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Executive summary
The coronavirus disease (COVID-19) is the first pandemic in history in which technology and social media have been used on a massive scale to keep people safe, informed, productive and connected. At the same time, the technology is enabling and amplifying an infodemic that undermined the global response, jeopardized measures to control the pandemic, and which has crossed into narratives accompanying other outbreaks and emergencies, such as seasonal influenza, mpox and polio.
Infodemics can negatively affect health systems and health professionals during disease outbreaks. They can cause confusion and risk-taking behaviours that harm people’s health, and lead to mistrust in health authorities and public health responses. The current global evaluation data on the intersection between the COVID-19 infodemic and health systems is limited to pulse surveys. They confirm the importance of infodemic management but do not explain its impact.
People who address health misinformation or try to understand the information environment communities are living in and how it affects perceptions and behaviour around a health topic are performing functions of an infodemic manager. It is important to note that infodemic management as a professional field has emerged and matured during the COVID-19 pandemic. But people who do this type of work may be found in many different roles within the health system, from health promotion to direct patient communication and care, to digital health and health information analysis, to risk communication and community engagement.
This report outlines an analysis of 68 collected interviews telling stories of experience of the COVID-19 infodemic by infodemic managers to draw out learning about the impact of, and response to, the COVID-19 infodemic and the utility of story-based approaches as a tool for evaluation and learning. Contributors worked in Ministries of Health, WHO Regional and Country Offices, and organizations including the United Nations Children’s Fund (UNICEF), universities, think tanks, and a wide range of Civil Society Organizations, particularly those focusing on health. They came from 41 different countries.
The purpose of this analysis was to provide practical insights and learning for use by practitioners and decision makers within the infodemic management community, including policy makers and researchers. The analysis found that:
Health care professionals are at the ‘front line’ of the infodemic. They were regarded as ambassadors of the healthcare system, and expected to serve as sources of information, advice, and guidance. Healthcare practitioners felt a strong obligation to shield people from the infodemic, even though their efforts were not always well received. They encountered widespread public skepticism towards the healthcare system they represented, doubt regarding the credibility of the information they provided, and occasional hostility towards them as individuals. This situation gave rise to significant tension and a crisis of confidence. Additionally, many healthcare professionals themselves struggled to discern trustworthy information. Consequently, their role within the community was undermined, exacerbating the already daunting challenges of the situation and adding further stress and insecurity.
Nevertheless, encouraging outcomes also emerged from analysis. Being members of their local community gave healthcare professionals an insight into local dynamics. This advantage facilitated their interaction with influential individuals and institutions within the community, enabling them to effectively disseminate accurate information. Interviewees cited instances where they, and other community members, had successfully utilized personal stories to influence others. Such impactful exchanges were only achievable through personal interactions, and were seen as more effective than generic, preconceived advice that was delivered through mass media.
Context is key to understanding people’s behaviour. What led people towards negative beliefs and behaviours during the COVID-19 pandemic was complicated, based on previous experience and often highly localized. Pre-existing vaccine hesitancy, mistrust of authority, and conspiracies were all major contributing factors. These issues had roots in past experiences, including previous epidemics like Ebola, which fostered mistrust in healthcare systems, as well as fraught vaccination campaigns like Dengvaxia in the Philippines and polio in Nigeria. Conspiracies emerged, and in some instances, politicians, authority figures, and community leaders perpetuated these fears, sometimes for personal gain, but often due to their own misguided beliefs. Again, personal stories were found to be particularly effective in addressing these context-specific concerns, as they drew from lived experiences within those specific communities and environments. It was noted that context would evolve over time, potentially rendering previously effective health promotion or infodemic management responses less effective in the current situation.
Frontline workers were equally exposed to the infodemic. The COVID-19 virus and its corresponding vaccine presented a host of unknowns, especially during the initial stages of the pandemic. Many healthcare workers became overwhelmed by information overload or faced a dearth of guidance, leading to heightened anxiety. Many lacked avenues for seeking support and advice from peers or colleagues. The landscape of information and guidance was also subject to frequent changes, making it difficult to discern reliable sources. This knowledge gap became fertile ground for misinformation to flourish and exacerbate people’s uncertainty and eroded their trust in their own medical training and official advice. However, those interviewees who possessed a greater understanding of Infodemic Management (IM) or had undergone a World Health Organization (WHO) IM global training reported feeling more confident in dealing with the infodemic. The interviews highlighted instances of health systems responding to the infodemic, such as issuing guidance to employees and the public, directing frontline workers towards specific tasks, and establishing credible sources of information. However, the implementation of these measures was often perceived as sluggish.
Technology played a positive role in Infodemic Management. While technology and social media played a role in exacerbating the COVID-19 infodemic, our increased connectivity also presented opportunities for combating misinformation. Interviewees sought information from many sources, and many made efforts to address misinformation on social media platforms. Furthermore, greater connectivity facilitated WHO to reach out to frontline workers and deliver Infodemic Management training. WHO also disseminated materials and resources that empowered organizations and individuals to cascade WHO IM training to others. Through the internet, organizations and health authorities were able to create ‘easy access’ / one stop repositories of reliable information, and provide guidance, tools and protocols. There were also email newsletters and updates offering front-line workers links to useful resources, news and information. Mobile phones and social media were also used by people to connect with peers and with health services.
Stories were found to be a powerful tool for gathering qualitative evidence and challenging the infodemic. The stories represented a rich, varied and deeply personal record of how front-line workers and individuals had been affected by the COVID-19 infodemic, and also by the pandemic itself. It was also possible to gain insights into some of the ways in which storytellers responded to the infodemic and had successfully used personal stories as part of this process. Simply hearing experiences from other contexts or past infodemics can help them to learn and better prepare for practicing IM in the next emergency. Skills in storytelling have helped infodemic managers feel more confident and offer them another tool in their armoury. The skill of storytelling helped front-line workers and infodemic managers to connect more effectively with colleagues and their community. It was felt that comparing different stories as well as drawing on a diversity of stories and contexts, would be the most useful for IM. Also telling stories across disciplines and among people who have different roles in IM could be powerful in increasing learning and understanding of the importance of different roles.
“ Those human stories can actually make the important health messaging seem credible, relatable and applicable in people’s contexts in a way that data is unable to reach them.” (Female workshop participant)
A key challenge is whether stories are seen as credible sources of evidence by decision makers and senior managers. This was linked to both the collection of stories for the purpose of understanding impact, but also using stories as a way of sharing experience and information. In some contexts, the media is viewed as entirely untrustworthy, and infodemic managers might need to be careful how stories are shared and what media is used to do so. It was widely agreed that in order to make a story-based approach useful efforts are needed to develop capacity, make time and put effort into making sure IM stories are collected in the right way.
In conclusion, the analysis has yielded valuable insights applicable to both the infodemic management community and broader health systems. The analysis findings, validated by practitioners, demonstrates the potency of storytelling as a tool for capturing qualitative evidence on the impact of the COVID-19 infodemic at personal, community and health systems levels. It can also be used to explore infodemic response, barriers and opportunities.
The methodology and approach employed in this analysis can be replicated by other members of the WHO infodemic management community to enhance their understanding of the COVID-19 infodemic’s effects. Additionally, the methodology can be adapted to other healthcare scenarios, such as health promotion campaigns for measles or seasonal influenza vaccination.
Engaging the community and frontline workers in a participatory manner can build trust and will generate robust evidence that deserves recognition. To integrate these insights into infodemic management practices and harness the potential of employing participatory, story-based approaches in the future, it is crucial to embrace them as part of the evaluationfeedback-planning process. The lessons derived from this feedback present opportunities for action, enabling critical reflection and improvement of program interventions and pandemic preparedness. Recommendations fall within the remit and capabilities of the infodemic management community and health authorities, as well as those individuals tasked with health emergency preparedness and response. They will need to be customized according to the specific circumstances in which they are to be implemented.