Establishing Infodemic Management in Germany: A Framework for Social Listening and Integrated Analysis to Report Infodemic Insights at the National Public Health Institute

Social listening applied to tailor communication on immunization in the Republic of Moldova

Although the Republic of Moldova had good vaccination rates, anti-vax messages have recently begun to spread, eroding the population's confidence. Vaccination coverage against measles, mumps, and rubella at the target age of 12 months decreased from 95% in 2008 to 83% in 2021. The recent measles outbreak in Romania and three confirmed cases in Moldova, combined with the refugee crisis, have highlighted the importance of vaccination and sparked online conversations on this subject. A mixed-methods study was conducted, involving social listening activities on immunization using the Talkwalker software and qualitative analysis of the identified narratives. Out of 450 identified comments, 30 were selected for further analysis. Over 5 months, a total of 865 results were obtained, with an engagement rate of 6300. The peak in results occurred between 11 and 18 December, driven by the recent measles outbreak in Romania, which saw several confirmed cases and one death, as well as the first cases of measles in Moldova after 3 years. However, no significant increase in the engagement rate was recorded. Comments on immunization tended to reflect distrust in authorities and doctors, political and ideological views, and a lack of knowledge about the risks of vaccine-preventable diseases. The analysed conversations are assessed as having a low risk of spreading, though some employ techniques to influence or manipulate behaviours. The topic of vaccination is used to promote political ideologies through messages issued by the mass media. The information vacuum must be filled with messages designed to produce attitude change regarding vaccination.

Ethical Considerations in Infodemic Management: Systematic Scoping Review

BACKGROUND

During health emergencies, effective infodemic management has become a paramount challenge. A new era marked by a rapidly changing information ecosystem, combined with the widespread dissemination of misinformation and disinformation, has magnified the complexity of the issue. For infodemic management measures to be effective, acceptable, and trustworthy, a robust framework of ethical considerations is needed.

OBJECTIVE

This systematic scoping review aims to identify and analyze ethical considerations and procedural principles relevant to infodemic management, ultimately enhancing the effectiveness of these practices and increasing trust in stakeholders performing infodemic management practices with the goal of safeguarding public health.

METHODS

The review involved a comprehensive examination of the literature related to ethical considerations in infodemic management from 2002 to 2022, drawing from publications in PubMed, Scopus, and Web of Science. Policy documents and relevant material were included in the search strategy. Papers were screened against inclusion and exclusion criteria, and core thematic areas were systematically identified and categorized following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We analyzed the literature to identify substantive ethical principles that were crucial for guiding actions in the realms of infodemic management and social listening, as well as related procedural ethical principles. In this review, we consider ethical principles that are extensively deliberated upon in the literature, such as equity, justice, or respect for autonomy. However, we acknowledge the existence and relevance of procedural practices, which we also consider as ethical principles or practices that, when implemented, enhance the efficacy of infodemic management while ensuring the respect of substantive ethical principles.

RESULTS

Drawing from 103 publications, the review yielded several key findings related to ethical principles, approaches, and guidelines for practice in the context of infodemic management. Community engagement, empowerment through education, and inclusivity emerged as procedural principles and practices that enhance the quality and effectiveness of communication and social listening efforts, fostering trust, a key emerging theme and crucial ethical principle. The review also emphasized the significance of transparency, privacy, and cybersecurity in data collection.

CONCLUSIONS

This review underscores the pivotal role of ethics in bolstering the efficacy of infodemic management. From the analyzed body of literature, it becomes evident that ethical considerations serve as essential instruments for cultivating trust and credibility while also facilitating the medium-term and long-term viability of infodemic management approaches.

Beyond misinformation: developing a public health prevention framework for managing information ecosystems

The COVID-19 pandemic has highlighted how infodemics (defined as an overabundance of information, including misinformation and disinformation) pose a threat to public health and could hinder individuals from making informed health decisions. Although public health authorities and other stakeholders have implemented measures for managing infodemics, existing frameworks for infodemic management have been primarily focused on responding to acute health emergencies rather than integrated in routine service delivery. We review the evidence and propose a framework for infodemic management that encompasses upstream strategies and provides guidance on identifying different interventions, informed by the four levels of prevention in public health: primary, secondary, tertiary, and primordial prevention. On the basis of a narrative review of 54 documents (peer-reviewed and grey literature published from 1961 to 2023), we present examples of interventions that belong to each level of prevention. Adopting this framework requires proactive prevention and response through managing information ecosystems, beyond reacting to misinformation or disinformation.

A practical agenda for incorporating trust into pandemic preparedness and response

Despite widespread acknowledgement that trust is important in a pandemic, few concrete proposals exist on how to incorporate trust into preparing for the next health crisis. One reason is that building trust is rightly perceived as slow and challenging. Although trust in public institutions and one another is essential in preparing for a pandemic, countries should plan for the possibility that efforts to instil or restore trust may fail. Incorporating trust into pandemic preparedness means acknowledging that polarization, partisanship and misinformation may persist and engaging with communities as they currently are, not as we would wish them to be. This paper presents a practical policy agenda for incorporating mistrust as a risk factor in pandemic preparedness and response planning. We propose two sets of evidence-based strategies: (i) strategies for ensuring the trust that already exists in a community is sustained during a crisis, such as mitigating pandemic fatigue by health interventions and honest and transparent sense-making communication; and (ii) strategies for promoting cooperation in communities where people mistrust their governments and neighbours, sometimes for legitimate, historical reasons. Where there is mistrust, pandemic preparedness and responses must rely less on coercion and more on tailoring local policies and building partnerships with community institutions and leaders to help people overcome difficulties they encounter in cooperating with public health guidance. The regular monitoring of interpersonal and government trust at national and local levels is a way of enabling this context-specific pandemic preparedness and response planning.

The role of the (in)accessibility of social media data for infodemic management: a public health perspective on the situation in the European Union in March 2024

Public health institutions rely on the access to social media data to better understand the dynamics and impact of infodemics - an overabundance of information during a disease outbreak, potentially including mis-and disinformation. The scope of the COVID-19 infodemic has led to growing concern in the public health community. The spread of harmful information or information voids may negatively impact public health. In this context, social media are of particular relevance as an integral part of our society, where much information is consumed. In this perspective paper, we discuss the current state of (in)accessibility of social media data of the main platforms in the European Union. The European Union's relatively new Digital Services Act introduces the obligation for platforms to provide data access to a wide range of researchers, likely including researchers at public health institutions without formal academic affiliation. We examined eight platforms (Facebook, Instagram, LinkedIn, Pinterest, Snapchat, TikTok, X, YouTube) affected by the new legislation in regard to data accessibility. We found that all platforms apart from TikTok offer data access through the Digital Services Act. Potentially, this presents a fundamentally new situation for research, as before the Digital Services Act, few platforms granted data access or only to very selective groups of researchers. The access regime under the Digital Services Act is, however, still evolving. Specifics such as the application procedure for researcher access are still being worked out and results can be expected in spring 2024. The impact of the Digital Services Act on research will therefore only become fully apparent in the future.

Management of infodemics in outbreaks or health crises: a systematic review

Introduction

The World Health Organization (WHO) defined an infodemic as an overabundance of information, accurate or not, in the digital and physical space, accompanying an acute health event such as an outbreak or epidemic. It can impact people's risk perceptions, trust, and confidence in the health system, and health workers. As an immediate response, the WHO developed the infodemic management (IM) frameworks, research agenda, intervention frameworks, competencies, and processes for reference by health authorities.

Objective

This systematic review explored the response to and during acute health events by health authorities and other organizations operating in health. It also assessed the effectiveness of the current interventions.

Methods

On 26 June 2023, an online database search included Medline (Ovid), Embase, Cochrane Library, Scopus, Epistemonikos, and the WHO website. It included English-only, peer-reviewed studies or reports covering IM processes applied by health organizations that reported their effectiveness. There was no restriction on publication dates. Two independent reviewers conducted all screening, inclusion, and quality assessments, and a third reviewer arbitrated any disagreement between the two reviewers.

Results

Reviewers identified 945 records. After a final assessment, 29 studies were included in the review and were published between 2021 and 2023. Some countries (Pakistan, Yemen, Spain, Italy, Hong Kong, Japan, South Korea, Singapore, United Kingdom, United States, New Zealand, Finland, South Korea, and Russia) applied different methods of IM to people's behaviors. These included but were not limited to launching media and TV conservations, using web and scientific database searches, posting science-based COVID-19 information, implementing online surveys, and creating an innovative ecosystem of digital tools, and an Early AI-supported response with Social Listening (EARS) platform. Most of the interventions were effective in containing the harmful effects of COVID-19 infodemic. However, the quality of the evidence was not robust.

Discussion

Most of the infodemic interventions applied during COVID-19 fall within the recommended actions of the WHO IM ecosystem. As a result, the study suggests that more research is needed into the challenges facing health systems in different operational environments and country contexts in relation to designing, implementing, and evaluating IM interventions, strategies, policies, and systems.

Misinformation on resuscitation and first aid as an uncontrolled problem that demands close attention: a brief scoping review

OBJECTIVES

Misinformation is currently recognised by the World Health Organization as an apparent threat to public health. This study aimed to provide an outline of published evidence on misinformation related to the potentially life-saving interventions - first aid and cardiopulmonary resuscitation (CPR).

STUDY DESIGN

A scoping review.

METHODS

The review was conducted in accordance with the PRISMA Extension for Scoping Reviews. English-language publications describing original studies that evaluated the quality of publicly available information on first aid and/or CPR were included without limitations to the year of publication.

RESULTS

Forty-four original studies published between 1982 and 2023 were reviewed. Annual number of publications varied from 0 to 6. The studies have focused on the evaluation of information concerning initial care of cardiac arrest, choking, heart attack, poisoning, burns, and other emergencies. Forty three studies (97.7 %) have reported varying frequencies of misinformation, when public sources, including websites, YouTube videos, and modern artificial intelligence-based chatbots, omitted life-saving instructions on first aid or CPR or contained incorrect information that contradicted relevant international guidelines. Eleven studies (25.0 %) have also revealed potentially harmful advice, which, if followed by an unsuspecting person, may cause direct injury or death of a victim.

CONCLUSIONS

Misinformation concerning CPR and first aid cannot be ignored and demands close attention from relevant stakeholders to mitigate its harmful impacts. More studies are urgently needed to determine optimal methods for detecting and measuring misinformation, to understand mechanisms that drive its spread, and to develop effective measures to correct and prevent misinformation.

Informing social media analysis for public health: a cross-sectional survey of professionals

BACKGROUND

During the COVID-19 pandemic, the field of infodemic management has grown in response to urgent global need. Social listening is the first step in managing the infodemic, and many organizations and health systems have implemented processes. Social media analysis tools have traditionally been developed for commercial purposes, rather than public health, and little is known of the experiences and needs of those professionals using them for infodemic management.

METHODS

We developed a cross sectional survey and distributed through global infodemic management networks between December 2022 and February 2023. Questions were structured over four sections related to work-practice and user needs and did not collect any personal details from participants. Descriptive analysis was conducted on the study results. Qualitative analysis was used to categorise and understand answers to open-text questions.

RESULTS

There were 417 participants, 162/417 who completed all survey questions, and 255/417 who completed some, all responses are included in analysis. Respondents came from all global regions and a variety of workplaces. Participants had an average of 4.4 years' experience in the analysis of social media for public health. COVID-19 was the most common health issue people had conducted social media analysis for. Results reveal a range of training, technical capacity, and support needs.

CONCLUSIONS

This paper is the first we are aware of to seek and describe the needs of those using social media analysis platforms for public health purposes since the start of the COVID-19 pandemic. There are key areas for future work and research, including addressing the training, capacity building and leadership needs of those working in this space, and the need to facilitate easier access to better platforms for performing social media analysis.

Effective Infodemic Management: A Substantive Article of the Pandemic Accord

Social media has proven to be valuable for disseminating public health information during pandemics. However, the circulation of misinformation through social media during public health emergencies, such as the SARS (severe acute respiratory syndrome), Ebola, and COVID-19 pandemics, has seriously hampered effective responses, leading to negative consequences. Intentionally misleading and deceptive fake news aims to harm organizations and individuals. To effectively respond to misinformation, governments should strengthen the management of an "infodemic," which involves monitoring the impact of infodemics through social listening, detecting signals of infodemic spread, mitigating the harmful effects of infodemics, and strengthening the resilience of individuals and communities. The global spread of misinformation requires multisectoral collaboration, such as researchers identifying leading sources of misinformation and superspreaders, media agencies identifying and debunking misinformation, technology platforms reducing the distribution of false or misleading posts and guiding users to health information from credible sources, and governments disseminating clear public health information in partnership with trusted messengers. Additionally, fact-checking has room for improvement through the use of automated checks. Collaboration between governments and fact-checking agencies should also be strengthened via effective and timely debunking mechanisms. Though the Intergovernmental Negotiating Body (INB) has yet to define the term "infodemic," Article 18 of the INB Bureau's text, developed for the Pandemic Accord, encompasses a range of actions aimed at enhancing infodemic management. The INB Bureau continues to facilitate evidence-informed discussion for an implementable article on infodemic management.