By Jonah S. Rubin and Abby Holloway, Knox College
In February 2020, as public health authorities struggled to develop guidance for a rapidly spreading coronavirus, WHO Director-General Dr. Tedros declared: “We’re not just fighting an epidemic, we’re fighting an infodemic” (WHO 2020a). In response, the WHO quickly put together a team of “mythbusters” dedicated to fighting mis- and disinformation. Like COVID-19 itself, the effects of misinformation are highly age dependent. Studies have shown that older Americans are far more likely to share false information about COVID-19 on social media than any other age group (Owen 2020; for general information on the effects of age on misinformation in general see also Wylie et al. 2014).
As experts in the emerging field of “infodemiology” are quick to note, the challenges of information management during public health crises is nothing new. As Sylvie Briand, WHO Director of the Pandemic and Epidemic Disease department, put it: “every outbreak will be accompanied by … misinformation, rumours, etc. We know that even in the Middle Ages there was this phenomenon” (Zarocostas, 2020). Yet even if these challenges are nothing new, the metaphorical framing of an “infodemic” represents a new paradigm for thinking about health information. Drawing on an anthropological tradition that looks at how metaphors help concretize inchoate and emergent situations (Fernandez 1986; Lakoff and Johnson 2003), we ask: In what ways does the WHO see the challenges of mis- and disinformation as being like a viral pandemic? And how does this understanding of information as being virus-like enable or constrain the response of public health authorities?
In some ways, the “infodemic” builds on disease metaphors in familiar ways. In our social media age, virality has become the go-to image for describing the rapid spread of information across virtual networks. Much like viral epidemics spread briskly across pre-existing social networks of kin and colleagues (Napier 2020), breaking news media, memes, misinformation flow expeditiously and grow exponentially across established virtual social networks.
Pre-figuring public health responses
Yet the idea of the infodemic can also pre-figure public health responses to the virus in surprising ways. Epidemiologists have long emphasized the importance of avoiding stigmatizing or blaming those who contract disease. In conceptualizing misinformation as being virus-like, the WHO similarly approaches health misinformation as an independent phenomenon to be managed, rather than overcome. At a recent conference on the subject, WHO Special Envoy David Nabarro, thus advocated “real respect and appreciation for people who believe in conspiracy theories” (purnatt 2020). For Nabarro, the belief that the pandemic is “all some hoax that is created as a result of particular behavior by powerful and rich people” emerges because this conspiracy “matters to them, for their sense of worldview.” Nabarro insists that “we cannot oppose any particular belief system.” Instead, he advocates affirming conspiratorial world views in order to fit pertinent health information within conspiratorial ideologies and, eventually, produce shifts in public behavior that accord with their advocated scientific practices.
To demonstrate the importance of accepting conspiratorial worldviews, Nabarro drew on his past experiences in global health management efforts. In Nepal, Nabarro’s initial attempts to address low infant mortality weight were rebuffed by leaders who insisted, “we have our own belief systems about disease.” It was only when the WHO learned to respect these beliefs, he insisted, that progress could be made on nutrition and sanitation but only if you, “let us do it in our way. Don’t force us into seeing things your way.” These lessons, he declared, were incorporated into his work in Liberia during the 2014 Ebola epidemic, where the WHO worked to convince villagers that funerary rituals were a major source of transmission: “You resolve it yourself using your imagery, your belief systems, but just make certain that the risks of Ebola are decreased.”
Nabarro’s pleas for respect in the face of opposing worldviews is not an embrace of medical pluralism. Instead, it stems from a pragmatic concern with how to work with those “will find us potentially unacceptable” and still find a way for health professionals to “support people as they make their journey of discovery, as they work through and make sense of this new phenomenon.” For all his professions of humility in the face of those with opposing beliefs, this is not a relationship of equals. At no point is the WHO meant to alter its epistemologies or health practices to account for spiritual, religious, or cultural health. Instead, identity-affirming beliefs must be validated yet quarantined in their own spheres of non-rationality, in order to allow people to embrace what biomedicine already knows.
In likening conspiracy theories to religious and cultural beliefs, Nabarro once again draws on images associated with viral epidemics. Biomedicine conceptualizes sickness as an external force (Hahn 1995, 133-134). Although individual and population risks may be assessed and managed, a viral infection is something that happens to a patient, rather than something under a patient’s control. In much the same way, infodemiology approaches beliefs – be they religious, cultural, or conspiratorial in nature – as an external phenomenon beyond an individual’s control. As long as these belief systems remain in their non-rational reservoirs, they may be tolerated. But they must be managed, less they impinge on the proper domains of biomedicine.
Just as the viral metaphor prefigures the WHO’s perception of misinformation so too can it prefigure the response. Increasingly, the WHO is conceptualizing its approach to the infodemic as a campaign of “inoculation.” As Tim Nguyen, leader of the WHO’s Information Network for Epidemics, put it: “We believe we need to vaccinate 30% of the population with ‘good information,’ in order to have a certain degree of ‘herd’ immunity against misinformation” (WHO 2020b).
Yet far more is at stake in battles over health practices than the WHO’s infodemiology metaphors might admit. Medical anthropologists have shown how biomedicine’s narrow focus on the mechanisms of disease transmission and control can erase the socio-political dimensions of disease (eg. Farmer 2009). When Nabarro attributes low Nepalese birthweights to religious beliefs, he ignores the structural poverty that social approaches to medicine repeatedly identify as the primary driver of the problem (see Christian et al. 2006). And when he discusses Ebola as a problem of cultural communication, he ignores the ways the WHO’s response was hampered by its failures to consider how a military-like public health tactics would be interpreted in the midst of recent and ongoing political conflict (Benton 2014; Abramowitz 2017). In a context where the WHO works closely with contested political authorities to manage the lives and deaths of large populations, their interventions cannot help but be political.
The WHO’s attempts at antipolitics are all the more problematic when it comes to conspiracy theories. Conspiracy theories do not merely ask biomedicine to make room for alternative epistemologies. Instead, they accuse biomedicine of being a smokescreen, disguising more nefarious ends. Far from demanding acceptance for alternative worldviews, conspiracy theorists call for the revelation of covert forces supposedly manipulating events and institutions.
Social scientists and the WHO
Social scientists have proposed a wide variety of explanations for the persistence of conspiracy theories, including attributing them to political propaganda, the erosion of trust in political institutions, and expressions of popular dissent by alienated groups. But regardless of their origins, conspiracy theories cannot be analyzed apart from the politics they express. This is especially so in the case of COVID-19 denialism, whose cause has been championed by populist authoritarians the world over.
The WHO’s attempt to engage communities is well founded. And the desire of a multilateral institution to avoid political squabbles is easily understandable. But combatting the so-called “infodemic” requires moving beyond the anti-political paradigms suggested by these biomedical metaphors. Who can speak and be heard as an authoritative source of health information will always be intimately bound up in relations of power. Because of this, effective information management, like the pandemic itself, requires a full recognition of the social and political forces driving its spread.
Abramowitz, Sharon. 2017. “Epidemics (Especially Ebola).” Annual Review of Anthropology 46 (1): 421–45. https://doi.org/10.1146/annurev-anthro-102116-041616.
Benton, Adia. 2014. “The Epidemic Will Be Militarized: Watching Outbreak as the West African Ebola Epidemic Unfolds.” Fieldsites Series: Ebola in Perspective. Society for Cultural Anthropology website. October 7, 2014. https://culanth.org/fieldsights/the-epidemic-will-be-militarized-watching-outbreak-as-the-west-african-ebola-epidemic-unfolds.
Christian, Parul, Shipra Bunjun Srihari, Andrew Thorne-Lyman, Subarna K. Khatry, Steven C. LeClerq, and Sharada Ram Shrestha. 2006. “Eating Down in Pregnancy: Exploring Food-Related Beliefs and Practices of Pregnancy in Rural Nepal.” Ecology of Food and Nutrition 45 (4): 253–78. https://doi.org/10.1080/03670240600846336.
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Fernandez, James W. 1986. Persuasions and Performances: The Play of Tropes in Culture. Bloomington: Indiana University Press.
Hahn, Robert A. 1995. Sickness and Healing: An Anthropological Perspective. New Haven, CT: Yale University Press.
Lakoff, George, and Mark Johnson. 2003 . Metaphors We Live By. Chicago: University of Chicago Press.
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Owen, Laura Hazard. 2020. “Older People and Republicans Are Most Likely to Share Covid-19 Stories from Fake News Sites on Twitter.” Nieman Lab (blog). October 26, 2020. https://www.niemanlab.org/2020/10/older-people-and-republicans-are-most-likely-to-share-covid-19-stories-from-fake-news-sites-on-twitter/.
purnatt. 2020. David Nabarro – Headline Talk at First WHO Global Infodemiology Conference, 29 June. https://www.youtube.com/watch?list=PLwmB5Aqso7V7B2-eq2HBPDFI6GWxYGjX3&v=DD851DMDRG8&feature=emb_logo&ab_channel=purnatt.
World Health Organization (WHO). 2020a. “Novel Coronavirus (2019-NCoV).” Situation Report 13. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200202-sitrep-13-ncov-v3.pdf.
World Health Organization (WHO). 2020b. “Immunizing the Public against Misinformation.” August 25, 2020. https://www.who.int/news-room/feature-stories/detail/immunizing-the-public-against-misinformation.
Wylie, Lindsey E., Lawrence Patihis, Leslie L. McCuller, Deborah Davis, Eve M. Brank, Elizabeth F. Loftus, and Brian H. Bornstein. 2014. “Misinformation Effect in Older versus Younger Adults: A Meta-Analysis and Review.” In The Elderly Eyewitness in Court, 38–66. New York, NY, US: Psychology Press.
Zarocostas, John. 2020. “How to Fight an Infodemic.” The Lancet 395 (10225): 676. https://doi.org/10.1016/S0140-6736(20)30461-X.
Jonah S. Rubin is an Assistant Professor of Anthropology at Knox College. His research looks at the politics of technocratic knowledge. His research looks at how civil society organizations use forensic medicine to transform the status of the dead in post-fascist Spain. He is also leading a research project on the politics of fact checking, news literacy education, and other efforts to combat “fake news.”
Abby Holloway is an undergraduate student majoring in anthropology/sociology at Knox College. Her research interests include constructions of identity and their interactions across various state and social bodies.
Key Words: World Health Organization (WHO), misinformation, health education, conspiracy theories, metaphor
This is the twenty-first post in The Age of COVID-19 series, co-edited by Celeste Pang, Cristina Douglas, Janelle Taylor and Narelle Warren. Please send your contribution to Narelle.Warren@monash.edu
All contributions will also be published on Somatosphere