Misinformation and Disinformation: An Increasingly Apparent Threat to Global Health Security

By Marc Trotochaud and Matthew Watson

In the broadest possible conception, communication is a system that allows humans to share information with one another. Words and images can shape how we perceive information, a factor that plays a large role in our decision-making processes. Messages can incite emotion, provoke dialogue, and, albeit rarely, shift one’s self-perception or understanding of their relationship with those around them. At our core, humans are social beings, and communication is the natural product of that reality.

In public health, researchers have spent decades studying the best way to use communication to prompt protective health behaviors. Vast numbers of academic studies continuously add to the pool of professional knowledge, and it is the prerogative of health communicators to efficiently relay new information to populations of interest. In health security, communication is a major factor in how we plan for and respond to threats that can impact large populations.

Over the past fifteen years, some aspects of the practice of communication have changed dramatically. The rapid accessibility of mobile devices and the rise of social media platforms (Facebook, Twitter, Instagram, SnapChat, and others) has created a very noisy information landscape, which presents new challenges for public health practitioners and health security professionals. 

Of these challenges, misinformation and disinformation propagation has commanded the public spotlight over the past few years and has significantly damaged the global informational landscape. This two-part post will detail the impact of health-related misinformation and disinformation, its effects on health security, and the potential for addressing this issue in the near future.  

How Did We Get to This Point? 

Misinformation and disinformation are not new, but it is clear that the changes in how people consume information has catalyzed their production. Traditionally, people received their information through interpersonal interactions or via a traditional media channels like TV, radio, or print. The conglomerates that produced news content had guidelines in place that let them play a gatekeeper role for public information. These guidelines were far from a perfect system, but there was a universal understanding of how this system worked, which established a familiarity with how information traveled.   

This understanding changed dramatically when social media platforms made their way into the informational landscape. These platforms were created to bring people closer together. They offered unmoderated content creation and the ability to easily access and share information. Regardless of the intricacies of each specific platform, they each shared a common goal of inducing interaction between users. In effect, they were building a network of individual two-way communication channels on a massively expanded scale. 

As the user bases for these sites grew, this two-way vision transformed into what’s come to be known as a “many-to-many” communication system. While many argue the technicalities of the title, there is agreement on this core principle: many individuals now have the ability to post information to many people, at any time and with limited regulation. Now multiple voices speak to a number of topics, and with a click of a button, any individual can share their personal thoughts with the world. This non-direct, two-way communication system has pivoted who shares and receives information, flipping the script on information seeking. With social media’s rapid introduction into the technological sphere and the fast adoption of a many-to-many system, the tradition gatekeepers of information quickly became outdated, and the lack of a coordinated effort to adjust opened a window for misinformation production.  

During this same time period, advances in mobile technology created the perfect mechanism for personalizing these new platforms, increasing the amount of time that users interacted with them. The opportunity to access social media at a moment’s notice has expedited its growth, and led to the hyper-connected society we live in today. 

Social media is not the sole cause of this ‘post truth era’, but its outsized role is undeniable. This new information landscape has changed the traditional model of information sharing with its full impacts still not completely known. 

Misinformation and Disinformation: The Bad and The Worse

To best understand the impact of misinformation and disinformation propagation, it is important to acknowledge the fundamental difference between the two: intent. Simply put, misinformation is wrong or misconstrued information. It can stem from any number of sources, and has been a common plight for centuries. It is not purposefully shared with the knowledge that it is incorrect, and generally, its drive is not malicious. Disinformation, on the other hand, is incorrect information shared for that very reason. This distinction in intent is often hard to ascertain in real time but is critical in how one approaches its correction. 

Modern disinformation campaigns are a particularly virulent strain of propaganda. When paired with powerful social media platforms, disinformation activities have the ability to spread quickly with increased reach. These activities have become the subject of recent controversy, and have spawned multiple federal investigations. The case that has elicited the greatest response was an alleged campaign fueled by Russian trolls during the 2016 presidential election. The court proceedings tied to this case brought about massive social media purges, and unearthed the presence of foreign companies running disinformation campaigns around the world. While these efforts are certainly a pressing political and national security issue, a recent analysis clearly demonstrated that there is a connection to health communication as well. 

This past August, the American Journal of Public Health published an article that outlined a disinformation campaign that used programmed “bots” and online trolls to purposefully muddy the waters and rile up controversy between those who advocate for routine vaccination and those who oppose it. The strategic aim of this particular disinformation campaign was to use public health as a wedge issue, and to fan the flames of societal discord. The perpetrators of what the authors deemed “weaponized health communication” carried out their mission internationally through multiple social media channels. While the investigators did not attribute the campaign to a person or state, a sizeable portion of these trolls and bots were Russian accounts. 

What this article demonstrates is concerning. Public health has been, and continues to be, a topic that foregoes political differences for the betterment of health and wellbeing. Targeting health issues with the intent to divide is contradictory of the uniting nature fundamental to the discipline. There is danger present when health topics are used to drive people apart, and now there is a clear example of that being the case. Identification of these disinformation campaigns is just the starting point for an uncertain future, and it’s clear that immediate action is needed to address this growing concern. The next step will be moving from retrospective identification to a more engaged, proactive messaging posture. 

The Impact on Health Security and Health Communication

Misinformation and disinformation have both direct and indirect effects on the field of health security. Of these, the impact of incorrect information in the decision-making process seems most apparent. In the event of a disaster or emergency, timely communication of accurate information can be a major component in saving lives. The misinformation atmosphere can complicate this directly by sharing information that isn’t true. The 2014 Ebola epidemic, for example, was the victim of viral rumors that impacted how people perceived their risk of disease. In future disasters, people seeking information will now have to engage more actively with a growing amount of available material, or accept the potential that the information is wrong. 

The growing amount of available material highlights one of the indirect impacts stemming from false information propagation: there is an ever-growing amount of false information online, and there’s evidence that says people may give more attention to it than the truth. Both true and false stories are vying for attention, and some are finding that it’s more difficult for their messages to stick out. The product of these developments is a massive amount of available information, all fighting to be seen. Target audiences now face an ‘information overload’, prompting them to take mental shortcuts in how they select information. How people take these shortcuts has been the subject of decades of psychosocial research, serving as the backbone for theories that try and determine their influence on individual decision making. Many speculate that this new information acquisition process has been the driving factor in producing pockets of individuals where incorrect ideas may widely be accepted as truth. Now, the challenge for health communication practitioners is not just sharing information, but rather, doing so while simultaneously persuading diverse audiences that science reflects the truth

In addition to these challenges, an underlying growth in public distrust is a disconcerting development for health communicators and health security professionals. In recent years, this phenomenon has become increasingly well documented and has frustrated professionals from a wide range of disciplines. Portions of the public will deny overwhelming empirical evidence, whether it’s aimed towards climate change or vaccine efficacy, in favor of information that supports their beliefs – so called ‘confirmation bias’. Studies have shown that this gap persists across various audiences, presenting a disconcerting outlook for communication and health security. There have always been people who express skepticism of the scientific method, but the widespread vocal nature of modern dissenters presents a particularly lively challenge that will be harder to address. 

It seems all but certain that misinformation and disinformation propagation will be a challenge for future health communication efforts. Health communication is and will continue to be a critical component to health security, adding increased pressure to finding a solution for this problem. There is no clear best path forward, and the next steps we take will determine the impact of messaging efforts in this permanently altered communication realm. 

We will explore the wide-range of potential options in the second half of this blog, Misinformation and Disinformation Propagation: What Now?

“Out of an abundance of caution” – An overused phrase

Last October, when fear about Ebola was at its height in the US, we saw the phrase, “out of an abundance of caution” being used to justify just about anything under the sun.  Want to ban kids from schools because they shared a continental land mass with Ebola victims?  Go ahead and do it out of an abundance of caution. Want to confine anyone who gets sick on an airplane to the bathroom for a whole flight?  Go ahead and do it out of an abundance of caution.  In fact, out of an abundance of caution, we should really plan to never read anything online again, so that we can be sure that the phrase never takes hold in our brains. 

Now that the fear around Ebola has died down, it’s a saner moment to think about what that phrase really does.  It allows businesses, schools, leaders in the government, and others in charge to enact policies that are scientifically unfounded but potentially irrational and, sometimes, to infringe upon the rights of others. We are hardly the first to complain about over-reaching policies set out of an abundance of caution, but it’s a recurring problem worth considering. 

Making decisions in a responsible way means weighing potential outcomes with the chances that those outcomes might occur.  The phrase, “out of an abundance of caution,” is often used when explaining an action that isn’t necessary, but is going to be done anyway because you want to be extra careful. Unfortunately, this throws the whole decision making process for a loop, because it assumes that there are no consequences for overly cautious and unnecessary actions.  Yet these actions always have a cost – in money, resources, time and, sometimes, civil liberties. 

Further, using the phrase undermines the science-based messages surrounding risk.  During the Ebola outbreak, public health officials repeatedly cited science-based messages that the disease could only be transmitted by people experiencing symptoms of the disease and that there was no science-based rationale for putting asymptomatic individuals in quarantine.  The Louisiana Department of Health and Hospitals highlighted these points in a manual on Ebola (the link to the document has since been removed from the website) then noted that quarantine would be used in Louisiana regardless of risk category.

What the phrase really suggests to the public is that these actions were actually needed, otherwise they wouldn’t be done.  Either something is necessary, and should be done, or is unnecessary and shouldn’t be done. One justification for acting out of an abundance of caution is calming public fears.  But do these actions actually calm public fears, or do they make a threat seem bigger than it really is? A better approach is to be transparent about what we know about risks, what science says we should do to minimize those risks, and maybe most importantly, be clear about what we don’t know. A transparent approach to communicating risk has been shown again and again to be more effective than trying to obfuscate the facts and make one sweeping decision “out of an abundance of caution.”

Using the phrase to justify our actions is tempting, especially when we are a little scared and not sure what to do. But let’s be honest with ourselves and others about the risks we face and act accordingly, rather than out of an abundance of caution. 

It would be crazy to think that thousands of Americans could be rounded up, out an abundance of caution, to spend the next few years in the middle of our country in internment camps.  Yet, that happened to thousands of Japanese-American citizens during World War II.  So let’s avoid falling into the “out of abundance of caution” mindset.  It’s often used to justify actions on the margins of advisability, and in reality it usually serves to signal a dangerous combination of fear and rashness.