A strategic look at mis and disinformation

This month, millions of adults and children have been offered the flu vaccine as part of a national programme to protect both individuals and the NHS from the impact of seasonal flu. The vaccine offers significant protection from severe illness and is incredibly safe. However, during the 2024/25 season, only 40% of people under the age of 65 in one or more clinical risk group took up the offer.

Flu is just one example. Earlier this year the tragic death of a child in Liverpool from measles prompted a widespread call to parents to take up the offer of the vaccine.

Given that no infection in living memory has achieved population immunity without vaccination, it can be hard for those of us working in public health and/or medicine to understand why people are hesitant. However, unless we do understand, and work to tackle the mis and disinformation out there, we will see more avoidable illness and death – heartbreaking for individuals, families and communities, as well as a considerable source of pressure on our health and social care services.

Misinformation is not just an issue in the fight against infections as the harrowing case of Paloma Shemirani highlighted, and there are many documented examples of medical malpractice and research misconduct which further feeds lack of trust. Increasingly too, investigative journalism has shed light on some of the commercial influences underneath such mis and dis information, sadly often reinforced by the algorithms and systems behind news and social media sites, now our main source of information.

More widely, across many non-communicable diseases, we have seen how the skilful use of information and PR impacts on health policy, with the methods and tactics of the tobacco industry having been widely replicated by other harmful commodities. Ultimately, the result of this dissemination of factually incorrect information is more deaths than would have been the case with stronger policy that excludes industry from its development. We just have to look at the reduction in tobacco-related deaths that resulted from the ban on advertising and smoking in public to see that taking this ‘public health approach’ to policy, as opposed to placing all responsibility on individual choice, saves lives.

This isn’t only a health issue. ‘Merchants of Doubt’ is an excellent read on the use of misinformation and offers insight into how some scientists, with connections to politics and industry, helped shape climate science to skew policy towards fossil fuel use at a time when taking action may have helped avoid some of the consequences we now face.

Regardless of the topic, misinformation, which is skilfully and wilfully woven into our everyday lives, and often targeted at particularly vulnerable sections of society, severely undermines public support for science-based policy. That comes with consequences.

It is exceptionally difficult to fight these arguments with logic and reason alone. So, what can we do to counteract it and overcome the battle between hearts and mind? As a Director of Public Health, one of my jobs is to break down the barriers that stop us living a healthy life. Along with accessibility, affordability and convenience, the amount, accessibility and credibility of information available holds people back from choosing healthy food or an active lifestyle, and also from taking up the offer of vaccines. Importantly, all of these factors also shape the views of policy makers. Levelling out the playing field is a complex issue and involves making sure that people have the right information, at the right time and are able to act on it.

We need to take the time to answer people’s questions honestly and in a non-judgemental way so that they have all the information available to them. It is important too that information is given by credible people who have the trust and respect of those asking the questions. We saw during the pandemic just how important that was in rolling out the Covid-19 vaccination – community and faith leaders have more engagement with some parts of the community than healthcare professionals.

Once the seed of doubt is sown, it can be harder to overcome so we need to be more proactive and targeted in how, where, and when, we present the benefits and advantages of what are life-saving interventions. Instead of blaming individuals who, for good reasons, have questions and doubts, we need to tackle the industries and people who perpetuate the myths. We also need to shine a light on the methods people and industry use to perpetuate false and misleading information so that individuals – and importantly the media – can see it for what it is instead of treat it as fact. Only then will we be able to effectively counter the messages carried by a range of ever pervading and powerful social media apps which, thanks to the various algorithms, act to constantly reinforce and polarise views.

As author, journalist, and researcher, Professor Tom Rosenstiel, said: “Misinformation is not like plumbing, a problem you fix. It is a social condition, like crime, that you must constantly monitor and adjust to.”

And adjust we must because while people are making money from encouraging others to choose not to get vaccinated, or drink less, or eat more healthily, we will continue to see many more children – and adults – die from what are largely entirely preventable causes.

I don’t have the answers to what is clearly a complex and sometimes emotionally charged issue, but it matters because it shapes our attitude to policy and, as always, I look to my peers and colleagues for insight, experience and practical tips in the hope that we can start to mitigate – and even overcome – this ongoing and widespread practice.