COVID-19 Health System Response Monitor (HSRM)

Raffael Heiss¹, Madeleine Waser¹, Michelle Falkenbach², Jakob-Moritz Eberl³

¹MCI Management Center Innsbruck

 ²Cornell University

 ³Ludwig Maximilian University Munich and University of Vienna

During the COVID-19 pandemic, Europe and the world witnessed a tremendous increase in misinformation. This includes false, inaccurate or incomplete information, which is shared without harmful intent, e.g., due to a lack of knowledge. But it also includes misleading information shared intentionally, e.g., to support a certain ideological cause (e.g., the anti-vaccination movement) or to pursue commercial interests (e.g., generate advertising revenue). Such intentional sharing of misleading information is often referred to as disinformation, a special case of misinformation.

There is reason to believe that the COVID-19 pandemic created a nurturing environment for misinformation. This environment is characterized by a) a high level of threat perceptions, and b) a lack of knowledge on the nature of the new disease. These two factors have made it difficult for people to cope with the situation, contributing to the circulation of conspiracy theories and pseudo-scientific remedies (Heiss et al., 2020; Rutter et al., 2020).

As a result, international observers have warned of a rapid spread of “misleading or fabricated news, images, and videos” (WHO, 2020), which the World Health Organization has labelled an infodemic. While misinformation on social media is not new, the tremendous amount and rapid spread of such information during a pandemic has posed a challenge to many governments and public health institutions. Given that widespread adherence to preventive behaviours is key to controlling transmission rates, the added confusion provided by misinformation is extremely counterproductive.

In this review, we outline how governments and public health organizations have responded to the infodemic across Europe. Information was collected through a literature review and expert interviews (see Table 1). The interviews were conducted with fact-checking experts, who are on the front-line fighting misinformation on social media. Only in Hungary, we consulted academic experts, since no fact-checking website existed at the time of the investigation (Gajdos, 2021).

The selected countries include Austria , Germany , Hungary, Italy , Norway , and Romania. These countries were chosen to cover different regions within Europe. We identified five response activities which are discussed in depth below. They include the establishment of task forces, the strategic use of online communication, the involvement of health experts, restrictions of the free flow of information, and the effort on improving the health and media literacy of the population. The results presented here provide first pointers on how to better organize the fight against misinformation during COVID-19 and future pandemics.

Task Forces were formed to oversee the implementation of restrictions, but also to tackle misinformation

Many governments have initiated COVID-19 task forces, which also tackled the issue of misinformation. In Austria, the government initiated a digital crisis task force (“digitaler Krisenstab”). The main task of this group was to oversee the implementation of the government campaign “Schau auf dich, schau auf mich” (“take care of yourself, take care of me”), which called for adhering to hygiene and social distancing regulations. The campaign was conducted in cooperation with the Red Cross and was communicated via various media channels (including daily newspapers and TV). However, the task force also employed police students to identify and debunk circulating misinformation, which was critically observed by the public (Goldberg, 2020). Even though the goals of the task force found general support, observers criticized a lack of transparency of its activities (Reporter ohne Grenzen, 2020).

In Italy, the government also initiated a commission to monitor misinformation. The commission was composed of representatives from the health ministry, the department of information and publishing, the civil protection office, and external experts (journalists, researchers, fact-checkers), including Giovanni Zagni, co-founder of facta.news, an Italian fake news debunking website. According to Zagni, the commission had insufficient power, a too broad and ill-defined scope, and was unable to find consensus among the involved experts. Furthermore, some opposition parties used the situation and attacked the initiative as “an attempt to introduce state censorship and suppress freedom of speech”, says Zagni. As a result, the commission failed to have a meaningful impact on the reduction of misinformation.

In Romania, the government initiated a task force in charge of the vaccination strategy and campaign. According to Calistru, co-founder of the Romanian fact-checking Website factual.ro, the responsibilities within the task force were shared between ministries (health, interior, defence), services for telecommunications and public health agencies. The composition of the subgroup in charge of the vaccination campaign was led by a military doctor, but the exact composition was not transparent, says Calistru. At the same time, the coalition partners in government imitated their own campaigns, indicating a lack of coordination.

According to Calistru, the campaign efforts failed to reach their goals, mostly because of a general distrust in political authorities and messages, a lack of coordination between them, and the late involvement of key stakeholders, such as employers or general practitioners. Furthermore, since the end of 2020, the populist party Alliance for the Union of Romanians entered the legislative body as a strong opposition force, promoting conspiracy and anti-vaccination ideas (Stoica et al., 2021).

Online communication was provided directly on government websites and amplified by social media platforms

In many countries, governments have created websites that provide information on developments and restrictions related to COVID-19. In Austria, the health ministry created a website on which citizens can access information pertaining to the COVID-19 pandemic and related social measures (e.g., social distancing, masks etc.). The website also provides a section for frequently asked questions and points to links for psychological support. Furthermore, even though data quality was often contested (Halla & Oberhofer, 2020), the Austrian Agency for Health and Food Safety (AGES), one of the key public health agencies in Austria, created a dashboard for relevant pandemic indicators (e.g., infection rates) on the national and regional levels. The AGES also runs a telephone hotline which citizens can call to get information on coronavirus developments.

Despite these initiatives, Bernd Kerschner from the Austrian fact-checking website “medizin-transparent.at”, a Cochrane Austria project, identifies flaws: “Government policies and containment measures were changing constantly and the communication of these changes was delegated to the media, leaving citizens potentially irritated and confused”, says Kerschner. For example, information on quarantine regulations or vaccination efficacy and side effects have been distributed across different websites. According to him, a central website with consistent and current updates explained in a simple manner would have been helpful.

In Germany, the government has also been active in disseminating information via social media. Some platforms actively offered to spread governmental information partly free of charge (Breher, 2020). Of course, such cooperation may also be beneficial for big tech companies, which have come under criticism for circulating misinformation on their platforms. This is particularly true for Telegram, where the lack of strict control mechanisms has been criticized as providing fertile soil for Corona misinformation (Hohlfeld, 2021). Based on a cooperation with the tech company, the German government created a Telegram information channel, through which they sent push messages to all Telegram users and provided updates on the pandemic, including mini fact checks.

In other countries, such as Hungary, efforts have been criticized. Although the government has created a central information platform, observers have commented on the quality of the data provided. Eva Bognar, a researcher at the Central European University’s Center for Media, Data and Society, reported that journalists could not access county-level data on infections and death rates. Furthermore, the available data were only shared as pictures, and journalists had to take screenshots and create their own excel sheets to follow infection trends. Bognar argues that due to the “lack of information available in Hungary, the space for alternative narratives is wide open, and people’s hunger for alternative explanations are increasing”.

The involvement of health experts in public-facing roles varied between countries

There is evidence for the importance of involving experts in health communication processes (Vraga & Bode, 2017). In Norway, the deputy director of the Norwegian agency for health has been an important player in government communication. Similarly, German virologist Christian Drosten and the Swedish state epidemiologist Anders Tegnell played a key role in communicating policy measures. In Austria, political actors undertook the role of key communicators during the first phase of the pandemic. The so-called “virological quartet” was composed of the chancellor, the vice-chancellor, the health minister and the domestic affairs minister. Only later on, the government decided to involve health experts (along with political heads at county levels) in their communication strategy, indicating a learning process, in which the important role of health experts has been increasingly acknowledged.

Even though the involvement of experts can increase credibility, experts may also share misinformation. According to Giovanni Zagni, even some highly educated Italian academics are firm believers of COVID-19 related misinformation and conspiracy theories. In Germany and Austria , experts such as Sucharit Bhakdi, a retired microbiologist who has denied the effectiveness of vaccination, provided academic legitimacy for scepticism towards policy measures aimed at reducing transmissions. Using health experts in communication processes is thus not a strategy that can overcome all misinformation since those who are spreading rumours can refer to other real or pseudo-experts with minority opinions to undermine the voice of experts, who represent mainstream scientific consensus.

The free flow of information was restricted in some contexts

Some countries imposed more rigorous restrictions on freedom of information. In Hungary, the government passed a law that enabled the jurisdiction to prosecute people who intentionally share misinformation and to send them to prison for up to five years. This was heavily criticized by domestic and international observers because the law may enable public institutions to criminalize those who criticize the management of the COVID-19 pandemic. Furthermore, the law may also lead to self-censorship, since journalists and citizens anticipate prosecution and thus may no longer use their freedom of expression to the full extent (Radu, 2021).

According to Eva Bognar, beyond the government criminalizing the sharing of misinformation, they can also publicly share some incorrect information. For example, the Hungarian government shared a table on vaccination effectiveness in which Sputnik V performed best and Biontech-Pfizer performed worst. The calculations used were criticized as being misleading because they were based on unbalanced data sources (Vaski, 2020). Bognar also explains that many observers fear the legislation was not intended to stop misinformation from being produced or disseminated and that even though no journalists were prosecuted on the back of this law, many fear that it would lead to an increase in self-censorship.

In Romania, the government authorized the executive authority on communication and telecommunication to closedown websites that spread misinformation. However, the criteria remained vague and according to Calistru, the actions that were taken by the public authorities were unclear, subjective and failed to reduce the amount of misinformation.

Calistru reports that the Romanian government did not provide the public with easily accessible information on key pandemic indicators. The government also extended the timeframe in which they had to respond to freedom of information requests. Such actions may “limit the extent to which journalists can provide the public a service that disambiguates truth from falsehood” (Radu, 2021, p. 2). Furthermore, Calistru reports that some politicians aimed to gain popularity by sharing inaccurate information during the 2020 national and local elections in Romania. In this context, the EU has been an important source of accurate information in Romania.

Improving health and media literacy will allow people to be more resistant to misinformation

The improvement of health and media literacy aims at empowering people to judge content by themselves. In Norway, Geir Molnes from Faktisk Norway suggests that media and health literacy should be part of school education. His organization actively involves teachers, who are part of the Faktisk team and also help to create content for primary education. On their website, teachers can find study sessions to teach media literacy to children. The Romanian NGO Funky Citizens, which runs factual.ro, hosted weekly Facebook broadcasts with scientists and medical doctors and provided training on countering disinformation for civil society organizations and citizens.

In addition to health literacy, it is important to foster media literacy. This includes not only the knowledge of technological features but also the ability to judge sources and assess content based on competent information acquisition in the digital world. While this is important to incorporate in school, Bernd Kerschner, from Austria’s medizin-transparent.at, argues that media literacy needs to be boosted in older people, in particular, echoing other calls from academia (ARD, 2021).

Conclusion: empowerment before regulation

Taken together, European governments have followed two different approaches in countering misinformation. The first strategy is targeted at reducing the amount of misinformation by restricting the free flow of information. In some countries, this strategy was more pronounced, such as in the case of Hungary. In other countries, more tentative attempts to reduce the free flow of information were publicly criticized and repelled. For example, the work of task force activities which aimed to reduce the amount of misinformation was often criticized, for these activities touch on the sensitive topic of state intervention in freedom of speech. As a result, the success of many task forces was rather limited.

The second approach is about the empowerment of citizens. To this end, governments tried to increase citizens’ knowledge ad hoc, such as by creating websites, social media channels and information campaigns. Such campaigns are important to inoculate citizens so that they become resistant to misinformation as well as to provide important information for self and third-party corrections (Heiss, 2021). Unfortunately, some of our interviewees mentioned that official websites often presented incomplete information, which was often provided on multiple different websites and used too technical language.

According to Alice Echtermann, from the German fact-checking platform “correctiv.org”, public health institutions should be primarily involved in providing reliable health-related information. This information, however, needs to be presented in a form that allows the wider public to understand and use it. In the future, governments and public health institutions could strengthen their collaboration with NGOs and fact-checking platforms and create more attractive and consistent information online.

Because misinformation goes beyond national borders, European and international initiatives are needed. For example, the EU employs a task force within the StratCom, the EU diplomatic service’s strategic communications division, to actively monitor and debunk disinformation. However, the attempts to combat disinformation efforts have been described as poorly resourced and some call for delegating the monitoring and debunking of misinformation to civil society organizations (Perrone & Loucaides, 2021).

Despite their importance, ad hoc approaches to counter misinformation also have certain flaws, especially when freedom of information flows are at risk. Unfortunately, the process of providing knowledge and skills to citizens is a lengthy and complex process, which is not feasible over a short period of time. In fact, assisting citizens to become resistant against misinformation needs long-term strategies, targeting both younger and older generations. On the EU level, the European Digital Media Observatory provides a networking platform for independent fact-checkers and provides media literacy tools to support national literacy campaigns. Such efforts need to be further strengthened. In fact, this is an urgent call for efforts in the post-pandemic period, where governments can invest in improving citizens’ competence to judge and reject misinformation which is a strong weapon in the battle against future infodemics.

References

ARD (2021). Older people particularly vulnerable? (Ältere besonders anfällig?) ARD. https://www.tagesschau.de/faktenfinder/podcast/was-sind-fake-news-101.html

Breher, N. (2020). When the Ministry of Health sends a push message. (Wenn das Gesundheitsministerium eine Push-Nachricht schickt.) Tagesspiegel. https://www.tagesspiegel.de/politik/social-media-kommunikation-in-der-coronakrise-wenn-das-gesundheitsminsterium-eine-push-nachricht-schickt/25779934.html

Goldberg, A. (2020). Office of the chancellor: Where are the 150 fake news reports? (Kanzleramt: Wo sind die 150 Fake News?) Falter. https://www.falter.at/zeitung/20200408/kanzleramt--wo-sind-die-150-fake-news/_c0e800c296?ref=nav

Gajdos, R. (2021). We Need a Fact-Checking Website in Hungary and Here’s Why. https://cmds.ceu.edu/we-need-fact-checking-website-hungary-and-heres-why

Halla, M., & Oberhofer, H. (2020). Covid-19 data: stop the monopoly of knowledge! (Covid-19-Daten: Stopp dem Herrschaftswissen!). Der Standard. https://www.derstandard.at/story/2000122696492/covid-19-daten-stopp-dem-herrschaftswissen

Heiss, R. (2020) Fighting health infodemics: The role of citizen empowerment. Eurohealth, 26 (3), 23-25. https://apps.who.int/iris/bitstream/handle/10665/338919/Eurohealth-26-3-23-25-eng.pdf

Heiss, R., Gell, S., Röthlingshöfer, E., & Zoller, C. (2021). How threat perceptions relate to learning and conspiracy beliefs about COVID-19: Evidence from a panel study. Personality and Individual Differences, 175. https://doi.org/10.1016/j.paid.2021.110672

Hohlfeld  R. et al., (2021). Communicating COVID-19 against the backdrop of conspiracy ideologies: How public figures discuss the matter on Facebook and Telegram. Preprint. http://dx.doi.org/10.13140/RG.2.2.36822.78406

Perrone, A. & Loucaides, D. (2021). ‘Spreading like a virus’: inside the EU’s struggle to debunk Covid lies. The Guardian. https://www.theguardian.com/world/2021/aug/17/spreading-like-a-virus-inside-the-eus-struggle-to-debunk-covid-lies

Radu, R. (2020). Fighting the ‘Infodemic’: Legal Responses to COVID-19 Disinformation. Social Media + Society, 6(3). https://journals.sagepub.com/doi/10.1177/2056305120948190

Rutter, H., Wolpert, M., & Greenhalgh, T. (2020). Managing uncertainty in the covid-19 era. BMJ, 370. https://doi.org/10.1136/bmj.m3349

Stoica, M., Krouwel, A., & Cristea, V. (2021). Stealth populism: Explaining the rise of the Alliance for the Unity of Romanians. LSE European Politics and Policy (EUROPP) blog. https://blogs.lse.ac.uk/europpblog/2021/02/26/stealth-populism-explaining-the-rise-of-the-alliance-for-the-unity-of-romanians/

Vaski, T. (2021). ​​Gov’t Publishes Controversial Data to Prove Sinopharm and Sputnik Better Than Pfizer. Hungary Today. https://hungarytoday.hu/hungary-vaccines-vaccine-effectiveness-inoculation-vaccine-effectiveness-comparison-pfizer-sputnik-sinopharm/

Vraga, E. K., & Bode, L. (2017). Using expert sources to correct health misinformation in social media. Science Communication, 39(5), 621-645. https://journals.sagepub.com/doi/10.1177/1075547017731776

WHO (2020). Immunizing the public against misinformation. Geneva: WHO. Available at: https://www.who.int/news-room/feature-stories/detail/immunizing-the-public-against-misinformation

Table 1: List of experts who were interviewed to provide country-specific insights and background information (country, expert, platform/organization)

• Austria, Bernd Kerschner, https://www.medizin-transparent.at
• Germany, Alice Echtermann, https://correctiv.org
• Hungary, Eva Bognar & Judit Szakacs, https://www.ceu.edu
• Italy, Giovanni Zagni, https://facta.news
• Norway, Geir Molnes, https://www.faktisk.no
• Romania, Elena Calistru  https://funky.ong/en/; https://www.factual.ro

Note: The authors would like to thank the above-listed experts who participated in the interviews.