Fake News: Old Enemy, New Challenges.

Misinformation can be one of the biggest obstacles to good global health management, both in emergency situations and in general health promotion. While we all like to think that scientific advancement and consensus is enough to convince people that is sadly not the case. The difficulty with misinformation is that it can interfere in efforts during a crisis, it can cause panic, and it can even reverse progress that had already been made. This is growing issue as the world becomes increasingly connected and sources become harder to verify.

Even when the world was committed to fighting the Ebola outbreak in 2014 misinformation still risked throwing everything off. Firstly, the rapid isolation of patients and disposal of bodies alienated and stoked mistrust within local populations. While sensible strategies for managing the infection’s spread they led to a rise in rumours around kidnapping, medical experimentation, and body snatching (amongst others)[1]. This led to mistrust in health professionals, delays in presentation, and the hiding of (infectious) bodies of the deceased. At the same time, the initial four cases of Ebola in the United States brought a slate of rumour mongering and misinformation[2], spreading through social media like wildfire. This changed the political landscape of the discussion and may have led to a more isolationist policy strategy.

Currently, during the Indonesian crisis a series of fake news articles was spread, again through social media, about the risk of an impending second earthquake with plausible sounding “experts” thrown in[3]. This caused panic in the already stricken population prompting government intervention – using time and resources better suited to rescue efforts and stabilisation. Alongside this, as is a surprisingly common trend in any natural disasters, fake “missing persons” posts have been making waves[4]. These spring out of any well-publicized event and use stock or stolen photographs of people who have supposedly gone missing. Sometimes the aim of this is to trick people out of donations but other times the motive is unclear. In either case, this distraction from people who are really missing muddies the waters and slows interventions down.

Already established public health interventions aren’t immune to the dangers posed by misinformation, particularly now in the information age. While anti-vaccination sentiment isn’t new (it was already brewing in Victorian England[5]), it has been given new life by mass communication and social media. It has become easier to add voices to a movement, granting it unnecessary weight in numbers, but also potentially drowning out any evidence. This has real world effects with increasing rates of measles cases (and deaths) being linked to the rising “anti-vax” movement.

In modern days all of these forms of misinformation are linked in a few specific ways. Firstly, there is a diverse variety of motives behind the spreading of misinformation. Some people are “true believers” who fundamentally believe what they are sharing despite any evidence to the contrary. Some people have been unable or unwilling to fact verify and instead rely on what they’ve read as the truth (ignoring or not knowing the age old adage – never trust what you see on the internet). Finally, some people do it as an act of internet trolling (in fact, some rumours were started initially as an internet prank but have taken on a life of their own).

Tackling all of these things is difficult. These easiest group to target is the group of people who spread misinformation because they are misinformed. In this case, a fast and effective communication strategy adopted at the onset of any crisis cross-cutting multiple forms of media. This involves harnessing the power not just of social media but whichever media is most relevant to the important populations (be it mobile networks, radio networks, or others). Messages should be short and to the point, providing easily understood (but also easily verifiable) information. Ideally, this should be delivered by people who are trusted (if you are unsure about the power of a spokesperson I recommend looking at the power celebrities have brought (positively) to cancer research funding and (negatively) to the anti-vax movement).

In targeting the other two groups there is no easy answer. Ultimately the best way to counter misinformation is to give the people the tools to fact check and verify. If we improve the health literacy of populations globally while also empowering them to identify (and dismiss) false information we can reduce the impact misinformation can have. Until then it will pose a challenge to any global health intervention.

Fake news – certainly. But real damage.

[1] https://af.reuters.com/article/commoditiesNews/idAFL8N1W55H7

[2] Merino José G. Response to Ebola in the US: misinformation, fear, and new opportunities; BMJ 2014; 349:g6712

[3] https://www.theguardian.com/world/2018/oct/04/sulawesi-tsunami-indonesia-battles-fake-news-as-hoaxers-spread-panic

[4] https://www.independent.co.uk/news/uk/home-news/manchester-attack-explosion-arena-missing-people-fake-images-social-media-share-facebook-twitter-a7750756.html

[5] Wolfe RM, Sharp LK Anti-vaccinationists past and present. BMJ. 2002;325:430–2 10.1136/bmj.325.7361.430

Author Details: Dr. Eliot Hurn, Foundation Year 2 County Durham and Darlington Foundation Trust.

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