Proceedings of a Workshop—In Brief | APRIL 2023

Navigating Infodemics and Building Trust during Public Health Emergencies

An “infodemic” describes the rapid spread of large amounts of sometimes conflicting or inaccurate information that can impede the ability of individuals, communities, and authorities to protect health and effectively respond in a crisis.¹ Even a deluge of accurate information can overwhelm the public.

In times of emergency, people do not always have access to the information they need. The COVID-19 pandemic incited an unprecedented infodemic highlighting the impact of misinformation, disinformation, and information disseminated with malicious intent on the effectiveness of public health action and national health security.

At the request of the Centers for Disease Control and Prevention (CDC), the National Academies of Sciences, Engineering, and Medicine hosted a two-day public workshop on April 10-11, 2023 to examine the history of public health infodemics, the impact of infodemics on trust in the public health enterprise, and tools and practices used to address infodemics.

Statements and opinions expressed are those of individual workshop presenters and participants. [Read full disclaimer]

[1] The workshop planning committee devised its own definition of "infodemic" to steer the workshop planning process and to contextualize the term within the workshop's scope, while also acknowledging other pre-existing definitions and their utility.

The History and Complexity of Infodemics

The first session began with remarks from Nancy Tomes, Stony Brook University, who described the history of infodemics, noting their occurrence during the 1918-1919 influenza pandemic, the 1980s HIV/AIDS pandemic, and the 2003 severe acute respiratory syndrome outbreak. Tina Purnat, World Health Organization, explained how the speed and scale of infodemics now exceed the current capacities of health information technologies and underfunded health systems. Dietram A. Scheufele, University of Wisconsin-Madison, described the effects of an amalgam of science, policy, and partisan politics on declining trust in science. Umair Shah, Washington State Department of Health, discussed rumors that affected behavior during the responses to Hurricanes Katrina in 2005 and Harvey in 2017, as well as rumors that fueled discrimination against Asian Americans during the COVID-19 pandemic.

Key Points:

In the early stages of previous disease outbreaks, evolving science could inadvertently generate confusion before adequate evidence and consensus are established. Infodemics flourish within the expectation gaps between an idealized faith in science and the realities of the limited scientific evidence that can be produced at short notice (Tomes).
Over the past 15 years, narratives that influence knowledge, attitudes, perceptions, and behaviors related to public health emergencies have circulated faster in our increasingly digitized society. To keep pace, health authorities must be quicker to identify and respond to circulating narratives (Purnat).
Science-based decision making alone cannot eliminate variance or generate trust, as differing public health policy conclusions can be based on the same science (Scheufele).
Effective infodemic management requires diverse tools and capabilities that include “soft skills,” such as communications and engagement, in addition to proficiency in epidemiology and data collection (Shah).

Responding to Infodemics

Tara Kirk Sell, Johns Hopkins Bloomberg School of Public Health, stressed that a constellation of interventions is needed to effectively meet the diverse needs of various communities and populations in addressing infodemics. Annie Sundelson, Johns Hopkins Bloomberg School of Public Health, outlined a set of approaches that can be used to help manage infodemics. Sandra Quinn, University of Maryland, provided an overview of the Building Public Trust in Public Health Emergency Preparedness and Response (PHEPR) Science workshop held in 2022.

Key Points:

Building trust in PHEPR practice and science can be accomplished by emphasizing the importance of relationship building with diverse communities, cross-sector collaboration, communication, and transparency (Quinn).
Approaches for managing infodemics can be used at the institutional and structural, interpersonal and community, informational, and individual levels of society (Sundelson).
These approaches are discussed in further detail in the workshop's commissioned paper which provides an overview of infodemic management tools and approaches that have been developed at the international, national, state, and local levels. Read the paper here .

Institutional and Structural Considerations

Maddie Perlman-Gabel, New York City Department of Health and Mental Hygiene, described the work of the department’s Misinformation Unit that was established in March 2021 to identify factors undermining COVID-19 vaccine confidence. Phil Maytubby, Oklahoma City County Health Department (OCCHD), shared how OCCHD used sentiment analysis surveys to inform their COVID-19 vaccination campaign messaging community. Scott Burris, Temple University, discussed how public health law can be leveraged to address infodemics. Ian Brooks, University of Illinois Urbana-Champaign, discussed how the Pan American Health Organization/WHO Anti-Infodemic Virtual Center for the Americas (AIVCA) has established international, multidisciplinary teams to detect, research, prioritize, and respond to misinformation threats.

Key Points:

Public health infodemic management efforts should (1) prioritize equity and accessibility, (2) think globally and act locally, (3) grow external relationships, (4) foster internal collaboration, and (5) build capacity for monitoring and evaluation (Perlman-Gabel).
Sentiment analysis conducted across media types to identify words connected to a message that are perceived negatively by various demographics led to revisions in the Oklahoma City COVID-19 vaccination campaign to increase positive public perception (Maytubby).
Public health law services can help address infodemics by drafting laws better designed to avoid resistance and explaining and implementing the enacted rules more clearly (Burris).
AIVCA categorizes, evaluates, and prioritizes misinformation to direct response resources toward the narratives that are most likely to generate behavioral changes that could negatively affect public health (Brooks).

Community Engagement

Lisa Cox, Missouri Department of Health and Senior Services, described how public health officials leveraged preexisting relationships to reach certain communities and engaged with trusted messengers to connect with other hard-to-reach communities. Monica Schoch-Spana, Johns Hopkins Bloomberg School of Public Health, explained how community-based participatory research techniques can reveal nuanced values and priorities within vulnerable groups. Teresa Wagner, The University of North Texas Health Science Center at Fort Worth, highlighted support for health literacy as an approach to counteracting harm from infodemics. Highlighting the importance of cultural context and meeting community members where they are, Amanda Boyd, Washington State University, explored infodemic preparedness and response efforts within Indigenous communities.

Key Points:

Effective emergency preparedness hinges on cultivating relationships with community leaders in advance of an event and communicating with them about public health goals (Cox).
Engaging with communities can yield public health interventions that are more culturally competent, attuned to local conditions, and socially acceptable (Schoch-Spana).
Community health workers (CHWs) are well-positioned to deliver understandable health information to the individuals they serve. Just as CHWs assist people in navigating complicated health care systems, they can help individuals navigate misinformation during public health emergencies (Wagner).
Health communication efforts are most successful when they honor the experience and expertise already present in native communities—such as tribal elders and medical professionals—who understand local perceptions of and barriers to health programming (Boyd).

Individual and Information Approaches

Kate Starbird, University of Washington, explored a framework for and the benefits of shifting the terminology around infodemics, specifically the term “rumor.” Neil Johnson, The George Washington University, showed how mapping the ecosystem of online communities can predict the potential spread of misinformation. Alejandro Posada, Internews, discussed how social listening can used to synthesize public discourse into insights about a particular community. Christopher Voegeli, CDC, highlighted the State of Vaccine Confidence Insights Report series, in which CDC provides iterative and inductive analyses of misinformation, tracks themes, and issues recommendations. Rachael Piltch-Loeb, Harvard T.H. Chan School of Public Health, described psychological inoculation, or “pre-bunking,” a communication technique that builds psychological resistance against a future persuasion strategy.

Key Points:

Diminished public trust in officials, coupled with increasing diversity of online platforms, creates a context vulnerable to the spread of misinformation (Starbird).
Small but active online communities can negatively affect state and national interventions; mapping can anticipate this resistance and provide triggers for the public health response to misinformation (Johnson).
Social listening insights can inform efforts to establish and strengthen connections between stakeholders, resulting in networks that can coordinate efforts to improve the accuracy and appropriate timing of communications (Posada).
Debunking misinformation will have limited effectiveness unless the larger social and cultural forces that bolster misinformation are addressed, which requires evidence-based approaches that leverage socio-behavioral and epidemiological insights (Voegeli).
“Pre-bunking” has demonstrated potential in increasing an individual’s ability to identify misinformation and decrease the likelihood that they share misinformation (Piltch-Loeb).

Looking Forward

During the concluding roundtable discussion, panelists identified practices, capacities, capabilities, partnerships, and collaborations that could be developed within the next decade to address infodemics. William Hallman, Rutgers Global Health Institute, discussed the integration of effective communication strategies into every aspect and every level of public health. Demetre Daskalakis, White House National Mpox Response, reflected on the U.S. mpox experience and lessons learned for risk communications. Michael Fraser, Association of State and Territorial Health Officials, underscored how community engagement efforts should be at the forefront of infodemic response strategies. Jewel Mullen, University of Texas at Austin, remarked on the impact of community health works and their role during an infodemic. Bruce Y. Lee, City University of New York, shared a systems perspective on how to confront future infodemics.

Key Points:

Community engagement strategies should shift toward structures that facilitate bottom-up communications, from communities to public health organizations (Hallman).
Public health authorities have an opportunity to avert a future panic-neglect response cycle by maintaining relationships and strengthening communications infrastructure that were developed in response to the COVID-19 pandemic and other past crises (Daskalakis).
To avoid repeating past missteps, public health practitioners and academia should train local officials to understand and utilize risk communication strategies to avoid absolute statements that often generate mistrust and lack of confidence (Daskalakis).
Public health agencies should improve practices for obtaining and incorporating community feedback and input (Fraser).
Sustainable professionalization of community health workers would support a framework in which community engagement plays a role in detecting infodemics (Mullen).
Communities of practice for infodemic management should strive for inclusion to avoid further marginalizing disenfranchised populations (Mullen).
Public health authorities and practitioners should anticipate and leverage emerging technological innovation to shift from a reactive to a proactive response to infodemics (Lee).

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The planning committee’s role was limited to planning the workshop, and the Proceedings of a Workshop-in Brief has been prepared by the workshop rapporteurs as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants. These views are not necessarily endorsed or verified by the National Academies of Sciences, Engineering, and Medicine, and they should not be construed as reflecting any group consensus.