Infodemic management as a function of health emergency preparedness and community resilience

I had the pleasure to speak today at a webinar organized by SE European Health Network and Central European Initiative. I took the opportunity to reflect on how I see infodemic management as part of emergency preparedness and community resilience. Thanks to Elisabeth Wilhelm of US CDC for bouncing ideas off with me and providing the perspective on vaccine acceptance and demand.

Infodemics in online and offline ecosystems are not distinct from eachother

We’ve all been affected over the past year by the information overflow about COVID-19 in our personal lives. And at the same time, we’ve been trying to respond as public health practitioners in new ways. Health misinformation is as old as the pyramids and it can cause real harm during uncertainty of a health emergency. But the additional challenge in this pandemic has been the mere fact that this global emergency has been taking place in a digitally transformed world where information travels faster than ever before. Anyone can be an author, publisher and editor of information online. This means that there are more and more ways for information to flow around the traditional “influencers” or “gatekeepers” of quality health information. Over the past year we have all experienced the sheer volume and cacophony of information while trying to keep ourselves, our families and communities safe. People and communities are online and offline connected and interdependent in complex ways. So the digital information and swarming of online opinions affects even those people who are not directly or actively using online and social media. 

The infodemic can cause real harm in offline world

The infodemic is this surge of information that occurs during an outbreak and which contains information of varying quality, and some of it may also be mis or disinformation. Health misinformation is a serious challenge to public health response in this pandemic and is directly amplified by our digital information ecosystem. The surge of information in digital media has meant that it is harder to reach people with information, to provide the right information at the right time, and also to promote people’s resilience to misinformation when they are exposed to it on a daily basis through their trusted relationships with family, friends and community circles. And I think we’ve seen that infodemics can lead to weakened social cohesion, which has been a major challenge not only for public health response and health systems, but also for governments as they manage the fallout on their societies and economies.

Infodemic management can help inform response activities

Misinformation increasingly mirrors epidemics. We’ve also seen that infodemics can prolong or intensify epidemics, so we do need to develop and apply evidence-based approaches for infodemic management. And even though infodemics cannot be prevented, they can be managed. Currently, this challange is gaining a lot of attention because of discussion of strategies that need to be put in place to promote vaccine acceptance and demand during vaccine rollout in countries. But the infodemic is affecting also pandemic response in general.

Infodemic management goals won’t be fulfilled and emergency response in this pandemic won’t end with a person receiving a vaccine jab. And actually, with the current still lagging supply of vaccines, we for a while still won't be clear how much the slow uptake of vaccines is because of vaccine confidence issues, and how much this is due to challenges in digital health, human resources and health systems. We will only be able to know how much the infodemic is affecting vaccine uptake when there is vaccine available and people still may not be getting vaccinated even though they are eligible to receive the jab. We know that all communities will face vaccine confidence issues, but currently can’t quantify its scale and impact.

At the same time, the infodemic about COVID-19 vaccine has been spilling over into parallel discussions about COVID-19, treatments, and public health measures. The discussion has become increasingly intertwined with people’s personal world view beliefs, and their attitudes towards authorities, government, and communities. All of this is affecting public health response to the pandemic.

Short and longer term approaches to managing the infodemic

Over the past year, WHO has worked across whole of society and built new partnerships across sectors and society to tackle various angels of infodemic management. I’ve shared linked below to some resources about infodemic management framework, a WHO public health research agenda for managing infodemics, and country experiences that were presented at our three infodemic management conferences last year. We have worked, for example, on shorter term approaches like building partnerships with social media platforms, working with new communities online and offline, making high quality health information be more engaging and more attractive to better compete with misinformation, developing new analytical approaches using data science, and strengthening partnerships with factcheckers and civil society. And we coupled those approaches with more longer term ideas such as identifying where we still have evidence gaps to support infodemic management, building the science of infodemiology, supporting social inoculation innovations and digital, media, information literacy efforts to build resilience to misinformation, and discussing ethics of infodemic management and its relation to freedom of expression.

Information pumping or banning misinformation is not addressing the underlying issues

There are two lessons I’d like to emphasize from our experience last year. The first one is that it’s important to separate the harm that mis- or disinformation may be causing to society at large and to the groups who are vulnerable in particular. People living in communities that have been heavily impacted by COVID-19 tend to be the same communities that haven’t been well linked to health services. So it can be tempting but it is reductive to suggest that the infodemic will be better handled by reducing the amount of circulating misinformation and that this is sufficient to build trust and reduce vaccine hesitancy.

But at the same time, pushing out high quality health information is an essential activity but also not the solution. We need to go the extra step in reimagining what social listening is in today’s online and offline information ecosystem. And we need to think through what community resilience to the infodemic and to misinformation really looks like. 

Here is the key driver of our evolution in approaches and thinking:

What makes social listening different from surveillance is our accountability to address issues that we’ve identified with communities and our relentless commitment to clear eyes of evaluation and public health impact. So for remainder of my talk I’d like to focus on three things: (1) our accountability to communities we work with, (2) our commitment to evaluation, and (3) supporting community resilience.

First, when we work with communities, we must have a clear commitment to address the issues that we’ve identified and come to understand through social listening. Traditionally, we’ve listened to rumors offline, but now we are more and more are able to sense conversations online that give us clues about where citizens ask genuine questions and express concerns. In either case, our interventions will be more relevant when the feedback from communities drives not only risk communication strategies, but also is informing wider health system response. When we hold ourselves accountable to act on what we’ve learned from the community, then we will build and maintain trust going forward. And we will also make sure that the response interventions will be more impactful and effective.

Second, I talked about the need for a clear commitment to evaluation. In our jobs, we are trying to cope with a situation and information overflow we’d never experienced at this scale in a pandemic before. Now is then the time to build on our experience of the past year. We’ve innovated a lot of new partnerships and new approaches. And we now work and live in what some call the “new normal”. But I find it more useful to think that we are actually building the next evolution of the capacity in our public health and health systems to deliver more human centered and equity-focused emergency response with more local impact. If we are to respond to the needs of the most vulnerable and to identify and improve effective interventions, we must strive for clear vision of evaluation. This means that we must be striving for more real time, more integrated data analysis than ever before, and using this information for intervention and systems building.

And it means that traditional communications analysis or survey-based social science approaches need to lean in and innovate to be coupled with health system, equity-based health information analytics. And this needs to happen much faster, in near real time. I think the only way to achieve this in the future is to recognize that integrated real time data analysis requires a multidisciplinary team that is fluent in the matter at hand, and that this team is then driving the formulation of recommendations for response on par with epidemiological analysis. We need to use technology to help generate and analyze the data, and humans to understand the context and make recommendations. In many countries, infodemic analysis is an add-on task to colleagues on top of their other responsibilities, and in many places there are no team, let alone individuals, who are dedicated to this work. But in future, we must recognize that this capacity and skillset is needed and that investment in it must be made.

Third, to promote community resilience to the infodemic we must become more fluent in understanding and engaging communities of different kinds and of different sizes. Our traditional approaches to working with influencers have limited public health impact in a digital ecosystem where algorithmic content curation is the driver of what information people see online and how they spread information through their own personalized networks. We must practice more participatory engagement, and strive for communities to be co owners of engagement and infodemic management strategies. Instead of just trying to “persuade” communities who have been marginalized to, for example, accept the vaccine, we should lean forward and collaborate with them, where they become their own infodemic managers. Tailoring messages to communities is the first step, but a truly resilient community in an infodemic doesn’t have to rely on health authorities for credible, accurate information, or rely on health authorities to have misinformation mitigated and addressed. Instead of framing the question around how health authorities might tailor messages and better address the infodemic around COVID-19 vaccines, how about we reframe this as a different question: “how can we help communities build capacity and processes to share health information and address misinformation as locally as possible?” The solutions to our problems of communicating about COVID-19 or the COVID-19 vaccine or in future epidemics will always best be localized.

In conclusion

Infodemic management during the current pandemic can help authorities respond with a greater impact. To do this, we are challenged to work and build trust with communities online and offline, at a greater micro-level than we’ve ever had to consider before. We are also challenged to be more effective in producing content and distributing it so that it is more attractive and can compete with overflow of other information and misinformation. We even need to reimagine what an online persona of a health authority is, to better use the online digital relationships. We are challenged to better support and equip our health care workers who are the trusted face of the health system and response in communities. And we are challenged to be more fluent with making sense of data so that we can base our interventions on information from many different sources, communities and the health system. This experience we will help us be more effective now, and will help us build better preparedness systems, capacities and processes.

It will take a whole-of-society approach to end COVID-19 as we know it. And with each effort we make to not just communicate but also empathize and listen to the concerns of those we serve - and then act on those concerns - we build upon the bridge of trust to that future.

Resources:

• WHO framework for infodemic management
• WHO public health research agenda for infodemic management
• 3rd WHO conference on infodemic management
• Materials from WHO infodemic manager training
• WHO platform for AI-supported social listening in 20 pilot countries
• WHO booklet “10 steps to community readiness”

Selected posts about infodemic management:

• https://www.dhirubhai.net/in/tinadpurnat/detail/recent-activity/posts/
• https://www.dhirubhai.net/pulse/mitigating-infodemic-front-lines-health-systems-tina-d-purnat/ 
• https://www.dhirubhai.net/pulse/approaching-trust-building-through-infodemic-lens-tina-d-purnat