Readers Write: Public Health Agencies Share the Blame for COVID-19 Misinformation

Public Health Agencies Share the Blame for COVID-19 Misinformation
By Peter Bonis, MD

Peter Bonis, MD is chief medical officer of Wolters Kluwer Health.

Surgeon General Vivek Murthy, MD, MPH asked big tech companies to provide data related to COVID-19 misinformation and issued an advisory on confronting health misinformation, reflecting the vital importance trustworthy health information plays in public health. The consequences of misinformation can be deadly to individuals and, tragically, to entire populations, as we have witnessed during the pandemic.

The surgeon general’s approach is, however, unlikely to achieve a meaningful impact on online health misinformation even if big tech companies comply with his request. The impact of misinformation is rooted in the trust that people place in it over alternatives.

The public has good reason to be mistrustful of official sources of information, making our nation’s health agencies partially culpable for the misinformation problem we face today. During the pandemic, we received conflicting guidance that changed frequently, didn’t satisfy our information needs, and was politicized. No “official” source of information has earned unalloyed trust, a role the CDC should own.

Well-intentioned spokespeople delivered inconsistent messages and disagreed in public forums, sometimes acrimoniously, leaving us with serious doubts about what to believe. At the same time, we have been terrified by the uncertainty and bewildered that the agencies charged with protecting us did not have the equipment, distribution systems, regulatory processes, and other operational mechanisms that we’d expect.

These factors contributed to making us less than confident in official sources of information and hence receptive to misinformation. Thus, the issue is bigger than addressing misinformation, it is a matter of restoring trust in our public health system and the policies and recommendations it delivers.

Fortunately, the White House just appointed Ashish Jha, MD, MPH as the new face of the federal coronavirus response. He will be instrumental in coordinating the response across federal agencies. It’s critical that Dr. Jha and Dr. Murthy collaborate, as misinformation and the coordinated federal response are intertwined. 

The Senate Health Education Labor and Pensions (HELP) committee is also addressing the topic. It is working on the PREVENT Pandemics Act, bipartisan legislation aimed at improving coordination between public health agencies. One component of the proposed legislation will require a senate-confirmed CDC director, a recognition that the public has lost faith in the CDC.

Now to a possible solution that Drs. Jha, Murthy and the HELP committee might consider. We can help tackle misinformation, fortify our public health system, restore the CDC’s reputation, and be better prepared for the next pandemic, all with the same set of actions. The best way to reduce the impact of misinformation is to create a preferred and trusted alternative.

The creation, maintenance, and dissemination of reliable health information are complex. I have spent the last 20 years helping to create and oversee UpToDate, one of the most rigorously vetted sources of medical information that millions of healthcare professionals worldwide rely on every day. From my vantage point, it’s clear where and how public health agencies are falling short and what solutions are needed. The CDC needs support to better tackle the curation and dissemination of information for healthcare professionals, policymakers, and the public. 

Curation involves identification of relevant clinical and policy questions, use of relevant data, and expert peer-review with stakeholders. Questions must be addressed directly, even when information is incomplete or evolving. It should include relevant perspectives, incorporate feedback, and be updated continuously. Controversies should be addressed, the evidence should be transparent, and recommendations that reflect the strength of convictions should be explicit.

Dissemination involves having clear communication approaches across multiple reading abilities, languages, and user types; intuitive user experiences tailored for healthcare professionals, policymakers, and the public; and a content platform that is easy for search engines to index. Major public health announcements should be published and disseminated with coordinated efforts across public health agencies, media, and social media. Officials speaking on behalf of public health agencies should confidently refer to the guidance, distinguishing extemporaneous comments and reflections from consensus opinion.

Applying these principles to develop a trustworthy clinical information service will reduce the impact of misinformation. Search engine and social media algorithms (and policies) will point to and prioritize such guidance. The public would still be free to pursue alternative points of view, but they could be compared against a trusted reference standard while fringe, conspiracy and unscientific information could be more easily de-prioritized—or dismissed.