Misinformation and the US Ebola Communication Crisis: Analyzing the Veracity and Content of Social Media Messages Related to a Fear-inducing Infectious Disease Outbreak

"Health communicators need more information on misinformation and the social media environment during a fear-inducing disease outbreak to improve communication practices."

Misinformation is a troubling issue in public health-related messaging and potential barrier to effective disease outbreak preparedness and response. Studies have described the role misinformation has played in fueling vaccine hesitancy and contributing to outbreaks of vaccine-preventable diseases (VPDs). Examples of health misinformation during public health events or emergencies include false remedies for illness, incorrect information on disease transmission, or allegations that the disease (or the vaccine) is associated with a government conspiracy. Technologies, such as social media and cellphones, that connect networks of people who often share similar opinions and cultural beliefs have exacerbated and amplified this problem. The purpose of this study is to describe the content of Ebola-related tweets, with a specific focus on misinformation, political content, health-related content, risk framing, and rumours.

The researchers opted to look through the lens of the 2013-2016 West Africa Ebola epidemic, as misinformation related to Ebola was common. Despite very low case counts within the United States (US), rumours, misperceptions, and/or inaccurate information (e.g., about experimental Ebola vaccines) was common, potentially leading to fear, uncertainty, and confusion amongst the public. Coverage from traditional media sources was dispersed on social media, where it joined a mixture of factual and false information.

To assess the situation, they examined tweets from a random 1% sample of all tweets published September 30 - October 30 2014, filtered for English-language tweets mentioning "Ebola" in the content or hashtag, that had at least 1 retweet (N= 72,775 tweets). They analysed the 3,113 tweets that met inclusion criteria, using public-health-trained human coders to assess tweet characteristics (joke, opinion, discord), veracity (true, false, partially false), political context, risk frame, health context, Ebola-specific messages, and rumours. They assessed the proportion of tweets with specific content using descriptive statistics and chi-squared tests.

Selected findings:

• Of non-joke tweets, 10% of Ebola-related tweets contained false (5%) or partially false (5%) information. Tweets with false information often focused on debunked rumours.
• Overall, 8% of tweets mentioned an Ebola-related-rumour, and 2% refuted untrue rumours. Most often (N= 61), these rumours focused on the idea that the Ebola outbreak was a conspiracy created by political figures, the news media, or pharmaceutical companies.
• Excluding joke tweets, 25% of tweets were related to politics; for example: "Dear @SpeakerBoehner, If we're too broke for Food Stamps, veterans benefits or an Ebola vaccine, why do we still need Big Oil subsidies?"
• 28% of the tweets contained content that seemed designed to generate a response from and conflict with other Twitter users; similar trends have been observed by other researchers assessing vaccine misinformation on social media.
• 42% of the tweets contained risk-elevating messages, such as those related to the fatal nature of the disease.
• When comparing tweets with true information to tweets with misinformation, a greater percentage of tweets with misinformation were political in nature (36% vs 15%) and contained discord-inducing statements (45% vs 10%).
• Discord-inducing statements and political messages were both significantly more common in tweets containing misinformation compared with those without (p<0.001).

The researchers suggest that the results demonstrate that, although misinformation was not found in the majority of analysed tweets, it was still present at notable levels. Considering the networked nature of Twitter, some users were likely to have received a much greater percentage of Tweets containing misinformation. That said, slightly more than half of the tweets mentioning Ebola as an airborne disease also refuted it, highlighting the potential of crowd-sourced correction of misinformation.

In their estimation, the findings also indicate politicisation of a seemingly neutral international health emergency. Ebola response activities within the US and the time period of interest in this study corresponded with the leadup to US midterm elections (which occurred Nov 4 2014). This temporal overlap may have contributed to the political content found in many tweets. As other researchers have noted, when a statement is associated with a particular conservative or liberal viewpoint, readers who align with that political ideology may be less likely to critically assess the truth of the statement, which can pose a challenge for promoting evidence-based policies in public health responses. One approach to ensure that accurate information is included in political discourse would be to provide frequent updates and concise information (e.g., in the form of frequently updated disease information fact sheets) to policymakers and political staff members to ensure that science-based health information is easily available.

Research assessing the effects of correcting health misinformation has shown varied results. However, the researchers assert that "effectively addressing misinformation will likely involve multifaceted approaches, such as developing compelling public health awareness campaigns, engaging in media literacy efforts, and monitoring...circulating content to develop proactive responses to emerging communication issues. Public private partnerships between social media companies and public health agencies to promote public health messages is also an important component in combating misinformation, as observed in the partnership between the World Health Organization and social media companies to combat the novel coronavirus disease 2019 (COVID-19) misinformation..."

In conclusion: "Policy makers, public health practitioners, and social media companies will need to work together to develop communication strategies and response frameworks in advance of outbreaks to mitigate misinformation and the resulting public health impacts." Although each public health event is different, this study could provide insight into the possible social media environment during a future epidemic.