How misinformation, medical mistrust fuel vaccine hesitancy
More than two dozen experts discussed how to combat misinformation about COVID-19 and the vaccines at a virtual conference held Aug. 26.
Public trust in government agencies and health professionals; access to vaccines and treatments; and accurate, clear, nonjudgmental information about COVID-19 are key to counteracting misinformation about the disease.
Those were some of the takeaways from Infodemic: A Stanford Conference on Social Media and COVID-19 Misinformation, a virtual event that brought together experts in biomedical ethics, public health and medicine with representatives from social media companies, the faith community and government.
“Infodemics are often defined as too much information — an abundance, an overabundance, of good and bad,” said Heidi Larson, PhD, the founding director of the Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine. “But what is even more important than the sheer quantity of information is its dynamic, fast-moving and fast-changing nature — like epidemics, which spread quickly through populations. They are challenging when they are negative, but there is an opportunity that credible information and trusted voices can also have a viral nature.”
Stemming the tide of misinformation, or inaccurate information, and disinformation, or deliberately misleading information, is critical to increasing vaccination rates across the country, particularly in underserved communities. Black Americans are 1.4 times less likely than white Americans to be vaccinated.
Distrust in the Black community of medical professionals is long-standing, deep-seated and justified, said health equity expert Italo Brown, MD, clinical assistant professor of emergency medicine at Stanford.
“Black communities have a lasting and lingering distrust of health care, of health care providers, and of the systems and institutions that have supported it,” said Brown, citing centuries of abuse of Black Americans that began with the slave trade. “Currently, we still see elements of mistreatment in the medical system. We can’t continue to gaslight communities of color around this topic.” Reversing that mistrust will require conversations on restorative justice, partnerships with trusted messengers, and innovative and culturally sensitive ways to share accurate information about the virus.
“Our culture tends to be very viral,” said Brown, who is African American. “Oral tradition is as common to us as the sound a hot comb makes when you put it on a stove. When we learn about information, it’s often passed down a chain. But we struggle because that chain of information very seldom has fact checkers — people who we trust who can give us adequate information in languages with a sense of cultural competency and linguistic appropriateness tailored to the Black community.”
Lack of access
In many cases, the problem may be less about hesitancy to be vaccinated than about lack of access to vaccine sites and reliable information. “If you don’t have a regular doctor, you don’t have a trusted source in the medical field to resort to,” said Gloria Giraldo of Latino Health Access. “When some people have access to the medical system, and some do not, that underlies some of this distrust.”
Inequities in global vaccine distribution may also drive skepticism about the motives of vaccine makers and public health officials, Giraldo said, especially among immigrants worried about friends and family members in countries with inadequate vaccine supplies.
Giraldo challenged public health officials to “walk the talk” by focusing not just on vaccine-distribution efforts in underserved communities, but also by acting as partners with the community. “I do see an opportunity for our public health department and our health authorities to restore trust,” she said.
Other speakers emphasized the need to partner with local, trusted voices in the community, including religious leaders and community activists.
“Early in the pandemic, we were trying to figure out what was going on,” said Adrian Perkins, the mayor of Shreveport, Louisiana. “When we geolocated where our COVID-19 cases were, we could see high densities in African American neighborhoods, even though there were rumors that African Americans were immune.” Perkins mobilized leaders of the faith communities in Shreveport to encourage their congregations to follow Centers for Disease Control guidelines to prevent the spread of the virus. “Soon we saw a precipitous drop in cases across the city,” Perkins said.
“I have 52 weeks of the year where I speak to people,” said the Rev. Gabriel Salguero, president of the National Latino Evangelical Coalition. “We have a consistent audience who trusts us. We baptize their children, we marry, we bury. We should leverage that moral influence and platform.”
The politicization of the virus also hampers the spread of reliable information, Perkins said. “If the person putting out the information isn’t part of your political party, they don’t listen. But they will listen to their grandmother or their pastor.”
Other speakers discussed how best to counter false claims about the virus and the vaccine, as well as how to use social media platforms to share accurate information. Teaching people how to discern good information from bad will help them “make these choices out of a place of knowledge,” said infectious disease expert Jessica Malaty Rivera. Rivera, the science communication lead at the Covid Tracking Project for The Atlantic, is widely followed on Twitter.
“The anti-vaccine community and the misinformers are very savvy and have been able to use some of the resources that the science community has used for so long to demonstrate efficacy and safety, and they will manipulate them,” Rivera said. “Teaching people to be discerners of that truth is much more powerful than dumbing it down.”
“This is the result of a lack of investment in scientific communication at the federal level,” Rivera said. “Many of us are doing damage control on a constant hamster wheel.”
Rivera discussed the use of a persuasive technique called a “truth sandwich”: Repeat the portion of the misinformation that is true, refute what is incorrect and close with the truth. Grace and patience, rather than shaming, also play a role. “You may need to repeat 14 times — the vaccines are safe, the vaccines are effective — for someone to finally accept it,” she said. “Shame-based motivation to seek information sends you to the darkest part of the internet.”
The role of social media
Not all health care workers on social media are reliable sources, however. “We have to have accountability for medical professionals who distribute harmful information,” said Vin Gupta, MD, a pulmonary critical care physician at the University of Washington. At the same time, he said, it is important to encourage physicians and other health care workers to use social media to promote actionable content. “Much of academia doesn’t engage with social media in an effective way,” Gupta said. “We’re not taught how to do that.” Gupta emphasized the importance of telling stories and using pictures to convey powerful public health messages, like the image of an egg in a frying pan to represent the brain of a drug addict. “Make it less about you; cut through partisanship,” he said.
Representatives from Facebook, Twitter and Google described how their platforms aim to identify and reduce the impact of potentially harmful misinformation by labeling questionable posts, redirecting people to trusted websites, and making it difficult or impossible for others to amplify flagged content. Still, Perkins said, “I would want them to be a lot more aggressive. This virus is aggressive, and their approach should be the same.”
Bioethicist Arthur Kaplan, PhD, of the New York University Grossman School of Medicine, pointed out that, ideally, people would learn not to get their medical information from social media, which he likened to billboard companies renting out space to a variety of messengers with little regard for content. But he contended that the presence of misinformation on the internet might not be the primary driver of vaccine hesitancy. “People hunt facts to support their values,” Kaplan said. “It’s less a trigger than it is reinforcement. You have to realize you’re in a values fight.”
The conference was organized by associate professor of emergency medicine Michael Gisondi, MD, and undergraduate student Rachel Barber and sponsored by the Stanford Ethics, Society and Technology Hub; the Department of Emergency Medicine; and Stanford Introductory Seminars. A recording of the conference is available at https://www.youtube.com/watch?v=gYTt8pRB5d0.
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