Communication as leadership: adaptive communicative leadership in public health mega-crises

Introduction Mega-crises such as the COVID-19 pandemic are characterized by interconnected disruptions, heightened uncertainty, and the rapid spread of mis-, dis-, and mal-information. These conditions intensify demands on public health leadership, requiring not only effective decision-making but also sustained communication, coordination, and trust-building across diverse institutional and cultural contexts. While risk communication, community engagement, and infodemic management (RCCE-IM) have emerged as a critical response framework, limited research examines how leaders enact these practices within dynamic and networked crisis environments. Methods This study draws on 62 semi-structured interviews with political, public health, and communication leaders across six countries: the Netherlands, Italy, Spain, Sweden, the United Kingdom, and the United States. Using a qualitative, AI-assisted analytic approach, the study explores how leaders reflected on their experiences managing COVID-19, with particular attention to leadership practices, role enactment, governance conditions, and RCCE-IM across levels of governance. Results Findings show that crisis leadership during prolonged public health mega-crises is best understood through the interaction of leadership repertoire, dynamic role-switching, and governance conditions. Leaders continuously navigated overlapping political, administrative, and communicative responsibilities while “zooming in” to manage operational demands and “zooming out” to maintain strategic oversight. Communicative, collaborative, and adaptive leadership practices were most central, while directive and hierarchical approaches were adopted more selectively in response to specific governance contexts and operational requirements. Role fluidity enabled flexibility and coordination but also generated tensions, including role ambiguity, governance fragmentation, resource constraints, and uneven communicative capacity. Discussion/conclusion This study advances a conceptual model of adaptive communicative leadership in prolonged public health mega-crises, positioning RCCE-IM as a governance framework that connects leadership practice, role-switching, and the mitigation of mis-, dis-, and mal-information. The findings highlight the need for hybrid governance, cross-sector coordination, and sustained investment in communicative capacity to strengthen legitimacy, coordination, adaptation, and resilience in future mega-crises.