An hourglass model for conceptualising stigma in infectious disease outbreaks

This study introduces the hourglass stigma model, developed to conceptualize and address stigma in the context of (re)emerging infectious disease outbreaks. Drawing from 34 interviews with global stakeholders including outbreak responders, researchers, and community advocates, the model identifies five domains—context, thoughts, emotions, manifestations, and impact—to analyze how stigma evolves and influences outbreak dynamics. The researchers aimed to create a practical, theory-informed tool to ensure stigma is systematically integrated into outbreak preparedness and response strategies, particularly because stigma has historically been overlooked or inadequately addressed in public health planning.

The study found that stigma is deeply embedded in both the societal and structural aspects of disease outbreaks, often shaped by collective memory, cultural norms, and power dynamics. It noted that outbreak responses—such as contact tracing or quarantining—can unintentionally expose individuals, thereby increasing stigma. Fear-based messaging, hygiene-focused narratives, and moral judgments about disease transmission were common stigma drivers. The emotional burden and social exclusion resulting from stigma can outlast the disease itself and deter health-seeking behavior. The model also highlights the need for responders to improve institutional trust and adopt culturally sensitive strategies to mitigate stigma’s effects during outbreaks.