The creation of the Internet and the evolution of the digital age transformed the communication landscape, generating unprecedented opportunities to quickly and easily seek and share information—including that related to health. In 2013, Pew Research Center found that nearly two-thirds (59%) of US adults sought health information online in the past year.1 More recent research indicates that number is now closer to 75%.2 With more than 1 billion health-related searches occurring on Google every day,3 it is clear that people are increasingly turning to the Internet for answers about their health. These trends have enabled the field of public health, including local health departments (LHDs), to expand their reach at a time when shrinking budgets and workforce attrition threaten capacity to engage communities.4 While digital channels are valuable mechanisms for LHDs to communicate accurate health information and guidance to the public, they have recently become gateways for the rapid spread of mis- and disinformation.
The Cost of Misinformation: Burdening the Public Health System
Misinformation is defined by the inadvertent spread of misleading and false information, whereas disinformation reflects the deliberate and coordinated spread of misleading and false information.5 Misinformation proliferates partly because people are more likely to accept advice and information from friends, family, and people they feel their community trusts. For example, the Media Insight Project found that “people who see an article from an unknown trusted sharer, but one written by an unknown media source, have much more trust in the information than people who see the same article from a reputable media source shared by a person they do not trust.”6 Alternatively, disinformation campaigns are more strategic and play on public mistrust of government and authority.7 Both have created obstacles for public health professionals seeking to provide health education and services to communities. In fact, the ramifications of inaccurate or false information can be very resource-intensive, placing a strain on health departments.
Consider the nationwide measles outbreak in 2019, in which the United States experienced the largest number of reported measles cases (n = 1282) since 1992.8 While a couple of main factors contributed—including importation through international travel and low pockets of vaccination—the US Centers for Disease Control and Prevention specifically noted that misinformation also played a role.9 Spurred by a 1998 study that falsely claimed a link between vaccines and autism,10 misinformation about vaccines has continued to spread over the last 2 decades, although the study was debunked and retracted. Despite the anti-vaccine community representing a very small minority—the median vaccine refusal rate among US families with children in kindergarten is just 2.2%11—it perpetuates false information with an extensive reach.
More than two-thirds of anti-vaccine Web sites represent information as “scientific evidence” to support the idea that vaccines are dangerous, and nearly one-third use anecdotes to reinforce that perception.12 Furthermore, bots—automated social media accounts that use artificial intelligence to mimic the appearance and manner of a human user to promote specific narratives—are being used to amplify anti-vaccine views.13 By targeting certain groups—including parents of children with autism spectrum disorder, grieving mothers who have lost children, immigrant communities, and religious groups—anti-vaccine proponents have sowed skepticism about the safety of vaccinations. Not only does this skepticism put people's health at risk but it also carries a hefty cost.
Recent research shows that the cost of a measles outbreak ranges from $9862 to $1 063 936, and the median cost per case is $32 805.14 In 2013, the New York City Department of Health and Mental Hygiene's response to a measles outbreak cost an estimated $395 000, which supported more than 10 000 hours of staff time along with other costs (eg, advertising, vaccine, laboratory supplies).15 In 2019, Clark County Public Health spent nearly $865 000 responding to a measles outbreak.16 These estimates demonstrate just how burdensome a disease outbreak—and the misinformation that contributes to the spread of disease—can be on the public health system. While mis- and disinformation pose threats to health communications, there are ways to combat their effects.
Combatting Misinformation and Disinformation
Among the 80% of people who seek health information online, some lack the ability to discern the validity of information that they view.17 Epidemiologists have compared online information spread as working similar to infection transmission, so an educated public is key to reducing the spread of disease.5 By partnering with existing coalitions and advocacy groups to distribute literacy information and programs, LHDs can post information or launch campaigns that prepare the public to identify evidence-based research results, recognize signs of mis- and disinformation, and engage in effective fact-checking. Working to increase media and health literacy can help people successfully sort through information from multiple sources and identify mis- and disinformation.
Local health departments should also establish and maintain relationships with verified local media outlets, which are more trusted than national outlets18 and can assist in disseminating accurate information to the public. Such partnership allows for the public to obtain information from reliable sources, which they can then share with the certainty that the information is accurate. This also helps increase the amount of legitimate information available through online formats.
Finally, LHDs should routinely engage with audiences on digital and social channels. By frequently posting timely, reliable, and transparent information to social media, LHDs can provide the public with situational awareness, dispel rumors, and establish themselves as the media's first point of contact for health information. Over time, consistent communication on these platforms will position the LHD as a trustworthy source and build an audience that can further disseminate trusted information from public health agencies.
Digital communications channels are here to stay, so ongoing efforts to address mis- and disinformation are critical. While research into this issue continues, practical actions—such building trust with communities, actively publishing and sharing verified information, and increasing media and health literacy—can help mitigate current challenges. Until more ways to combat mis- and disinformation are finalized, LHDs and public health professionals can fight this battle one verified post and share at a time.
1. Fox S, Duggan M. Health online 2013. Pew Research Center Web site. https://www.pewresearch.org/internet/2013/01/15/health-online-2013/
. Published January 15, 2013. Accessed February 10, 2020.
2. Weber Shandwick. The great American search for healthcare information. https://www.webershandwick.com/wp-content/uploads/2018/11/Healthcare-Info-Search-Report.pdf
. Published 2018. Acce-ssed February 10, 2020.
3. Murphy M. Dr Google will see you now: search giant wants to cash in on your medical queries. The Telegraph. https://www.telegraph.co.uk/technology/2019/03/10/google-sifting-one-billion-health-questions-day/
. Published March 10, 2019. Accessed February 10, 2020.
4. Johnson SR. Report: public health funding falls despite increasing threats. Modern Healthcare. https://www.modernhealthcare.com/government/report-public-health-funding-falls-despite-increasing-threats
. Published April 24, 2019. Accessed February 11, 2020.
5. Felten C, Nelson A. Countering misinformation with lessons from public health. New Perspect Foreign Policy. 2019;(18). https://www.csis.org/countering-misinformation-lessons-public-health
. Accessed February 10, 2020.
6. Media Insight Project. “Who shared it?”: how Americans decide what news to trust on social media. https://www.americanpressinstitute.org/publications/reports/survey-research/trust-social-media
. Published March 20, 2017. Accessed February 10, 2020.
7. Benkler Y. Cautionary notes on disinformation and the origins of distrust. MediaWell. https://mediawell.ssrc.org/expert-reflections/cautionary-notes-on-disinformation-benkler
. Published October 29, 2019. Accessed February 10, 2020.
8. Centers for Disease Control and Prevention. Measles cases and outbreaks. https://www.cdc.gov/measles/cases-outbreaks.html
. Published February 3, 2020. Accessed February 10, 2020.
9. Centers for Disease Control and Prevention. CDC media statement: measles cases in the U.S. are highest since measles was eliminated in 2000 [press release]. https://www.cdc.gov/media/releases/2019/s0424-highest-measles-cases-since-elimination.html
. Published April 25, 2019. Accessed February 11, 2020.
10. Belluz J. Research fraud catalyzed the anti-vaccination movement. Let's not repeat history. Vox. https://www.vox.com/2018/2/27/17057990/andrew-wakefield-vaccines-autism-study
. Published March 5, 2019. Accessed February 10, 2020.
11. Poon L. How mandatory vaccination fueled the anti-vaxxer movement. CityLab. https://www.citylab.com/life/2019/04/anti-vaxxer-history-new-york-measles-mandatory-vaccination/586969
. Published April 24, 2019. Accessed February 10, 2020.
12. Johns Hopkins University Bloomberg School of Public Health. Anti-vaccination websites use “science” and stories to support claims, study finds: anti-vaccine positions are frequently embedded with information about positive behaviors like eating healthy, breastfeeding. ScienceDaily. http://www.sciencedaily.com/releases/2015/11/151103134800.htm
. Published November 24, 2015. Accessed February 14, 2020.
13. Broniatowski DA, Jamison AM, Qi S, et al Weaponized health communication: Twitter bots and Russian trolls amplify the vaccine debate. Am J Public Health. 2018;108(10):1378–1384.
14. Pike J, Leidner AJ, Gastañaduy PA. A review of measles outbreak cost estimates from the US in the post-elimination era (2004-2017): estimates by perspective and cost type published online ahead of print January 22, 2020. Clin Infect Dis. doi:10.1093/cid/ciaa070.
15. Schnirring L. Study shows high price tag for measles outbreak response. Center for Infectious Disease and Research Policy Web site. http://www.cidrap.umn.edu/news-perspective/2018/07/study-shows-high-price-tag-measles-outbreak-response
. Published July 30, 2018. Accessed February 10, 2020.
16. Clark County Public Health. Measles outbreak. https://www.clark.wa.gov/public-health/measles-investigation
. Published April 29, 2019. Accessed February 10, 2020.
17. Igoe KJ. Establishing the truth: vaccines, social media, and the spread of misinformation. Harvard T.H. Chan School of Public Health Web site. https://www.hsph.harvard.edu/ecpe/vaccines-social-media-spread-misinformation
. Published July 10, 2019. Accessed February 10, 2020.
18. Sands J. Local news is more trusted than national news—but that could change. Knight Foundation Web site. https://knightfoundation.org/articles/local-news-is-more-trusted-than-national-news-but-that-could-change
. Published October 29, 2019. Accessed February 10, 2020.