Introduction

The COVID-19 pandemic has been the perfect storm in how international and domestic politics, misinformation, paranoia, and media bias contributed to an undermining of democratic and community values, and heightened fear and distrust among various sections of the population, around the world.

At the time of writing, as new vaccines flood the world to combat the spread of the COVID-19 virus, and the virus itself seems to be mutating into newer strains, a number of other issues still remain especially about how to combat the viruses of misinformation and conspiracy thinking that have also exploded exponentially with the spread of the pandemic. In the near future, while we may finally have a vaccine for the COVID-19 virus, what we still need is a vaccine for the misinformation virus.

Seneviratne and Muppidi [1]

The SARS-CoV-2 virus is responsible for COVID-19. The global COVID pandemic has highlighted many challenges that governments and first responders, around the world, face in communicating with the stakeholders in their societies.

“On 31 December 2019, the WHO was informed of cases of pneumonia of unknown cause in Wuhan City, China. A novel coronavirus was identified as the cause by Chinese authorities on 7 January, 2020 and was temporarily named ‘2019-nCoV’. Coronaviruses (Co-V) are a large family of viruses that cause illnesses ranging from the common cold to more severe diseases. A novel coronavirus (nCoV) is a new strain that has not been previously identified in humans. The new virus was subsequently named the ‘COVID-19 virus’. On 30 January, 2020, Dr. Tedros Adhanom Ghebreyesus, the WHO Director General, declared the novel coronavirus outbreak a public health emergency of international concern (PHEIC), the WHO's highest level of alarm. At that time there were 98 cases and no deaths in 18 countries outside China. On 11 March, 2020, the rapid increase in the number of cases outside China led Dr. Ghebreyesus to announce that the outbreak could be characterized as a pandemic. By then more than 118,000 cases had been reported in 114 countries and 4,291 deaths had been recorded” [1].

The first COVID-19 case was confirmed in the US in January 2020. Contrary to public belief, deaths related to COVID-19 doubled after the arrival of the vaccines. The US COVID-19 Vaccination Program began on December 14, 2020, and as per numbers of the Centers for Disease Control (CDC) as of mid-December 2021, at least 72.4% of the US population had received at least one dose of the COVID-19 vaccine with close to 61.2% being fully vaccinated. In addition, about 57.1 million additional/booster doses in fully vaccinated people were reported as per the Centers for Disease Control. Despite that, more people died from COVID-19 in 2021 compared to 2020. As of writing this chapter (in December 2021), the U.S. had registered over 50 million COVID-19 cases, the most in the world, including over 800,000 mostly preventable deaths. This number is twice the 400,000 deaths registered in mid-January 2021 as per the dashboard data of Johns Hopkins University.

Omicron

As is commonly understood, viruses constantly change through mutation and sometimes these mutations result in new variants of the virus. Some variants emerge and disappear while others persist. The CDC has been using genomic surveillance to track the variants of SARS-CoV-2. Since scientific labels are difficult to remember and report, the common recourse is to label them by the place of origin or spread thereby leading to discrimination and stigmatization. Hence, the World Health Organization (WHO), after consultations with experts around the world, decided to identify Variants of Interest or Variants of Concern of the Coronavirus (COVID-19) with easy to remember Greek letters of the alphabet and encouraged everyone especially scientists, world media, and governments to adopt this nomenclature. Of these past variants, Delta has been the most dominant one, followed by eight others (Epsilon, Zeta, Eta, Theta, Iota, Kappa, Lambda, and Mu) that have fizzled out.

A recent new variant (B.1.1.529) was detected in specimens collected in Botswana on November 11, 2021 and identified in South Africa on November 14, 2021. On November 24, 2021, South Africa reported the identification of this variant to the WHO. On November 26, 2021, the WHO named the B.1.1.529 Omicron and classified it as a Variant of Concern (VOC). In doing so, it decided to skip two of the Greek letters that were next in the order, namely, Nu and Xi, and went to Omicron because it explained that ‘Nu’ was too easily confounded with ‘New’ and ‘Xi’ was a common surname. Since the best practice was to avoid causing any stigmatization or discrimination to any cultural, social, national, regional, professional, or ethnic group, it was deemed obvious [2]. As per the European Centre for Disease Prevention and Control (ECDC), the Omicron variant is the most divergent variant that has been detected in significant numbers during the pandemic so far, which raises concerns that it may be associated with increased transmissibility, significant reduction in vaccine effectiveness, and increased risk for reinfections. As of 26 November 2021, ECDC has classified this variant as a Variant of Concern (VOC) due to concerns regarding immune escape and potentially increased transmissibility compared to the Delta variant [3].

This variant (Omicron) has mutations that change the spike protein on the virus’s surface allowing the virus to evade the human body’s immune response making currently available vaccines and treatments less effective. So, there is an increased possibility of breakthrough infections too. On December 1, 2021, the first confirmed Omicron case was identified in the USA in a person who had returned from South Africa. A second case was reported on December 2, 2021 in a person who had no international travel history but had attended a convention in the days preceding. As per the CDC, while there were such reported cases in individuals without travel history to Southern Africa in the US, most of the cases detected in several European nations as well as Australia, Brazil, Canada, Hong Kong, Israel, Japan, Nigeria, Norway, Sweden, and the UK were travel-related cases. As of December 19, 2021, there were 4,691 confirmed cases in the European Union (EU) and European Economic Area (EEA) with an additional 30,220 confirmed cases outside of the EU/EEA [4].

According to the CDC, Omicron was detected in most US states and was causing concern among public health officials. But as of writing this chapter, it is the Delta variant that still dominates in the US, and many hospitals are still overwhelmed. As of December 15, 2020, while the Omicron variant accounted for less than 3% of US cases, the numbers could double every two days, as per Lori Tremmel Freeman, CEO of the National Association of County and City Health Officials [5]. That means Omicron could soon become the dominant US variant. Experts estimate the true toll of COVID-19 to be even higher and even with the availability of vaccines, predict a surge with more transmissible variants like Omicron. The CDC expects that anyone with Omicron infection can spread the virus to others even if they are vaccinated or don’t have symptoms. However, reports from South Africa’s National Institute for Communicable Diseases (NICD) and other preliminary studies indicate that while the Omicron variant appears to cause less severe disease than previous versions of the coronavirus, the Pfizer vaccine seems to offer less defense against infection from it but still provides good protection from hospitalization. The best solution for now, as advocated by public health officials, is for everyone to be vaccinated and get booster shots as also to practice safe behaviors like social distancing, wearing of masks, and frequent testing as required.

According to the WHO, as of the first week of January 2022, a record 9.5 million cases of the coronavirus were tallied around the world, noting a 71% surge in the weekly count of infections as Omicron swept worldwide. The WHO also warned that it still needs to be taken seriously.

“While Omicron does appear to be less severe compared to Delta, especially in those vaccinated, it does not mean it should be categorized as mild. Just like previous variants, Omicron is hospitalizing people and killing people” said the Director General of WHO, Tedros Adhanom Ghebreyesus at a press briefing in Geneva recently.

Its impact on the elderly is still unsure as most of the cases studied have been in younger people. For now, the best way to address the spread of this virus is to control incidence, implement strong public health and social measures, and adopt preventive social behavioral practices like social distancing, sanitizing, mask wearing, vaccinations, etc. However, in many societies around the world characterized by poverty and other socially vulnerable demographics, a bigger challenge has been the inability of governments to counter the negative socioeconomic and mental consequences of rigorous lockdowns to prevent the spread of the virus, while also providing wages, food, and/or means of sustenance for vulnerable populations that have found it difficult to survive without access to daily wages or working conditions. The migrant labor crisis in India at the beginning of the pandemic is a tragic example. The situation is complicated in the USA by polarization of the political atmosphere, prevalence of misinformation, and misconception of social responsibility vis-à-vis individual freedom/rights.

While the best strategy available, getting everyone vaccinated, easier said than done because of the unequal distribution of vaccines globally and vaccine hesitancy among a sizeable percentage of the population. The WHO Director General has repeatedly called for greater global equity in the distribution and access to vaccines. As per the WHO, 109 countries will miss the WHO’s target of 70% of the world’s population to be fully vaccinated by July 2022. At least 36 nations have not vaccinated even 10% of their populations and about 80% of severe patients worldwide are unvaccinated. As per its weekly epidemiological report, the WHO said that:

During the week of 27 December 2021 to 2 January 2022, following a gradual increase since October, the global number of new cases increased sharply by 71% as compared to the previous week, while the number of new deaths decreased by 10%. This corresponds to just under 9.5 million new cases and over 41,000 new deaths reported during the last week. As of 2 January, a total of nearly 289 million cases and just over 5.4 million deaths have been reported globally. All regions reported an increase in the incidence of weekly cases, with the Region of the Americas reporting the largest increase (100%), followed by the Southeast Asia Region (78%), and the European Region (65%). The African Region reported a weekly increase in the number of new deaths (22%) while all the other regions reported a decrease as compared to the previous week.

Major reasons for this vaccine hesitancy, especially in the USA are:

  1. (1)

    A history of bad experiences (e.g. Tuskegee experiments) among minority and/or marginalized populations that created a trust deficit in government infrastructure

  2. (2)

    Easy spread of misinformation in a world of social media

  3. (3)

    A confirmation bias for conspiracies about the virus catalyzed by a proliferation of user-generated content (and a lack of fact-checking)

  4. (4)

    Media irresponsibility and spread of deliberate disinformation

  5. (5)

    Religious beliefs and sensibilities

  6. (6)

    The historical culture of privileging individual freedom/choice as a personal right in the USA over the welfare of the larger community.

A Kaiser Family Foundation report estimated that the cost of preventable hospitalizations for unvaccinated adults went from USD 0.6 billion in June 2021 to USD 3.7 billion in August 2021, with a total USD 5 billion spent on it across these three months alone. During this time, the number of unvaccinated adults who were hospitalized primarily for COVID-19 treatment went up from 39,000 to 342,000, the report estimated. In this period of three months, it was also estimated that over 280,000 hospitalizations could have been prevented by vaccinations alone [6].

Public health experts predict that more, possibly powerful, variants will emerge in the future since a lot of people are still unable/unwilling to be vaccinated. This is a major concern because of the risk that some of the future variants might outrun the efficacy of the current vaccines, countermanding all the successful efforts so far in controlling the virus, and thereby, putting everyone again at risk.

COVID-19 Information and Misinformation

“Despite its ranking, the United States has reported the greatest number of COVID-19 cases and its response to the pandemic has generally been viewed as extremely poor. These results highlight that although the Global Health Security (GHS) Index can identify preparedness, resources, and capacities available in a country, it cannot predict whether or how well a country will use them in a crisis. The GHS Index cannot anticipate, for example, how a country’s political leaders will respond to recommendations from science and health experts or whether they will make good use of available tools or effectively coordinate within their government. The Index does, however, provide evidence of the tools that countries have and the risks they need to address to protect their communities. Countries that fail to use those tools or address those risks to thereby enable an effective response should be held accountable” [7].

From an information standpoint, the impact of COVID-19 is even more evident across all sections of society. Irrespective of one’s economic status, there has been a blatant disregard for safe and healthy practices—from believing misinformation, to not adopting safe/preventive practices, to denying scientific facts, to vaccine hesitancy, among others.

“To inform is to communicate with the intention to make aware, educate, and persuade. There are also other purposes of conveying some message content—the form and content is different depending on the channel/medium. Certain qualities that are unsaid and assumed that it is ‘true’, based on facts, is not intentionally falsified, or manipulated. In this day and age, a lot of that is communicated is also qualified by the credibility of the source. To not do that intentionally can be broadly construed as disinformation or misinformation” [1].

A comprehensive study on COVID-19 misinformation by researchers at Cornell University found that the biggest driver of such misinformation in the US was President Trump. This study sampled 38 million articles published in English language media around the world and identified the most prominent misinformation topics that appeared in traditional and online media in the early phase of the pandemic from January 1 to May 26, 2020. The top 11 conspiracy theories identified by this study include the following (Fig. 1) [8].

Fig. 1
A horizontal bar graph estimates the most prevalent misinformation topics during COVID. Some of the top 5 data and their values are as follows. Miracle Cures 295351, New World order 49162. Democratic party hoax 40456, Wuhan Lab 29312, and Bill Gates 27931.

Conspiracy theories and misinformation about COVID—themes. Source Table reproduced from Evanega et al. [8] Coronavirus misinformation: quantifying sources and themes in the COVID-19 ‘infodemic’

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The spread of a number of these conspiracies was fuelled by partisan media stories that bordered on disinformation campaigns as also social media forwards among groups of believing audiences. The dynamics of such media consumption and subsequent social and political behavior/s was also worsened by how search engines and algorithms guided media audiences down a rabbit hole, by promoting related searches, irrespective of the factual content of the news items/stories, and thereby, contributed to enhancing the irrational and baseless fears of the unknown, fuelled by this conspiratorial thinking, without any fact-checking or cautionary messages. This increasingly got these audiences to populate and live in echo chambers without exposure to any contradicting views. Misinformed stories on mainstream media outlets like Fox aimed at appealing to a biased audience for ratings. This combined with Whatsapp and Telegram group forwards by members of groups like QAnon led to the infamous Capitol Hill riot on January 6, 2021. Later hearings are exposing how confirmation bias and lack of opposing views combined with a blind trust in politicians led to perceived trust/belief in disinformation and biased sources leading to false conclusions and belief in propaganda by vested interests. Media mentions of President Trump within the context of different misinformation topics made up 37% of the overall misinformation conversation, much more than any other single topic. Donald Trump was likely the largest driver of the COVID-19 misinformation ‘infodemic’. In contrast, only 16% of media mentions of misinformation were explicitly ‘fact-checking’ in nature, suggesting that a substantial quantity of misinformation reached media consumers without being challenged or accompanied by factually accurate information. These findings are of significant concern because if people are misled by unscientific and unsubstantiated claims about the disease, they may attempt harmful cures or be less likely to observe official guidance and thus risk spreading the virus.

A recent study found that misinformation and political polarization have a strong influence on vaccination rates. As per a study by the National Public Radio (NPR), there was a direct correlation between COVID infections and people’s political leaning. It found that unvaccinated persons were three times as likely to lean Republican as they were to lean Democrat. As per the study findings, people living in the U.S. counties that went heavily for Donald Trump in the recent presidential elections had much lower vaccination rates and were nearly three times more likely to die from COVID-19 than those who lived in counties that voted for President Biden. As per the report [9].

NPR looked at deaths per 100,000 people in roughly 3,000 counties across the U.S. from May 2021, the point at which vaccinations widely became available. People living in counties that went 60% or higher for Trump in November 2020 had 2.73 times the death rates of those that went for Biden. Counties with an even higher share of the vote for Trump saw higher COVID-19 mortality rates.

In October, the reddest tenth of the country saw death rates that were six times higher than the bluest tenth, according to Charles Gaba, an independent health care analyst who has been tracking partisanship trends during the pandemic and helped to review NPR's methodology. Those numbers have dropped slightly in recent weeks, Gaba says: “It's back down to around 5.5 times higher.”

As the study by Evanega et al., 2020 also pointed out, “In previous pandemics, such as the HIV/AIDS outbreak, misinformation and its effect on policy was estimated to have led to an additional 300,000 deaths in South Africa alone. If similar or worse outcomes are to be avoided in the present COVID-19 pandemic, greater efforts will need to be made to combat the ‘infodemic’ that is already substantially polluting the wider media discourse.”

The GHS 2021 report also indicated that, “some countries found that even a foundation for preparedness did not necessarily translate into successfully protecting against the consequences of the disease because they failed to also adequately address high levels of public distrust in government and other political risk factors that hindered their response. Further, some countries had the capacity to minimize the spread of disease, but political leaders opted not to use it, choosing short-term political expediency or populism over quickly and decisively moving to head off virus transmission” [7].

The Kaiser Family Foundation’s COVID-19 Vaccine Monitor is an ongoing research project that measures and tracks attitudes and experiences with COVID-19 vaccinations [10]. “Using a combination of surveys and qualitative research, this project tracks the dynamic nature of public opinion as vaccine development and distribution unfold, including vaccine confidence and acceptance, information needs, trusted messengers and messages, as well as the public’s experiences with vaccination.” Some of the key findings include the following:

  • “As 2021 comes to an end and the country faces another new variant and rising infection rates, a majority of the public now say they are frustrated about the status of COVID-19 vaccinations in the U.S., and the share who say they are optimistic has decreased eighteen percentage points since January. At the same time, the share of fully vaccinated adults who report receiving a booster dose has more than doubled in the last month, with one-fourth of fully vaccinated adults (16% of all adults) reporting receiving a COVID-19 booster dose.

  • Older adults are most likely to report receiving a booster dose, with at least one-third of Black adults, Hispanic adults, and White adults over the age of 50 saying they have already received a booster dose and many more saying they plan to get a booster dose soon. This suggests that the initial concerns some Black and Hispanic adults had with the COVID-19 vaccine may have dissipated. Yet, among those who are fully vaccinated, younger Black adults seem slightly more hesitant to get a booster dose with three in ten younger Black adults saying they will not get an additional shot, compared to one in eight younger Hispanic adults and White adults.

  • Partisanship continues to play an outsized role in initial vaccination uptake as well as intention to get a booster dose. Four in ten Republicans remain unvaccinated and smaller shares of vaccinated Republicans—especially older Republicans—report receiving a booster dose. Seven in ten unvaccinated adults say they aren’t confident that the vaccines are safe for all adults.

  • Roughly one-third (36%) of those who are pregnant or trying to become pregnant remain unvaccinated. One reason why this population may be less likely to get vaccinated is because nearly six in ten (57%) say they are not confident the COVID-19 vaccines are safe for pregnant women.

  • Three in ten workers now report that their employer has required them to get the COVID-19 vaccine even as the share of the public that support the federal government requiring employers to mandate vaccines has dropped five percentage points since October. More than half of employees who work in workplaces with 100 employees or more (the size of companies covered in this federal requirement) either say their employer already requires vaccination (36%) or say they want their employer to require it (17%). Four in ten (41%) say they do not want their employer to require COVID-19 vaccination.

  • Majorities of Black adults and Hispanic adults, two groups that have reported disproportionate impacts of the coronavirus throughout the pandemic, say the pandemic has had a negative impact on their ability to afford many household expenses. People in these groups are also more likely to report that they feel the government has not done enough to help either their communities or people like them.”

Data from the same study also showed that “one in four adults remain unvaccinated with one in seven (14%) continuing to say they will ‘definitely not’ get vaccinated (a share that has held relatively steady since December 2020) and an additional 3% saying they will only do so if they are required for work, school, or other activities. Nearly three-quarters of adults say they have received at least one dose of the COVID-19 vaccine and another 2% say they will get vaccinated ‘as soon as possible’, similar to the shares who reported the same last month. Another 6% say they want to ‘wait and see’ before getting a COVID-19 vaccine.”

The data also showed that disproportionate sections of certain groups—Republicans, Evangelicals, and uninsured adults remain unvaccinated. There were also disparities in vaccine uptake between those with (83%) and without college degrees (68%); between adults over 65 (89%) and those who were 18–29 years old (67%). Also, two-thirds of Hispanic, Black, and White adults reported receiving a vaccine [10]. In addition, the pandemic also negatively impacted the mental health of more than half of the adults in the US.

While several households were impacted by loss of household incomes, food and housing insecurity, and health care coverage, children, especially those from low-income households and communities of color were disproportionately affected. The unavailability and/or the unequal distribution of pandemic-related support resources has also disproportionately impacted the populations that most need them in these uncertain times.

Way Forward

In a healthy society, science communication plays a key role—from advocating prevention to helping nurture healthy lifestyles and habits, to disseminating credible information, and creating an awareness of facts. Science communication also has a major role to play in countering the virus of misinformation in any society by identifying the factors responsible and advocating strategies to reduce such barriers to the adoption of safe and healthy behaviors, especially during a global pandemic. It is also important to promote media literacy, especially in the general population, by creating an awareness about fact-checking and information dissemination while countering the spread of misinformation, conspiracy theories, and enhancing sensitization to the politicization of the issues. This will help bring about awareness, attention to self-perception of risk, trust in scientific authority, belief in government measures, and adoption of advocated preventive and better behaviors for the common good.

Traditional models for science communication can generally be divided into two paradigms—the one-way, information transmission dissemination paradigm and the two-way, deliberative, dialogic public participation paradigm [11]. The approaches in both paradigms are important to address the spread of the virus as also to address knowledge, attitudes, and practice to bring about behavioral change in stakeholders. However, with the proliferation of social media, the one-way or dialogic models may not be sufficient to address communication that is facilitated by social media. A lot of the misinformation is disseminated through forwards via social media and group chats like WhatsApp, Telegram, and Signal without any fact checking.

From its initial discovery in Wuhan, China, the COVID-19 virus spread globally and mutated into various strains. While the Omicron strain is now the latest to emerge, most of the current infections and deaths in the USA are still attributed to the Delta variant. Across the country, there has been a spike in the number of infections and deaths.

“The 2021 Global Health Security (GHS) Index finds that despite significant steps taken by countries to respond to the COVID-19 pandemic, all countries remain dangerously unprepared to meet future epidemic and pandemic threats. Importantly, countries now have a more acute understanding of what this lack of preparedness means for their health and prosperity. This understanding presents an opportunity to convert high levels of political awareness about pandemics to long-term gains in preparedness by sustaining newly developed tools and building additional capacities to better protect lives and livelihoods against the next pandemic” (7).

These challenges highlight the need for developing effective strategies that can help stop the spread and transmission of the coronavirus. It is important to create an environment of trust and transparency that promotes an appetite for fact-checking to counter blatant misinformation and conspiratorial thinking.

During the HIV/AIDS pandemic, there were no vaccines to offer biomedical solutions and a lot of effort, therefore, went towards promoting prevention strategies including adopting healthy habits and practices. In a COVID-19 scenario, in a population that has a high vaccine hesitancy, promoting safe behaviors, enabling trust in authority, and belief in scientific facts, is very important. Hence, promoting social distancing, wearing of masks, and sanitization are an important aspect of prevention, especially in the unvaccinated.

Another lesson from past pandemics is audiences’ self-perception of risk. Individual self-perception of risk is an important factor to address, as was found in HIV/AIDS-related studies was to dispel the myth that one is either immune or not likely to contract the virus even when one is aware of the risk factors and behaviors. The same is true when one considers knowledge, attitudes, and practices around other issues of concern like climate change, environmental pollution, etc. The natural progression from a pandemic to an endemic state depends on several complex factors. Few pandemics end up becoming endemic. As people become used to variants and learn to live with the mutations of the COVID-19 virus, regular booster doses might just become the order of the day to protect against the disease. However, to be protected against the misinformation virus, there is still a long way to go.