The Perfect Enemy | The public health battle against COVID misinformation continues. - Slate
October 27, 2023

The public health battle against COVID misinformation continues. – Slate

The public health battle against COVID misinformation continues.  Slate

Mis- and disinformation have been prevalent throughout the COVID-19 pandemic, but in recent months anti-vax activists and conspiracy theorists have latched on to a new phrase to help their cause: “died suddenly.” Anti-vaxxers hoping to convince people that COVID vaccines are linked to sudden deaths among younger people have invoked the term while trying to exploit tragic events like the death of soccer journalist Grant Wahl, or Damar Hamlin suffering a cardiac arrest during an NFL game. Though that theory has no scientific evidence to support it, the “died suddenly” rhetoric has gained a lot of traction on social media. What makes COVID misinformation so spreadable, and how can public health officials combat the rumors?

On Friday’s episode of What Next: TBD, I spoke with Katelyn Jetelina, an epidemiologist and data scientist, about the rise of the viral dog whistle “died suddenly.” Our conversation has been edited and condensed for clarity.

Lizzie O’Leary: In your latest newsletter, you had a heading that said “Deaths by Vaccination Status: It’s not even close.” What does the data show?

Katelyn Jetelina: Underlying all these rumors is the belief that COVID-19 vaccines are harmful, in an intention to possibly depopulate the planet. If that had any merit, we would expect that those who are vaccinated are more likely to die than those are unvaccinated. And we are clearly seeing the opposite. The U.K. CDC released data evaluating all deaths—car accidents, strokes, COVID-19—by vaccination status. And when you visually display that on a graph, there is a clear distinction between the unvaccinated dying (of whatever cause) much higher than the vaccinated, leading to confirm that vaccines continue to save lives.

How big a data set are we talking about?

We have more evidence than any other vaccine or any other disease in the history of humans that the benefits of COVID-19 vaccines, particularly around mortality, continue to greatly outweigh the risks. We’ve never had so much coordination or teamwork looking at one thing and it’s so clear.

You wrote about something called the post hoc fallacy. Can you explain that?

The post hoc fallacy basically means that, even if everyone got a placebo vaccine, these stories of sudden deaths are statistically bound to happen. Even if everyone had gotten a placebo shot, there would still be deaths after that shot. In order for there to be no deaths after vaccination—no car accidents, no dog bites, whatever—that vaccine would not only have to be proven to be safe, but actually would have to prevent all deaths, from every cause.

Is there something about the way we communicate on social media that makes these theories that have a whiff of scientific language or a whiff of statistics more easily digested online?

There have been studies that false information travels six times faster than true information on social media. And there’s many reasons for this. One, speed is key. Rumors are lies spread before the truth can get its pants on, and filling the information void quickly is something that becomes very viral. For example, take the NFL tragedy. There was no information about what happened and they very quickly took advantage of it. Same with Grant’s death.

Another tactic that’s used is “failed to provide context.” Vaccine rumors are intentionally vague. For example, what vaccine? What’s the condition? And so, because they are so intentionally vague, there are different hypotheses that are blended together, allowing proponents to shift from one thing to the other.

Another thing is a kernel of truth. Almost all vaccine rumors have something that is true, but is then distorted or exaggerated. It’s usually within scientific terms that make it very difficult for the layman to separate what’s true and what’s not true.

If you look at misinformation around COVID vaccines, you might find posts on social media saying, such-and-such effect “showed up on VAERS.” That’s a federal database, the Vaccine Adverse Event Reporting System. It’s an open system where anyone can report something that happened after a vaccine. How does it work?

VAERS is a type of safety surveillance system and it’s passive, which means that it runs on an honor system. Usually, doctors go and type something in if someone had an adverse event after a vaccine—not just COVID vaccines, but really anything. The challenge with it, at least during the pandemic, is that it’s dependent on people providing accurate data. And because of this there’s many disclaimers on the website, which is run by the CDC, saying that it’s possible that it’s incomplete or inaccurate. VAERS is imperfect, and that’s why we also have to have active surveillance systems to make sure that we can detect rare but true safety signals after vaccines.

I heard a story that someone entered into VAERS that they became the Incredible Hulk.

That’s right. A doctor submitted a VAERS report to say, “My patient turned green. They have these incredible muscles, they are ripping through bricks.” Just to show what this honor system is dependent on.

If there are serious side effects to the COVID vaccines, how are they tracked? Because there have been some.

We do depend on VAERS, but we also look at other things. We rolled out V-safe. That’s active surveillance, the CDC actively looking for information. And there’s other things like hospital databases that they’ve been looking at. These monitoring systems aren’t perfect, but they’re pretty darn good, because they were actually able to find very rare but serious side effects quickly after our vaccine rollouts during COVID-19.

Is that why, for example, the Johnson & Johnson vaccine basically is not recommended now?

That’s exactly right. Right after the J&J vaccine, which is not an mRNA vaccine, we found very quickly it was linked to about a 4 in 1 million chance of a fatal blood clot, a very specific type of fatal blood clot. And because of this true signal, and because we have alternative vaccines, they stopped recommending Johnson & Johnson altogether.

I think a lot of Americans, of all different political stripes, feel like public health messaging can be contradictory. The CDC guidance has shifted a great deal, a lot of people feel ready to give up. How do you approach that problem, that sense of distrust or unease that feels like it’s only worsened recently?

I’ve been really disappointed about scientific communication, particularly from leadership, for the past three years. Our lack of effective communication has really set the stage for information voids, for disinformation, and for a lot of confusion during this info-demic, this overabundance of information. I try to communicate uncertainty really clearly—what we know and what we don’t know, how we’re trying to answer what we don’t know, and bringing people along for the ride in this proactive sense of scientific discovery. There’s also reactive communication, combating mis- and disinformation, challenging those views, and listening to concerns so you can help address those concerns and help people make evidence-based decisions.

While Americans may trust their own doctors, confidence in medical science has slipped over the pandemic. Last February, a Pew poll showed that only 29 percent of U.S. adults have a “great deal” of confidence in medical scientists. That’s down from 40 percent in November 2020. For Republicans, the numbers are even starker: Just 15 percent have a great deal of confidence in medical scientists, down from 30 percent in 2020.

This is the nemesis of public health: When it works it’s invisible. This is very different than medicine—you can see the impact of a surgery. This is different than the drug industry—we can see the immediate impact of a prescription. In public health, we don’t see what we prevented.

The other really big challenge with public health is that we are treating millions at a time instead of individuals. That’s been really challenging in an increasingly individualistic society like the United States where infectious diseases violate the assumption of independence. What you do as an individual directly impacts that person next to you, unlike diabetes, unlike cancer, where if I’m sitting next to you on a bus, what you do doesn’t really matter. Getting that perspective clearer and more direct has been incredibly challenging in this very polarized landscape.

Are there places that are doing that well?

A big case study that I continue to be amazed with, particularly around communication, is Vietnam. They set the stage very early for COVID. Before the virus even arrived, everyone knew what SARS-CoV-2 was. Everyone knew what they needed to do. They framed it that we are all against the virus, we’re not against each other. And that quick communication set the stage that we never really got in the United States.

But that’s a much smaller, more homogenous population.

It is much smaller, but I think that we can do it in the United States. We can have public health campaigns like they do. They had continuous communication with text messages. They cracked down on misinformation. One of the reasons they were so successful in that communication aspect was because they failed miserably during SARS, the 2003 epidemic that they experienced. And after that, they self-reflected and changed things on a systematic level. Fifteen years later, they were prepared for this new threat. I’m really hoping that we do that in the United States, so we’re prepared for the next epidemic.

Can we?

We can; it’s a matter of if we will. We can do it, it’s just the implementation and the willpower I have yet to see.

What would have to happen do you think in order for the United States to move towards something more like the Vietnam example you’re citing?

There need to be systematic changes. We need to treat misinformation/disinformation as a public health concern. We need surveillance systems, prevention strategies, interventions. We need to know where it’s spreading and why and how. We need the ivory towers to really change their culture around scientific communication. And, we need to strengthen these grassroots, communication is also bottom up. We need to strengthen these networks that we’ve created throughout the pandemic so we can alter it really quickly if there is, for example, another monkeypox or another polio outbreak.

Future Tense is a partnership of Slate, New America, and Arizona State University that examines emerging technologies, public policy, and society.