Opinion: How disciplined guesswork can combat the next infodemic

An infodemic — a portmanteau of “information" and “epidemic” — refers to the rapid circulation and abundance of both accurate and inaccurate information about an issue such as a disease outbreak. As competing facts, rumors, concerns, and fears circulate, it becomes increasingly difficult to know right from wrong, which in turn breeds distrust, and gives rise to conspiracy theories that seek to fill the knowledge gap. Sound familiar? That’s because we are living in the age of the infodemic. Rising divisive and hate speech online, including misinformation and disinformation allowed to spread like wildfire on social media, is a crisis that needs to be taken seriously. Recent trends in the social media ecosystem, such as the disbanding of Twitter’s Trust and Safety Council, are not encouraging and could have devastating consequences for society, including on public health and well-being. A newly published historical analysis by the World Health Organization Regional Office for Europe shows that while infodemics in the realm of public health are not in themselves new, their intensity has increased over the past 50 years. A review of historical cases — the 1918 influenza pandemic, the early years of HIV/AIDS in the 1980s, and the 2003 severe acute respiratory syndrome outbreak — shows that all three were associated with information-related challenges, including difficulties with the volume, veracity, and variety of information available, along with information voids created variously by a lack of knowledge or suppression of information. Our analysis has shown that infodemics flourish in the expectation gap between an idealized faith in science and the hard realities of what science can produce at short notice. New disease outbreaks such as COVID-19 can create a cycle of scientific uncertainty and confusion that contradicts the expectations of both policymakers and the public regarding what science can and should do. Failure to immediately deliver on such expectations provides fertile ground upon which infodemics can grow. The 1918 flu pandemic — which killed at least 50 million people — certainly meets the criteria of an infodemic: There was an abundance of information but uncertainty about how to process it. Given the context of World War I, it even led to “fake news" that the pandemic stemmed from some type of germ warfare. When the next pandemic arrives, we can — and must — be ready for the infodemic that will inevitably accompany it. --— In the 1980s, as the first HIV/AIDS clusters were noticed among men who have sex with men in the United States and a number of other countries, some health professionals and the media alike began to use the term gay-related immune deficiency. This framing both resulted from and further fed into the considerable stigma and discrimination that targeted the MSM community, and significantly limited the initial development of scientific knowledge as well as of public health policy. For example, early cases among people who did not fit the stereotypical profile were left out of epidemiological bulletins and diagnostic criteria, meaning that the emerging epidemic among Black Americans went unrecognized and the diagnosis and treatment of women with HIV were constrained. Fast forward a couple of decades to the emergence of SARS in China in 2003, which coincided with the rapid spread of digital communications and the advent of social media. Because of the initial dearth of information on the outbreak’s origins, even as the virus spread rapidly around the world in a relatively short time, rumors abounded. Providing accurate information in a timely way, including to media, proved highly challenging. From Hong Kong to Toronto, it often became difficult for public health experts to stay ahead of what people knew, which in turn made it difficult to present a consistent, workable control and containment plan to the larger public. And that brings us to the present day, and COVID-19. Looking back over the last three years, it’s clear we see echoes of past missteps: not recognizing the need for timely, accurate information, even when our knowledge was limited; not communicating consistently and clearly enough, including communicating uncertainty; and, within the public health sector, not holding ourselves, and others, accountable to the degree expected by the public. To improve this, WHO is now partnering with platforms including YouTube and Facebook to develop new tools and techniques that flag misinformation before it spreads further, providing greater access to reliable, evidence-based resources and empowering people to make informed choices. But the way forward will not be easy. Communicating the science surrounding a disease — especially a new one — is hard. Identifying a new pathogen and anticipating its threat level requires integrating very different types of scientific evidence: laboratory tests, epidemiological trends, and direct observation of the spread of disease. This process calls for a kind of applied science known as disciplined guesswork. With more and better data, the results of that disciplined guesswork improve, but early statements may need to be corrected based on the new evidence, as happened repeatedly with COVID-19 in the initial months in particular, but even down the road as the pandemic evolved. This process of revision, which is central to scientific inquiry, can become the source of potential misinformation and contradict expectations that the tools of modern science can swiftly and accurately diagnose infectious disease threats. Given the immense power of social media and other online platforms to create and shape people’s opinions and knowledge, their role and responsibility in addressing infodemics are absolutely critical to the functioning of society and of vital public services like health. History has provided us with many lessons that the world has not yet fully absorbed, and our interconnected, online world has both intensified our propensity to be impacted by infodemics, as well as provided us with tools to tackle these better. When the next pandemic arrives, we can — and must — be ready for the infodemic that will inevitably accompany it.