20 Infodemic: How Has the Epidemic of Misinformation Affected the Response to COVID-19? Series | COVID-19 & response strategy Authors: Carlos Chaccour (ISGlobal), Rafael Vilasanjuan (ISGlobal)* [ This is the twentieth Misinformation has played an impor- ment of the president of the United document in a series tant role during the COVID-19 pandem- States—as well as the inclusion of iver- of discussion notes ic. A general public desperate for reliable mectin in the national therapeutic guide- addressing fundamental data and a scientific publishing industry lines of Peru and Bolivia on the basis of questions about still characterised by many features of the in vitro experiments and fraudulent data2. COVID-19 and response Gutenberg era have contributed to a par- Other critical areas where false or mis- strategies. These allel pandemic: an infodemic. The term represented information has played a role documents are based infodemic refers to an overabundance of during this pandemic include the debate on the best scientific information—some accurate, some not— around the protection of children dur- information available on a particular subject. The World Health ing confinement, theuse of face masks and may be updated as Organisation (WHO) has long used this and the actual level and duration of im- new information comes term to describe an excess of information to light.] munity to the virus. This epidemic of about a topic, including many hoaxes or misinformation has been exacerbated by rumours, which make it difficult to find rushed scientific publication, the prioriti- reliable sources and guidance. sation of partisan activism over evidence, Most aspects of the COVID-19 debate and a general excess of opinions and de- have been burdened by this infodemic. liberately misleading information in a 22 September 2020 Examples on the therapeutic front1 in- context of data scarcity. The infodemic clude the rise and fall of hydroxychlo- poses risks to both the response to COV- Photo: Mònica Moreno / roquine and the promotion of diluted ID-19 and the opportunity to consolidate Barcelona City Council bleach as a treatment—both large- better practices for the future. ly fuelled by the personal endorse- * Carlos Chaccour is an Assistant Research Professor and the Chief Scientific Officer of the BOHEMIA Project at ISGlobal and Rafael Vilasanjuan is the Director of Policy and Global Development at ISGlobal. The authors wish to thank Adelaida Sarukhan, Joe Brew and Gonzalo Fanjul for their collaboration on the production of this brief. 1 Saitz R, Schwitzer G. Communicating Science in the Time of a Pandemic. JAMA. 2020; 324(5):443–444. 2 Chaccour C. Ivermectin and COVID-19: How a Flawed Database Shaped the Pandemic Response of Several Latin-American Countries. ISGlobal. 29 May 2020. www.isglobal.org 1 The Haste 1. of a Pandemic “With journals Scientific journals play a key role in the dis- published just 11 days3 after the first cases overwhelmed, the semination of knowledge. They generally were officially reported to the WHO. The scientific community serve as guarantors of the trustworthiness rapid emergence of knowledge on the vi- and quality of the material they publish. rus (SARS-CoV-2) and the disease (COV- turned to pre-prints— To do this, they rely on the peer-review ID-19) quickly overwhelmed the capacity manuscripts posted process, in which other scientists—i.e. of the publishing industry to assess manu- to online repositories peers—review manuscripts before the ed- scripts and publish papers. itors make a final decision on the basis of without peer One prominent journal, JAMA,4 saw its the reviewers’ comments. This process, review—with the submissions increase by nearly 300% however, is not flawless, nor is it designed genuine intention of (11,000 submissions in six months) (Fig- to spot fraud or misconduct. In fact, the ure 1). For the first few months of the pan- rapidly sharing useful process itself can contribute to misinfor- demic, an average of 367 COVID-related knowledge. This mation due to profound intrinsic issues articles were published per week, with a approach accelerated that arise from today’s scientific publish- median time from receipt to acceptance ing business and the use of its products by dissemination but did of just six days5. Nevertheless, reconciling the media and the general public. not ensure quality.” this enormous volume with high quality and fast dissemination is a difficult task. 1.1. Pressure on Journals There was a paradoxical and urgent need The scientific community has rushed to to slow down and safeguard quality at the conduct life-saving research on the novel expense of speed6. Public trust in science coronavirus at an unprecedented speed: was at risk7. the first genome sequence of the virus was Figure 1. Number of Manuscripts Submitted to JAMA during the Pandemic. 1 January–1 June 12.500 11.000 10.000 7.500 5.000 4.000 2.500 0 2020 2019 3 Zhang YZ, Holmes EC. A Genomic Perspective on the Origin and Emergence of SARS-CoV-2. Cell. 2020; 181(2):223:227. 4 Bauchner H, Fontanarosa PB, Golub RM. Editorial Evaluation and Peer Review During a Pandemic: How Journals Maintain Standards. JAMA. 2020; 324(5):453–454. 5 Palayew A, Norgaard O, Safreed-Harmon K, Andersen TH, Rasmussen LN & Lazarus JV. Pandemic publishing poses a new COVID-19 challenge. Nature Human Behaviour. 2020; 4:666-669. 6 Publishing in the time of COVID-19. Editorial. The Lancet Global Health. Volume 8 July 2020. 7 Bauchner H, Fontanarosa PB, Golub RM. Editorial Evaluation and Peer Review During a Pandemic: How Journals Maintain Standards. JAMA. 2020;324(5):453–454. www.isglobal.org 2 Manuscripts focused on COVID-19 Original research (full-length manuscripts, brief reports and 33% research letters) Opinion (Viewpoints, A Piece of My Mind) 67% and reviews Source: Bauchner H, Fontanarosa PB, Golub RM. Editorial Evaluation and Peer Review During a Pandemic: How Journals Maintain Standards. JAMA. 2020;324(5):453–454. 1.2. Pressure on Scientists 1.3. Pressure on the Public With journals overwhelmed, the sci- The general public is rightfully full of entific community turned to pre- questions and demanding answers from prints—manuscripts posted to online scientists and policymakers. Unfortu- repositories without peer review—with nately, the feeling of urgency among jour- the genuine intention of rapidly sharing nalists and their audiences has prompted useful knowledge. This approach accel- a rush to share new findings and hypothe- erated dissemination but did not ensure ses, regardless of the quality of the under- quality. Pre-prints require that the aca- lying data. This misinformation, in turn, demic community expend additional ef- can rapidly lead to anxiety and confu- fort to discern between rigorous and sion among information recipients. less-rigorous experiments and inter- In addition, the general public—and pretations. Many scientists have been some journals—may mix politics with lured by the sudden availability of funds science, supporting or rejecting drugs for COVID-19 research8. and public health measures on the basis Furthermore, the pandemic has exacer- of where they stand in the political sphere. bated pre-existing job instability and Activism is often placed before evidence. precariousness in academia9 especially A clear example of this is the use of face for those most affected by it, including fe- masks in the United States11: many Re- male researchers10. publican-leaning people see masks as an attack on individual freedom, despite In short, it would not be fair to exempt strong public health evidence supporting scientific institutions themselves from their efficacy in limiting viral spread responsibility for the infodemic. These in- . stitutions are cogs in a knowledge-genera- tion system that needs cooperation more than ever but will never forget that it is built around competition. Consequent- ly, in their communications, the very insti- tutions called upon to provide responses have not always prioritised added value and the common good over the ambition of conquering positions more central than those occupied by their rivals. 8 Pai, M. Covidization of research: what are the risks? Nature Medicine. 2020; 26, 1159. 9 Afonso A. How Academia Resembles a Drug Gang. The London School of Economics and Political Science Blog. 2013. 10 Gewin V. The Career Cost of Covid-19 to Female Researchers, and How Science Should Respond. Nature. 2020. 11 Aratani L. How did face masks become a political issue in America? The Guardian, 21 June 2020. www.isglobal.org 3 Consequences 2. of the Urge “The rush to The rush to produce results has led to The Surgisphere database also contributed produce results some flawed and even fraudulent studies greatly to the use of an antiparasitic drug making it into very prestigious journals, for the treatment and prevention of COV- has led to some with immediate consequences12. A large ID-19 in the Americas14. Thousands of flawed and even observational study published in The people were injected with a veterinary for- fraudulent studies Lancet in May 2020 showed that hydrox- mulation of the drug15, speculation drove making it into ychloroquine did not benefit (and even prices up and medicines were counter- very prestigious harmed) COVID-19 patients. Within 48 feited—all as a result of the ivermectin journals, with hours, the WHO-sponsored Solidarity trial infodemic in Latin America16. immediate put their hydroxychloroquine arm on hold. Funders and scientists around the world consequences.” made decisions based on the report. But the data used in the study was never made public by its owner, a now-defunct compa- ny called Surgisphere13. A previous report based on the same dataset and published in the New England Journal of Medicine in- fluenced how doctors prescribed cardiovas- cular drugs to COVID-19 patients. Both papers were later retracted by the au- thors, not the journals.