The alarming uptick in health misinformation is a “serious threat to public health,” says the U.S. Surgeon General, but there are steps to counter the problem.

LIKE MOST PUBLIC HEALTH PRACTITIONERS, Robert Niezgoda has encountered a variety of myths and conspiracy theories about health issues throughout his career. Currently a doctoral student in epidemiology in the University of Iowa College of Public Health, Niezgoda previously served as the director and emergency response planner for Taney County Health Department in Missouri.

“The current situation with COVID-19 vaccine misinformation reminds me of what occurred during the 2009-2010 H1N1 pandemic,” he recalls. “Misinformation was circulating regarding the vaccine as the mass vaccination efforts started. Many of the misinformation talking points were similar to what we’ve been hearing today—the vaccine wasn’t tested; manufacturing was rushed; the vaccine contained monkey blood, microchips, and so on.”

There were also rumors about “military quarantine of entire cities or that there would be vaccination requirements to drive from one region of the country to the next,” he says. “This created a lot of difficulties with mass vaccination.”

Even without a pandemic to navigate, it can be challenging to sort through the deluge of health messages received from social media, television, friends and family, and hundreds of other sources. While much of this information is credible, a significant portion is inaccurate at best, and dangerous at worst. Misinformation isn’t a new phenomenon, but with the growth of the internet and social media, it can be amplified and spread more rapidly than ever before, easily leaping beyond geographic boundaries.

The current alarming explosion of misinformation around COVID-19 prompted the U.S. Surgeon General to issue an advisory in July 2021, which warned: “Health misinformation is a serious threat to public health. It can cause confusion, sow mistrust, harm people’s health, and undermine public health efforts. Limiting the spread of health misinformation is a moral and civic imperative that will require a whole-of-society effort.”

Disinformation and Misinformation

The advisory defines misinformation as “information that is false, inaccurate, or misleading according to the best available evidence at the time.” Related but distinct is disinformation, defined as “misinformation spread intentionally to serve a malicious purpose, such as to trick people into believing something for financial gain or political advantage.”

Misinformation isn’t a new phenomenon, but with the growth of the internet and social media, it can be amplified and spread more rapidly than ever before.

While medical treatments, vaccines, climate change, and diet/nutrition are some the many subjects that have been saturated with both disinformation and misinformation over the years, the tobacco industry is one of the most notorious offenders of using disinformation for financial gain. In addition to using unsubstantiated claims and misleading language in its advertising, Big Tobacco has flat out lied to the public.

“The tobacco industry knew that nicotine was addictive, and they testified in Congress in 1994 that it was not,” says Shannon Lea Watkins, CPH assistant professor of community and behavioral health, who studies tobacco and e-cigarette use.

She and other researchers are looking at what type of tobacco and e-cigarette messages are being spread on social media. “Increasingly, pro-tobacco content is not coming directly from the industry, but it’s coming from influencers and peer-to-peer communication,” she says.

Watkins is currently working with a team of students on several papers that examine how e-cigarettes are discussed in social media. One paper is looking at changes in e-cigarette use and perceptions around the beginning of the COVID pandemic when it was unclear if vaping increased the risk or severity of the disease.

“In an information vacuum where there’s no clear messaging from public health and it’s too early to have empirical evidence yet, [social media] becomes a discussion platform where people are trying to process and understand what’s true,” Watkins says. “A lot of untruths are discussed there.”

The Role of Social Media

Nearly 3 out of 4 Americans search online for health and medical information, and 82 percent of the U.S. population had a social networking profile in 2021. However, few social media platforms attempt to differentiate between credible and non-credible sources of health information, leaving consumers to make their own judgments. 

Misinformation can proliferate in part because we tend to surround ourselves with like-minded people online and in real life, creating an “echo chamber” that reflects and reinforces our own viewpoints and beliefs. Additionally, social media algorithms serve up similar content based on what we’ve previously viewed or shared, creating “reinforcement loops” of information.

Misinformation also frequently has a powerful emotional component. As the Surgeon General’s advisory explains, misinformation “is often framed in a sensational and emotional manner that can connect viscerally, distort memory, align with cognitive biases, and heighten psychological responses such as anxiety. People can feel a sense of urgency to react to and share emotionally charged misinformation with others, enabling it to spread quickly and go viral.”

Identifying Credible Sources

While individuals are responsible for what they view and post, there’s a growing call for social media platforms to take additional steps to counter misinformation. In early 2021, the National Academy of Medicine (NAM), with funding from YouTube, convened an independent advisory committee that focused on developing a set of principles for identifying credible sources of health information in social media.

Sue Curry, College of Public emeritus dean and distinguished professor of health management and policy, was a member of the independent advisory committee that authored the resulting NAM Perspectives discussion paper published in summer 2021.

Social media platforms “have an important opportunity—and a growing responsibility—to intervene, not only to counteract harmful trends, but also to enhance consumers’ access and exposure to high-quality, science-based health information,” the authors write.

Trustworthy sources share science-based information without financial incentives and with transparency about where the evidence comes from.

The paper focuses specifically on the evaluation of sources of health information, rather than content. The authors propose that a credible source of health information should meet three foundational principles: it should 1) provide information that is consistent with the best scientific evidence available at the time, 2) be objective, and 3) be transparent and accountable.

Although the paper is geared toward informing the policies of social media platforms, organizations that share health information through social media as well as members of the public can also benefit from the guidance. The paper also addresses the need for additional strategies to supplement source evaluation, including content assessment, management of misinformation, health literacy, and other ethical and public health considerations.

Sifting through the complex interplay of these dynamics posed a daunting task for the authors.

“The most challenging aspect was knowing that principles and attributes for credible sources is necessary but not sufficient for addressing health misinformation in social media,” says Curry. “Identifying credible sources is just a first step and needs to be augmented by ensuring that the content or health information itself is based on sound evidence.”

Although it’s difficult to distill the paper into one main takeaway, “Given the focus on sources, I’d say a key message is ‘consider the source’ when presented with health information,” Curry advises. “Trustworthy sources share science-based information without financial incentives and with transparency about where the evidence comes from.” 

Increasing Understanding

Efforts to slow the spread of COVID-19 have been hampered by widespread misinformation about public health measures such as vaccination and masking. Not only are hospitals and health systems strained by the consequences of pandemic misinformation, but so are family and community relationships.

“Unfortunately, we are now in a most undesirable situation where an extreme level of mistrust and disrespect exists such that even the most basic communication is problematic,” says Niezgoda.

“It can be difficult to have conversations with family and friends who might not share your values or trust in science,” says Natoshia Askelson, associate professor of community and behavioral health. She studies health communication and behavior change and has worked on several projects addressing vaccine hesitancy. “It is important to recognize their concerns and try to understand what might be influencing their hesitancy—is it a concern about safety, or a distrust in science or the government, or a belief in a myth about COVID-19? Trying to figure out what is driving the hesitancy can point to what they might need to hear to change their opinion. It is possible to move people who are vaccine hesitant to a place of more confidence and intention to get the vaccine.”

Many people who share misinformation aren’t purposely trying to misinform, the Surgeon General’s advisory points out. Instead, they may be raising a concern, making sense of conflicting information, or seeking answers to honest questions.

“We need to try to respectfully understand those who are being influenced by these messages,” adds Niezgoda. Ridiculing or ostracizing people, especially if it’s done by community leaders and elected officials, “will only create more divisiveness while strengthening beliefs in the misinformation,” he cautions. “If we increase our understanding of one another, we’ll be better able to develop respectful and effective communication strategies.”

In today’s hyper-connected and polarized environment, it can feel like an uphill battle to counter falsehoods and conspiracies about health and other topics. But we can all take a few simple steps to avoid spreading misinformation. Before hitting that send or retweet button, verify the accuracy of information by checking with trustworthy and credible sources, and, perhaps most importantly, follow a simple rule: If you’re not sure, don’t share.

This story originally appeared in the fall 2021 issue of InSight.