Not all Covid ‘misinformation’ is equal – or even misinformation

We are apparently still arguing about these. Photo: Bloomberg

Thousands of Americans have died because they did not get Covid vaccinations. A sea of anti-vaccine misinformation contributed to the problem, from rumor-mongering about the shots causing mass death to propaganda touting the benefits of ivermectin. Public health officials seemed powerless to stem the tide of lies. One of the big challenges public health officials now face is how to restore trust so that people listen to future guidance on everything from flu shots to childhood vaccines.

But a new study on Covid misinformation, published this week in the Journal of the American Medical Association, makes it clear that doctors and public health experts have some way to go in figuring out how to do that. Overdiagnosing "misinformation" – as the study does – will do more harm than good.

The study, by six researchers at the University of Massachusetts, Amherst, started with a worthy goal: examining the role of doctors in spreading dangerous misinformation on social media. But the study undermines its own purpose by wrongly classifying value judgments and some scientifically valid points as misinformation.

For example, consider this statement, which a doctor posted on Facebook in February 2022: "It's time to recognise natural immunity as at least as good as vaccinations and end the mandates."

Paul Offit – who has decades of experience fighting anti-vaccine misinformation – called foul at the JAMA study author's classification of this statement as misinformation. The first part about natural immunity is true, he said. And the call to end vaccine mandates was one view in a legitimate debate – a value judgment, not a fact.

Offit is a physician, director of the Vaccine Education Center at Children's Hospital of Philadelphia, and a member of the panel advising the Food and Drug Administration on Covid vaccine policy. 

He reminded me that when the vaccines were first being rolled out and in limited supply, there were questions about whether health-care workers who were previously infected should be vaccinated. Those in charge of planning the rollout realised it was just too cumbersome to test everyone to find out who had already been infected. It was expediency that motivated the policy, he said, not any doubt about infection-induced immunity.

"Vaccines are ineffective at preventing Covid-19 spread," was another claim posted on social media by a physician that was also listed as misinformation by the JAMA authors. But the clinical trials for vaccines did not test participants unless they reported symptomatic disease, so the trials could not determine whether getting vaccinated protected against under-the-radar cases — mild or asymptomatic infections that could potentially spread to others.

Subsequent observational studies did show that while not perfect, the vaccines did reduce the odds of all infections, said Monica Gandhi, an infectious disease doctor at University of California San Francisco. But that changed in the summer of 2021 with the emergence of the delta variant. After that point, she said, the benefit of vaccination was only to protect against severe disease and death.

The JAMA paper also labeled as misinformation statements questioning the efficacy of masks – but that is just one side of a complex debate, argues Gandhi. Wearing a well-fitted mask can protect the wearer, but there is disagreement about the costs and benefits of universal masking, especially masking children in daycare or at school. Offit says he interprets "masks work" to mean high-quality masks protect the wearer – not that we should go back to forcing cloth masks on toddlers in daycare.

The JAMA article also labeled as misinformation statements about downsides of masking. But several studies concluded that having to wear a mask all day can impede the ability of children (and adults) to interact and communicate. It is not "misinformation" to discuss downsides of public health measures.

Gandhi, author of Endemic: A Post-Pandemic Playbook, says the fight against misinformation has been corrupted by the way Americans tend to send messages in sound bites, from "just say no to drugs" to "vaccines work" to "wear a damn mask." It is not helpful or scientific to define misinformation as anything that contradicts such slogans.

And some in public health may wrongly assume people are misinformed because they have chosen to accept some degree of infection risk. Yet a public that is unwilling to make every possible sacrifice – indefinitely – to prevent even the tiniest chance of infection is not necessarily misguided.

Policing misinformation carefully and thoughtfully is becoming a wider problem in public health. "Respectful scientific discourse and debate is how science was done prior to Covid, and something broke when Covid arrived," said Shira Doron, an epidemiologist at Tufts University Medical Center.

Public health scientists have to figure out how to get back to the kind of nuanced, thoughtful discussions that were the pre-pandemic norm. Overgeneralizing and politicizing information breeds public distrust, which increases the appeal of contrarians who peddle anti-vaccine rumors and innuendo.

When people at high risk of dying from Covid are more afraid of the vaccine than the disease, something has gone very wrong. That is the kind of misinformation that can kill.

F.D. Flam is a Bloomberg Opinion columnist covering science.

Disclaimer: This article first appeared on Bloomberg, and is published by special syndication arrangement.