”But we’re not just fighting an epidemic; we’re fighting an infodemic. Fake news spreads faster and more easily than this virus, and is just as dangerous.” WHO Director-General, Dr Tedros Adhanom Ghebreyesus, Munich 15 February 2020

Vaccine hesitancy fueled by the spread of mis- and disinformation online has led many countries to struggle vaccinating sufficient parts of their population against COVID-19. The ECCMID 2021 seminar “Ethics and conspiracy regarding vaccines” focused on the issue of the current infodemic and approaches for managing it. This is the final part of a series summarizing three topical questions answered in the seminar. Previously, topics such as WHO and social media have been covered in Question #1: What is an infodemic and how is the WHO fighting it? and Question #2 Who and what are the drivers behind the success of the anti-vaccine rhetoric?

Hva er situasjonen i Norge? 

Før vi går videre, så ønsker vi å presisere at i Norge er det liten vaksineskepsis i forhold til i mange andre europeiske land. Vi har i Norge høy vaksinasjonsgrad av koronavaksinering og man ser også at vaksinedekningen i barnevaksinasjonsprogrammet har vært godt over 90% i løpet av koronapandemien. Dette viser tallene fra SYSVAK i 2019 og 2020. Vi har likevel valgt å ta med innholdet fra foredraget på ECCMID, da dette temaet er en av de 10 største utfordringene til WHO.

Question #3: Infoveillance, censorship and behavioral manipulation — what are the ethical implications of infodemic management approaches?

Nikola Biller-Andorno explained how the most effective approaches in infodemic management may also be the most controversial ones in her presentation “Antivax in social media: an ethical analysis”. 

Approaches for infodemic management include social listening, censorship of misinformation, behavioural manipulation, and encouraging critical thinking and public engagement in health-related discourse. Each of these approaches has their place in tackling the spread of mis- and disinformation, but their ethical implications need to be carefully evaluated, and their use justified.

These infodemic interventions may be classified as either “top-down” or “resilience oriented” solutions, with the top-down solutions including harsher measures such as social listening, censorship, and behavioural manipulation. From an ethical viewpoint, the use of top-down approaches requires sufficient justification (e.g., substantial threat to public health), as well as establishment of a clear ethical framework and limits in order to not infringe upon individuals’ fundamental rights.

Resilience oriented solutions are focused on preventing and managing misinformation in the future. These include reshaping social media spaces to avoid filter bubbles, fostering the critical thinking and digital literacy skills of the general public, and encouraging open public engagement in health-related discourse. In current social media spaces, it is easy for people to create their own private communities and exclude themselves from public discussion, subsequently avoiding seeing opposing opinions. Resilience oriented solutions may be questioned for their effectiveness in the present moment: can we afford to not take stronger action to secure public health at the moment?

Each of these solutions has their time and place in the management of the infodemic. Top-down approaches may be considered necessary in the short term. In the medium term, the focus should be directed to how health organisations communicate: more effective communication strategies could include increased use of emotional language as well as recruiting pro-vaccine influencers. Additionally, social media spaces should be augmented to avoid filter bubbles and social polarisation. Resilience oriented approaches are most suitable for the long term as a means of preventing future infodemics by building resistance to misinformation at the societal level. Encouragement and opportunities for open public health discussion should be provided. One opportunity for this is PubliCo (https://publico.community/), an online platform created to help people engage with pandemic discussion.

As many countries struggle to vaccinate large parts of their populations due to vaccine hesitancy, anti-vax campaigns may be considered a real threat to public health, and thus warrant action by authorities. All action, however, needs to be ethically evaluated, with top-down approaches subjected to special scrutiny. Care should be taken to avoid entering a “cyber-race of most effective manipulation” in looking to influence people’s behaviour, and instead other solutions should be sought with a focus on long-term approaches.

ECCMID 2021 references:

Antivax in social media: an ethical analysis. Nikola Biller-Andorno (Zurich, Switzerland). Presented online at ECCMID 2021 on 10  July 2021. 

Additional references:

Folkehelseinstituttet, Barnevaksinasjonsprogrammet i Norge - rapport 2019 og 2020 (fhi.no), rapport 2021.
Folkehelseintituttet, Koronavaksinasjons-statistikk - FHI, oppdatert 5.10.2021, lest 06.10.2021