Learning from the impact of misinformation and past infodemics: advancing public health through transparency, trust, and community engagement

In their recent analysis in The Lancet Infectious Diseases, Sabrina Jin and colleagues performed a narrative review of secondary historical sources to evaluate past infodemics of misinformation, including smallpox, cholera, 1918 influenza, and HIV [1]. This historical review effectively highlights how sociopolitical issues create a fertile breeding ground for mistrust and the exacerbation of vulnerabilities, which, when paired with delay in scientific consensus and rapid flow of information via the media, can lead to public health misinformation integration with significant consequences. Currently, we are reminded of another example of the insidious impact of misinformation as measles cases reach staggering levels globally [2]. As of 2023, the World Health Organisation (WHO) reports that global measles cases have increased 18% since 2022. Globally, deaths have increased 43% since 2021, primarily among children, despite the availability of a safe and effective MMR vaccine [2]. The publication of Andrew Wakefield’s flawed study on the link between the measles, mumps, and rubella (MMR) vaccine and the development of autism is a stunning example of the far-reaching effects of misinformation and has been directly implicated in rising measles rates and vaccine hesitancy. Four years after its publication, the Wakefield study was highlighted in a British Broadcasting Company (BBC) special that questioned the safety of the MMR vaccine. Studies analysing the impact of media dissemination of the Wakefield study findings demonstrate that the public’s understanding of the MMR vaccine was established in only one month, during significant media scrutiny [3]. While studies demonstrate that the public retained key themes that were reiterated during this period (e.g. vaccines cause autism), nuanced information was lost [3]. Furthermore, the news media has been cited as a primary source of vaccine information for parents [3]. During the early 2000s, the MMR vaccine’s perceived safety increased when media coverage decreased, followed by decreases when media coverage increased [3]. This spread of misinformation is supported by the accessibility and dissemination potential of social media, as well as complex political climates and psychological factors and beliefs such as “purity” and “liberty” [4]. Today, MMR vaccine misinformation rages on despite the retraction of the Wakefield study and the culmination of significant evidence that the MMR vaccine is not associated with autism and the retraction of the original study.

To combat public health misinformation, it is crucial to adopt the recommendations from Jin et al. which emphasise enhancing science communication approaches and including community members in research activities to improve the robustness of research and trust [1]. Furthermore, implementing additional strategies to amplify transparency and trust is highly advisable. Key to these additional strategies is the promotion of open science as a standard practice. By making the research process more transparent - such as open reporting of methods, data, code, and analyses – and enhancing reproducibility and accuracy through open reviews before research as well as replication and reuse of data after initial research, we can directly confront public health misinformation and infodemics [5]. While some transparency practices such as conflict of interest and funding disclosures achieve rates of 80% or higher, others essential to open science – such as code sharing, data sharing, and pre-registration of research – are observed in less than 10% of infectious diseases research publications, highlighting the significant need for open science to support trust in public health information in this area [6]. Furthermore, the 'Scientific Integrity Task Force Report’ released by the White House Office of Science & Technology Policy supports the principles of open science, emphasising the critical role of such principles in enhancing the reliability, accessibility, and trustworthiness of scientific information [7].

Building on the premise of transparency, it is crucial to also enhance public health information trust through community engagement. Beyond the community collaborative research approaches highlighted by Jin et al. engaging community-based organisations and local leaders in other activities can significantly propel trust and public health outcomes [1]. Following the WHO’s guidelines on community engagement for COVID-19 vaccination as a model, one can observe how leveraging the influence of local leaders and organisations can promote the acceptance and success of public health information and activities [8]. Community mobilisers, including faith-based organisations and local health workers, are essential in connecting with local community members, coordinating local efforts, and developing effective, culturally sensitive health information and interventions [8]. These community-centered strategies, substantiated by systematic reviews, are fundamental to increasing trust and optimising public health outcomes [9].

By emphasising both science transparency and comprehensive community engagement, we can address the dual challenges of misinformation and the erosion of public trust, crucial for mitigating the impact of infodemics and enhancing public health responses.

Disclosure statement

No potential conflict of interest was reported by the authors.