Research emphasizes that public health leadership played a key role in increasing public trust and achieving good health outcomes during the COVID-19 pandemic [4, 5]. Multiple studies have identified evidence-based decision-making as a foundational leadership practice. Leaders who relied on scientific expertise and public health guidance were more successful in establishing credibility and sustaining public adherence to mitigation measures such as masking, physical distancing, and vaccinations [4, 6]. Additionally, transparent and consistent communication fostered trust and ensured compliance with mitigation efforts, especially when leaders were required to implement restrictive policies [4, 7, 8]. Adding to these insights, research suggests that leaders who prioritized empathy, stewardship, and emotional support were better able to sustain morale among healthcare workers and maintain organizational stability during prolonged uncertainty [6].

Some studies report high rates of physical violence, verbal abuse, and cyber harassment experienced by public health officials in their leadership roles during the COVID-19 pandemic [9–11]. One survey revealed that approximately one-third of U.S. public health workers reported at least one form of workplace violence, including stigma, job-related threats, and bullying or harassment [10]. Evidence suggests that poor workplace conditions and harassment towards public health officials led to high rates of poor mental health, burnout, quitting, or contention between public officials [12–15]. Survey-based research on local health department leaders found that over 57% reported experiencing verbal abuse, threats of violence, or lawsuits, with 88% indicating that such harassment negatively affected their mental health and 66% reporting staff shortages that compounded organizational strain [16]. These findings underscore how workplace violence and harassment during COVID-19 were both widespread and consequential, extending beyond isolated incidents and becoming embedded within broader institutional and political contexts [11]. While many studies have analyzed leadership during COVID-19, the ALF offers unique insights into the nature of the leadership challenges and the harassment faced by public health officials.

The ALF was developed by Ronald Heifetz, Marty Linsky, and colleagues at the Harvard Kennedy School as a tool for understanding and exercising leadership when faced with adaptive problems [3, 17, 18]. Heifetz defines adaptive problems, in contrast to technical problems, as those driven by underlying conflicts in values, beliefs, and loyalties where the exact nature of the problems is hard to define and the solutions are unknown [17]. These problems are challenging because addressing them requires people to change their ways and build something new. Across international and domestic contexts, COVID-19 has been framed not merely as a technical challenge of leadership but as a complex and adaptive problem requiring emotional intelligence, continuous learning, and flexibility [6, 7]. The pandemic presented the world with innumerable instances of adaptive problems, among the most pressing being how to overcome political and cultural differences to unite against the spreading virus. While the lack of definitive scientific consensus at the outset only intensified the adaptive nature of the work needed to make progress against the virus, the inherent tension between scientific experts and elected officials made the work fundamentally adaptive in nature [19].

The ALF distinguishes between leadership exercised by individuals who are in positions of authority and leadership without authority, recognizing that leadership can come from those with or without authority but that the opportunities and constraints between the two types of leadership differ [17]. Leadership can therefore be considered a practice or activity rather than a job someone is assigned.

Another key feature of the ALF is that it highlights the inherent danger of exercising adaptive leadership since, by definition, addressing these problems requires challenging people’s core values and beliefs [17]. Doing so generates opposition or resistance on behalf of those being pushed to change their ways which, in the case of COVID-19, regularly surfaced in the form of harassment towards officials doing their best to make public decisions in the face of uncertainty. Heifetz and Linsky highlight historical examples of individuals being literally assassinated for exercising adaptive leadership, and they point out that assassination can also happen figuratively as those exercising leadership are ignored, marginalized, or otherwise neutralized for representing controversial perspectives that another faction in the social system wants to silence [3]. Figurative assassination of public health officials in the form of threats and harassment was common during the pandemic.

When faced with the uncomfortable reality that they may be part of the problem, stakeholders often engaged in work avoidance, which Heifetz et al. define as conscious or unconscious patterns of behavior that distract people’s attention from the difficult work required of meeting an adaptive challenge. Work avoidance may include behaviors such as focusing only on the technical parts of a problem, engaging in interpersonal conflict, or, as evident in the many examples of harassment of public officials during the pandemic, the scapegoating and attacking of authority figures. Because of the strong opposition to and danger faced by those exercising adaptive leadership on adaptive issues, the ALF emphasizes the central role of purpose as a driving motivation for being willing to exercise leadership.

In contrast to traditional hero models of leadership in which the leader is the person with authority who claims to have all the answers, the ALF recognizes the importance of giving the work back to others by mobilizing them to take responsibility for solving problems. The ALF identifies and recommends productive behaviors that can help those exercising adaptive leadership to give the work back. These include listening with curiosity and compassion in heated situations. There are times when exercising leadership requires holding steady by remaining steadfast in the face of opposition rather than overreacting or attempting to respond to every criticism. Those exercising leadership must be willing to accept responsibility for their difficult decisions and for the possibility that they may play a role in perpetuating the problem. Partnering is another important act of leadership in which those exercising leadership collaborate with others who share their points of view across or within organizations. Support from these partners can be critical to identifying the underlying issues and moving forward with a plan of action.

As noted above, many studies have explored the importance of strong leadership during the COVID-19 pandemic, and others have sought to document the harassment faced by public officials during this period. Ours is the first to apply the ALF as an analytical tool to specific stories of harassment to identify insights into exercising leadership on adaptive problems in the face of serious opposition. While the ALF emphasizes the importance of and opportunities for leadership without authority, the focus of this study is on leadership from public officials in positions of authority during the COVID-19 pandemic.

This study employed a systematic qualitative media content analysis to examine U.S. newspaper coverage of public health officials during the COVID-19 pandemic. The purpose was 1) to identify and categorize incidents of harassment (defined as all forms of opposition from the public and from elected officials, including threats, doxxing, stalking, verbal abuse, firing, etc.) and 2) to examine how leadership behaviors described in media accounts aligned with constructs from the ALF. Since newspaper coverage does not account for all instances of harassment towards public health workers, the results should be viewed as an analysis of media portrayals of such incidents.

The study focused on U.S.-based newspaper articles published between January 1, 2020, and 31 December 2023, a period encompassing the height and aftermath of the COVID-19 public health response. We conducted a comprehensive literature search using Newspaper Source Plus and Newswires (EBSCO) databases, accessed through the Brigham Young University library. Searches were limited to newspaper publications within the specified date range. As shown in Table 1, the search strategy used Boolean operators and incorporated key terms related to COVID-19, public health leadership, harassment, political pressure, and professional turnover.

Figure 1 illustrates the article identification, screening, and selection process. The initial search yielded 6,624 newspaper articles. Three reviewers independently screened article titles and previews (displayed in the EBSCO search results) to determine relevance. Articles were excluded if they 1) did not involve public health officials in the United States (defined as public health officials or other public officials whose responsibilities related to public health) or 2) were unrelated to harassment, threats, political pressure, or professional turnover. Articles with ambiguous relevance were retained for full-text review. This first round of screening resulted in 120 total articles. In the final round of screening, two reviewers conducted a full-text review of all remaining articles, reviewing a subset of 20 articles together to establish consistency in applying inclusion and exclusion criteria. After confirming uniformity, the reviewers divided the remaining articles and conducted independent full-text reviews. Discrepancies were resolved through consensus and bi-weekly meetings, resulting in a final study dataset of 50 articles.

Once the initial and full-text screening were completed, we developed a theory-informed codebook through an iterative process informed by a review of the ALF, existing literature on public health leadership, and the initial screened articles. We refined and finalized the codebook through team discussion and pilot coding, with definitions clarified to ensure conceptual consistency and analytic rigor. The final codebook characterized different types of harassment and their consequences, and it operationalized key ALF constructs, including holding steady, partnering, giving work back, listening, demonstrating empathy, accepting responsibility, and fighting back. Two reviewers then uploaded and coded the final sample of articles in Dedoose qualitative data analysis software (Version 9.0.107). Each reviewer reviewed and coded half of the articles before jointly reviewing all of the coded articles together to ensure consistency in applying the codebook. Following the article screening and coding, relevant data were extracted and analyzed using a directed thematic analysis focused on identifying recurring patterns related to different forms of harassment and leadership behaviors exhibited by public health officials in the dataset. Frequencies were reported to organize and characterize the relative prominence of themes across coded newspaper articles, consistent with recommendations for the appropriate use of numbers in qualitative research, rather than to estimate prevalence or imply statistical generalizability [20].

Our coding identified seven leadership behaviors described in the ALF that public health officials exhibited in response to incidents of harassment (see Table 5).

There were 25 instances of partnering, with Kentucky serving as a pertinent example. Kentucky was extremely hard hit by the pandemic due to a lack of resources after the Department of Health experienced severe fiscal constraints dating back to 2008 [21, 22]. The Health Department received a generous grant from AmeriCorps to assist in the department’s COVID efforts, in large part thanks to the partnerships formed by the department. “For a smaller organization like us to get this kind of grant, we’ve just been thrilled,” reported Dana Cox Nickles, executive director of the Kentucky Health Departments Association (KHDA). “We were encouraged to apply by our national association, and we had help writing the grant from state partners who will be helping us with the training. It’s been a joint effort.” In a different example of partnering, following her resignation from the Kanawha-Charleston Health Department, Dr. Sherri Young indicated that the support she received from her peers was an upside of the job, despite significant harassment. “You have incredible support from the people you work with,” Young said. “You’re working to save lives, and you’re doing it together.”

Another leadership behavior exhibited by public health officials was holding steady, with 22 instances. Despite experiencing harassment on all sides, public health officials continued to work and push forward public measures. As Dr. Karen Landers, a health officer with the Alabama public health department, expressed, “We know viruses will mutate, and SARS-CoV-2 is no different, as we saw before with delta. The core preventive measures haven’t changed. We’re going to continue to apply the same standards that we have for the last 2 years.” In advising public health officials on how to respond to harassment, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, stated, “People calling for you to be beheaded, fired, thrown in the fire pit or whatever, that’s just noise. You don't pay attention to that.”

Accepting responsibility was a leadership behavior found 13 times in the coded articles. For example, in King County, Washington, Mr. Duchin witnessed what few public health officials were lucky enough to experience: widespread public support and praise for his leadership. However, Duchin publicly focused on his administration’s failures: “We’re seeing the consequences now of a complete and utter failure to ensure we have a full and robust vaccination system,” he reportedly said. Some public health officials who experienced vicious harassment reported feeling sobered, with public health board members who saw severe backlash in Arizona feeling enthusiastic about their work, with one board member stating, “You actually now know what you do is important. The decisions you make as an elected official have ramifications.”

Many public health officials fought back (n = 11), especially when facing harassment from leadership. Following her firing as chief coronavirus data officer in Florida after refusing to cede to Governor Ron DeSantis' demands to falsify data to justify reopening plans, Rebekah Jones created her own COVID-19 tracking site. In Hawaii, state epidemiologist Jennifer Smith acted as a whistleblower, exposing mistreatment of public health officers in the state’s health department. “People of our community have been confused, frustrated and anxious. I spoke out because the people of Hawaii deserve not only to be as safe and healthy as possible during the pandemic; they deserve to know the facts,” Smith said.

Public health officials demonstrated the behavior we coded as giving work back in six unique instances. In an interview with a reporter, Governor Mike DeWine of Ohio expressed his frustration that the public is not more routinely involved in discussions surrounding who has responsibility in containing the virus. “I think our job at this point, all of us, 11.7 million Ohioans, is to do what we can to slow the spread,” he stated. “The thing that is going to slow our recovery and could halt it in its tracks is if people are scared and back off … The rebound of the economy is tied at the hips to how well we are doing in fighting the coronavirus. If we start losing that battle, the economy will not recover. That’s what is sometimes missed in this discussion … people.” In another instance, Dr. Rachel Levine, the director of Pennsylvania’s Department of Health, criticized the Department of Health and Human Services’ inability to give work back to the states, creating severe distribution problems with antigen testing kits. “We have a perspective from each state that is valuable and should be considered as decisions are made,” Levine said. “We all need to work together.”

Listening and demonstrating empathy were each found four times in our sample. Following the firing of Health Officer David Bishai in Hartford, fellow officers highlighted his “efforts to listen to and mobilize the community”. In Hawaii, when questioned on why she continued to work under the harsh conditions, Smith stated her motivation was empathy for the people in need: “We all wanted to help people, but we didn't have the resources to do it.”