The effects of misinformation among the general population and decision making bodies in relation to public health are not a new phenomenon, though the challenge has grown exponentially in parallel with the internet age and the democratization and globalization of information. The global spread of misinformation during COVID-19 pandemic has had far-reaching effects on both the compliance of the public to infection prevention recommendations and national responses implemented by countries.
Statement of the Issue
Misinformation about COVID-19 hurts public health and hinders appropriate national responses. Often the focus has been on the general public listening to fringe medical professionals or non-experts, but this is not the only phenomenon. Governments have been affected as well, and their response to the pandemic can be hindered by misinformation. Furthermore, when governments use of support misinformation, it can affect their perceived legitimacy, both domestically and internationally.
Fear of both disease and the medical establishment’s recommendations on how to avoid it is a very human and universal response. An abundance of misinformation and fake news has always been present, especially during public health emergencies, where both individuals and governments feel overwhelmed. From the slaughtering of Jews that were claimed for spreading the Black Plague 1 to the anti-vaccine cartoons of the early 1800s2, to today’s COVID-19 “infodemic”3, history is filled with examples. The current anti-mask sentiment has its roots in the 1918 Spanish Flu pandemic, when local governments and the Red Cross were mandating the wearing of masks.4 By 1919 this movement had developed into the San Francisco Anti-Mask League, which included doctors and at least one city official, lending it an air of legitimacy.5
The misinformation around COVID-19 is especially problematic because of its scope, reach, and nature. A new disease coupled with the widespread platforms of the internet, a fully interconnected and globalized world the sheer variety of misinformation concerning virtually every aspect of the disease. From its origin, its severity, transmission, or prevention, potential cures, to the veracity of reported data; there is a literal tsunami of misinformation surrounding the pandemic. This not only erodes trust in the established governing and medical bodies, but makes it difficult for non- experts to know what to believe and for experts to know how to address the issue.
Currently, we are seeing large, sometimes violent, protests around the world against confinement, wearing masks and social distancing.6,7 There are a number of unverified cures that are pandered by snake oil salesmen both on local and national levels.6,8–10 The US Food and Drug Administration currently has a list of over 100 ineffective and fraudulently marketed products against which it has issued warnings, though of these are only the tip of the iceberg.11,12 Many people believe that 5G networks spread COVID, and that Bill Gates wants to microchip everyone when they create a vaccine.
Information Pertinent to the Issue
On a grassroots and individual level, there is a major issue with the amount of power and attention fringe opinions are getting. Quack doctors and fake documentaries such as “Plandemic” are getting unprecedented attention from the public, who have become hungry for an unlikely hero.13,14 Social media outlets such as Facebook and YouTube have essentially evolved into echo chambers, where users can get their world view mirrored back to them endlessly, regardless of veracity.
On a national level, the debate around misinformation has become highly politicized in many countries, and is no longer only about public health. Presidents such as Donald Trump, Jair Bolsonaro, and Andry Rajoelina have all touted unproven cures to the public, and Russia has targeted the US directly with a misinformation campaign centered around misleading American readers. 15–19
Other regions have enacted policies that are not all evidence based, for example, France, Spain, and China, have been spraying disinfectants outdoors to kill the virus, when experts deem this totally unnecessary, useless damaging to the environment and dangerous for people who breathe them in.20–23
Regarding laws and policies, it is very difficult to address this plethora of misinformation, because it is coming from so many sources and is so widespread. A global study published by the American Society of Tropical Medicine and Hygiene identified 2,311 reports of rumors, stigma, and conspiracy theories in 25 languages from 87 countries. The false information was related (in descending order) to illness, transmission and mortality, control measures, treatment and cure, cause of disease /origin, and violence (as well as many miscellaneous cases). Of the 2,276 reports for which text ratings were available, 82% of claims were false.24
Responses and Policy options
The cost of this infodemic, and the changes in behavior that is causes at individual and community levels are probably almost impossible to calculate. One study by a cybersecurity firm estimated the cost of online fake news (before the pandemic) to be at around $78 billion.25 There have been numerous initiatives to try to tackle the issue, but the quantity of misinformation is staggering. Notable the World Health Organization created a “Mythbusters” series designed to appeal to and educate laypeople about COVID-19.26 Social media giants have been removing posts, though these actions are slow and often happen far too late. 27 Governments do have laws about how to tackle misinformation but generally potential prosecution is limited to actors who “ further unlawful objectives” such as violence or terrorism, and the COVID-19 disinformation falls into a grey area, even if it is meant to sew chaos.
Governments and health agencies must track misinformation as it happens, and engage local communities and other stakeholders to help fight it.24 Governments should make selling fake or unproven cures punishable if they are dangerous, fine people breaking confinement orders, and be transparent about their own policies and mistakes. The general public has a hard time understanding that governments are also subject to a learning curve in a pandemic, and it is vital that this be communicated for legitimacy. Individuals need to be taught basic scientific literacy, how to fact check, and how to follow an argument logically. This should be integrated at all levels of education and fields, not just at the university level.
The medical community needs to learn more about how to communicate with target audiences, and make sure that practitioners take the time to listen to the people believing fake news, and sympathize with their worries. This infodemic is worsened by a deep mistrust in organized medicine, and the community can only fight against such a problem by actually engaging positively with their target audiences. More must be done to address the deep rift between scientists, policy makers, and the public. Government policies should include listening to expert groups, and working to make infection prevention measures less about politics and more about health. Social scientists, anthropologists, psychologists, and behavior change experts should all be consulted for any high level policy making. International organizations need to continue working across sectors to try to address the issue of misinformation about the pandemic in the most comprehensive way possible.
- 700 years before Coronavirus: Jewish life during the black death plague. Beit Hatfutsot https://www.bh.org.il/blog-items/700-years-before-coronavirus-jewish-life-during-the-black-death-plague/ (2020).
- Davis, K. The Cow-Pock—or—the Wonderful Effects of the New Inoculation! https://editions.covecollective.org/content/cow-pock%E2%80%94or%E2%80%94-wonderful-effects-new-inoculation (2019).
- Zarocostas, J. How to fight an infodemic. The Lancet 395, 676 (2020).
- Mask Resistance During a Pandemic Isn’t New — in 1918 Many Americans Were ‘Slackers’. Discover Magazine https://www.discovermagazine.com/health/mask-resistance-during-a-pandemic-isnt-new-in-1918-many-americans-were.
- Smith, K. N. Protesting During A Pandemic Isn’t New: Meet The Anti-Mask League Of 1918. Forbes https://www.forbes.com/sites/kionasmith/2020/04/29/protesting-during-a-pandemic-isnt-new-meet-the-anti-mask-league/.
- Coronavirus: Anti-mask protests held across the world. NewsComAu https://www.news.com.au/world/coronavirus/global/coronavirus-antimask-protests-held-across-the-world/news-story/2d2513d5b503050c8a0a25e7e6d48e30#.zdbrc (2020).
- Anti-lockdown protests around the world | Reuters.com. https://www.reuters.com/news/picture/anti-lockdown-protests-around-the-world-idUSRTX7H61S.
- Oleandrin, Covid-19 Treatment Pitched to Trump, Could Be Dangerous – The New York Times. https://www.nytimes.com/2020/08/20/health/covid-oleandrin-trump-mypillow.html.
- Kravitz, R. L. When Trump pushed hydroxychloroquine to treat COVID-19, hundreds of thousands of prescriptions followed despite little evidence that it worked. The Conversation http://theconversation.com/when-trump-pushed-hydroxychloroquine-to-treat-covid-19-hundreds-of-thousands-of-prescriptions-followed-despite-little-evidence-that-it-worked-140156.
- Coronavirus: The misinformation circulating in Africa about Covid-19. BBC News (2020).
- Affairs, O. of R. Fraudulent Coronavirus Disease 2019 (COVID-19) Products. FDA (2020).
- List of unproven methods against COVID-19. Wikipedia (2020).
- Sayare, S. He Was a Science Star. Then He Promoted a Questionable Cure for Covid-19. The New York Times (2020).
- PolitiFact: Fact-checking ‘Plandemic,’ a documentary full of false conspiracy theories on the coronavirus. https://www.tampabay.com/news/health/2020/05/11/politifact-fact-checking-plandemic-a-documentary-full-of-false-conspiracy-theories-on-the-coronavirus/.
- Outcry after Trump suggests injecting disinfectant. BBC News (2020).
- NordlingMay. 6, L., 2020 & Pm, 4:00. Unproven herbal remedy against COVID-19 could fuel drug-resistant malaria, scientists warn. Science | AAAS https://www.sciencemag.org/news/2020/05/unproven-herbal-remedy-against-covid-19-could-fuel-drug-resistant-malaria-scientists (2020).
- Bostock, B. Russia has been publishing English-language articles to spread COVID-19 disinformation to Americans, US officials said. It could skew the 2020 elections as it did in 2016. Business Insider France https://www.businessinsider.fr/us/russia-running-coronavirus-disinformation-websites-target-us-voters-ap-2020-7 (2020).
- Swan, J. Trump eyes new unproven virus ‘cure’ promoted by Ben Carson and the CEO of MyPillow. Axios https://www.axios.com/trump-covid-oleandrin-9896f570-6cd8-4919-af3a-65ebad113d41.html.
- Carmichael, J. G. and F. Fake cures in Bolsonaro’s Brazil. BBC News (2020).
- Taylor, A. Photos: Large-Scale Disinfection Efforts Against Coronavirus – The Atlantic. https://www.theatlantic.com/photo/2020/03/photos-large-scale-disinfection-efforts-against-coronavirus/607810/.
- (19) Don’t spray disinfectants to kill coronavirus, WHO advises. https://edition.cnn.com/world/live-news/coronavirus-pandemic-05-16-20-intl/h_0f2325d2b58893ae656ac8e522afad79.
- Wildlife deaths from coronavirus disinfectant use alarm scientists. Animals https://www.nationalgeographic.com/animals/2020/08/disinfectant-public-cities-pandemic-urban-wildlife-cvd/ (2020).
- Outcry as Spanish beach sprayed with bleach. BBC News (2020).
- COVID-19–Related Infodemic and Its Impact on Public Health: A Global Social Media Analysis | The American Journal of Tropical Medicine and Hygiene. http://www.ajtmh.org/content/journals/10.4269/ajtmh.20-0812.
- CHEQ | Fake News | 2019. https://www.cheq.ai/fakenews.
- World Health Organization. Mythbusters. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters (2020).
- Lerman, R. Facebook says it has taken down 7 million posts for spreading coronavirus misinformation. Washington Post.