Cox R, Conley W. Why social media giants’ attempts to cure the infodemic may be yet another detriment to black americans in the fight against COVID-19. Harvard Public Health Review. 2021; 30.
It is well documented that COVID-19 is disproportionately affecting the black community. Black Americans are hospitalized with COVID-19 at a much higher rate than white Americans (Alonso-zaldivar, 2020). As of February 2021, African Americans are nearly twice as likely to die from COVID-19 as whites, according to the Centers for Disease Control. Historically, this at-risk population has been plagued by an institutional foundation of mistrust with the American healthcare establishment at large. The way in which social media companies have chosen to label misinformation could not only be contributing to skepticism within this group but also perpetuating health disparities within the black community. It is vital that black Americans receive accurate evidence-based medical data but equally critical that they trust the source of that information.
Social media giants Facebook, Twitter, and YouTube have all recognized the capacity for misleading/harmful information to be spread on their forums in relation to the COVID-19 virus. Moreover, recent studies have shown that there are no significant differences between the spreading patterns of information considered questionable compared with that deemed reliable (Puri et al., 2020). All platforms claim to demote problematic content, while elevating information from authoritative sources on their sites. Facebook has been a leader in this regard stating it would put “…special emphasis on stemming misinformation related to the COVID-19 pandemic, including giving out $1 million in grants to partnering with fact-checkers…” (Cohen, 2020). However, without transparent and coherent fact-checking guidelines from these conglomerates, all appear to have inadequacies with their pandemic responsive plans; and these shortcomings could inadvertently and detrimentally impact black Americans.
The basis for black Americans’ mistrust of the health system in this country is a complicated lineage that has repeated itself too many times to be fully documented here, but far too often be ignored. Incidents of medical professionals misusing black Americans are a permanent stain on our national history; and though this history dates back centuries, is it is not ancient history by any means. During the better part of the 20th century, sterilization abuses against women of color were commonplace. Though they occurred throughout the country, it was so prevalent in the south that the term “Mississippi appendectomy” was coined to denote the routine practice of sterilizing African-American women who were admitted to the hospital for other operations (Suite et al., 2007). The four decades long Tuskegee Experiment, whereby hundreds of African American men were unknowingly subjected to untreated syphilis, ran unfettered until 1972. Even after treatment was discovered, researchers provided no effective care so that the full progression of the disease could be studied. In the 1950s, doctors at John Hopkins Hospital utilized cervical cancer cells from Henrietta Lacks, a black mother of five. Research and medical advancements from those cells continue globally to this day, though Lacks died in 1951 never consenting to or being compensated for this usage (Morrison & Reeves, 2020).
It is important to note that these actions were not carried out by rogue doctors behind closed doors. Rather, the sterilizations had the stamp of state governments and the US Supreme Court alike; and the Syphilis Study was carried out by the Centers for Disease Control and US Public Health Services. This is significant historical context because the foundation for black people’s wariness when it comes to American medical practices is rooted in systematic injustices perpetrated by local and national entities. Research has shown that modern-day medical mistrust is not solely related to the vestiges of past mistreatment, but has also grown from current experiences of discrimination in the healthcare system (Hostetter & Klein, 2021). Trust is a foundational element in the doctor/patient relationship. Inequities in access to health insurance, health care facilities, and treatments make it more difficult for black people to obtain care and develop these relationships (Hostetter & Klein, 2021). Simply put, many do not have confidence that the government or American organized medical institutions have black persons’ best health interests in mind.
Currently, it is this very type of organizational medical group that is referenced when users click on links to COVID-19 information on social media platforms. When Facebook fact-checkers deem an article to contain inaccurate information, a visual label will appear that the article has been debunked and the reader will be given additional fact-checking articles for context (Facebook, 2020). If an article has been removed, a message will appear advising the user to “Help Friends and Family Members Avoid False Information About COVID-19” (Brodwin, 2020). It encourages the reader to share a link to the World Health Organization’s (WHO) list of common rumors about the virus. On YouTube, fact-checkers attach content denoted as misleading to another authoritative source link such as the Centers for Disease Control or WHO (Bhaskar Chakravorti, 2021). The primary social media companies have also offered free ads to appropriate public health organizations causing users to be inundated with a surplus of messages from organized healthcare institutions.
While this appears a reasonable course of action for companies to take, it may in fact be having the adverse effect on black Americans. The “infodemic” era has most Americans struggling just to process the overload of pandemic news. In fact, Twitter has reported that there is a COVID-19 related tweet every 45 milliseconds and the hashtag #coronavirus was the 2nd most used in all of 2020. (Puri et al., 2020) A recent study shows that in the United States, “members of racial and ethnic minority groups are those most likely to contribute to COVID-19 content on social media” (Campos-Castillo & Laestadius, 2020). An interesting discovery in this research was that older adults and men, groups traditionally less likely to use social media, were some of the largest contributors within these minority groups. (Campos-Castillo & Laestadius, 2020). With copious amounts of false data in circulation, it is imperative that these high-risk members be able to easily navigate to science-based sources to protect themselves and their families.
However, those who grew up in homes permeated with a generational distrust of organized medicine may not feel comforted to see every piece of COVID related information fact-checked using these institutions as the resource. This constant labeling and redirection create a double-edged sword that could cause some to question the validity of the material, or even worse, ignore it entirely. This is notably evidenced in the differences between black and white Americans being vaccinated in the first rollout of the COVID-19 vaccines. While not every state is reporting information by race, for those that are, the numbers are clear. Black Americans are getting vaccinated at significantly lower rates than white Americans (Recht, 2021). Some of this disproportion can be attributed to access, but some is a lingering deep-rooted fear of the system.
There are no straightforward answers to preventing the dissemination of misinformation on social media venues. Facebook currently removes misinformation that could lead to imminent physical harm (i.e.: instructions to drink bleach to cure the virus, etc.), but leaves other erroneous articles tagged with debunking data from mainstream medical associations (Brodwin, 2020). Certainly, social media giants must balance the responsibilities of ensuring accuracy while still protecting freedom of speech. But are these labeling measures enough considering they could be triggering for a particularly vulnerable population? Some forums have advocated for targeted fact-checking that utilizes the open peer-review process used by medical journals. Social media content could simply be tagged with a ‘Reviewed Content’ status following a formal peer-review process (Trethewey, 2019). This might be less provoking than the current labeling with major medical organization redirects. Nonetheless, would it not be safer from a medical standpoint to insist that these companies simply remove invalid information, leaving users with legitimate articles free of additional labels and tags? Perhaps as a country, it is time to take a harder look at this from a legislative approach. Enacting stronger censorship laws in times of national crises, such as a pandemic, could mandate that social media platforms do just this.
At no point in history have we had such instantaneous access to online medical information, or medical misinformation for that matter. Likewise, at no point in history has that surfeit of data threatened to cause such harm. As pandemic social distancing has become the norm, so has social media become an essential source of both communication and news. With millions utilizing these platforms, network owners are feeling the burden more than ever to ensure the accuracy of their content. Fact-checkers have been advantageous in this endeavor, though there is an urgent need for more research to identify the most effective means of fact-checking health claims on social media. Beyond effective fact-checking, social media giants must address that there is still a disconnect in the way COVID-19 information is being labeled and presented, and for black Americans, this disconnect could be deadly.
Alonso-zaldivar, R. (2020, June 23). Medicare data: Blacks likelier to be hospitalized for COVID. AP NEWS. https://apnews.com/article/6ca95304c48f72c3ae96f9844435d37a.
Brodwin, E. (2020, April 30). Experts question Facebook’s approach to combat Covid-19 misinformation. STAT NEWS. https://www.statnews.com/2020/05/01/facebooks-covid-19-misinformation-campaign-is-based-on-research-the-authors-worry-facebook-missed-the-message/.
Bhaskar Chakravorti Dean of Global Business. (2021, April 21). Social media companies are taking steps to tamp down coronavirus misinformation – but they can do more. The Conversation. https://theconversation.com/social-media-companies-are-taking-steps-to-tamp-down-coronavirus-misinformation-but-they-can-do-more-133335.
Campos-Castillo, C., & Laestadius, L. I. (2020). Racial and Ethnic Digital Divides in Posting COVID-19 Content on Social Media Among US Adults: Secondary Survey Analysis. Journal of Medical Internet Research, 22(7). https://doi.org/10.2196/20472
Cohen, D. (2020, April 16). Facebook begins warning users who interacted with misinformation about Covid-19. https://www.adweek.com/performance-marketing/facebook-begins-warning-users-who-interacted-with-misinformation-about-covid-19/.
Hannah Recht, L. W. (2021, January 19). Black Americans Are Getting Vaccinated at Lower Rates Than White Americans. Kaiser Health News. https://khn.org/news/article/black-americans-are-getting-vaccinated-at-lower-rates-than-white-americans/.
Hostetter, M., & Klein, S. (2021, January 14). Understanding and Ameliorating Medical Mistrust Among Black Americans. Commonwealth Fund. https://www.commonwealthfund.org/publications/newsletter-article/2021/jan/medical-mistrust-among-black-americans.
Facebook Inc. (2020, August). How Facebook’s Fact-Checking Program Works. Facebook – Journalism Project. https://www.facebook.com/journalismproject/programs/third-party-fact-checking/how-it-works.
Morrison, A., & Reeves, J. (2020, April 5). Amid coronavirus pandemic, black mistrust of medicine looms. PBS. https://www.pbs.org/newshour/nation/amid-coronavirus-pandemic-black-mistrust-of-medicine-looms.
Puri, N., Coomes, E. A., Haghbayan, H., & Gunaratne, K. (2020). Social media and vaccine hesitancy: new updates for the era of COVID-19 and globalized infectious diseases. Human Vaccines & Immunotherapeutics, 16(11), 2586–2593. https://doi.org/10.1080/21645515.2020.1780846
Suite, D. H., La Bril, R., Primm, A., & Harrison-Ross, P. (2007). Beyond misdiagnosis, misunderstanding and mistrust: relevance of the historical perspective in the medical and mental health treatment of people of color. Journal of the National Medical Association, 99(8), 879–885.
Trethewey, S. P. (2019). Strategies to combat medical misinformation on social media. Postgraduate Medical Journal, 96(1131), 4–6. https://doi.org/10.1136/postgradmedj-2019-137201
Ronald E. Cox is a doctor of medicine candidate at the Medical College of Wisconsin. He is passionate about the field of medicine and exploring opportunities to maximize community public health.
William Conley is from Milwaukee, Wisconsin, and is a third-year medical student in otolaryngology at the Medical College of Wisconsin. He is passionate about public health, medical education, and promoting diversity in medicine.