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To fight coronavirus, America needs leaders who are first followers

We all need to step up and become first followers of proven public health strategies.

Lt. Gov. Karen Polito, far left, and Governor Charlie Baker are briefed before a press conference in a drive-through COVID-19 testing site at Gillette Stadium that is exclusively for first responders to utilize.Jim Davis/Globe Staff

Americans typically hate being told what to do. Autonomy and individualism are hallmarks of the US Constitution and are embedded in our national culture. We take pride in being unique, in doing the impossible, in being a leader. Amid the COVID-19 pandemic, leaders and followers across the country share a sense of anxiety and uncertainty. The way we approach leadership today will define our place in world history.

Leaders must know how to follow. In fact, the “first follower” may be the least recognized yet most influential type of leader that America desperately needs right now. First followers — described vividly in this 2010 TED talk by entrepreneur Derek Sivers — are not the creators of an idea, policy, or behavior, but they are the critical link for any movement to take off. When first followers outwardly demonstrate their commitment to someone else’s idea, they attract more followers and make it socially acceptable for the masses to adopt that idea too. During this pandemic, America needs more leaders who are first followers.


Importantly, this charge applies as much to non-health-care professionals as it does to clinicians, health care leaders, and government officials. During this pandemic, we all need to step up and become first followers of proven public health strategies.

Non-health care professionals

If your expertise is outside of health care, you can be a first follower for trusted organizations like the Centers for Disease Control and Prevention, the World Health Organization, or your state’s health department. These vetted sources offer reliable guidelines regarding the treatment and prevention of COVID-19. Official travel advisories and strategies to avoid infectious respiratory secretions (e.g., handwashing, social distancing) are posted on their websites. Refer to these sources in daily conversations with family, friends, and coworkers. As a first follower, living out this trustworthy information in your own life sets an example for others in your social circle to imitate.



If you directly provide health care, you can be a first follower at your own institution. Identify respected leaders at your institution who are aligning organizational policies with official recommendations from the CDC, the WHO, and well-reputed public health figures. For instance, you can highlight the most relevant parts of hospital-wide policies for your individual department. Be willing to speak out against those who contradict this guidance. Be a first follower for trusted local leaders, and in turn lead your emergency room, clinic, or inpatient teams that look to you for direction.

Health care leaders

If you have a formal leadership role at your institution, you can be a first follower of other health care system leaders. While each institution’s situation is nuanced, and COVID-19 reaches different regions on variable timelines, following the lead of similar health care systems nationally and internationally is a courageous leadership action. When rigorous scientific evidence is not immediately available, you can consider advice from health care leaders across the country. The humility to ask for help is a core characteristic of first followers. The payoff could identify proven strategies to save patients’ lives across your region.

Government leaders

If you are a government leader, you can have immeasurable impact as a first follower of public health expertise. In addition to official public health agencies, you are privy to venerable advice directly from infectious disease and epidemiology experts. Being a first follower means acting on those experts’ strongest recommendations — regardless of political ties — with policies and strategies that are proving to be beneficial in countries ahead of the United States on the pandemic curve. For the sake of the American people, as government officials, demonstrate life-saving leadership by embracing the first follower mindset.


As strongly as individualism and independence define American culture, the coronavirus pandemic calls for leadership that contrasts with our typical desire to be unique. Now more than ever, America needs more first followers to amplify reputable messages and implement successful public health interventions that have shown promise elsewhere. Although Americans have an innate urge to stand out, failing to be first followers of proven public health strategies risks landing America on the wrong side of world history.

Dr. Jason Pradarelli is a general surgery resident at Brigham and Women’s Hospital and a Safe Surgery Fellow at Ariadne Labs. Dr. Gerard Doherty is chair of the Department of Surgery at Brigham and Women’s Hospital, surgeon in chief of Brigham Health and Dana-Farber Cancer Institute, and a professor of surgery at Harvard Medical School.