of survival for millions.

What distinguishes the current moment is the scale of global interdependence. Earlier crises were largely contained within regions. Today, disruptions are transmitted across borders through tightly integrated supply chains, financing systems, and health workforces. The Ukraine conflict, for instance, has affected global pharmaceutical logistics and energy prices, indirectly increasing healthcare costs across Europe, Asia, and beyond. The result is not just localized breakdowns, but a systemic fragility in global health security.

Conflict as a cost multiplier in health delivery

Healthcare systems are tightly linked to global supply chains, making them highly vulnerable to geopolitical disruptions. When conflicts interrupt trade routes, restrict exports, or trigger sanctions, costs rise almost immediately, across pharmaceuticals, medical devices, and even basic supplies.

Energy shocks add further pressure. Hospitals, being energy-intensive, face higher operating costs as fuel and electricity prices climb. In conflict zones, even critical functions like vaccine cold chains and intensive care become difficult to sustain. The result is a steady increase in healthcare costs, one that is unevenly felt. While high-income countries may cushion the impact through insurance and subsidies, LMICs face a harsher reality, where rising out-of-pocket expenses can push millions into poverty.

At the same time, conflicts are driving up demand for care. Displacement, malnutrition, and infectious disease outbreaks are becoming more frequent, often compounded by climate-related crises. This creates a vicious cycle. Underfunded systems struggle to respond, outcomes worsen, and long-term costs escalate as preventable issues turn into full-blown crises.

Health communicators bridging gaps in a fragmented world

In times of systemic stress, communication becomes a strategic imperative. Health communicators are no longer just interpreters of science. They are interpreters of risk, resilience, and national preparedness. Their role is to translate complex realities into actionable understanding, to advocate for evidence-based decision-making, and to maintain trust in institutions. In today’s environment, narrative gaps are becoming policy gaps. When health is absent from security conversations, it is often absent from security budgets.

In the current context, communicators must:

• Elevate the narrative around health as a security priority, not a secondary concern.
• Highlight the human impact of budget cuts, moving beyond statistics to real stories.
• Counter misinformation proactively, especially in conflict-affected and resource-constrained settings.
• Support policy advocacy, ensuring that health remains central in national and global agendas.

Equally important is the need for communicators to adopt a more systems-oriented approach. This means connecting the dots between geopolitical decisions and health outcomes, helping stakeholders understand that these are deeply interconnected challenges. Investing in health is not just a moral imperative; it is an economic and strategic one. Strong health systems contribute to productivity, stability, and resilience. They are foundational to national security in the broadest sense.

Governments, multilateral organizations, private sector players, and civil society must come together to reassert the importance of health in the global agenda. Innovative financing mechanisms, public-private partnerships, and more efficient use of resources can help bridge funding gaps. But without political will, these solutions will remain insufficient.

If current trajectories persist, the consequences will extend far beyond strained health systems, they will reshape how societies absorb risk, respond to crises, and sustain economic stability. Healthcare cannot remain the residual line item in a world that is becoming more volatile, more interconnected, and more vulnerable. Narratives shape priorities, and priorities shape funding. If health continues to be framed as a cost rather than a cornerstone of resilience, it will keep losing ground to more immediate, visible threats. That framing must change urgently and decisively. Over the next decade, the countries that succeed in protecting population health will not necessarily be those spending the most on healthcare, but those most effectively integrating health into national security thinking. The real question before policymakers and global leaders is whether nations can remain economically stable, politically resilient, or socially secure while treating health as a

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His fears did not dissipate after the birth of the baby. Instead, they worsened. One night when the baby began to cry, and his wife failed to get up immediately to soothe him, Jake yelled out, “Shut the F… up!” Horrified by his actions, his wife turned on him. “What is wrong with you?!” she asked.

Jake eventually discovered what was wrong, but not before his job and his marriage suffered the effects of his changed behavior. Jake had developed what one in ten new fathers (13 percent according to some estimates) suffer from. Until recently, it was believed that only women suffered from Postpartum Depression (PPD.) While there is still no diagnostic category for PPD in the DSM, it is subsumed under the general category of Major Depressive Disorder.

SYMPTOMS OF MALE POSTPARTUM DEPRESSION

Symptoms of male PPD share many similarities to those in women. A partial list, includes:

• Irritability, anger, or aggressive behavior.
• Easily stressed.
• Withdrawal from family and relationships.
• Poor concentration and difficulty focusing.
• Changes in appetite or sleep patterns (insomnia or oversleeping).
• Feeling overwhelmed, anxious, or hopeless.
• Suicidal thoughts.
• Risk-taking behaviors including substance and alcohol use.
• Physical symptoms including headaches and stomach aches.
• Indecisiveness.
• Restricted range of emotion

CAUSES OF MALE PPD

Several factors put men at risk for PPD, including sleep deprivation, a prior personal or family history of depression, or a feeling of being shut out from mother and child. Up to half of all men with a depressed partner also show signs of depression according to one study, but surprisingly, fathers also experience hormonal shifts that alter mood, especially a decline in testosterone.

A 2024 article on Understanding Paternal Postpartum Depression notes that while more women than men suffer PPD (one in 7 versus one in 10), men also experience hormonal changes.

Jonathan R. Scarff, in his article Innovations in Clinical Neuroscience; Postpartum Depression in Men, explains that low testosterone in general is linked to symptoms of depression in men, while low levels of estrogen, prolactin, vasopressin, and/or cortisol in new fathers negatively affect father-infant bonding/attachment.

PUSHED OUT BUT RESPONSIBLE

Jenna Berendzen, ARNP at UnityPoint Health, suffered severe postpartum depression and anxiety after the birth of her son. While Berendzen was admitted to the county perinatal psych unit, her husband was left to worry about her and to figure out how to single handedly care for their new baby. Two years later they discovered that he, too, had suffered PPD, yet he couldn’t say anything at the time because, in his mind, he hadn’t given birth, especially a C-section. Instead he felt pushed aside while trying to carry the load of the entire family,”

An Allied Health article notes, “Many dads want to be active participants in the care of their new baby, but sometimes end up feeling like they’re on the outside. As the bond between mother and child begins to strengthen, fathers may feel sidelined. “Many men have a breadwinner mentality that compels them to bottle up the pressure and downplay symptoms of PPD both as they are preparing for fatherhood and afterward.”

In an article I wrote for L.A. Baby when my own son was a baby, I noted how women tended to believe they knew what was best for their baby, and as a result, often pushed their husbands out of the nursery, which only added to the father’s feelings of ineptitude, rejection and even abandonment. The result was that dads didn’t really bond with their babies until the child was older.

BECOMING A FATHER

Despite the dearth of research on new fathers, some experts claim that the journey to fatherhood represents a unique and transformative time in a man’s life. According to one study, “A man does not become a father only at the moment when the child is born…it is a long-lasting dynamic process where the father’s identity is formed and sustained through various experiences.”

Once the baby is born, everything suddenly becomes real. Even the diminutive size and fragility of a newborn can feel overwhelming. Dads need support, reassurance and education about how to hold and care for an infant. This is where some men back off, preferring to abdicate the “tender tasks” to mom, rather than learn from her.

In my own book Midlife Parenting, A Guide to Having and Raising Kids in Your 30s, 40s and Beyond, I found that men who start parenting later in life are more mature and settled. However, many of them are also accustomed to more freedom and independence, which presents its own challenges.

CHANGING ROLES AND EXPECTATIONS FOR FATHERS

Researchers point out that the psychological process of becoming a father has changed in the last couple decades. As one study notes: “We can observe a shift in the perception of the father’s role in Western societies, and in younger generations there is a growing incidence of the so-called “new fatherhood” associated with emotional intimacy and availability of the father as well as increased involvement of the father in childcare and household care.” The authors point out that today men are not only welcomed, but are expected to attend parenting preparation courses and to be present during childbirth as well as postnatal care.

SO WHAT’S A DAD TO DO?

The good news is that there is treatment for male PPD. It begins the moment the couple learns they are having a baby. That’s when the conversations should start, says one researcher who offers the following advice:

• Invite Active Participation: Active participation in the pregnancy, supporting one’s partner, and learning what to expect during and after delivery will help fathers feel involved and prepared.
• Talk to a Financial Planner: Money is a top challenge. With proactive conversation and some professional guidance, new fathers will know what to expect and how to best navigate the expenses of having a child.
• Lean into Support: As the baby’s arrival date approaches, soon-to-be fathers should lean into their support system. Reinforcing relationships and being open to advice will help fight the fear of the unknown.
• Seek out Help: As men are preparing for fatherhood, it’s normal to occasionally feel overwhelmed. It’s important to seek out help sooner rather than later and work to solidify a healthy mindset before the baby arrives.

If symptoms do emerge, dads should seek out professional help. Jonathan Scarf suggests that in serious cases, psychotherapy, especially cognitive behavior therapy (CBT) and interpersonal therapy (IPT) have been shown to be effective, as well as daily morning light to correct circadian rhythms, which are related to PPD.

For some men, individual or couples therapy may be preferred over anti-depressants. Other times a combination may be most effective. Treatment can be short-term or long-term, based on whether there are deeper or more serious underlying issues, which are exacerbated by the birth of a child.

Other recommendations include meditation, yoga and other “mindfulness” approaches to stress. And finally, it would be helpful if employers or government programs supported paid paternity leave for men, recognizing the value of fathers in the earliest stages of parenthood.

Christi Taylor-Jones is a Licensed Marriage and Family Therapist, Jungian Analyst and writer. She is author of Midlife Parenting and Touched by Suicide. She is also a mother and soon-to-be grandmother.

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The Strait also ships vaccines.

Save the Children has a consignment of urgently needed medicines stuck at a supplier’s warehouse in India. The road route is closed due to conflict. The usual fallback — air freight — has just doubled in price due to jet fuel prices. The charity’s chief executive, Janti Soeripto, put the situation to NPR earlier this month: “The transport for the drugs is more expensive than the drugs themselves.” That sentence is the story this piece is about. Not the Strait, not the oil, not even the war. The slow, awkward arithmetic by which a maritime closure thousands of miles away ends up determining whether a child in Kandahar gets a vial of antibiotics.

What the Strait actually carries

Commercial activity through Hormuz remains around 90 per cent below pre-war levels, according to analysis from the Council on Foreign Relations. Pre-conflict, around 3,000 vessels transited the strait each month; the latest House of Commons Library figures put current traffic at roughly five per cent of that. The strait is partially open, partially closed, and oscillating depending on the state of the Lebanon ceasefire and which side has most recently accused the other of violating it.

The pharmaceutical reading of those numbers takes a different shape. The Gulf Cooperation Council region serves as a transit hub linking Africa, Asia, Europe, India and the United States, and its pharmaceutical industry, valued at $23.7 billion, relies on imports through Gulf airspace and the strait for around 80 per cent of its product. Most of what matters most moves by air, not by container ship. Wouter Dewulf, professor at the University of Antwerp and a specialist in pharmaceutical logistics, told Al Jazeera last week that 35 per cent of pharmaceuticals move by air, and around 90 per cent of life-saving pharmaceuticals and vaccines do. He estimates that 22 per cent of global air cargo flows are exposed to disruptions in the Middle East.

Why a closed sea lane raises the cost of a mosquito net

The mechanism is rarely intuitive. India, which produces almost half of US generic prescriptions, depends on the strait for around 40 per cent of its crude oil imports — and that crude is the upstream feedstock for the petrochemicals used in active pharmaceutical ingredient manufacturing. With oil trading above $100 a barrel, the cost of producing the ingredient rises before a single tablet has been pressed. Indian air cargo rates have climbed 200 to 350 per cent on some routes, according to industry analysis, and war-risk insurance premiums for vessels transiting Hormuz have, by some measures, surged more than 1,000 per cent since late February.

The exposure is not abstract. The US Pharmacopeia has flagged that 48 per cent of US amoxicillin oral suspension is produced in Jordan, alongside a quarter of doxycycline hyclate capsules — common antibiotics, sourced from inside the conflict’s regional footprint.

It travels further than that. Jean Kaseya, director-general of Africa CDC, told reporters earlier this month that fuel shortages are pushing up the cost of producing mosquito nets, which are made from polyester, which is made from petrochemicals, which depend on a sea lane currently being charged at over a million dollars a transit when it is open at all. Malaria control is now, by an unobvious chain of reasoning, also a Hormuz story.

And the medicines that can’t wait

Of all the downstream consequences, the cold chain is the most exposed. Vaccines, insulin, biologics, and cancer therapies must be maintained within a narrow temperature range, typically between 2 and 8 degrees Celsius. Most of those products move by air, not sea, and most of the world’s high-volume air corridors run through Gulf hubs that have been variously closed, struck or rerouted around. Prashant Yadav, senior fellow for global health at the Council on Foreign Relations and one of the leading specialists in the field, has pointed to the timing problem with characteristic clarity: cargo carriers need roughly a week and a half to recover for every week of suspended shipments.

The arithmetic compounds.

It is partly a structural constraint. Yadav has also noted that European airlines and the two African carriers that have stepped in are unlikely to add new cargo capacity, as the disruption might continue for a few more months. Capacity is not bought overnight, and the current ceiling is, more or less, the medium-term one.

The countries most exposed are those already short of a buffer. The European Union has a stockpiling mechanism. The UK has flagged the risk of medicine shortages within weeks, but holds some reserve. The United States ordered a six-month stockpile of essential medicines last year. Sub-Saharan Africa, by contrast, imports around 70 per cent of its pharmaceuticals and runs far closer to the wire — arriving at this moment as aid budgets across major European donors are repackaged as investment rather than grants. Routine immunisation in much of the region relies on Gavi-procured stock that travels through the same air corridors, and the cold chain in those settings was already fragile before any of this began. How long current buffers hold is a function of variables nobody is in a position to forecast confidently. Bob Kitchen, vice-president of emergencies and humanitarian action at the International Rescue Committee, who is based in Nairobi, told NPR that he had not seen a comparable convergence in his career — pandemic, Ukraine and the current crisis included. A UN-managed depot in East Africa is currently holding stocks bound for Sudan, Ethiopia and other acute crises that cannot be released.

Save the Children’s drugs are still in India. As of late April, the strait remains effectively closed despite a conditional ceasefire, with Iran and the United States locked in a dual blockade as Pakistan-mediated talks continue. France and the UK have signalled that they will lead an international defensive mission once a sustainable ceasefire holds. None of that gets a vial to Kandahar this week.

What is the longer-term lesson? Supply chain analysts have been writing it for years, and now have a vivid case in front of them. A global medicine system optimised for cost works only as long as nothing goes wrong in three or four key chokepoints. Hormuz is one. The Suez and the Bab al-Mandeb are others. The Panama Canal is a fourth. The system functions until it doesn’t, and the people who feel the failure first are rarely the people the system was designed for.

Soeripto’s sentence is worth reading again. The transport for the drugs is more expensive than the drugs themselves. It is not, on its face, a sentence about war or oil or even shipping. It is a sentence about who, in a system held together by chokepoints, ultimately pays the bill. The strait will reopen. The arithmetic — and the question of who absorbs it — will not.

The post The Strait That Ships the World’s Vaccines appeared first on Medika Life.

From court decisions, recent analysis challenging vaccine skepticism polling results, and congressional testimony, the past month reflects a vindication of the value of immunization, scientific advancement and plain old common sense over ideology-based medical beliefs untethered from clinical evidence.

It would be nice to think that cooler heads have prevailed and we are seeing a return to science-backed decisions guiding American vaccine policy. But the reality is that a resurgent defense of immunization practices may be driven by two bigger forces: measles and midterms.

As I wrote five years ago, disease can be a powerful change agent. Thanks to the ultra-high effectiveness of the measles vaccine to prevent measles outbreaks, an entire generation of kids, parents and healthcare providers had never seen the disease or knew what kind of devastation it could bring. With measles out of sight and out of mind, it was easy for a small band of vocal critics to cast doubt on the value of the measles vaccine. Instead of building on a culture of collective action against disease, we allowed that small band of critics to grow into a chorus of public health freeloaders.

Measles had other ideas. With our weakening herd immunity – a result of declining vaccination rates – it didn’t take much for the virus to quickly reintroduce itself. Since the start of the year, there have been more than 1,700 cases of infection across 19 outbreaks throughout the country. We haven’t seen case numbers this high in 35 years. And if the deaths of American children from measles aren’t tragic enough, we are now on the verge of losing our status of officially eliminating measles. As a preeminent leader in immunology science, it is a startling embarrassment for the U.S. to accept this public health defeat.

Americans of all political stripes now seem to be paying attention. Following a decade of significant decline in vaccination, particularly among Republicans, there now is a push to back away from hardline anti-vaccine rhetoric ahead of the midterm elections. It’s easy to see why: at a time when measles outbreaks are a highly visible example of failed policy by the incumbent ruling party, politicians are not willing to risk being associated with practices that are out of step with the direction in which most U.S. voters want to go.

It’s telling that 66% of MAGA voters support vaccination as a requirement for kids to attend school. The measles outbreak has done a lot to educate people on the value of vaccines, which may be one reason why last week’s congressional testimony by RFK Jr., in which he was forced to admit that the measles vaccine is both safe and effective, and the timely appointment of Dr. Erica Schwartz, a physician and vaccine supporter, to lead the CDC may reflect the political liability posed by alternative vaccine doctrine in the months leading up to the midterm elections.

With growing distrust in federal vaccine messaging, there is a vacuum of credible sources for Americans to turn to for vaccine guidance. That void may actually be an opportunity in disguise for vaccine communicators.

Health care providers, including pharmacists, are still the most trusted source for reliable vaccine information: 4 out of 5 Americans look to these professionals to provide the right mix of personalized, empathetic communication with credible safety and efficacy information. Their stories can carry the power of connection, compassion and candor that we need right now.

Vaccination may seem like a black and white decision for a lot of us, but health care providers know that many parents need help navigating the gray areas. How we tell those stories – and who tells them – is essential to strengthening the national conversation around immunization.

Working more closely together, vaccine makers, innovators in antibody science, medical institutions and non-profit advocacy groups can create more compelling, unified communications that reach people when they are closest to making immunization decisions. This can be done by leveraging the voices of medical professionals to convey the emotional value of protecting our children against preventable disease instead of defaulting to statistics-heavy, complex messaging; pulling those stories through in coordinated media and policymaker engagement; and linking back to credible research sources that feature more prominently in online searches.

If the current measles epidemic in the U.S. is a crisis of our own making, it’s our responsibility to leverage the harsh health and economic lessons from this experience. We must act, not for the political convenience of the midterm elections, but to create better, more durable immunization policies and communications that again can unite Americans against our common disease enemies.

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One example would be pain. Research published in the Journal of Neuroscience found that when people didn’t know how much a painful heat stimulus would hurt — when they watched a group of others who disagreed wildly about it — they felt more pain than when the group agreed. The heat itself didn’t change. Only the uncertainty did. That single finding opens a door onto something much bigger: the way the brain interprets incoming signals doesn’t just affect physical pain. In fact, it shapes every experience, every emotion, and every belief we form about the world around us.

The Brain Is a Prediction Machine, Not a Camera

Your brain doesn’t work like a camera, passively recording what’s in front of it. It works more like a detective — making its best guess about what’s happening based on past experience, context, and whatever signals it can pick up in the moment. In fact, this is the way AI works the same way because it guesses what you intend when you are dictating to it. That’s based on what you have known to use before. It’s not original; it’s from something you’ve already said or thought.

Scientists call this predictive processing. Fancy words for something that’s simple. The brain is constantly generating a model of reality and checking it against what the senses report. Most of what you experience isn’t raw sensory data. It’s the brain’s best guess, already processed and interpreted before you’re even aware of it.

This has enormous consequences. Because your brain fills in gaps with guesses, your perception of any situation is shaped as much by what you expect as by what’s actually there. Research on how emotions are built in the brain confirms this same pattern. Feelings aren’t simple, automatic reactions that arise out of nowhere. They’re constructed — assembled by the brain from past learning, bodily signals, and whatever the surrounding context suggests is happening — all woven together into something that feels completely immediate and real. Fear, hope, dread, excitement — none of these are just responses to the world. They’re interpretations. And like all interpretations, they can be mistaken.

This might be unsettling to hear. But it’s also genuinely freeing, because it means your perception of reality isn’t fixed. It can be trained.

The Brain’s Thumb on the Scale

Here’s the catch. The brain doesn’t interpret experiences evenly. It has a strong, built-in bias toward the negative. This explains why negative information is so strongly entrenched in our minds. Negative information is stored more vividly in memory and carries more weight in the decisions we make than equivalent positive information does. This isn’t a character flaw. It’s an evolutionary feature.

Our ancestors survived by treating ambiguous situations as dangerous — if a rustle in the bushes might be a predator, it was safer to assume the worst and run. The cost of a false alarm was low; the cost of missing a real threat could be fatal.

In modern life, that same wiring creates serious problems. We’re exposed to more alarming information than any previous generation — not necessarily because the world is more dangerous, but because we carry a device in our pockets that streams us the worst of humanity around the clock. Research on how news consumption affects perception found that a steady diet of threatening content actively cultivates a distorted view of the world, pushing people to overestimate danger (The Scary World Syndrome) and feel a constant sense of impending doom that doesn’t match their actual circumstances.

In one study on risk perception during a health crisis, people overestimated their personal risk of dying from a disease by more than 270 times the actual probability. Their brains weren’t computing risk. They were amplifying fear.

Uncertainty makes all of this worse. Much worse. The same research that revealed how uncertainty increases physical pain also showed that not knowing what to expect activates a specific brain region — one that amplifies the intensity of an experience, for better or worse. And this effect isn’t limited to physical sensation.

Research on stress and health outcomes has found that the threat of losing a job can actually be more damaging to physical health than losing it outright, because the brain treats an uncertain threat as something to brace against continuously — a draining, exhausting posture that takes a real toll on the body over time. Sounds like burnout, doesn’t it? It isn’t just pain that uncertainty turns up. It’s almost everything the brain interprets as potentially threatening, which, given the negativity bias, covers a whole lot of ground.

What makes this particularly important in today’s world is that this feedback loop isn’t passive. The beliefs we form — shaped by perception, fear, and repeated exposure to alarming information — circle back and filter what we’re willing to notice next.

Research on how beliefs affect the brain’s processing of sensory information suggests that what we expect to see and feel actually controls what reaches our conscious awareness. Our beliefs aren’t just conclusions we reach. They become part of the filter that determines what evidence the brain even considers. This is like throwing the wheat away with the chaff.

What You Can Actually Do About It

Understanding how the brain constructs experience isn’t just interesting. It points directly to what we can do differently.

The first step is recognizing that your interpretation of a situation isn’t the same thing as the situation itself. When you feel dread about a conversation you haven’t had yet or are certain something’s going to go wrong, your brain is filling in a gap with a guess — shaped by past experience, current stress, and the negativity bias — not delivering a reliable preview of the future. That awareness alone, when you can genuinely hold onto it, changes your relationship with the feeling. You don’t have to argue with it or push it away. You just don’t have to treat it as truth.

The second step involves what you feed your brain. Because the brain builds its models of the world out of the patterns it encounters most often, the information environment you live in genuinely shapes how you perceive things — including things that have nothing directly to do with that environment. Heavy exposure to alarming content trains the brain to scan for threats even in neutral situations. Seeking out different perspectives, sitting with ambiguity instead of rushing to resolve it, and spending time in environments where uncertainty is met with curiosity rather than alarm — these gradually reshape the models your brain is running.

The third step is learning to treat uncertainty itself differently. That’s harder than it sounds, because not knowing really activates stress responses that narrow attention and make everything feel more urgent and more threatening. But evidence consistently shows that people who can stay open when they don’t know what’s coming — who can resist the pull toward premature conclusions — think more flexibly, solve problems more creatively, and make sounder decisions. The ability to hold more than one interpretation in mind at once isn’t a fixed personality trait. Like any other cognitive skill, it responds to practice.

None of this is an argument for forced optimism or pretending that hard things aren’t hard. Negative emotions carry real information and serve genuine purposes when they’re in proportion to what’s actually happening. The goal isn’t to replace one distortion with another. It’s important to notice when the brain’s interpretive machinery is running hot — turning not-knowing into catastrophe, amplifying uncertainty into doom — and to remember that what feels like reality is always, to some degree, something the brain has made.

The world you live in isn’t the world as it is. It’s the world your brain has built for you, piece by piece, out of everything it expects, fears, and has learned to look for. That’s not a reason for despair. Actually, it’s an invitation to get curious about the builder — and to ask whether the story it’s been telling you still has to be the only one.

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Early in the book, Nosta writes, “The solved can never touch the whole.”  That line lingers. It captures the essence of his argument. AI can solve, generate, synthesize, and accelerate. Yet something about the human experience of thinking, the struggle, the friction, the meaning-making, exists beyond resolution.

This tension defines the book. It is not anti-technology. Nosta is deeply engaged with AI and candid about its value. He describes large language models as tools that “move faster and connect more disparate concepts than our minds could ever manage on their own.”  He is equally clear that this capability introduces a subtle risk. We may begin to outsource not just tasks, but thought itself.

That distinction matters more than many may be willing to admit.

From Tools to Thought

One of the most compelling contributions of The Borrowed Mind is its framing of AI not as the next step in computing, but as a turning point in cognition. Nosta traces a clear arc. Gutenberg unlocked words. Google unlocked facts. AI, he argues, is unlocking thought. 

That progression is elegant, yet also unsettling. Words and facts could be externalized without fundamentally altering the structure of human reasoning. Thought is different. It is intimate. It is identity. It is how we become.

Nosta reminds us that thinking once required effort, a type of natural friction that created sparks of innovation. “The distance between question and answer created space for our discernment.”  Within that space, judgment formed, curiosity deepened, and understanding took root.

AI compresses that distance. It removes friction. It delivers coherence with remarkable speed.  One of the book’s most important insights emerges here. Coherence is not the same as understanding.

Nosta introduces the concept of “anti-intelligence,” describing it as “fluency without understanding. Coherence without experience.”  AI does not think. It mirrors the structure of thinking. It produces language that resembles reasoning without sharing its origin.

In health, where evidence, interpretation, and judgment must coexist, this distinction is not academic. It is operational. It shapes how clinicians trust tools, how leaders deploy them, and how patients ultimately experience care.

The Seduction of the Socratic Mirror

One of the most original sections of the book is Nosta’s description of the “Socratic Mirror.” He draws a parallel between classical dialogue and modern AI interaction. Socrates asked questions to surface the truth. AI, in a different way, reflects our thinking back to us, reframed, extended and sometimes clarified.

Nosta writes that the model “…does not tell me what to think but creates the conditions under which my own thinking could deepen.” This is where the book moves beyond critique and into possibility.

Used well, AI becomes a cognitive partner. It expands perspective, accelerates exploration, and invites iteration. In clinical research, patient engagement, and system design, this capacity holds enormous promise.

Nosta does not romanticize the relationship. He recognizes its asymmetry. The model has no interior life. It does not ponder. It does not carry consequence. It does not bear responsibility. That responsibility remains human.

Rethinking the Fear of Displacement

A persistent anxiety runs beneath every conversation about AI. Many fear it will become a job slayer, a force that displaces rather than elevates human contribution. That concern is understandable, yet not new.

Every meaningful advance in technology has reshaped how people work. The wheel did not eliminate labor. It redefined movement. The stethoscope did not replace physicians. It extended their ability to listen and interpret. The tollbooth transponder did not end transportation roles. It changed the flow and focus of human involvement. Each innovation shifted roles, demanded new skills, and expanded what people could do.  AI belongs in that lineage.

What distinguishes this moment is not the elimination of work, but the redistribution of cognitive effort. The real risk is not that machines will think for us, but that people may become less inclined to think for themselves. Nosta’s warning is subtle yet profound. Surrendering curiosity, judgment, and reflection to systems that generate answers with ease risks dulling the very faculties that define human intelligence.

This is why The Borrowed Mind is such an important read at this moment. It does not dismiss concerns around job displacement. It reframes it. The central challenge is not protecting roles as they exist today, but strengthening the uniquely human capacities no system can replicate. Creativity, discernment, ethical reasoning, and the ability to navigate ambiguity are not diminished by AI. They become more essential.

The book offers reassurance without complacency. The future of work will favor those who sharpen their thinking, engage deeply with ideas, and remain active participants in their own intellectual development. The machine is not the adversary. Neglecting the development of one’s own mind is a danger.

Composite Intelligence and the Limits of the Machine

Nosta introduces “composite intelligence” to describe the interaction between human and machine cognition. Composite does not mean blended into sameness. It means distinct contributions working in concert. The model brings speed and breadth. The human brings depth.

This triad becomes one of the most useful frameworks in this book. AI excels in velocity and scale. Depth, the slow transformation of understanding, remains human. As Nosta writes, “Models do not ponder.” 

In health, this distinction is profound. Data can inform. Algorithms can suggest. The act of deciding, especially in moments of uncertainty, requires something more. It requires what Nosta elevates as the defining human contribution. Virtue.

Drawing on Aristotle’s concept of practical wisdom, Nosta reminds us that judgment is forged through experience, consequence, and accountability. A model can generate options. It cannot live with outcomes.

This is where the book resonates most deeply for those working in health. Intelligence is becoming abundant. Discernment is becoming scarce and, therefore, more valuable.

The Risk of the Borrowed Mind

The book’s title is not metaphorical. It is a warning. Nosta argues that as engagement with AI deepens, internal dialogue begins to change. The model becomes a cognitive tuning fork, subtly shaping how questions are framed, how ideas are explored, and how answers are anticipated. This dynamic is not inherently negative. It can elevate thinking, accelerate learning, and make complex domains more accessible. Dependency remains the concern.

Reliance on generated thought risks weakening the muscle of original thinking. Access can be mistaken for understanding. Individuals may become, in Nosta’s words, “cognitive clones.” 

This concern is particularly relevant in health ecosystems already strained by time, complexity, and administrative burden. The temptation to offload cognitive work will be strong. The discipline to remain intellectually engaged will be essential.

A Book About AI That Is Not About AI

What makes The Borrowed Mind stand apart is that it is not ultimately about technology. It is about humanity. Nosta writes, “This book is not really about technology. It is about you.”  That idea anchors this work.

Readers are challenged to consider what it means to remain “the authors of our own minds.”  Not passive recipients of generated insight, but active participants in meaning-making.

This question sits at the center of the health ecosystem’s future. As AI becomes embedded in clinical workflows, research, and patient engagement, the issue is not whether it will improve efficiency. It will.

The deeper question is whether it will deepen humanity or dilute it. Will it create space for clinicians to think more deeply, connect more meaningfully, and act more wisely? Or will it create a system that values speed over reflection, output over understanding, and coherence over truth?

Nosta offers no simple answers. He offers a framework for asking better questions.

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Over 987 million people around the world now use AI chatbots regularly. Research shows that nearly half of Americans with ongoing mental health conditions have turned to a chatbot for emotional support in the past year alone. That’s a huge number of people relying on a technology that’s still very new in mental health care. So what does this mean?

Is it a big step forward in making help more accessible, or are we taking a risky chance? As with most things, the truth is somewhere in the middle. These tools offer real benefits, but they also come with real risks. It’s important to look at both sides honestly.

The Case for AI Chatbots in Mental Health

First, let’s look at why so many people are turning to these tools. There’s a mental health crisis, and not enough providers to help everyone who needs it. Long wait lists, high costs, and the ongoing stigma around seeking help all make it harder for people to get care. For someone who can’t afford therapy, can’t find an available provider, or feels too embarrassed to talk to someone in person, a chatbot that’s always available can feel like a lifeline.
Research supports this to some extent. Corporations are responding to this, and more TV ads are appearing that offer online therapy with or without chatbots.

A systematic review of 31 randomized controlled trials, which is considered the gold standard in research, found that AI chatbots helped reduce anxiety and depression symptoms in adolescents and young adults. Another meta-analysis of 14 strong trials found a clear positive effect on mental health outcomes, showing these tools are more than just placebos. For college students, who often face unique pressures and may avoid formal help, chatbots have shown promise in building coping skills and improving emotional well-being.

Anonymity is important, too. People are more likely to open up when they don’t feel judged. Studies show that users see the chatbot’s lack of social expectations as a big advantage. It’s easier to admit you’re struggling when you don’t have to worry about what someone else thinks. For people with anxiety, this low barrier could mean the difference between getting some support and getting none.

Mental health professionals have noticed these benefits, too. A 2025 study found that many clinicians see AI chatbots as a useful way to offer support between therapy sessions, provide education, and reach people who might not seek care otherwise. When the alternative is no help at all, the accessibility and scalability of chatbots are hard to ignore.

Where These Tools Can Cause Real Harm

This is where things get more difficult. The same qualities that make chatbots appealing, like being available, warm, and endlessly patient, can also make them risky for people in real psychological distress. We need to remember that chatbots are designed to keep users constantly engaged. It can be very hard to disconnect because the connection becomes so strong that it almost feels like leaving a friend.

Researchers have found something called a “compassion illusion” the strong feeling that an AI understands you, cares about you, and responds to your emotions in a meaningful way. An algorithm has no ability to “feel” or “care.” It feels real, but it isn’t. This gap between what people feel and what’s actually happening is where problems can start, especially for vulnerable people who may not realize they’re relying on something with no clinical judgment, no duty of care, and no way to notice if they’re getting worse.

A Stanford University study found that several popular therapy chatbots failed important therapeutic tests. They not only showed stigmatizing attitudes toward conditions like schizophrenia and alcohol dependence, but also gave dangerous responses in crisis situations. In one case, a chatbot responded to a subtle mention of suicidal thoughts by cheerfully naming tall bridges — something a good therapist would never do. Instances such as this have resulted in lawsuits related to suicides.

Another study tested ten AI chatbots using fictional teen mental health scenarios. Nearly a third of the time, the bots supported harmful ideas suggested by the fictional teens, such as dropping out of school or avoiding all human contact. None of the ten bots managed to challenge every dangerous suggestion. By any clinical standard, that’s a failing grade.

There’s also the problem of people relying too much on chatbots. Since these systems are always available and don’t make human mistakes, they can become someone’s main source of emotional support. Psychiatrists are now seeing cases of what’s called “AI psychosis” in patients, especially those with mental health vulnerabilities, who develop worse delusions or paranoia after spending a lot of time with chatbots. Because chatbots tend to agree and mirror rather than challenge distorted thinking, they can quietly make things worse over days or weeks.

This isn’t just a theoretical risk. It’s happening in clinical offices right now.

What We Still Don’t Know — and Why That Matters

The uncomfortable truth is that we don’t have enough research to know how often AI chatbots help, how often they cause harm, or who is most at risk. A review of 160 studies found that only 16 percent of the newer large language model-based chatbot studies had gone through clinical efficacy testing. Most are still in early testing stages. It’s like handing out a new drug before the clinical trials are finished.

Media coverage hasn’t made things clearer. Studies looking at news reports on AI chatbots and mental health found that journalism often focuses on the most severe, emotional outcomes, like suicides and hospitalizations, and presents them as clear cause-and-effect stories, even though the real evidence is much less certain. In most cases, there were already mental health conditions, substance use issues, or major life stressors involved. AI may have played a part, but it’s rarely the whole story.

Clinicians surveyed about AI chatbots have also raised concerns that aren’t getting enough attention. These include data privacy concerns, the risk that people will rely on chatbots instead of professional care, and the fact that these tools don’t know when to stop. They can’t pause a conversation, send someone to emergency services, or alert a family member. They can’t do the most important things when someone is truly in crisis.

The truth is that we’re still in the early days. Research is growing quickly — the number of studies on mental health chatbots quadrupled between 2020 and 2024. But strong, large-scale clinical evidence is still behind the technology. Millions of people are using these tools while science tries to keep up.

So what does this mean for you? An AI chatbot might really help you get through a tough night or teach you some coping skills. But it could also mislead you, support harmful thinking, or make you feel supported when you actually need a real person to help.

Use these tools carefully. If you’re dealing with serious depression, suicidal thoughts, trauma, or psychosis, they are not a substitute for professional care, no matter how warm or available they seem. If you’re using a chatbot for lighter support or just to sort out your thoughts, notice how you feel over time. Are you feeling more isolated or more dependent on it? That’s important to pay attention to.

This technology is here to stay. What we urgently need are clearer safety standards, better regulations, and more honest conversations about what these tools can and can’t do. Until then, a bit of healthy skepticism is helpful.

The post AI Chatbots and Your Mental Health: What Should You Know? appeared first on Medika Life.

I’m always surprised that the LSHTM gives me the privilege of returning to talk about the shifting landscape of funding and how to help assure that it is spent well and to benefit Africa’s future. As I met the Zoom room full of bright, engaged students (many of whom are living the challenges of adequate funding daily in countries such as Uganda, Nigeria, Kenya, and Cameroon) I was struck by how fast the familiar old world of advocacy died, and how urgent it is that we build a new one.

My perspective is shaped by 35 years as a policy and communications consultant working across the continent. I have seen the era of the “Great Man” advocacy, where we simply tried to bend the ear of a US President or a billionaire philanthropist. We look back at those days with rose-tinted glasses: the billionaires and rich-country leaders were fickle and their focus was often on getting recognition or a seat at the top table, not on the real need. Even when they did try to assess the real needs, it was usually through the uninformed eyes of over-priced management consultants whose only knowledge of Africa came from airport VIP lounges. The billionaires were also shockingly bad at effective advocacy for something as obviously cost effective as health spending.

In any case, those days are over. If we want to secure the future of health in Africa, our work to influence policy must evolve to meet a much harsher, more complex fiscal reality.

The Shifting Foundation of Global Health Funding

We have seen a fundamental failure in advocacy around health funding. The data released by the OECD reveals a stark trend: the era of expanding bilateral aid is ending. Total Official Development Assistance (ODA) is contracting, and 96% of that decline is driven by just five donors: Germany, the UK, Japan, France, and most significantly, the USA.

The US alone is responsible for three-quarters of the global decline in health funding. While Germany has technically become the largest provider of ODA for the first time in history, even it is cutting budgets, albeit in an attempt to become more efficient. Meanwhile, traditional multilateral ODA, money flowing to the WHO or the World Food Programme for example, is shrinking less than bilateral grants, but the overall pie is getting smaller.

The good news is that the World Bank and regional development banks such as the African Development Bank (AfDB) are stepping in to fund some health projects. There are questions over “additionality”: are these institutions really funding things that private equity or other lenders to states would not? And there are frequent criticisms that the banks have failed to create funding buckets for innovative models such as low-cost private-sector primary care. However, there are real successes. The AfDB in particular has said loudly and clearly that economic growth depends in large measure on better health and has encouraged governments and funding agencies to invest accordingly.

The Rise of the America First Bilateral Accords

US funding has not disappeared: it has shrunk and mutated into the America First health policy. This administration is moving away from broad global initiatives toward strict bilateral health accords between the US and individual African countries. These are not just funding agreements; they are ideological and strategic contracts that come with significant strings attached.

Under these accords, the US makes a five-year commitment with a clear “exit strategy”: funding is front-loaded but tapers off to zero, forcing national governments to take on “ownership.” While national ownership sounds positive, the requirements are often demanding.

The focus is what you would expect from an administration with an ideological focus derived from Project 2030. It is on maternal and child health (and, yes. The State Department often says that it is the health of children “born and unborn”) and infectious disease.

These accords also require African countries to share pathogen data and specimens with the US within five days of an outbreak. This creates a parallel data mechanism to the WHO and, more importantly, seeks to capture what one of the post-graduate students called, “the new oil.” Africa holds 80% of humanity’s genetic diversity. In an era of genetic medicine, this data is a massive national asset. Several students at LSHTM rightly pointed out that countries like South Africa and Kenya see this as a key resource to be traded for R&D investment, not just given away for a few years of HIV funding. Africa is also developing national health databases that can be used to assess and model the impact of interventions and, as when the continent pioneered payments from mobile phones, it is less encumbered with antiquated existing systems and threatened vested interests.

Most alarmingly to me, these accords are sometimes tied to non-health issues. We’ve seen Zambia refuse to sign because the US tied HIV funding to access to critical minerals and mining data.

One Path Forward: the Accra Reset

The Accra Reset sets out to be a roadmap for this new era. It aims for 55% of health spending to be domestic by 2030, funded in part through “sin taxes” on sugar-sweetened beverages and tobacco. Other means of national funding include surcharges on profitable data transactions and health solidarity funds. Its organisers say that these taxes will raise £750 million in 2026 in six countries alone. I think that’s a high estimate, but there is real money there.

The Accra framework is, though, delusional in thinking that out-of-pocket health can be reduced over the next five years. The AfDB projection is that the private health market in Africa will explode. This is not necessarily bad news for health equity: much of the growth will come in highly efficient fixed-cost private primary care models targeted to working people (although, admittedly, rarely to the bottom of the pyramid or the working poor). These models can be valuable ways to give fast access to innovation and convenient, timely provision of sexual and reproductive health services.

Recommendations for the New Advocate

Given this backdrop, I suggested that these elite advocates do the following.

1. Make Health Explicitly Political

We often hear that health should be non-political. This is a mistake. Non-political subjects are boring and ignored. We need health to be the subject of election campaigns, impassioned debates and social media memes. When health becomes a political must-have, politicians make promises they can be held to. We want people shouting about health in the streets of Accra, Nairobi, and Lagos.

2. Frame Health as a Capital Asset, Not a Cost Centre

We must stop arguing for funding based solely on morality. We need to speak the language of Finance Ministers. According to the World Bank and the AfDB, health is a growth engine.

• ROI Data: For every $1 spent on malaria treatment, the economy gets $35 back. For paediatric immunisation, it’s $20. For SRHR, the returns are less often quantified rigorously but similarly massive because they enable women to enter the workforce and stay productive.
• Preventative Care as Infrastructure: Just as investing in robotics improves productivity, investing in the health of a citizen from birth to age 65 creates a stock of human capital that belongs on a national balance sheet, as the World Bank has now recognised.

3. Build Alliances with FBOs

Faith-Based Organisations (FBOs) provide roughly 30% of healthcare in Africa. The America First plan prioritises them, in part because it plays well to US domestic audiences and, in part, because they are efficient and embedded in communities. While we may disagree with some FBOs on abortion or family planning for unmarried youth, they have incredible national reach. As one student noted, a Pentecostal church in Nigeria aiming for a branch every 15 minutes of walking distance is a more powerful delivery network than any government programme. We must engage them to improve quality and advocate for rights within their frameworks.

4. Harness the Power of Media and Social Media

We can’t forget about media, especially in Africa where so many people are still dependent entirely on TV and local radio and where online and offline newspapers are declining less slowly.

Increasingly, though, we must go where the people are — which is social media. During the lecture, students raised concerns about medical influencers spreading misinformation or misogyny. My response: then we must flood the zone. We need to train responsible influencers. When Joe Fazer, a bodybuilding influencer with about 30 million followers produces content about health equity, he can mobilise a generation we will never reach through traditional policy papers.

Overall, we are in a time of great opportunity and serious danger. The transition from aid to co-investment is the only way to escape the whims of Washington or Berlin. We must be like the “trained revolutionaries” Lenin spoke of — professionals who know how to stir up movements and demand that our governments prioritise health not because a donor asked them to, but because their own citizens demand it.

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Health systems are not stepping into artificial intelligence from a place of calm or control. In the United States, spending now exceeds $4.5 trillion, with a significant share tied up in administrative work that adds complexity more than clarity. Clinicians are caring for more patients, navigating more data and making more decisions under pressure than ever before. The system is stretched. Artificial intelligence is entering at a moment when change is no longer a choice.

The discussion drew on the experience of three leaders who are not observing this shift. They are guiding it. Hal Wolf leads HIMSS, influencing digital health policy and implementation across more than 100 countries. Isaac Kohane, MD, PhD, Chair of Biomedical Informatics at Harvard Medical School, has spent four decades defining how data informs clinical care. Ran Balicer, MD, Chief Innovation Officer at Clalit Health Services, operates within one of the world’s most integrated health systems, where data and care are aligned across generations.

These are not just star panelists. They are system-wide architects.  What emerged from the hour-long conversation was not what artificial intelligence can do. It was a recognition that it is already doing more than most systems are prepared to guide and govern.

Dr. Kohane captured the tension immediately. “I think that we have to worry about the fact that we’re going both too slow and too fast.”

That statement reflects a reality many leaders feel but rarely express. Governance takes time because it must. Patient safety, validation and accountability require structure. Practice moves in real time. Clinicians do not have the luxury of waiting for perfect systems.

“They’re so desperate to do right by their patients to use other resources,” Dr. Kohane adds.

That instinct is not a weakness. It reflects a commitment to doing what is right for the patient. When clinicians turn to external AI tools, they are seeking clarity, speed, and confidence in their decisions. Artificial intelligence is already present at the point of care, shaping how physicians assess information, validate thinking, and move forward. The system is not adopting AI. The system is catching up.

This creates a condition that is difficult to measure and even harder to manage. Different clinicians use different ChatGPT platforms. Those tools produce different answers. Different assumptions shape those answers. Over time, consistency erodes. The system begins to operate with multiple definitions of truth (and the risk of varied outcomes).

Dr. Kohane’s warning is not about misuse. It is about misguided permanence. “The worst outcome will be if the worst parts of medicine get concrete poured over it, by AI.”

Artificial intelligence does not fix a system; without leadership, it accelerates the integration of incorrect assumptions. If workflows are inefficient, they become more efficiently inefficient. If bias exists in data, it becomes more precise. If fragmentation defines care, it scales.

This is not a failure of technology. It is a mirror held up to system-wide leadership.

Hal Wolf, among the health sector’s leading policy and operational voices, grounded this moment in proven experience. Health care has seen this pattern before. When internet connectivity entered hospitals, clinicians moved faster than governance. They created access where it was needed. Systems responded later. Risks were discovered after adoption.

Artificial intelligence now follows that same trajectory, though at far greater speed and with far greater consequences. Web connectivity gave quick access to information. Artificial intelligence influences how that information is interpreted and acted upon.

“We have to go faster,” Mr. Wolf said. “But there needs to be structure around it.”

That is the leadership challenge of this moment. Speed without structure creates exposure. Structure without speed creates irrelevance. The tension between the two is not something to resolve. It is something to manage continuously.

The industry has predictably responded to artificial intelligence. It has started where risk is lowest and return is clearest. Documentation, scheduling and revenue cycle optimization have become the entry points. These applications reduce burden and improve efficiency. They are necessary. However, they are not transformational.

The shift occurs when artificial intelligence moves into clinical decision-making. At that point, the question is no longer whether the system works. The question becomes whether it should be trusted.

Who owns a decision informed by an algorithm? How is accuracy validated? What happens when a clinician disagrees with a recommendation? These are not technical questions. They are questions of accountability. Artificial intelligence does not assume responsibility. It does not carry consequence. That remains with leadership.

Dr. Balicer reframed the conversation, shifting how the room thought about artificial intelligence. “There’s no such thing as AI neutrality. Algorithms are just opinions embedded in code.”

That insight is easy to acknowledge and difficult to operationalize. Every model reflects choices. What data is included? What outcomes are prioritized? What trade-offs are accepted? Those decisions are embedded in the system, shaping how it interprets information.

When a health system adopts an AI tool, it is not simply implementing technology. It is adopting a perspective.

At Clalit Health Services, alignment across payer and provider creates a system where priorities are consistent. Even there, external AI models introduce new assumptions. Those assumptions may not align with the system’s goals. If leadership does not define its own values, it inherits someone else’s.

This becomes real in proactive care. Artificial intelligence enables systems to identify patients at risk before they present. It allows for earlier intervention, often improving outcomes.

It also creates a new kind of pressure. “The toughest choice is what not to do,” Dr. Balicer said.

That statement deserves more attention than it receives. Health care has been built around responding to need. Artificial intelligence introduces the ability to anticipate it. When every patient can be flagged, every risk predicted and every intervention suggested, the system is no longer constrained by insight. It is constrained by capacity.

Artificial intelligence expands what can be done. It does not expand who can do it. Leadership becomes the act of choosing who does what based on validated data.

There is a moment that captures this shift. Imagine a primary care physician starting the day not with a schedule of patients who have called for appointments, but with a list generated by AI identifying individuals who are likely to experience clinical complications in the next six months. Some will develop chronic conditions. Some will require hospitalization. Some can be helped now – preventively.

The physician cannot see them all. Artificial intelligence expands what is possible. Leadership decides what is essential and permissible.

The industry often responds to complexity with activity. Organizations pilot, test and explore. They engage broadly without committing deeply. This creates motion. It rarely creates progress. Pilots are nothing more than experiments. At some point, leadership must decide what to scale, what to stop and what defines value.

Hal Wolf grounded the conversation in discipline. Without a defined, shared objective, effort becomes noise. Pilots create learning, though they often avoid decision-making. Leadership requires clarity. What problem are we solving? What outcome defines success? What are we willing to prioritize? Without those answers, artificial intelligence adds another layer of complexity to an already complex system.

Dr. Kohane brought the conversation back to the discipline of leadership. It cannot remain abstract. It must be informed by experience.

“Go and pay a few bucks and use three or four of the models… get a feel for what this does,” Dr. Kohane advised.

That is not a call for technical fluency. It is a call for leadership proximity. Leaders cannot guide what they do not understand. Artificial intelligence does not behave consistently across models. It produces different answers, shaped by different assumptions. Without direct engagement, those differences remain hidden, and leadership becomes removed from the very decisions it is responsible for guiding.

This is where many organizations hesitate. Artificial intelligence feels complex and complexity invites delegation. At this moment, delegation creates distance. Leadership is required to move closer, not further away.

Artificial intelligence is not reducing the role of leadership. It is redefining it.

This is not a gradual transition. It is already underway. Artificial intelligence is embedded in workflows, shaping decisions and influencing behavior in real time. The system is adapting whether leadership is ready or not.

The question is no longer whether artificial intelligence will shape the future of health. It will. The question is whether leadership will shape how it is applied.

Artificial intelligence will not fix health. It will scale whatever we allow it to touch. The question is whether it will scale what is best in health or what we have yet to fix.

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