LaRose E, Shroff A, Huang J, Gyenes N. Mobilizing public health professionals to support journalists and fact-checkers during the Covid-19 pandemic. HPHR. 2021; 33.
The emergence of the COVID-19 pandemic has resulted in an infodemic– a flood of epidemic-related information- that encompasses a plethora of misinformation that has arisen from rapidly evolving science, uncertainty, information gaps, and special interests. The misinfodemic– epidemic of misinformation, midinformation, and disinformation- has largely kept pace with the pandemic and continues to proliferate across online media and communication channels. The potential risks and dangers of misinformation are well documented in the literature and include adverse health effects like increased disease spread, hospitalization, and death; stigmatization of individuals and groups; increased health inequities; and distrust in government and public health guidance. The goal of the COVID-19 Expert Database was to employ the skills of public health professionals to provide an added layer of expertise for journalists, fact-checking organizations, and media outlets to improve health-reporting capacity, provide accessible COVID-19-related content, and distill complex scientific findings to support local and contextually-relevant communications. Launched in June 2020, the project was designed as an applied research initiative aimed at strengthening the quality of COVID-19-related health information and decreasing circulating misinformation to advance health equity.
In February 2020, the World Health Organization (WHO) proclaimed that the world is fighting an infodemic alongside the COVID-19 pandemic (Eysenbach, 2020; Tangcharoensathien et al., 2020). An infodemic is the “overabundance of information – some accurate and some not – that occurs during an epidemic” (World Health Organization (WHO), 2020b, 2020c). If an infodemic is not proactively managed, the volume of information and variable information quality can result in widespread public confusion, foster mistrust in government, and impede the public health response.
In addition, a secondary challenge presents itself: the emergence and spread of misinformation. Similar to the need for interventions to curb virus transmission, efforts are required to curb viral misinformation and its spread (Gyenes & Mina, 2018). In an age of digital technology, the spread of misinformation has kept pace with the pandemic. Myths, stigma, conspiracy theories, and misunderstandings about COVID-19 transmission, treatment, and interventions have had severe health implications. For example, misinformation, like recommending consumption of highly concentrated alcohol or disinfectant to kill the virus, has claimed hundreds of lives worldwide and resulted in thousands of hospitalizations (Islam et al., 2020). Misinformation-induced stigma and fear of being discriminated against have prevented people from seeking healthcare, further compromising their health. Combatting misinformation is vital to protect the public’s health as well as to address health inequities (Islam et al., 2020; Morley et al., 2020).
For decades, societies have relied on media communications in newspapers, magazines, radio broadcasts, and television. Journalists and other content producers have sought to understand their audiences and deliver meaningful content, and communities have trusted media outlets to provide engaging, relevant, timely, and accurate information. More recently, the public has increasingly relied upon the internet, social media, and messaging platforms to gather information about anything and everything, including products, services, health, travel, and politics.
Not all of the information portrayed across media channels is factually correct, and false information can have dire effects on health (Islam et al., 2020; Larson, 2018; Morley et al., 2020). Inaccurate information is often broadly categorized into misinformation (false information spread unintentionally) and disinformation (false information spread deliberately). However, during a time of limited and evolving knowledge, informational ambiguity can result in midinformation. Midinformation occurs when all the facts are not known and there is conflicting evidence, a scenario that is ideal for spreading rumors and conspiracy theories founded in incomplete information (Mina, 2020). Midinformation also results when questions or queries remain unanswered or when responses convey uncertainty; they create “data voids” or “data deficits” that are ideal for misinterpretation by the public or exploitation by media manipulators to further political, ideological, or other agendas (Golebiewski & Boyd, 2019; Gyenes & Mina, 2018; Mina, 2020; Smith et al., 2020). Together, this collective of misinformation, disinformation, and midinformation results in a misinfodemic that adversely impacts communities and the public health practice in general.
The COVID-19 pandemic is the largest pandemic to occur in the age of social media, and research has shown that more misinformation is circulated through social media platforms than news media outlets. Additionally, there is an established link between exposure to misinformation and disinformation about COVID-19 on social media and lower compliance to public health guidelines like social distancing and risk perceptions about the disease (Bridgman et al., 2020; Hameleers et al., 2020).
To this end, the WHO organized a technical consultation in April 2020 to develop a framework for managing the COVID-19 infodemic. The consultation was attended by 1483 individuals from 111 countries and across stakeholder groups and resulted in six policy implications over five infodemic management areas. It highlighted the need to verify emerging evidence, explain the scientific processes and findings, ensure that messages are available and accessible to communities globally, and coordinate efforts via strategic cross-sectoral partnerships. The consultation also highlighted the importance of both measuring and assessing the infodemic trends and impacts. Finally, the consultation recommended that infodemic management approaches be further developed to support preparedness, response, and risk mitigation efforts using data science and socio-behavioral research tools and methods (Tangcharoensathien et al., 2020).
Similarly, the United Nations Educational, Scientific and Cultural Organization’s (UNESCO) Communication and Information Sector and other United Nations actors have also highlighted the “disempowering impact of disinformation” by raising awareness on the themes around false information and ways to identify and respond to them. They have also supported independent, high-quality journalism and media and information literacy (MIL) initiatives (Posetti & Bontcheva, 2020b, 2020a).
Scientific journalism has long reported on discoveries and facts authenticated over time through peer-review processes and professional oversight. Outside of specific population health emergencies, such as the COVID-19 pandemic, health topics had rarely dominated headlines in mainstream news. While journalists and fact-checkers undergo extensive training on ethics, politics, neutrality, and other issues, few have health- or science-specific expertise. In addition, the rapid and continuously evolving nature of pandemic-related science alongside unvetted social media communications, increased public attention and awareness, and a broad public desire for and expectation of definitive information have made health communications especially challenging. Nevertheless, these trusted, professional communicators are well-positioned to support their audiences by ensuring the delivery of accessible and appropriately contextualized health-related information relevant to readers in their daily lives.
In a crisis, the public needs to understand the current situation, how it impacts them, why they should care, and what they should do (Leonard et al., 2020). However, there is a structural weakness in the global fact-checking industry: public health information requires new methodologies and frameworks to ensure that communications are accessible, accurate, timely, and appropriately contextualized for local communities (Gyenes & Marrelli, 2019). While there is no easy solution to address misinformation, disinformation, and midinformation across platforms, collaboration among traditional news media, social media, and public health stakeholders is necessary to tackle misinformation in all its forms and assuage public fears. One possible way to curb the spread of misinformation is to employ public health professionals, scientists, and researchers trained in health-related fields to support journalists and fact-checkers. These professionals can help break down and simplify scientific information so that accessible and accurate information is relayed to public audiences (Borel et al., 2018).
Since the start of the COVID-19 pandemic, there has been a rise in public health professionals’ engagement in public-facing communications via giving interviews, posting on social media, writing news articles and blog posts, and other methods. Most reports quote public health professionals and reference outputs from the WHO, the Centers for Disease Control and Prevention (CDC), and other leading health authorities. However, there have been inconsistencies in the health information reported, and there is an ongoing need for public health professionals to focus on direct communications with clear messaging.
Additionally, there is a need for public health professionals to prevent the spread of false information that can endanger public health, with agile responsiveness to mitigate the potential harm as much as possible. Relevant models for public health professionals to address misinformation include science journalism (Borel et al., 2018; Hetland, 2016), fact-checking through professionals (Chou et al., 2020; Lim, 2018; Park et al., 2021; Seaton et al., 2020), fact-checking through volunteers (Kim & Walker, 2020), having health professionals improve health literacy (Damian & Gallo, 2020), and using nudges to encourage people to think about accuracy before sharing on social media (Pennycook et al., 2020).
When supporting the clear communication of life-saving health information and the rapid response to misinformation, public health professionals can also inform the priorities of leading communicators on the most critical topics to focus on in an age of information overload. There are risk criteria frameworks that help guide emergency communication (Centers for Disease Control and Prevention (CDC), 2019; Ellis, 2018; Global Outbreak Alert and Response Network (GOARN) et al., 2020; Krause et al., 2020; Reynolds & W. Seeger, 2005; World Health Organization (WHO), 2020a). Meedan’s Digital Health Lab (DHL) is researching risk criteria to support journalists and fact-checkers in prioritizing the response to misinformation with the most potential for harm, such as viral messages that can directly harm lives by recommending dangerous false treatments.
In response to the COVID-19 misinfodemic, the DHL convened a group of public health professionals to improve health reporting in diverse communities around the world as a way to increase equitable access to accurate health information during the global pandemic. This paper aims to present how the DHL’s COVID-19 Expert Database was designed to mobilize public health professionals to support fact-checkers and journalists in delivering high-quality, health-related content and, thus, decrease health misinformation online.
During its inaugural year, the DHL team included two Doctor of Public Health (DrPH) graduates and two DrPH candidates from the Harvard T.H. Chan School of Public Health. The DrPH training has facilitated DHL’s work by teaching and emphasizing the skills needed for research translation and health communications (Harvard Doctor of Public Health (DrPH) Program, 2019; Public Health Foundation (PHF), 2021). For example, the DHL team has been communicating findings from scientific and clinical research to audiences with limited experience interpreting these types of studies, focusing on actionable insights. Additionally, contextualization of research findings to the local, regional, national, and international levels has been needed to ensure applicability for the DHL’s audience across six continents. To contextualize content, the DHL team has used simplified language, metaphors, glossary term definitions, and visuals to convey complex health subjects in an accessible manner. Finally, as part of learning how to build trust and provide evidence-based leadership in health communications, the DHL team supported user research interviews led by a Meedan behavioral scientist and is currently undergoing a process evaluation to further refine their work and continue to expand their understanding of audience needs.
The DHL was founded in 2018 with the goal of conducting research and developing applied initiatives to address health misinformation in the media and online. In 2019, before COVID-19 was declared a global pandemic, Meedan’s DHL had actively begun exploratory discussions with fact-checking organizations (FCOs) and media outlets in preparation for a new Health Desk Project. In this formative exploration, the DHL team identified a common challenge across fact-checking processes: the need to verify health-related fact-checks with a public health expert or leading health authority before publication. Organizations reported that this verification process, while necessary to ensure accuracy, slowed workflows, caused delays in how quickly news information was deployed to the public, and limited the number of fact-checks that can be performed in a given week.
The DHL team planned to develop and launch a Health Desk Project to facilitate and support health reporting and fact-checking efforts. Unlike many traditional public health communication strategies with public-facing efforts, the initiative was designed using a newsroom model. Questions or topics would be submitted by partner FCOs, journalists, and media outlets. A team of public health professionals would research and write high-quality responses accessible for those without specific training in science or health topics, designed for fact-checkers, journalists, and other communicators to use. The project would not provide medical advice or address questions about personal or individual health.
The team initially explored focus areas ranging from nutrition to non-communicable diseases. However, with the emergence of the COVID-19 pandemic in March 2020, the team’s preparedness and positioning provided a unique opportunity to pilot the intervention to support the dissemination of scientific findings sure to be a vital aspect of the pandemic response. Between March and June 2020, the COVID-19 Expert Database was planned, the website and database were built, and a team of public health experts was assembled. The planned project activities included collecting critical pandemic-related queries directly from fact-checking organizations, media outlets, and other community information leaders; and triaging the questions to assign them to team members to provide contextually relevant responses.
The pilot was launched in June 2020 with a team of Master of Public Health (MPH) (n=4) and DrPH (n=4) professionals and students, along with a professional journalist who served as the editorial lead. COVID-19-related questions were submitted to the team from journalists, FCOs, and media outlets, and additional questions were developed by the team based on new publications, guidance, and emerging science. The team discussed queries during the three weekly editorial sprints, and responses were written and provided to the requestor within 48 hours. In addition to the sprint workflows, questions relevant to breaking stories were prioritized and addressed to meet tight editorial deadlines, sometimes within only four to eight hours.
All queries and responses were recorded into a team database along with key references; glossary terms and definitions; details about the question source; information about whether or not the response varied based on gender, race, ethnicity; and information on the query country of origin. Once finalized, each entry underwent an editorial review to ensure clarity and a scientific review to ensure accuracy. Database entries were continually updated as a curated resource, and the COVID-19 Expert Database was accessible via the project website.
Between June 2020 and January 2021, more than 200 database entries were completed in response to questions sourced from more than 25 external organizations from 15 different countries worldwide, including India, Senegal, the Philippines, Nigeria, and the U.S. Between June and December 2020, the team responded to an average of 8.2 queries per week (up to 19 new queries per week) and updated an average of 4.5 updates per week (up to 30 updates per week). With this resource, partner organizations have been able to perform fact checks more rapidly, have increased the amount of content available to audiences, and have maintained trust established within their local communities by providing regular news content. An impact audit performed in the fall of 2020 found that 81% of the responses provided to partner organizations made it to the front page of Google search results for that topic in the region covered.
Health-related misinformation, midinformation, and disinformation preceded the internet age and will continue to be part of the global landscape, even once the COVID-19 pandemic has ended. Public health leaders have only begun to understand the extent to which misinformation presents a public health threat, especially for vulnerable individuals with limited health literacy.
In this initiative, public health professionals were successfully employed to provide an added layer of expertise to improve the health-reporting capacity of journalists, FCOs, and community-based communication leaders by distilling complex health pandemic-related topics for diverse audiences. Since the project was officially launched in June 2020, several key learnings have been identified. First, there is a clear need for public health experts to support journalists and fact-checkers in communicating science and health topics for broad audiences since many journalists and fact-checkers are not trained in science- and health-specific communications. Second, it is difficult to maintain a database keeping pace with the most current science in the context of a pandemic. Throughout the pandemic, rapid learning and live science have supported public health guidance, and recommendations about mask-wearing, social-distancing, and palliative therapies have changed often- sometimes over just a few days. Ensuring that each database entry reflected the most current guidance was impossible with a small team, and prioritization of updates proved critical. Finally, communicating very complex topics in a concise and accessible manner is challenging and time-consuming, especially when supports like definitions and contextualization are needed to ensure relevance. These and other learnings will be further explored, and the project will be redefined as the DHL Health Desk Project in the coming year.
While journalists and fact-checkers are well-equipped to report on facts provided by health authorities, facts alone are often insufficient to change behaviors deeply embedded in fears and beliefs. Additionally, navigating complex fact-checks using rapidly changing science is difficult, and misunderstanding, uncertainty, and data voids are known contributors to the spread of midinformation and misinformation. As discussed in prior papers, the “infosphere” or “information ecosystems” can influence health-related decision-making and health outcomes. Health information, including its availability, quality, and accessibility, should be considered as a social determinant of health and a contributor to health equity (Morley et al., 2020; Rice & Sara, 2019). Though traditional public health communications have focused on how leaders directly communicate with the public, the importance of strengthening health information online and via available and emerging media channels cannot be overstated. In this infodemic, ensuring availability and accessibility to high-quality health information is paramount.
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This paper and the work behind it would not be possible without the Meedan Digital Health Lab leadership team, including founding Director Nat Gyenes, News Lead Megan Marrelli, Public Health Research Lead Christin Gilmer, along with Ed Bice and An Xiao Mina from Meedan’s leadership team. We also thank Megan Marrelli, Christin Gilmer, An Xiao Mina, and Kelsey Price for contributing feedback on this manuscript.
Emily LaRose is a dietitian and nutrition and global health consultant who currently works as a Health Desk Process Consultant and Digital Health Lab Fellow at Meedan and Nutritionist Consultant to Operation Smile. In her work, she has written specialty reports on global human milk banking practices, health misinformation, and innovative food system programs; developed tools and protocols for clinical nutrition care delivery in humanitarian hospitals; taught university-level clinical nutrition courses; and provided nutritional care for critically ill hospitalized patients. Emily is a Doctor of Public Health Candidate at the Harvard T.H. Chan School of Public Health and is currently working on her thesis project exploring how public health professionals can support journalists and fact-checkers to prevent the spread of health misinformation.
Anshu Shroff received her Doctor of Public Health (DrPH) degree from Harvard University, with concentration in Humanitarian Studies, Ethics, and Human Rights and the Child Protection Certificate program. Anshu’s research areas include disaster management and risk mitigation using inter-sectoral, systems dynamics approaches); climate risk resilience; crisis leadership; and using indigenous knowledge to build community resilience for disasters. Anshu has worked at the United Nations Secretariat, UNDP, UNICEF, Gates Foundation, and the Institute of Healthcare Improvement.
Jessica Huang is a health education researcher who completed her Doctorate of Public Health at Harvard University and her Master’s in Education at Stanford University. She has been working on COVID-19 response and recovery initiatives with a number of organizations, ranging from a city mayor’s office to nonprofit organizations. Previously, she worked on global health and sustainable development initiatives with D-Lab at the Massachusetts Institute of Technology.
Nat Gyenes is researcher and writer focusing on the intersection of health and technology. She explores the way that the health information we encounter online impacts disease distribution, and the role that epidemics, and digital misinfodemics, have in changing cultures, traditions and societies.