Social media platforms, public health agencies, and communities must join forces to stop the rapid spread of false information.
The COVID-19 pandemic highlighted the impact of misinformation on public health. Although there are many examples of false information spread during periods of heightened fear, such as times of war, natural disasters, and disease outbreaks, there was an unprecedented increase during the pandemic due to the pervasiveness of social media. This article dives into the detrimental impacts of misinformation on public health, with a special focus on infectious diseases, and reviews initiatives to ensure accurate health messaging in the age of social media.
Social media emerged from the late 1990s into the early 2000s and has become a powerful platform for networking, self-expression, and information sharing. Prior to the pandemic, a survey conducted by the Pew Research Center found that 62% of adults in the United States got their news on social media.1 Although social media allows for convenient news sharing, there is no system to ensure that the information encountered is reliable. Social media users can quickly become inundated with information that has no merit; if not corroborated by trustworthy resources, false information can run rampant. A study by 3 scholars at Massachusetts Institute of Technology investigated all verified true and false stories distributed on Twitter from 2006 to 2017 and found that false information spreads more pervasively than truth online.2 The estimated 50% to 70% surge in internet use3 and the 10.5% uptick in social media use4 during the first wave of the pandemic, combined with global uncertainty and the search for understanding, fueled the spread of misinformation and disinformation.
In September 2020, the Pan American Health Organization, World Health Organization (WHO), and other health alliance groups issued a statement out of concern that the overabundance of information shared during the pandemic was creating barriers to accessing reliable information. The time line of viral outbreak to global pandemic to infodemic only took 9 months—a testament to how quickly information can be shared in the digital age. In March 2020, there were approximately 550 million tweets that included either the term coronavirus (or similar) or pandemic.5 In 2021, the Office of the Surgeon General released an advisory on confronting health misinformation, which is believed to undermine public health efforts, create mistrust, and have a detrimental impact on health through vaccine hesitancy and the use of inappropriate treatment modalities. In this advisory, 5 areas of focus are mentioned: equipping individuals with the tools to identify misinformation; expanding research to understand how misinformation spreads and evolves; implementing product design and policy changes on technology platforms to slow the spread of misinformation; investing in long-term effects to build resilience against health misinformation including the creation of health literacy programs; and; convening notable officials and research partners to explore the impact of health misinformation and identify best practices for preventing it.6
FALSEHOODS CREATED BY MISINFORMATION
It is worth mentioning that the COVID-19 pandemic is not the first time false information has had negative impacts on public health. Most notable was the since-debunked 1998 study that purported to link the measles-mumps-rubella (MMR) vaccine to the development of autism. In the immediate aftermath of publication, childhood vaccinations dropped; despite the paper being completely retracted in 2010, vaccination hesitancy remains higher than before it was published.7
In 2019, the United States had the greatest number of measles virus cases reported since 1992. During this same period, WHO revoked the measles eradication status for 4 countries in Europe.8 This emphasizes how difficult it can be to combat misinformation once it pervades public opinion. Predating this example was misinformation spread around AIDS transmission in the 1980s and the stigmatizing of individuals living with or at risk for developing HIV. Even earlier is the evidence of misinformation spread during the 1918-1919 influenza pandemic, with the belief that Germany was directing or facilitating the malicious spread of the virus or that vaccines were infecting recipients with the disease.9
MISINFORMATION SPED ALONG BY SOCIAL MEDIA
These stories each carry an example of how misinformation can negatively affect disease outbreaks. The largest difference between these examples and the COVID-19 pandemic is how the information spread. Gone are the days of waiting for news to break in the morning newspaper, on nightly broadcasts, or through word of mouth. Social media has exploded with an estimated 456,000 tweets sent, 46,740 Instagram photos posted, and 4,146,600 YouTube videos watched every minute of the day.10 Today, like never before, misinformation can reach millions with the tap of a screen.
A headline that grabs audience attention is likely to travel far. The screenshot of an article titled “Head of Pfizer Research: Covid Vaccine Is Female Sterilization” was no exception and was shared across numerous social media platforms. The origin of this seems to be traced to a European epidemiologist who theorized that the spike protein in the vaccine shared similarities with the genetic code of the placental protein syncytin-1 and could cause an immune response in the female body, leading to infertility.11 This post quickly gained traction and contributed to vaccine hesitancy that was already brewing in the young female population because pregnant women were not included in the initial randomized controlled trials of COVID-19 vaccines (although females did become pregnant during the trials in similar frequencies in both study arms). However, as more evidence became available, the CDC and American College of Obstetricians and Gynecologists recommended that anyone pregnant, breastfeeding, or planning to become pregnant receive the vaccine for maternal and fetal benefit. Nevertheless, the overall proportion of pregnant females vaccinated against COVID-19 from release of the vaccine in December 2020 to March 2022 was 27.5%. The concern regarding the safety of the COVID-19 vaccine in general, for women and newborns was one of the most common reasons provided for declining the vaccination.12
Another point of misinformation that spread across social media regarded ineffective remedies. As mortality numbers climbed, the public was eager for any hopeful news about therapies to combat the pandemic. This is how hydroxychloroquine and ivermectin entered the conversation. Ivermectin is an antiparasitic agent, whereas hydroxychloroquine was originally developed as an antimalarial agent but is now commonly used to treat autoimmune diseases. What they have in common is evidence of low-potency in vitro activity against SARS-CoV-2 and the subsequent whirlwind surge in demand as individuals clamored for their use. This demand created a supply shortage for their evidence-based indications. From February to May 2020, hydroxychloroquine was mentioned more than 160,000 times on Twitter with treatment, taking, and cure as the most frequently reported words associated with these tweets.13 Unfortunately, what got lost in the social media storm is that in vitro activity does not correlate to safety and efficacy in vivo. In fact, 5 randomized controlled trials found a trend toward mortality among patients with COVID-19 treated with hydroxychloroquine as well as an increased risk for adverse effects. Randomized controlled trials have also failed to demonstrate a mortality benefit with ivermectin, although it has less demonstrable adverse effects than hydroxychloroquine. The Infectious Diseases Society of America, in its guidelines on the treatment and management of patients with COVID-19, recommends against use of these agents.14
The spread of misinformation during disease outbreaks can be detrimental. The American Psychological Association believes the spread of misinformation is related to psychological and cognitive biases. If information is frequently liked, shared, or evokes fear, it is more likely to stick and can hold for years, even after facts prove otherwise, as seen with the MMR paper.15 Social media platforms and their increased utilization during the pandemic amplified the spread of any and all information that became available regarding the virus, vaccine, or available treatment modalities with no infrastructure in place to ensure the accuracy of information encountered. It is vital for social media platforms, public health agencies, and communities at large to collaborate to stop the spread of misinformation and combat the emergence of future infodemics.