Using Behavioral Science for Infodemic Preparedness: The Case of Vaccination Misinformation

"Infodemic management: Policymakers can prepare for the next pandemic by maintaining an infrastructure for social listening, engaging behavioral scientists in pandemic preparedness, and strengthening spokespersons and health care personnel."

Behavioural scientists define pandemic preparedness not only in terms of illness detection, prevention, and response but also in terms of people's vaccination readiness. A barrier to people's vaccination readiness is vaccination misinformation, which can impact individuals' knowledge, emotions, attitudes, perceived norms, and behavioural intentions. This paper reviews behavioural science research on countering vaccination misinformation by: (i) identifying relevant parameters for an effective response (i.e., detection), (ii) reducing individuals' belief in vaccination misinformation (i.e., response), and (iii) preventing its spread (i.e., prevention).

First, the paper shows that detecting (i) tactics of deception (using social listening) and the content of misinformation and identifying underlying attitude roots and opinion leaders are key to an effective response to vaccination misinformation. Tactic, content, and root detection usually requires monitoring multiple data sources, from online social listening tools (e.g., epitweetr), to qualitative interviews and surveys among the public. These sources also enable infodemic managers to detect opinion leaders, credible spokespersons for mass communication, and relevant media channels for intended populations. When combating vaccination misinformation in the mass media, infodemic managers should consider using credible institutions or collectives as sources for key messages, rather than a single individual.

Second, research cited here indicates that (ii) responding to infodemics with debunking, real-time rebuttal (public discussions with a science denier, for example, on social media, in televised debates, or during radio talk-shows), and empathetic refutational interviewing (ERI) is effective in reducing the detrimental effects of exposure to vaccination misinformation. Some tips that emerge from the literature: To increase the effectiveness of debunking, researchers recommend providing detailed corrections and alternative explanations to the misleading narratives. However, mass communication interventions such as debunking or rebuttal have several weaknesses. For instance, fine-grained knowledge about the psychological characteristics of the audience (e.g., moral values) is usually needed in order to effectively tailor an intervention, which is difficult in mass communication. In contrast, ERI does not aim to overwhelm the arguments of other individuals (here: patients) with scientific evidence but, instead, focuses on understanding and valuing the concerns of the patient first. Expressions of empathy are used in the conversation to decrease the likelihood of patients' reactance toward the key element of ERI - that is, tailored refutation of misinformation.

Third, (iii) preventing the detrimental effects of vaccination misinformation is possible by implementing forewarnings and inoculation interventions. For instance, research has shown that warning individuals about vaccination misinformation or making them aware of misleading decision contexts that foster the belief in misinformation can reduce the negative impact of later exposure to misinformation. More sophisticated psychological prevention measures against misinformation make use of inoculation theory, according to which individuals are exposed to a "weakened dose" of misinformation, followed by either explaining the scientific facts (i.e., issue-based inoculation) or uncovering the misleading rhetorical tactics that are used by spreaders of misinformation (i.e., technique-based inoculation).

Having reviewed the behavioural science research on countering vaccination misinformation, the paper outlines how infodemic management can be incorporated into a global pandemic accord for pandemic preparedness. This quest is in support of the protocol of the World Health Assembly Special Session in December 2021, which articulates the need for a World Health Organization (WHO) convention, agreement, or other international instrument on pandemic prevention, preparedness, and response. Some directives for a way forward, as delineated here, include:

• Build an infrastructure for social listening and constant monitoring of misinformation and the public's beliefs and concerns, which are crucial for an infodemic response. In line with the idea of pandemic preparedness plans, the infrastructure for social listening should be prepared during interpandemic phases, given limited time to deliberate on monitoring during a pandemic. Starting social listening before the next pandemic also enables infodemic managers to refine measurements to detect vaccination misinformation and misconceptions.
• Engage behavioural scientists in the campaign design process. Behavioural science offers a variety of interventions that make use of debunking as a tool to combat misinformation. For example, debunking texts and inoculation interventions can be disseminated online or as part of offline information campaigns.
• Strengthen spokespersons and healthcare personnel. Policies can incentivise trainings for health authorities or lay fact-checkers in effective rebuttal or adapt the curricula for medical and pharmacy students, as healthcare providers (HCPs) already have an immense workload during pandemics. In addition, creating opportunities for conversations about misconceptions between patients and HCPs through structured programmes can facilitate their use.

In conclusion: "Text-based debunkings, real-time rebuttals of science deniers, empathy-based corrections in physician-patient conversation, forewarnings, and inoculation interventions are part of an infodemic manager's toolbox to counter vaccination misinformation. These tools are not competing with each other but serve as building blocks of an infodemic preparedness plan that aims to build resistance against misinformation in several different contexts."