Publications

The Practical playbook for addressing health misinformation provides guidance on ways public health and medical professionals can set themselves up for success, make decisions on when they need to act to address misinformation, choose which actions and approaches might be useful to their audiences and information needs, and evaluate how their efforts are working.

In response to growing reports of concerning/harassing messages and backlash related to public health work, the Johns Hopkins Bloomberg School of Public Health established the FlagIt report and response system. The system uses a dedicated FlagIt email inbox for faculty and staff to report harassing or concerning messages related to public-facing work and has an autoreply message sharing available institutional resources.

The proliferation of false and misleading health claims poses a major threat to public health. This ongoing “infodemic” has prompted numerous organizations to develop tools and approaches to manage the spread of falsehoods and communicate more effectively in an environment of mistrust and misleading information. However, these tools and approaches have not been systematically characterized, limiting their utility. This analysis provides a characterization of the current ecosystem of infodemic management strategies, allowing public health practitioners, communicators, researchers, and policy makers to gain an understanding of the tools at their disposal.

When SARS-CoV-2 first began to sweep the globe, so too did information about the virus, including accurate, false, and misleading information. Almost immediately, this deluge of information was recognized as a significant threat to public health, with WHO Director-General Tedros Adhanom Ghebreyesus announcing in February 2020 that “we’re not just fighting an epidemic, we’re fighting an infodemic.” Since then, the notion of an infodemic, which has been defined by WHO as “an over-abundance of information – some accurate and some not – that occurs during an epidemic” (WHO, 2020), has gained traction as a serious and ongoing public health concern, interfering with individuals’ ability to obtain and/or trust accurate information when they need it most (WHO, 2020).

Misinformation and disinformation during infectious disease outbreaks can hinder public health responses. This analysis examines comments about masks and COVID-19 vaccines on Twitter during the first six months of the COVID-19 pandemic. We conducted a content analysis of 6,600 randomly selected English-language tweets, examining tweets for health, political, of societal frames; inclusion of true information, false information, partially true/misleading information, and/or opinion; political components; risk frames; and use of specific types of rumor. We found false and partially false information in 22% of tweets in which we were able to assess veracity. Tweets with misinformation were more likely to mention vaccines, be political in nature, and promote risk elevating messages (p<0.5). We also found false information about vaccines as early as January 2020, nearly a year before COVID-19 vaccines became widely available. These findings highlight a need for new policies and strategies aimed to counter harmful and misleading messaging.

The home healthcare worker is a unique, under-represented subgroup in healthcare research. Based on labor statistics, 87% are female and 39% lack affordable housing. Just over 50% receive some kind of public assistance and most do not have a college degree. Home healthcare workers are racially diverse and earn relatively low wages.¹ This population has high levels of vaccine hesitancy, yet close interaction with potentially at-risk individuals.^{2, 3}

A constellation of factors related to confidence, complacency, and convenience affect vaccine hesitancy.⁴ Innovative countermeasures that engage, educate, and empower diverse populations with varied beliefs, life circumstances, and means of engaging with media are needed.⁵ Personalized persuasion has proven to be effective means of motivating behavioral change,⁶ but requires a thorough understanding of sub-populations. Political discord and social divides heighten the need for highly tailored communications.⁷

We aimed to understand underlying motivations and/or behavioral inhibitions of the home healthcare population to support proactive public health outreach campaigns, and aid responses in future health crises. This study was conducted in accordance with Johns Hopkins University's Institutional Review Board.

A radiological emergency such as the detonation of a radiological dispersal device would have catastrophic health, environmental, and economic consequences. Community assessments can provide useful information about radiological and other emergency preparedness at the household level. Tools such as logic models can be applied to link data collected in a community assessment to planned activities and targeted outcomes. This study sought to answer how public health departments can use the results of a community assessment to improve preparedness for radiological and other types of emergencies and to present a sample logic model demonstrating how questions asked in a community assessment can be used to drive intended outcomes.

The COVID-19 pandemic has shown that false or misleading health-related information can dangerously undermine the response to a public health crisis. These messages include the  inadvertent spread of erroneous information (misinformation) or deliberately created and propagated false or misleading information (disinformation). Misinformation and disinformation have contributed to reduced trust in medical professionals and public health responders, increased belief in false medical cures, politicized public health countermeasures aimed at curbing transmission of the disease, and increased loss of life.

In this paper, we present a research agenda for longitudinal risk communication during a global pandemic. Starting from an understanding that traditional approaches to risk communication for epidemics, crises, and disasters have focused on short-duration events, we acknowledge the limitations of existing theories, frameworks, and models for both research and practice in a rapidly changing communication environment. We draw from scholarship in communication, sociology, anthropology, public health, emergency management, law, and technology to identify research questions that are fundamental to the communication challenges that have emerged under the threat of COVID-19. We pose a series of questions focused around 5 topics, then offer a catalog of prior research to serve as points of departure for future research efforts. This compiled agenda offers guidance to scholars engaging in practitioner-informed research and provides risk communicators with a set of substantial research questions to guide future knowledge needs.

One of the lessons learned from the COVID-19 pandemic is the utility of an early, flexible and rapidly deployable disease screening and detection response. The largely uncontrolled spread of the pandemic in the United States exposed a range of planning and implementation shortcomings, which if they had been in place before the pandemic emerged, may have changed the trajectory. Disease screening by detection dogs show great promise as a non-invasive, efficient, and cost-effective screening method for COVID-19 infection. We explore evidence of their use in infectious and chronic diseases, the training, oversight, resources required for implementation, and potential uses in various settings. Disease detection dogs may contribute to the current and future public health pandemics; however, further research is needed to extend our knowledge and measurement of their effectiveness and feasibility as a public health intervention tool and efforts are needed ensure public and political support.

The spread of Zika virus throughout Latin America and parts of the United States in 2016 and 2017 presented a challenge to public health communicators. The objective of our study was to describe emergency risk communication practices during the 2016-2017 Zika outbreak to inform future infectious disease communication efforts.

The COVID-19 pandemic has shown that health-related misinformation and disinformation can dangerously undermine the response to a public health crisis. Contradictory messaging and active subversion have reduced trust in public health responders, increased belief in false medical cures, and politicized public health measures aimed at curbing transmission of the disease. Setbacks in the COVID-19 response have highlighted that health-related misinformation or disinformation can lead to more infections, deaths, disruption, and disorganization of the effort. The public health response and communication environment in the United States have been disrupted by significant distrust in government, exacerbated by confusing and conflicting messages from leaders. As a result, information voids have developed, easily filled by false or misleading information and directly targeted by perpetrators of disinformation. Taken together, the spread and consequence of public health misinformation and disinformation can lead to a range of outcomes that have national security implications and require effective response.

Among the most pressing issues in preparing for the global response to a pandemic are the design, development, manufacture, and dissemination of vaccines. In 2018 and 2019, we conducted 48 interviews with prominent leaders in public health, pandemic preparedness, vaccine design, and vaccine manufacturing about how they would respond to a sudden, urgent need to manufacture 2 billion or more doses of vaccine. Little did we know that this scenario would become a dire global challenge a few months later with the onset of COVID-19. The response to this pandemic has shown that when leading vaccine manufacturers are fully engaged in a global response, it might be possible for them to manufacture substantial doses of vaccine on timelines faster than previously envisioned. It is now hoped that hundreds of millions of doses of vaccine will start to be produced sometime in the end of 2020 or the start of 2021, and that billions of doses of vaccine could be produced in the months that follow. Whether these timelines can be met or not, it is crucial now, while the world is fully attuned to the terrible consequences of pandemics, to begin preparing the system of global manufacturing for future pandemics. The following insights and recommendations are taken from our interviews with leading experts and our own analysis.

Effective communication during epidemics and outbreaks is a critical component of a public health response. Even more than usual, people need accurate information so that they can adapt their behavior and protect themselves, their families, and their communities against infection, onward transmission, and death. However, during an epidemic or pandemic, the communication environment can be complicated by an “infodemic,” which is the rapid, large-scale spread of health information and misinformation through a variety of media and informational channels.¹ This overabundance of information—some accurate and some not—makes it difficult for people to differentiate between false and true information, and has been particularly challenging to address during the ongoing coronavirus disease 2019 (COVID-19) pandemic. Addressing infodemics is a new and centrally important challenge to responding to acute health events. Given its global scale and rapid spread, the current COVID-19 infodemic is an important opportunity to find and adapt new preparedness and response tools to manage the information ecosystem in which we live.

The lack of radiation knowledge among the general public continues to be a challenge for building communities prepared for radiological emergencies. This study applied a multi-criteria decision analysis (MCDA) to the results of an expert survey to identify priority risk reduction messages and challenges to increasing community radiological emergency preparedness.

Most elementary schools, middle schools, and high schools across the United States have been closed since March in an effort to reduce the spread of COVID-19. Schools that are able to do so have replaced classroom education with remote learning, using a range of tools and approaches. As of the publication of this report, governors from most US states have recommended or ordered that schools remain closed for the remainder of this academic year, affecting more than 50 million public school students. While a few schools may reopen before the end of the current school year, most schools, students, and their families in the United States are now facing uncertainty about whether or how schools will resume for in-class learning in the fall.

The Ebola communication crisis of 2014 generated widespread fear and attention among Western news media, social media users, and members of the United States (US) public. Health communicators need more information on misinformation and the social media environment during a fear-inducing disease outbreak to improve communication practices. The purpose of this study was to describe the content of Ebola-related tweets with a specific focus on misinformation, political content, health related content, risk framing, and rumors.

This operational toolkit has been developed to help business owners who are considering reopening or expanding their operations to determine their establishments’ risk of transmission of COVID-19 and how to reduce it.

As displayed in the figure below, the Operational Toolkit consists of 3 parts: an instruction manual; a business risk worksheet; and an assessment calculator.

As some governments begin to lift strict public health measures and move into the next phase of their outbreaks of COVID-19, local, state, and federal authorities are planning for the gradual reopening of businesses and resumption of economic activity. While planning for a staged approach to business resumption must be coordinated by local, state, and federal authorities, individual organizations should start planning for how they will restart or expand their operations so that modification and mitigation measures will already be in place when work can resume and the new ”business as usual” can commence.

This operational toolkit allows business leaders to work through a 4-stage process to obtain an overall risk score for their business and to identify considerations for reducing both operational and individual level risks posed by COVID-19. The overall score represents the inherent risk of exposure to COVID-19 that may occur in a business and possible changes to daily operations and policies that can lower the inherent risk of exposure. This toolkit is intended to provide businesses with a starting point in their planning to reopen or expand their operations by identifying their risk levels for contributing to the spread of COVID-19 and providing them with a list of mitigation measures to implement that will increase the safety of their employees, clients, customers, and community. 

The 3 parts of the Operational Toolkit include:

1. An Instruction Manual (PDF)
   Instructions that explain how to complete the 4-stage Business Risk Worksheet and Assessment Calculator.
    
2. A Business Risk Worksheet (PDF)
   A 4-stage step-by-step worksheet for you to report and understand your business’s overall risk of spreading COVID-19 and how your business operations can be made safer.
    
3. An Assessment Calculator (XLSX)
   An Excel spreadsheet you will fill out to receive a calculated risk score and a modification score.

In 2015 and 2016, outbreaks of the Zika virus began occurring in the Americas and the Caribbean. Following the introduction of this new threat, the United States’ Centers for Disease Control and Prevention (CDC) issued testing guidance for the nation’s state public health laboratories. We collected and analyzed testing guidance for all fifty states and the District of Columbia for both 2017 and 2018. In both years, state testing guidance was consistent for men and non-pregnant women, but there was notable variation in guidance for pregnant women. In addition, there were changes between the two years as testing algorithms shifted toward guidance that recommended testing in more limited circumstances. States adopted large, or complete, portions of CDC testing guidance, but were not required to conform completely, 33% of states had identical guidance in 2017 and 49% in 2018. Some of these trends, such as specifying that testing be contingent on travel, or sexual contact with an individual who has recently traveled, to an area where the Zika virus was circulating, presents a potential deficiency in the United States surveillance capacity. Understanding variations in state testing guidance enables public health professionals to better understand ongoing surveillance. This analysis provides insight into the testing practices for the various states across the country. Better understanding of how states approach Zika testing, and how that testing changes over time, will increase the public health community’s ability to interpret future Zika case counts.

This article describes implementation considerations for Ebola-related monitoring and movement restriction policies in the United States during the 2013–2016 West Africa Ebola epidemic.