From Lego Pieces to Public Health Interventions: Actionable Reflections from the Mercury Project Solutions Summit

On October 3 – 4, 2024, the Mercury Project, together with the University of Nairobi’s Institute for Development Studies, welcomed leaders from the public, private, and philanthropic communities to the Mercury Project Solutions Summit. Abdul El-Sayed, doctor, epidemiologist, and director of the Wayne County, Michigan, Department of Health, Human, and Veterans Services, reflects on what he learned about how researchers and policymakers can work together to develop and implement evidence to improve well-being.

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I recently returned from Nairobi, where over two intense days at the Mercury Project Solutions Summit I thought a lot about how we do public health—in Wayne County, in the US, and around the world. Wayne County, like much of the world, struggles to ensure equitable access to and uptake of protective health measures, including vaccination. For example, in Wayne County, Michigan, HPV vaccine uptake is about 45 percent; in Kenya, it’s about 33 percent. Given this shared reality, I knew there would be valuable learning at the end of 18+ hours of flying from Detroit to Nairobi for this Social Science Research Council event, graciously hosted by the University of Nairobi’s Institute for Development Studies. 

We learned together through application, simultaneously getting smarter, better connected, and more concrete about the challenges we face. We leveraged the combined strength of 103 researchers (including Mercury Project teams and their results), health officials, public health program designers and implementers, and frontline health workers and communicators working around the world to tackle the challenges of vaccine uptake and trust in public health institutions. Collectively, we considered what we know, what we still need to know, and what we need to do to achieve high, equitable vaccination rates in cities, counties, and countries around the world.

Having observed how Nairobi traffic fits itself together and the specific implementation challenge we solved at the Summit, I found myself thinking a lot about Legos. Here’s what I am bringing back to Wayne County and the wider public health community:

1. We need different kinds of Lego blocks to build a coherent whole. We have some excellent, useful evidence—but limitations in the type, quality, and setting of that evidence hamper the overall structures we can build. More—and more diverse—evidence improves the complexity and completeness of our interventions.
2. We need to understand how the pieces interact to create a compelling structure. We’ve got some people working on the base of our structure and others working on the details, but we don’t understand whether or how to put them together into something greater than the sum of its parts to do the most good with the resources we have.
3. Sometimes the pieces don’t come together. Sometimes different interventions, regardless of how compelling the evidence for them might be, simply don’t stack together.
4. We need researchers and policymakers/implementers building the structure together and simultaneously. Sometimes we are building different parts of the structure and sometimes different structures altogether. The design and implementation approach of the Solutions Summit highlighted the value of defining the structure we want to create up front and then working together to study and assemble the most critical pieces.

We need all the Legos to create, fund, and implement a comprehensive, equitable public health strategy. 

As both a researcher and the director of the Department of Health, Human, and Veterans Services in Wayne County, which includes the Detroit metro area, I straddle two worlds: creating and using evidence to achieve better, more equitable health outcomes. In my capacity as director, I’m compelled to act swiftly within budget constraints. But as a researcher, I’m always open to the idea that our interventions could be better—if we had more evidence. This tension illuminates critical gaps in our current approach. With the evidence we currently have, we can see the general shape of what we’re trying to create. But we’re missing key components that would allow us to complete the picture. 

• Know the problem. In some cases, we need clearer information about the nature of the problem: Is misinformation or access (or both) the true binding constraint behind too-low uptake of vaccines and other protective health behaviors? More importantly, how do they interact with each other to make each of these individual problems worse? How do communities that we serve perceive what we’re trying to do? How do they read our motivations and interventions? Can we get actionable, systematic checks on “vibes” to rapidly shape communication content? We’ll always want more data, but we can get sharper on what we must have to act.
• Know the best options. In some cases, we need clearer information about which solutions to deploy in response to particular problems, given that they have been proven effective and good value for money.
• Try, test, and learn from deploying the best options. And in some cases, we need clearer information about how to implement tested solutions in the specific context in which we’re working. Nuanced local features of a community influence the success or failure of a public health initiative, and we need to know more about them. We need to build confidence that an initiative that worked in Flint could make a difference in Hamtramck.

When I was a kid, rather than build a new Lego set out of the box, my favorite structures were the ones I could build using parts from sets that were never supposed to go together—part pirate ship, part spaceship, part hospital, and part desert island. Innovative policymaking can’t be built out of the box. Instead, it’s about combining different pieces in ways that stack up to make the whole greater than the sum of its parts. But to do that, you need lots of different pieces. And that’s how we should be thinking about evidence. The more we have, the more we can arbitrage and try interventions together—building programs that capture the best of multiple pieces to create something purpose-built and effective. 

As I reflected on the 18+ hour trip back home to Detroit, I realized that the most important take-home is the need for active learning communities like the Social Science Research Council’s Mercury Project. Spaces like these accelerate the ability to identify information gaps while identifying innovative ways to stack the knowledge we already have. After all, Legos are fun enough on your own. But the structures we build are always better when we build them together. 

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