In his first Advisory as U.S. Surgeon General, Vivek Murthy warned that health misinformation is fueling the COVID-19 pandemic and poses an increasing risk to public health.
A Surgeon General’s Advisory is a public statement that calls attention to a public health issue and provides recommendations for how that issue should be addressed. Advisories are reserved for significant public health challenges that need the American people’s immediate awareness. And health misinformation is just that.
On July 16, reporters at the White House asked President Joe Biden for his views on health misinformation. “They’re killing people. … Look, the only pandemic we have is among the unvaccinated. And they’re killing people,” Biden responded.
And the very next day, Biden’s chief medical adviser, Anthony Fauci, told CNN he’s “certain” smallpox and polio would still be in the U.S. if vaccine misinformation spread like it has over COVID-19.
Social media channels like Facebook are not simply turning a blind eye to misinformation, but taking down every piece of misinformation is a tall order given the amount of users who post multiple times daily. In March, the Center for Countering Digital Hate said anti-vaccine activists on Facebook, YouTube, Instagram and Twitter had reached more than 59 million followers.
Facebook says it has removed more than 18 million pieces of COVID-19 misinformation and removed accounts that repeatedly break the rules. But this could merely be the tip of the iceberg. The tech giant points out that it created a well-used vaccine finder tool, and has introduced a health misinformation button in its reporting tool. But anyone who has tried to report health misinformation will know that the tech giant does not always consider posts to go against their standards. While companies are trying to stem the flow, it is clear that more must be done, but how?
“While information has helped people stay safe throughout the pandemic, it has at times led to confusion,” says the Advisory. “For example, scientific knowledge about COVID-19 has evolved rapidly over the past year, sometimes leading to changes in public health recommendations. Updating assessments and recommendations based on new evidence is an essential part of the scientific process, and further changes are to be expected as we continue learning more about COVID-19. But without sufficient communication that provides clarity and context, many people have had trouble figuring out what to believe, which sources to trust, and how to keep up with changing knowledge and guidance.
“Amid all this information, many people have also been exposed to health misinformation: information that is false, inaccurate, or misleading according to the best available evidence at the time. Misinformation has caused confusion and led people to decline COVID-19 vaccines, reject public health measures such as masking and physical distancing, and use unproven treatments.
“Misinformation has also led to harassment of and violence against public health workers, health professionals, airline staff, and other frontline workers tasked with communicating evolving public health measures.”
Health information is not restricted to COVID-19. The Advisory explains how misinformation around vaccination led to serious measles outbreaks in the U.S. and that “AIDS denialism” in South Africa contributed to more than 330,000 deaths. Health misinformation also creates unwillingness to seek life-saving treatments for conditions such as cancer and heart disease.
But our rapidly changing information environment, coupled with lockdowns, has made it easier for misinformation to spread at unprecedented speed and scale online.
Scientific research and fact is often presented in a somewhat dry manner that may not grab people’s attention as they scroll through post after post after post on their news feeds. Misinformation however is often framed in a sensational and emotional manner that can connect viscerally, distort memory, align with cognitive biases, and heighten psychological responses such as anxiety. “People can feel a sense of urgency to react to and share emotionally charged misinformation with others, enabling it to spread quickly,” the Advisory explains and cites a study which found that false news stories were 70 percent more likely to be shared on social media than true stories. Also, “algorithms that determine what users see online often prioritize content based on its popularity or similarity to previously seen content”, the Advisory continues. “As a result, a user exposed to misinformation once could see more and more of it over time, further reinforcing one’s misunderstanding.”
Health professionals and experts could better use technology and media platforms to share accurate health information with the public. For example, professional associations can equip their members to serve as subject matter experts for journalists who are better skilled to effectively communicate peer-reviewed research and expert opinions to the online masses. There is some mistrust between professionals in healthcare and mainstream media. This often leads important research and factual content to be published in health-specific journals which are read almost solely by those who are unlikely to be victims of misinformation. Media organizations must also take a step away from sharing sensational “click-bait” and find some middle ground to present the scientific research in a way that has much broader appeal. People want to be informed, nobody seeks to be shocked or provoked.
During the COVID-19 pandemic, there have been significant efforts to address health misinformation. The Advisory notes a few examples:
- Trusted community members, such as health professionals, faith leaders, and educators, have spoken directly to their communities to address COVID-19-related questions (e.g., in town halls, community meetings, via social and traditional media).
- Researchers have identified leading sources of COVID-19 misinformation, including misinformation “super-spreaders”.
- Media organizations have devoted more resources to identify and debunk misinformation about COVID-19.
- Some technology platforms have improved efforts to monitor and address misinformation by reducing the distribution of false or misleading posts and directing users to health information from credible sources.
- Governments have increased their efforts to disseminate clear public health information in partnership with trusted messengers.
But the Surgeon General says more work is needed and everyone can play their part. “Before posting or sharing an item on social media, for example, we can take a moment to verify whether the information is accurate and whether the original source is trustworthy. If we’re not sure, we can choose not to share. When talking to friends and family who have misperceptions, we can ask questions to understand their concerns, listen with empathy, and offer guidance on finding sources of accurate information.”
It will take more than individual efforts however and often by the time someone is believing misinformation, it is too late for us to do anything meaningful about it. The Advisory asks what kinds of measures should technology platforms, media entities, and other groups adopt to address misinformation. And what role is appropriate for the government to play? How can local communities ensure that information being exchanged—online and offline—is reliable and trustworthy?
The Advisory lists several recommended actions to fight health misinformation:
- Equip Americans with the tools to identify misinformation, make informed choices about what information they share, and address health misinformation in their communities, in partnership with trusted local leaders.
- Expand research that deepens our understanding of health misinformation, including how it spreads and evolves; how and why it impacts people; who is most susceptible; and which strategies are most effective in addressing it.
- Implement product design and policy changes on technology platforms to slow the spread of misinformation.
- Invest in longer-term efforts to build resilience against health misinformation, such as media, science, digital, data, and health literacy programs and training for health practitioners, journalists, librarians, and others.
- Convene federal, state, local, territorial, tribal, private, nonprofit, and research partners to explore the impact of health misinformation, identify best practices to prevent and address it, issue recommendations, and find common ground on difficult questions, including appropriate legal and regulatory measures that address health misinformation while protecting user privacy and freedom of expression.
The Advisory lists a number of actions that tech companies could take to help stop the spread of misinformation. For example, make meaningful long-term investments to address misinformation, including product changes; redesign recommendation algorithms to avoid amplifying misinformation; build in “frictions”— such as suggestions and warnings—to reduce the sharing of misinformation; and make it easier for users to report misinformation. Tech companies should also amplify messages from trusted sources and protect those experts from online abuse.
Along with several suggestions for government, the Advisory recommends expanding efforts to build long-term resilience to misinformation. For example, promoting educational programs that help people distinguish evidence-based information from opinion and personal stories.
Health misinformation will remain a threat to public health after this current pandemic. It is hoped however that COVID-19 will teach us to be better prepared and alert to misinformation, and that the information environment will become better at separating fact from fiction.