Tina D Purnat

Public health

Health misinformation

Infodemic management

Digital and health policy

Health information and informatics

Tina D Purnat
Tina D Purnat
Tina D Purnat
Tina D Purnat
Tina D Purnat
Tina D Purnat
Tina D Purnat

Public health

Health misinformation

Infodemic management

Digital and health policy

Health information and informatics

Blog Post

Fireproofing against the infodemic for epidemic prevention & preparedness

I gave a speech recently segueing into brainstorming what different actions we could be taking for prevention, preparedness and response to infodemics.

Here’s the talk. Thx to Terri Senft and Elisabeth Wilhelm for their comments.

Infodemic shocks to the systems

Today I want to give a brief sketch of how the WHO infodemic management team began, how infodemic management has evolved over the past two years, and how we see our work going forward.

The other day, a friend shared an illustration that struck me: it featured a phone on fire with “fake news.” Around the phone, there was a community running around trying to manage the fire. Certainly, everyone at WHO has been firefighting for the past two years, and the fight has gone well beyond fake news. This is not the first global pandemic the world has faced. It’s certainly not the first time that people had disproportionate access to clear, accurate, and timely health information. If this isn’t the first fire we’ve faced, what makes it so hard to manage?

The answer comes down to two words: scope and pace. When we started thinking about the infodemic at the WHO, we originally thought in terms of disinformation and misinformation. This isn’t unlike the cartoon image I talked about earlier featuring the phone on fire with fake news. It didn’t take long, though, for us to see that understanding was short-sighted. Yes, dis and misinformation were a part of the infodemic, but soon enough, we realized that scope was too narrow: people were also struggling just as much with once accurate but now outdated information, with information overload, and even with fundamental confusion. Yes, digital platforms were its original breeding ground, but the incredibly fast pace of this infodemic comes from how it spreads from online exchanges to offline interactions, and back again, often through photos and videos.

When the fire that is this infodemic arrived at our doorstep, I think it is safe to say that nobody at WHO was truly prepared. To be fair, we did have some warning: global health security especially urged us to think about preparedness and prevention, and some of us even set up the sprinklers (otherwise known as monitoring systems.) For a range of reasons, those sprinklers didn’t adequately switch on when there was smoke, and now we are fighting fire.

We know that it’s more expensive to pick up the pieces after an emergency than it is to prevent it. One reason for this is that emergencies tend to shock systems. Infodemic shocks we’ve endured to date include new worrying scientific information, new programmatic guidance, and new disease dynamics (like the emergence of a new variant of a virus.) We have seen direct evidence of harm (like violence against health care workers or detection of a cluster of adverse events to a medication or vaccine.) We’ve also witnessed downstream harms caused by unregulated, confusing, and ever-changing and public health guidance that includes almost no infodemic management response.

Preparing to respond to infodemics

It’s been a difficult year for infodemic management, but I would like to play optimist for the moment. Let’s say that in 2022, we somehow manage to put out the bulk of fires on the infodemic front. What then? To stick with our metaphor, a prudent course of action would be to move to the fire marshalling phase. To be a fire marshal, a person needs a mindset that goes beyond emergency response and towards vigilance promotion. What would infodemic vigilance look like? In epidemic management we have IHR, but we have no equivalent for infodemic management. This needs to change.

Over the past year, what we have come to understand is that despite having ‘info’ in its name, managing the quality or amount of information people receive is only one part of infodemic management. People receive all sorts of information—accurate, inaccurate, applicable, not applicable–each minute. Some of it they respond to immediately, some of it they argue with, some they avoid, some they ignore as not of value to them. Behavioral psychologists argue that that when it comes to getting people to take action, the pathway runs from information to emotion to action. That space—from emotion to action—is where we want to be focusing next. To anticipate the next wave of rumors, stigmas and conspiracy theories that ‘stick’ in particular communities, we may want to work backwards. We start with adverse behaviors (for instance vaccine hesitancy, or masking resistance) and consider the negative sentiments that might lead certain communities to consider those behaviors. From there, we can postulate what sorts of information-oriented issues might come up. We could do this through sophisticated modeling, by scenario exercises, or by plain old community conversations.

To bring this home for a moment, let’s think about something like New Year’s resolutions. How many of you have stuck to your January 2021 resolution to eat healthier this year? How many of you are planning on doubling down in January 2022 and wanting to do things differently next year? We call this the intent-to-action gap, and as we all know, the struggle is real. When we think of our eating this year, how many of us can think of work, family or personal emergencies that compromised our commitment to making healthy eating choices? I thought so.

Let’s move from the personal to the political. In a sense, the emergency conditions of Covid-19 have created a perfect storm for an infodemic to flourish. Some people have gotten sick with covid-19 because they didn’t think was that serious, or they ingested treatments like ivermectin or methanol. Other people didn’t know how to protect themselves from covid because they either didn’t receive information or they thought the information was confusing and ever-changing.

Think about your Whats app and how many messages you’ve gotten in the last year. How many of messages were related to covid and how many were from family and friends. How many messages increase your blood pressure and how many made you worry about family members who are making risky decisions about their health? How many people did you try convince otherwise with public health arguments and science?  How often did you change someone’s mind? If it’s hard for you and you work at WHO, imagine what it’s like for someone who doesn’t work for WHO.

The bottom line is that the infodemic is global, but the impacts are intensely personal.

Towards prevention of infodemics

We’ve all been managing our personal infodemics and WHO has also taken up the global role in managing infodemics and developing strategies on how to mitigate its harms through tools, partnerships, country support, policies , research and innovation.

We probably wish we could go back into a time machine and maybe change preparedness and resilience and how our health systems worked before COVID-19 arrived. But the COVID-19 infodemic has offered unprecedented challenges that were never anticipated before. Now is the time to continue innovating while we respond to this public health emergency but to also look into the future to solidify preparedness and prevention activities. That way the next time the next emergency hits, we will have fewer WhatsApp messages that will raise our blood pressure and make us worry about family and friends. Next time, the infodemic should meet more resilient individual’s and communities – that are less likely to act on health misinformation.

The way we propose to get there is through the following.

First, we need to be competent firefighters. This requires getting better at producing quick, accurate, attractive, attention-grabbing and highly engaging information that is at least as convincing as what is being produced by peddlers of disinformation. At the moment, we are trying to use a garden hose in an age where the private sector has access to high pressure not a firehose. Not only are the most virulent false claims, rumors and conspiracy theories more attention-grabbing than the messages we produce, they also spread more quickly than health authorities can track.

Second, while we firefight in some areas, we need to fire-marshal everywhere else. What’s clear is that basic infodemic safety precautions are not in place. We do need to invest more into systems and structural changes. At the moment, none of the systems that might detect infodemic signals are integrated or aligned to allow for integrated analysis of varied data sources.

And third: A city can have the best firefighters and the most vigilant marshals, but if every building is made entirely of paper, it will eventually burn down. In the same way, the first community to become vulnerable to infodemic spread is the one where questions, concerns and needs go unaddressed. Some of these questions, concerns and needs might be clearly health-related, and some might seem to be about ancillary issues. All of it needs to be understood. We call this fire-proofing.

The infodemics and information overload are here to stay whether we are in an emergency or not, and we need to build tools, procedures and networks that will allow us to coexist with it. Did you know that the weather channels in California now predicts chances of fire in California as part of their forecast? Ideally in infodemic management we should reach the same point when we can calculate the risk of infodemic outbreaks.

Please join us in thinking about what these three buckets of work—fighting, marshalling, and fire-proofing– may look like. 

Source of image: The machine runs amok: Twisted facts, fake news and social media spoofs can turn society upside down. One UW team is working to help us through the infodemic.

I wrote this LinkedIn blog I wrote at the end of 2020, after a year of working to address the COVID-19 infodemic. Follow me on LinkedIn.