Published by the AMSA Global Health Reactive Advocacy Team:
Sally Boardman, Jacqueline Bredhauer and Guy Jeffery.

2021. The year following the unforgettable 2020. Never has there been a time in recent decades where all the world has so closely followed every news release, press conference and ‘groundbreaking’ scientific research. From the beginning of the pandemic, COVID-related news has dominated social media, utilising  sensationalist headlines with emotive language of fear and disaster to grasp readers’ attention. Absent from these articles however, is the extent to which the mass media has influenced both the ‘story’ and thus the outcomes of the Australian public’s response to this pandemic. 

The World Health Organization (WHO) is well attuned to the potential threats of social media in spreading misinformation and undermining public health. In 2020, the WHO listed ‘earning public trust’ as one of the ten greatest global healthcare challenges in the next decade. [1] Further, in 2019, vaccine hesitancy was listed as a top global health threat. [2] In today’s ’post-truth’ era, the voice of social media echoes louder than that of global health experts. [3] This smothering of expert voices has contributed to rising vaccine hesitancy in Australia, and hampered the roll-out of Australia’s COVID-19 vaccination program. Mistrust in the vaccine due to fear of side effects combined with the broad criticism of the Australian government’s vaccine roll-out, has only divided Australian’s further, and questioned the effectiveness of the government response. 

In situations like a pandemic, building trust is one of the key parameters in achieving a successful and unified public health response, however also one of the most challenging. It is difficult to uphold a unified approach, supported by credible information and transparency, when dealing with a crisis unmatched and marred with uncertainty.  This is the perfect climate for the media to exploit if they so choose. 

A survey conducted in April by the Sydney Morning Herald and Resolve Strategic found that approximately one third of Australian’s surveyed were either ‘not at all likely’ or ‘not very likely’ to be vaccinated, with concerns expressed regarding vaccination side-effects, practical access and a perceived low risk of COVID-19 in Australia; all of which are highly likely to have been influenced by the media’s shaping of these issues. [4] 

The role of the media has recently been questioned more intently in response to their coverage of the Australian COVID-19 vaccine roll-out, with RACGP president Dr Karen Price speaking up on the issue and stating the media needs to “calm down and be responsible with reporting standards in a pandemic in which everyone has a responsibility to their community.” Australian Medical Association Vice-President Dr Chris Moy also expressed concern that the media is essentially “playing doctor, and it’s actually causing a material effect on vaccine confidence.” [5] 

Given some of the recent news headlines include “NSW woman dies of blood clots after jab” or “NSW woman’s death likely linked to AstraZeneca vaccine” and “Covid-19: when governments started lying to us”, it is hardly surprising that Australian’s are fearful with constant undermining of government credibility and public trust. 

Whilst these issues have been brought to light, this is not the first time the media has affected trust in healthcare through provocative headlines that sensationalise statistics and leave the public increasingly hesitant. Take for example, the 2002 media coverage on Hormone Replacement Therapy (HRT). In 2002, the results of the Women’s Health Initiative (WHI) study, revealing a possible link between the use of HRT and breast cancer and other conditions, were released to the media prior to publication. Ensuing sensationalist headlines lead to a drop of 40-80% in HRT usage, and market infiltration of unregulated alternative therapies with limited evidence of efficacy and, in some cases, undesirable risks. Media fear-mongering replaced nuanced cost-benefit discussions about HRT with individual patients. A negative perception of HRT lingers despite a re-analysis of the WHI study, and the results of other trials, that do not justify universal hesitancy. [6] 

In regards to COVID-19, there is still a significantly lower risk of developing blood clots compared to the risk associated with actually contracting the coronavirus. [7] A study by Oxford University found that the incidence of cerebral venous thrombosis (CVT) after COVID-19 was 42.8 per million people [8], compared with the reported incidence following the Astrazeneca vaccine of 2-5 per million people. [9] Notably, whilst the incidence of CVT has been reported as low as between 0.4-5 million per year, a South Australian study found that the background incidence in a study population of 953 390 was 15.7 per million people, higher than previously thought. [10] This data helps place into perspective the relative risk of vaccine-induced CVT, something that has been skewed by journalistic ‘framing’ a concept whereby information is intentionally presented in such a way that our brains become biased and associate the terms ‘COVID-19 vaccine’, ‘clots’ and ‘death’ together, even if reports are discussing the low risk of clots or death. [11]  

As health professionals, it is important that we do not ignore that a risk, however small, exists, but refocus the conversation to be viewed in terms of a risk-benefit comparison.

What can we learn from misinformation during the COVID-19 pandemic?
In our increasingly digital world it is difficult to separate the health professional voice from the constant barrage of information flowing through an attention economy. Media institutions should be held accountable for the quality of information they share about public health emergencies. Public health officials need to present clear messages, and work with the media, to support a unified response. The Australian Government should monitor vaccination hesitancy, and other forms of health misinformation, to inform targeted strategies towards improving science communication and building trust. Finally, medical students have an important role to play in being the voices to speak truth and evidence into a saturated world of false and purported information. 

If you would like further information on the influence of misinformation and the media and how to combat it, the following resources provided by the World Health Organization are targeted at improving healthcare practitioner’s knowledge on the COVID-19 vaccine and media response. 

1) COVID-19 vaccine information for health professionals: a guide to equip you when speaking to patients/family/friends about the COVID-19 vaccine 
2) Vaccine confidence fund: a fund exploring how social media and online platforms can be leveraged to support confidence in and uptake of COVID-19 and routine vaccinations. Currently accepting applications for research proposals. 

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Reference List 

1. World Health Organization. Urgent health challenges for the next decade [Internet]. 2020. Available from: https://www.who.int/news-room/photo-story/photo-story-detail/urgent-health-challenges-for-the-next-decade
2. World Health Organization. Ten threats to global health in 2019 [Internet]. 2019. Available from: https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019 
3. Iyengar S, Massey DS. Scientific communication in a post-truth society. Proceedings of the National Academy of Sciences. 2019 Apr 16;116(16):7656-61. 
4. Crowe, D. Almost one-third of adult Australians say they’re unlikely to get COVID vaccination: survey. Sydney Morning Herald. 2021, May 19. Available from: https://www.smh.com.au/politics/federal/almost-one-third-of-adult-australians-say-they-re-unlikely-to-get-covid-vaccination-survey-20210518-p57szo.html 
5. Tsirtsakis, A. ‘Seeds of fear and mayhem’: Concerns media hindering vaccine rollout. NewsGP. 2021, April 16. Available from: https://www1.racgp.org.au/newsgp/clinical/seeds-of-fear-and-mayhem-concerns-media-hindering 
6. Burger HG, MacLennan AH, Huang KE, Castelo-Branco C. Evidence-based assessment of the impact of the WHI on women's health. Climacteric. 2012 Jun 1;15(3):281-7. Available from: https://www.tandfonline.com/doi/abs/10.3109/13697137.2012.655564 
7. Woodley, M. Blood clots up to 10 times more common with COVID than vaccines: Study. NewsGP. 2021, April 19. Available from: https://www1.racgp.org.au/newsgp/clinical/blood-clots-up-to-10-times-more-common-with-covid 
8. Taquet M, Husain M, Geddes JR, Luciano S, Harrison PJ. Cerebral venous thrombosis and portal vein thrombosis: a retrospective cohort study of 537,913 COVID-19 cases. medRxiv. 2021 Jan 1.
9. COVID PA. vaccine: EMA finds possible link to very rare cases of unusual blood clots with low blood platelets 2021. Available from: https://www.ema.europa.eu/en/news/astrazenecas-covid-19-vaccine-ema-finds-possible-link-very-rare-cases-unusual-blood-clots-low-blood 
10. Devasagayam S, Wyatt B, Leyden J, Kleinig T. Cerebral venous sinus thrombosis incidence is higher than previously thought: a retrospective population-based study. Stroke. 2016 Sep;47(9):2180-2.
11. Fatima SS. Understanding the Construction of Journalistic Frames during Crisis Communication: Editorial Coverage of COVID-19 in New York Times.