The work of Alive in 2025

Ruth Stewart

In 2025, Alive moved from developing a shared model for living evidence partnerships into testing that model in practice. That brought real progress, some useful lessons, and a need to be clearer about what changed from the original vision.

Alive began as a community-developed effort to transform evidence systems through living evidence partnerships, the frontrunner being a partnership focused on medicines for type 2 diabetes. In 2024, partners worked together to shape a model built around shared evidence needs, reusable evidence banks, and more timely support for decision-makers.

In 2025, we focused on testing that model in practice.

Reflecting and learning

2025 started with reflection on what we had learnt so far and what we could achieve going forward.

We learned that cost-sharing was not yet a viable way to sustain this work. The diabetes partnership showed the value of living evidence and of a broker to intermediate between the evidence and those using it, but it also showed that goodwill and volunteer effort were not enough to maintain the infrastructure needed over time.

Despite the community efforts in 2024, it also became clear that evidence leaders from other organisations understandably wanted to focus on their own work, and not adopt a model promoted by others. We had achieved some really strong shared thinking, and we continue to see a ripple effect of these ideas in ecosystem initiatives now - in particular, the commitment to curating living banks of data and analyses on key topics and drawing on them to serve decision-makers' evidence needs over time. What we hadn't achieved was shared ownership. This meant that the only people explicitly working to fundraise and implement the approach quickly became the Alive team at the Future Evidence Foundation.

I think we made some mistakes at this point. Our lack of communication led to the exclusion of partners we had hoped to work with. This wasn't a strategic choice; it was a mistake. We should have been clearer about the shift from the original Alliance as a shared community effort to FEF-led delivery of funded partnerships, and been much more proactive in collaborating with the original members of the Alliance. We also should have recognised more explicitly the time, ideas, and trust contributed by the original Alliance community. I am sorry that we did not do this well enough.

So by March 2025, a handful of living evidence partnerships were being implemented, all by Future Evidence Foundation. In this iteration of Alive, we became something different, with two distinct areas of work: a) an FEF team working to deliver living evidence partnerships, and b) the hosting of a community initiative as an evolution of the original Alliance.

What we have learnt in delivering living evidence partnerships

The Alive team at Future Evidence Foundation spent 2025 delivering living evidence partnerships in two different sectors: vaccines, in particular the HPV Living Evidence Partnership, which is working to improve coverage of the life-saving HPV vaccine for young women and girls in low- and middle-income countries; and climate & health, through the DESTINY programme, which is building AI-powered tools to accelerate and optimise evidence synthesis for decision-making for urgent climate and health challenges.

Through our work on HPV vaccine delivery and on DESTINY, we have begun to understand what living evidence partnerships require in practice: sustained user-engagement, deep relationship-building, clear evidence-user priorities, strong technical delivery, and enough time for evidence needs to become usable products and decisions.

Forming large communities of practice across broad geographies was both time-consuming and challenging, and the jury is still out on the value for money of this investment. There were rewards, with more varied and equitable inclusion of interest holders than would have happened otherwise, particularly those usually excluded from the discussions. As a result, the living evidence banks that we are now building reflect the inputs of these interest holders.

Through some similarly challenging approaches, we have both commissioned the generation of evidence to meet the communities' needs (in our HPV vaccines work) and worked with partners within the existing partnership consortium to ensure delivery of the evidence (in DESTINY). In our HPV work, this included setting aside over 1.5 million USD for evidence synthesis teams in the global south. What we know now is how much effort and resources this has taken, and we are hopeful that this will reap benefits in the year ahead. Our logic is that this will both drive greater equity in the evidence system and make the evidence more appropriate for use in these same settings. Our goal going forward is that the communities of practice that we have built will now help to drive greater and more engaged use of this evidence.

As these partnerships advance into 2026, we anticipate a year of delivering the evidence to our communities in more dynamic and responsive ways and ensuring that this evidence is integrated into decision-making. There is lots still to come in this work.

Hosting a community initiative (an iteration of the original 'Alliance')

We continue to learn that engagement with the wider living evidence community brings shared value. People around the world are committed to sharing and learning as they implement living evidence efforts.

In January 2025, we launched the Alive Learning Forum, an online community that met virtually throughout the year. The Forum is governed by a committee of Co-Chairs, with operational support from the Alive Secretariat. They have identified topics of interest to the living evidence community and ensured our multilingual live-translated sessions include thought-provoking speakers, learning opportunities, and debates. Engagement in the Forum was slow initially, but continues to grow steadily.

As part of our goal to share and learn alongside the broader living evidence community, we also built the Living Evidence Atlas to curate and share accessible information about the global landscape of living evidence activities. This resource is populated through a comprehensive, always-up-to-date evidence map of all global living evidence efforts, including living guidelines, evidence synthesis, evidence maps and repositories.

Feedback on these community activities has been positive, and new learning and collaborative relationships with partners have emerged as a result. Our reflection has been on the extent to which these should be driven by us or merged with other wider community efforts. With funding constraints affecting many previous living evidence community networks, we have been encouraged to continue with this work into 2026. We recognise that there is much more to learn together about living evidence and the value it can bring, and remain committed to sharing and learning from our own work with this wider community.

Reflecting on what we achieved

I am very proud of what the Alive team delivered in 2025. We learnt so much from these experiences - both in our challenges and our successes.

We have delivered value to the evidence community through the Alive Learning Forum and Living Evidence Atlas. We have built serious foundations: partnerships involving more than 200 people across 100 organisations and 20 countries, new evidence work in HPV and climate and health, and major investment in evidence generation by teams in low- and middle-income countries. The next test is turning that infrastructure into evidence that is used for decision-making.

Looking to the future

Our work now is to bring more clarity to who we are, how FEF-led project delivery and our hosting of the living evidence community relate to one another, and how living evidence partnerships can best serve decision-makers. The work continues, but with sharper expectations, more honesty about what we have learned, and a clearer focus on building evidence systems that are useful, equitable, and used.