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Infodemics and Infodemiology: a Short History, a Long Future 01 Pan American Journal Opinion and analysis of Public Health 02 03 04 05 06 Infodemics and infodemiology: a short history, 07 08 a long future 09 10 11 1 Chris Zielinski 12 13 14 15 Suggested citation Zielinski C. Infodemics and infodemiology: a short history, a long future. Rev Panam Salud Publica. 2021;45:e40. 16 https://doi.org/10.26633/RPSP.2021.40 17 18 19 20 ABSTRACT An “infodemic” is defined as “an overabundance of information – some accurate and some not – occurring 21 during an epidemic”. This paper describes the characteristics of an infodemic, which combines an inordi- 22 nately high volume of information (leading to problems relating to locating the information, storage capacity, 23 ensuring quality, visibility and validity) and rapid output (making it hard to assess its value, manage the gate- 24 keeping process, apply results, track its history, and leading to a waste of effort). This is bound up with the 25 collateral growth of misinformation, disinformation and malinformation. Solutions to the problems posed by an infodemic will be sought in improved technology and changed social and regulatory frameworks. One solution 26 could be a new trusted top-level domain for health information. The World Health Organization has so far made 27 two unsuccessful attempts to create such a domain, but it is suggested this could be attempted again, in the 28 light of the COVID-19 infodemic experience. The vital role of reliable information in public health should also be 29 explicitly recognized in the Sustainable Development Goals, with explicit targets. All countries should develop 30 knowledge preparedness plans for future emergencies. 31 32 33 Keywords Coronavirus infections; SARS virus; health communication; pandemics; health information management. 34 35 36 37 With the arrival of the COVID-19 pandemic, the output It soon became difficult, if not impossible to separate the 38 of information about this new global health threat began important from the mundane, the original from the repetition, 39 to grow at an exponential rate. According to Evidence Aid and – most worryingly – the true from the false. Indeed, the 40 Chairman Professor Mike Clarke “Since the pandemic miscommunications aspects of the pandemic soon began to 41 broke, over 75 000 scientific papers have been published appear like extended symptoms of the disease the communica- 42 on COVID-19 across the world and a new one is appearing tions were describing. 43 every three minutes in November [2020].” (1) Moreover, “an As a contribution to an understanding of the broader role of 44 extraordinary number of COVID-19 trials have been regis- information in health development, this paper describes the 45 tered since the pandemic started. The National Library of principal antecedents in this new field, outlines its components, 46 Medicine registry ClinicalTrials.gov lists 1087 COVID-19 and considers some possible solutions and next steps. 47 studies…” (2). 48 Not only was the volume of information growing rapidly, DEFINITIONS 49 but the speed at which new information was appearing unlike 50 anything seen before. “Preprint postings in MedRxiv have Health information met the Internet long before the term 51 increased over 400% (from 586 for the last 15 weeks of 2019 to “infodemiology” appears in the literature (4-6).Altogether, 52 2572 for the first 15 weeks of 2020), while views and downloads PubMed contains 16 314 mentions of the “World Wide Web” 53 have increased 100-fold.”(3) or “Internet” in biomedical literature before December 2002. 54 55 56 1 University of Winchester, Winchester, United Kingdom * chris@chrisziel 57 inski.com 58 59 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 IGO License, which permits use, distribution, and reproduction in any medium, provided the 60 original work is properly cited. No modifications or commercial use of this article are permitted. In any reproduction of this article there should not be any suggestion that PAHO or this article endorse any specific organization or products. The use of the PAHO logo is not permitted. This notice should be preserved along with the article’s original URL.Open access logo and text by PLoS, under the Creative Commons Attribution-Share Alike 3.0 N61 Unported license. Rev Panam Salud Publica 45, 2021 | www.paho.org/journal | https://doi.org/10.26633/RPSP.2021.40 1 Opinion and analysis Zielinski • Infodemics and infodemiology Of these, 7 121 also used the term “information”, and 34 the in the ivory towers of academe, generating papers and theories, term “epidemic”. So there had been numerous internet-based while both epidemics and infodemics are events that require applications to both health and information before this research combat in the real world of public health. activity was named. Infodemic management is the practice of managing these Prof. Gunther Eysenbach is credited as having coined the information events with the aim of ensuring that everyone term "infodemiology" in 2002 (7). His original definition was has access to the right health expert advice at the right time to “the study of the determinants and distribution of health infor- be able to take appropriate action. This entails social listening mation and misinformation—which may be useful in guiding (“infoveillance”) throughout a communication ecosystem and health professionals and patients to quality health information stakeholder engagement both online and offline. Because this is on the Internet. Information epidemiology, or infodemiology, an emerging field, it will continue to evolve and possibly quite identifies areas where there is a knowledge translation gap rapidly, especially given current “selection pressures”. between best evidence (what some experts know) and practice The field addressed by infodemiology has changed (and (what most people do), as well as markers for ‘high-quality’ expanded) significantly over the last two decades. Rather than information.” Later, he modified this definition to “the science attempt a description of the field, however, here we will focus of distribution and determinants of information in an electronic on an analysis of the characteristics of an infodemic. medium, specifically the Internet, with the ultimate aim to inform public health and public policy.” (8) CHARACTERISTICS OF AN INFODEMIC Both of Eysenbach’s definitions suggest information could be studied like a disease, that a cadre of infodemiologists would Using the WHO definitions, we can reduce the primary arise to supplement the epidemiologists. Since most epidemiol- characteristics of an infodemic to 1) the volume of information ogists are medical statisticians by training and spend their time generated, and 2) the velocity with which it appears. The most gathering and analysing statistics, the implications of the name significant of the secondary characteristics of an infodemic are was that this kind of academic approach could be applied to various forms of wrong information. infodemiology. It may be asked if volume and velocity are both necessary In a further paper (9), Eysenbach spells out the scope of the and sufficient conditions for an infodemic; for example, if a new field of infodemiology in more detail and offers a frame- large volume of largely true and helpful information about a work for it, introducing some basic metrics and distinguishing health condition emerges quickly, would we still consider it an supply-side features (e.g., publishing activity on the Inter- “infodemic”? net) from demand-based features (e.g., search and navigation An answer could be that, from the perspective of an infor- behaviour). In general, he considered that “these metrics and mation manager, any large-scale and fast-flowing outburst of methods are potentially useful for public health practice and information needs to be managed. Information management research, and should be further developed and standardized.” includes sorting and classification, reviewing and judging for In this paper (9), Eysenbach also coined the terms “info- veracity and usefulness, translating and adapting knowledge veillance” (for the systematic surveillance of information to make it appropriate for different audiences, drawing conclu- applications in public health) and “infodemic”, which he sions and extracting recommended actions for decision-makers. defined as “an excessive amount of unfiltered information It can often take a long time to identify whether any given infor- concerning a problem such that the solution is made more mation is in fact “helpful or true”, so the problems of volume difficult.”. and velocity remain for good and bad information alike. The new term was largely unused and forgotten until we The experience of the COVID-19 pandemic shows we are reached the era of COVID-19, when Dr. Tedros Adhanom not yet equipped to cope with an infodemic, although the Ghebreyesus, the World Health Organization (WHO)’s Director- development of promising methodologies and software tools, General, grappling with an epidemic, and later a pandemic, including those based on artificial intelligence, is progressing declared, at the Munich Safety Conference on February 15, 2020 rapidly. Table 1 sets out some of the primary characteristics of (10), “We’re not just fighting an epidemic; we’re fighting an an infodemic. infodemic.”. The sudden increase in the volume of information expe- The shift of source metaphor (from epidemiology to epidemic) rienced in an infodemic has immediate consequences
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