Pivoting towards managing accumulative harm of an infodemic

As I listen to the current wave of discussions about information pollution and misinformation, at least in health, I feel like we've taken several steps backward from what experience during COVID-19 pandemic showed. As our society grapples with the information environment and the lack of guardrails in this space, much of the attention about health misinformation is turning to oversimplified strategies.

One of the biggest misunderstandings, which Claire Wardle discussed in her recent article, is that we tend to overfocus on individual pieces of misinformation over other circulating narratives. Seemingly benign, low-quality information can over time erode trust and affect people’s values and beliefs in massive ways that have massive implications on society. She calls this the "drip drip drip effect" of repeated questions and narratives that can change people's attitudes and behaviors over time.

Health misinformation and unaddressed questions and concerns can become more harmful over time, the longer they go unaddressed. They also often resurface over time, as do zombie misinformation narratives (I wrote about them here), sometimes even jumping outbreaks or diseases. This can indicate unaddressed questions and concerns, or misinformation linking to values and identities that are integral to a person's worldview. So we have to be smarter thinking about health misinformation and its precursors.

I think we create our own blindspots when we describe information as "potentially harmful".

• Early understandings of infodemic have focused on characterizing information as a virus, and this was then taken further to understand that only factual information is credible and accurate health information within an information environment. This has skewed the approaches within the information environment to overwhelmingly factchecking, debunking and correcting health misinformation. This limits people’s understanding of the problem of the information environment and how this interacts with individual-level cognitive factors and behaviors, because we know people do not make decisions on facts, but with emotion.
• When we treat information as a potential hazard, this is only one or two steps away from strategies that could lead to information manipulation and propaganda, and coercive approaches towards health misinformation spreaders.
• Communities that are highly vulnerable to emergencies and outbreaks are similarly vulnerable to infodemics, and often have many health service and information needs that go unmet. We should not assume that belief in misinformation is an individual-level problem versus a systemic failure to reach all communities with health information they need to protect themselves and their families from harm.

So I think we need to pivot to understanding the harm mechanisms of the infodemic to metaphors that explain complexities like environmental pollution which causes accumulative harm. Our infodemic harm prevention efforts need to focus on health information exposure and measurement of it, and mitigation strategies across the information environment.

The infodemic is a complex phenomenon, but the health system has an important role in addressing it, just like it is mandated with protecting public health. Below are my ideas on steps health authorities can take to build infodemic management into public health practice:

• We should better identify potential infodemic harms that may be captured by routine health surveillance systems. There are individual, community and societal-level factors that require different infodemic interventions, and often, health systems are not set up to detect potential harms from infodemics, except downstream, such as when there are poison control center calls for overdoses for misuse of household cleaning products, or overprescription of medication, or when threats against health workers become actual instances of violence.
• We need to set up quality standards for how different actors within the information environment can address information pollution related to health, what this means for regulations and for existing health information systems and policies.
• All public health and emergency preparedness risk assessments should include "information environment" as a domain to mitigate risks for.
• We need a clear definition for health information equity that we can benchmark progress against to ensure communities are more resilient to future infodemics. This means determining where health authorities may be better positioned to support versus drive resilience building.