Misinformation, Disinformation, Malinformation (MDM): Weaponized Health Communication

Social media allows for easy access and sharing of information in real-time. Since the beginning of the coronavirus disease (COVID-19) pandemic, social media has been used as a tool for public health officials to spread valuable information. However, many Internet users have also used it to spread misinformation, commonly referred to as “fake news.” The spread of misinformation can lead to detrimental effects on the infrastructure of healthcare and society. The purpose of this scoping review was to identify the sources and impact of COVID-19 misinformation on social media and examine potential strategies for limiting the spread of misinformation. A systemized search of PubMed, Embase, and Web of Science electronic databases using search terms relevant to the COVID-19 pandemic, social media, misinformation, or disinformation was conducted. Identified titles and abstracts were screened to select original reports and cross-checked for duplications. Using both inclusion and exclusion criteria, results from the initial literature search were screened by independent reviewers. After quality assessment and screening for relevance, 20 articles were included in the final review. The following three themes emerged: (1) sources of misinformation, (2) impact of misinformation, and (3) strategies to limit misinformation about COVID-19 on social media. Misinformation was commonly shared on social media platforms such as Twitter, YouTube, Facebook, messaging applications, and personal websites. The utilization of social media for the dissemination of evidence-based information was shown to be beneficial in combating misinformation. The evidence suggests that both individual websites and social media networks play a role in the spread of COVID-19 misinformation. This practice may potentially exacerbate the severity of the pandemic, create mistrust in public health experts, and impact physical and mental health. Efforts to limit and prevent misinformation require interdisciplinary, multilevel approaches involving government and public health agencies, social media corporations, and social influencers.

BackgroundMisinformation on social media during natural disasters has become a significant challenge, with the potential to increase public confusion, panic, and distrust. Although individuals rely on social media platforms for timely updates during crises, these platforms also facilitate the rapid spread of unverified and misleading information. Consequently, misinformation can hamper emergency response efforts, misdirect resources, and distort public perception of the disaster’s true severity.ObjectiveThis narrative review aims to (1) critically evaluate the available evidence; (2) unpack the dynamics of misinformation on social media in the context of natural disasters, specifically natural hazards, shedding light on the challenges, implications, and potential solutions; and (3) develop a conceptual model linking misinformation, public impact, and disasters, grounded in sourced evidence.MethodsThe narrative review examines the impact of social media misinformation in the context of natural disasters. The literature search was conducted using the PubMed database and Google Scholar in April 2024. Studies eligible for inclusion were published in English, with no restrictions on publication date, geographic region, or target population. The inclusion criteria focused on the original research that examined social media misinformation related to natural disasters, specifically natural hazards.ResultsFrom an initial pool of 173 studies, 9 studies met the inclusion criteria for this review. The selected studies revealed consistent patterns in how misinformation spreads during natural disasters, highlighting the role of users, some influencers, and bots in amplified false narratives. The misleading messages disseminated across social media platforms often outpaced official communications, resulting in reduced trust and exacerbating anxiety, stress, and fear among affected populations. This heightened emotional response and erosion of trust in official communications influenced an individual’s susceptibility to the misinformation and prompted inappropriate actions. Consequently, such actions led to resource misallocation, overwhelmed emergency services, and diverted attention away from genuine needs. Collectively, these factors negatively impacted public health outcomes and diminished the effectiveness of emergency management efforts, as illustrated in the conceptual model developed to provide a greater understanding of this critical area of study.ConclusionsThis narrative review highlights the significant impact of misinformation in the context of natural disasters, specifically natural hazards. It stresses the urgent need for disaster preparedness and response plans that include targeted interventions such as real-time misinformation detection technologies, public education campaigns focused on digital literacy, and proactive debunking initiatives. Implementing these strategies can help mitigate the harmful effects of misinformation, strengthen public trust in official communications, enhance the effectiveness of disaster response, and improve public health outcomes.

BackgroundVaccine uptake has declined since the coronavirus disease 2019 pandemic began. The pandemic changed people’s perception about vaccination due to factors such as increasing mistrust in government, spread of misinformation, fear of side effects, unclear communication, concerns about rushed vaccine development, and opposition to mandates infringing on personal choice. Understanding different perspectives on vaccine decision-making is crucial for informing effective approaches to communicating about vaccines.Case presentationThis study presents three cases with varying attitudes and behaviors about vaccination for coronavirus disease 2019, traditional childhood illnesses, and influenza influenced by different contexts and experiences. The cases span the continuum of vaccine hesitancy and uptake, from distrustful and resistant (Alexis, 56-year-old non-Hispanic White American female), through resentment for mandated uptake of the expedited coronavirus disease 2019 vaccine versus trust of long-standing preventive vaccines (Nia, 51-year-old non-Hispanic Black American female), to accepting and adopting (David, 38-year-old non-Hispanic White American male). These cases have similarities and differences across ten key “themes,” including vaccine attitudes; decision-making motivations; prioritizing family’s health; influence of past vaccination trauma on decision-making; significance of social support; the importance of information to guide decisions; (dis)trust in news, social media, and politicians; disappointment in humanity; future recommendations including respecting individual autonomy and providing the necessary information for individual decision-making; and openness to future vaccines.ConclusionThe long-term impact of the public health response—including vaccine mandates—and aftermath of stigmatization of people with differing and less socially desirable vaccine beliefs on vaccine uptake and health and medical service engagement remains unknown. By drawing on rich, nuanced information collected from individuals at a time of intense national dialogue around vaccines, these three case studies offer unique and novel insights into how the dialogue around vaccine uptake should evolve to meet the needs of different people. These findings have implications for broadly promoting public health engagement by hearing varied experiences and tailoring approaches to reach diverse groups of individuals. Findings from these cases provide insights and recommendations for tailoring future pandemic-related responses to audiences with similar beliefs and experiences as those presented in these cases.

In recent years, the amount of untrue information, or ‘misinformation’, shared online has increased rapidly. This can have profound effects on society and has been linked to violence, political extremism, and resistance to climate action. One reason for the spread of misinformation is the lack of incentives for users to share true content and avoid sharing false content. People tend to select actions that they believe will lead to positive feedback (‘carrots’) and try to avoid actions that lead to negative feedback (‘sticks’). On most social media sites, these carrots and sticks come in the form of ‘like’ and ‘dislike’ reactions, respectively. Stories that users think will attract ‘likes’ are most likely to be shared with other users. However, because the number of likes a post receives is not representative of how accurate it is, users share information even if they suspect it may not be accurate. As a result, misinformation can spread rapidly. Measures aimed at slowing the spread of misinformation have been introduced to some social media sites, such as removing a few virulent spreaders of falsities and flagging misleading content. However, measures that change the incentive structure of sites so that positive and negative feedback is based on the trustworthiness of the information have not yet been explored. To test this approach, Globig et al. set up a simulated social media site that included ‘trust’ and ‘distrust’ buttons, as well as the usual ‘like’ and ‘dislike’ options. The site featured up to one hundred news stories, half of which were untrue. More than 900 participants viewed the news posts and could react using the new buttons as well as repost the stories. The experiment showed that participants used the ‘trust’ and ‘distrust’ buttons to differentiate between true and false posts more than the other options. As a result, to receive more ‘trust’ responses and less ‘distrust’ responses from other users, participants were more likely to repost true stories than false ones. This led to a large reduction in the amount of misinformation being spread. Computational modeling revealed that the participants were paying more attention to how reliable a news story appeared to be when deciding whether to repost it. Globig et al. showed that adding buttons to highlight the trustworthiness of posts on social media sites reduces the spread of misinformation, without reducing user engagement. This measure could be easily incorporated into existing social media sites and could have a positive impact on issues that are often fuelled by misinformation, such as vaccine hesitancy and resistance to climate action.

BackgroundThe rapid evolution of social media in recent years has increased public exposure to suicide. While research has highlighted concerns about the role of social media in facilitating harmful discourse and imitative suicidal behaviour, there is a wide gap in our understanding of the impact of social media exposure in the aftermath of a suicide, and no research to our knowledge from preventive public and mental health perspectives. This qualitative study explored the experiences of public and mental health professionals in relation to social media exposure following a suicide. The study aimed to (1) Better understand social media risks from a public health perspective; (2) Provide insights for public health policy and strategy to enhance suicide prevention efforts and inform guidance for responding.MethodsIn-depth interviews were conducted with 10 purposively sampled public and mental health professionals based on their roles in crisis response, suicide prevention, and digital monitoring. Data were collected through semi-structured interviews, focusing on their experiences of responding to suicide-related risks on social media, including the spread of information across platforms, public engagement with content, impact, and intervention challenges. Data were analysed using thematic analysis to identify emerging themes.ResultsFour key themes emerged: (1) The communicative ecology of social media (where the public act as content purveyors, rapidly disseminating varied and often unregulated narratives); (2) Harmful effects (including the copycat effect and toxic discourse); (3) Positive effects (where protective discourse and moderation offer harm reduction opportunities); and (4) Challenges in intervention (including content moderation difficulties and algorithmic biases that amplify harmful narratives).ConclusionFindings highlight the need for improved content moderation, public health-led digital monitoring, and education on safe social media use. Strengthening real-time suicide surveillance, improving collaboration with social media platforms, and promoting public awareness of digital literacy are critical to mitigating risks and ensuring social media supports suicide prevention efforts. As digital communication continues to evolve, proactive public health strategies will be essential in safeguarding vulnerable individuals.

IntroductionSocial media facilitates the rapid spread of information and misinformation to the public. Medical students as healthcare professionals in training have a responsibility to support public health advocacy. As such, it is important to understand whether medical students feel comfortable to use social media as a tool to promote public health. There is little literature evaluating this. The covid-19 pandemic gives us a unique opportunity to characterise this relationship.MethodsThis is a cross sectional survey-based study run by the student surgical society at Hull York Medical School. Data will be collected on confidence of medical students in receiving, appraising and resharing information on social media. The study will first be run as a single centre study. Following data collection and analysis, will be promoted to other student surgical societies across the UK to be run as a collaborative national study.Results Primary ObjectiveHow confident are medical students in receiving, appraising and resharing information they receive on social media?: Secondary Objective: Is there a relationship between years of training or postgraduate/undergraduate status and confidence in using social media amongst medical students? How often do medical students use social media as their primary source of information? Is there adequate education on how social media can be used to combat misinformation?: Conclusion: The covid-19 pandemic allows a unique opportunity to characterise the relationship between medical students, social media, and health advocacy. Understanding this relationship will help guide medical education to incorporate social media as an effective tool in healthcare.

In December 2019, reports emerged of pneumonia clusters of unknown cause at health facilities in Wuhan, China. These cases were linked to a wet animal wholesale market in the region and, after extensive epidemiologic investigation, led to identification of a novel coronavirus (COVID-19). COVID-19 is among a family of viruses – called coronaviruses – that can affect both humans and animals (Zhu et al., 2020). Coronavirus infections are respiratory in nature and can range from the common cold with mild symptoms to more severe infections, such as severe acute respiratory syndrome and Middle East respiratory syndrome (Perlman, 2020; World Health Organization [WHO], 2020). The newly identified COVID-19 infection typically presents as fever, tiredness, fatigue, and dry cough (Huang et al., 2020). However, more severe symptoms such as dyspnoea, diarrhoea, pneumonia, and others have been reported. As of 9 March 2020, cases of COVID-19 have been reported in countries across the world. The global number of reported cases has surpassed 100,000 with almost 4,000 deaths (WHO, 2020). China remains the highest risk area but, clearly, COVID-19 is a global health problem. Nurses are central to COVID-19 prevention and response efforts. Nursing is the largest healthcare profession in the US and the world, with approximately 3.8 million nurses in the US and over 20 million nurses worldwide. Nurses are providing front-line care in the most patient-facing role to complex COVID-19 cases that require hospitalization. Individuals who have preexisting health vulnerabilities are at greatest risk for COVID-19 complications or mortality and nursing resources are critical to managing this population. Public health experts predict that healthcare and hospital resources will become even more urgently needed as COVID-19 spreads in communities (Jiang et al., 2020; Pan, Wang, & Huang, 2020). As one of the most trusted health professional groups, nurses also play a key role in providing public education on disease prevention and reducing the spread of misinformation around the outbreak. There has been widespread misinformation on how COVID-19 is transmitted, who is at risk of transmitting or receiving the virus and where outbreaks are occurring (Wen, Aston, Liu, & Ying, 2020). For example, in some cases, Chinese and other Asian individuals have been assumed to be at higher risk for being infected with COVID-19 simply because of their nationality or race, resulting in stigma and xenophobia (Wen et al., 2020). There has also been misinformation about appropriate use of face masks. Some individuals have assumed that they are protected from COVID-19 by wearing a face mask – even though evidence is mixed from studies of other viral infections – and may neglect more efficacious infection prevention measures (e.g., handwashing) while also limiting the availability of face masks for response professionals who need them (Cowling, Zhou, Ip, Leung, & Aiello, 2010; WHO, 2020). Such misinformation may be spread via traditional media, social media, or in communities and can interfere with public health response efforts. Because of the unique patient-facing nature of nursing work in community, outpatient, and acute care settings, there are occupational risks to providing care during the COVID-19 outbreak. It is essential that nurses are supported to protect themselves during the management of COVID-19 in clinical care with clear infection control protocols (standard, contact, and airborne) and adequate availability of personal protective equipment at their place of work, including/N95 respirators, masks, gowns, eye protection, face shields, and gloves (American Nurses Association [ANA], 2020). Healthcare facilities employing nurses must ensure consistent availability and use of hand hygiene supplies; provide updated information on screening, isolation, quarantine, and triage procedures based on guidance from the Centers for Disease Control and Prevention or other appropriate public health agencies; and coordinate with local, state, or national outbreak management efforts (ANA, 2020). Healthcare leaders should closely monitor the well-being, occupational health, and safety of their clinical nursing staff. Nurses have a responsibility to stay home if they have travelled to areas that have declared states of emergency or contract COVID-19 in their work. Healthcare leaders must support and provide resources for nurses who are exposed to COVID-19 or experience other outbreak-related harm as a result of their work, even if nursing resources become strained. Despite these occupational risks and the immediate need for health system interventions to support nurses, nursing also has unique responsibilities in the COVID-19 outbreak. Nurses will continue to be at the front line of patient care in hospitals and closely involved with assessment and monitoring in outpatient and community settings. They must ensure that all patients receive individualized, high-quality care regardless of their infection status and participate in preparation for increased nursing and health system demand related to COVID-19. Nurses also must continue to provide education to patients and the public about the outbreak. This includes confronting misinformation, directing communities to reputable public health resources such as the World Health Organization and Centers for Disease Control and Prevention and promoting evidence-based infection prevention measures (Centers for Disease Control & Prevention, 2020; WHO, 2020). Leaders and educators in nursing should provide education to clinical nurses and support staff about current COVID-19 issues and risks specific to their practice area (e.g., paediatrics, maternal–infant health, nursing homes, schools, places of worship). This education should extend to nursing students, who may have additional considerations related to being in a campus environment. Finally, nurses should advocate for local, state, and national policy response to the COVID-19 outbreak and support local preparedness and prevention efforts (International Council of Nurses, 2020; National Nurses United, 2020). Particularly, there is a need for care coordination across public health departments, communities, and healthcare systems that nurses are ideally suited to providing. A global outbreak requires the active participation of the nursing workforce in clinical care, education and information sharing, public health, and policy. Nurses are already fully engaged in COVID-19 response and, with appropriate support, will be key players in ending the outbreak. No conflict of interest was declared by the authors in relation to the study itself. Note that M. Cynthia LOGSDON is a JAN editor but, in line with usual practice, this paper was edited by another editor. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Social media research during natural disasters has been presented as a tool to guide response and relief efforts in the disciplines of geography and computer sciences. This systematic review highlights the public health implications of social media use in the response phase of the emergency, assessing (1) how social media can improve the dissemination of emergency warning and response information during and after a natural disaster, and (2) how social media can help identify physical, medical, functional, and emotional needs after a natural disaster. We surveyed the literature using 3 databases and included 44 research articles. We found that analyses of social media data were performed using a wide range of spatiotemporal scales. Social media platforms were identified as broadcasting tools presenting an opportunity for public health agencies to share emergency warnings. Social media was used as a tool to identify areas in need of relief operations or medical assistance by using self-reported location, with map development as a common method to visualize data. In retrospective analyses, social media analysis showed promise as an opportunity to reduce the time of response and to identify the individuals' location. Further research for misinformation and rumor control using social media is needed.

Purpose: The unprecedented spread of misinformation during the COVID-19 pandemic was largely driven by social media platforms. Public understanding of masking, viral transmission, treatment options for COVID, and vaccination were distorted by the influence of social media platforms. The pandemic saw a rise of TikTok, another social media platform, whose role in the dissemination of misinformation has been far less studied. The relatively new social medial platform boasts millions of monthly U.S. users, with a large portion of those users being impressionable children, teens, and young adults. Given its popularity, its role in the spread of misinformation is likely substantial. The purpose of this study is to assess the quantity of COVID misinformation on TikTok in the period of 2020 to 2022, looking specifically at the number of anti- and pro-vaccine videos appearing on the platform. By assessing the impact severity of the anti-vaccine content on TikTok, this study will be able to inform future public health efforts of these effects, with the goal of curtailing the spread of medical misinformation. Methods: Videos were collected from the app by the research team retrospectively using four sets of search terms that appear frequently in pro and anti-vaccine related content. Researchers judged the videos as anti- or pro-vaccine while recording metrics on the videos such as likes and bookmarks. A total of 284 videos were selected for analysis. Comparisons were made between likes and the other metrics using p-values for significance. Results: 109 anti- and 175 pro-vaccine videos were identified. A larger share of the data set was pro vaccine. There was no significant difference between the number of likes between anti- and pro-vaccine content. Conclusion: This study took a novel approach to TikTok by examining videos using multiple search terms over the course of a three-year period. The lack of statistical significance in number of likes between anti- and pro-vaccine content, despite there being more pro-vaccine videos is indicative of pervasive misinformation is on TikTok. Ambivalence over medical facts is not reassuring for any public health effort. Our analysis found a larger share of misinformation than previous studies, providing further evidence that a supra-dominant positive narrative on social media platforms is difficult to achieve, even though this is critical for health care initiatives.

Context: Wealthy countries vary considerably in terms of how well they have been able to inoculate their populations against COVID-19. In particular, democracies have been constrained in their abilities to implement vaccine mandates, given enshrined protections of civil liberties and individual freedom in such regimes. While scholars have begun addressing the democratic constraint on vaccine mandates, less attention has been paid to the additional challenges democracies face in constraining the spread of vaccine misinformation—particularly misinformation that spreads online. Methods: This study combines large-N cross-country analysis with a case study of Germany to illustrate the “double bind” that democracies face when it comes to containing both the spread of disease and the spread of misinformation through social media. Findings: The cross-national analysis confirms that democracies have been less likely to enact vaccine mandates, and they have also been relatively more hesitant to restrict what people can see and share online. The case study of Germany highlights the normative and the procedural constraints underlying such decisions. Conclusions: These findings show that resources are often not the binding constraint on effective disease control, raising questions regarding the ability of high-income democracies to respond effectively to future public health emergencies.

While there has been substantial analysis of social media content deemed to spread misinformation about electronic nicotine delivery systems use, the strategic use of misinformation accusations to undermine opposing views has received limited attention. This study aims to fill this gap by analyzing how social media users discuss the topic of misinformation related to electronic nicotine delivery systems, notably vaping products. Additionally, this study identifies and analyzes the actors commonly blamed for spreading such misinformation and how these claims support both the provaping and antivaping narratives. Using Twitter's (subsequently rebranded as X) academic application programming interface, we collected tweets referencing #vape and #vaping and keywords associated with fake news and misinformation. This study uses systematic content analysis to analyze the tweets and identify common themes and actors who discuss or possibly spread misinformation. This study found that provape users dominate the platform regarding discussions about misinformation about vaping, with provaping tweets being more frequent and having higher overall user engagement. The most common narrative for provape tweets surrounds the conversation of vaping being perceived as safe. On the other hand, the most common topic from the antivape narrative is that vaping is indeed harmful. This study also points to a general distrust in authority figures, with news outlets, public health authorities, and political actors regularly accused of spreading misinformation, with both placing blame. However, specific actors differ depending on their positionalities. The vast number of accusations from provaping advocates is found to shape what is considered misinformation and works to silence other narratives. Additionally, allegations against reliable and proven sources, such as public health authorities, work to discredit assessments about the health impacts, which is detrimental to public health overall for both provaping and antivaping advocates. We conclude that the spread of misinformation and the accusations of misinformation dissemination using terms such as "fact check," "misinformation," "fake news," and "disinformation" have become weaponized and co-opted by provaping actors to delegitimize criticisms about vaping and to increase confusion about the potential health risks. The study discusses the mixed types of impact of vaping on public health for both smokers and nonsmokers. Additionally, we discuss the implications for effective health education and communication about vaping and how misinformation claims can affect evidence-based discourse on Twitter as well as informed vaping decisions.

Healthcare professionals had to face numerous challenges during the pandemic, their professional activity being influenced not only by the virus, but also by the spread of medical misinformation. In this regard, we aimed to analyze, from the perspective of medical staff, the way medical and non-medical information about the virus was communicated during the pandemic to encourage the development of future research or interventions in order to raise awareness about the way misinformation affected medical staff. The study was conducted on Romanian healthcare professionals. They were asked to answer to a questionnaire and the sample of the research includes 536 respondents. The findings revealed that most respondents stated that information about alternative treatments against the virus affected the credibility of health professionals, and that younger professionals believed to a greater extent that trust in doctors was affected. The research also showed that respondents were well informed about the drugs used in clinical trials in order to treat the virus. Healthcare professionals declared that the spread of misinformation regarding alternative treatments, affected their credibility and the relationship with their patients. Healthcare professionals had knowledge about the drugs used in clinical trials, and they acknowledged the role of social media in spreading medical misinformation. However, younger professionals also believed that social media could be used to share official information about the virus.

Faith communities support a variety of public health initiatives as conduits of information and service distribution points. However, with the onset of the coronavirus pandemic (COVID-19), there is concern that religious communities may be echo chambers for misinformation and conspiracy theories that are undercutting the adoption of precautions to prevent transmission and the use of COVID-19 vaccines. The purpose of this study is to identify the receptivity to and spread of misinformation about COVID-19 by faith communities and whether embracing these inaccuracies constitutes a uniquely religious effect. This study conducted three small analyses approach. First, we engaged in the automated text mining of approximately 2.3 million discussion posts from discussion forums noted for their conspiracism and extremism. Next, secondary quantitative analysis of two recent surveys from the American Trends Panels by Pew Research conducted in April 2020 (N = 9482) and February 2021 (N = 9429) were conducted to determine whether sources of information and preventive behaviors related to the pandemic were associated with uniquely religious effects or possibly mediated by other factors such as sociodemographic characteristics or political views. The association of White evangelicals with politicized misinformation was consistent across all three small studies. Prior to the availability of vaccines, religious themes consistently appeared in 15–19% of COVID-19 social media posts and were higher in subsets of the discourse tied to misinformation. The framing of COVID-19 using religious language was associated with the Christian right in about half of the religiously-themed posts. Religious themes fell below the 15% threshold once the vaccine was available. In the survey research, small, uniquely religious effects were found with White evangelical receptivity of COVID-19 information from Donald Trump and less reliance on information from public health experts, and small, uniquely religious associations were found with preventive measures. Among White nonevangelical Protestants and non-Hispanic Roman Catholics, there was found the same combination of a higher likelihood of reliance on messages from the Donald Trump Presidency and a lower likelihood for news-media use. Black Protestants showed a higher level of use and trust in state and local government officials. The study confirmed higher use of social media among non-Hispanic Roman Catholics but did not find this relationship among Hispanic Protestants. Faith communities are not always receptive to public health messages that promote the public good. This study indicates that the religion effects can appear early, giving time for health education specialists to address them, and that these effects can diminish once preventive measures are available.

BackgroundThe quality of health information on social media is a major concern, especially during the early stages of public health crises. While the quality of the results of the popular search engines related to particular diseases has been analyzed in the literature, the quality of health-related information on social media, such as X (formerly Twitter), during the early stages of a public health crisis has not been addressed.ObjectiveThis study aims to evaluate the quality of health-related information on social media during the early stages of a public health crisis.MethodsA cross-sectional analysis was conducted on health-related tweets in the early stages of the most recent public health crisis (the COVID-19 pandemic). The study analyzed the top 100 websites that were most frequently retweeted in the early stages of the crisis, categorizing them by content type, website affiliation, and exclusivity. Quality and reliability were assessed using the DISCERN and JAMA (Journal of the American Medical Association) benchmarks.ResultsOur analyses showed that 95% (95/100) of the websites met only 2 of the 4 JAMA quality criteria. DISCERN scores revealed that 81% (81/100) of the websites were evaluated as low scores, and only 11% (11/100) of the websites were evaluated as high scores. The analysis revealed significant disparities in the quality and reliability of health information across different website affiliations, content types, and exclusivity.ConclusionsThis study highlights a significant issue with the quality, reliability, and transparency of online health-related information during a public health challenge. The extensive shortcomings observed across frequently shared websites on Twitter highlight the critical need for continuous evaluation and improvement of online health content during the early stages of future health crises. Without consistent oversight and improvement, we risk repeating the same shortcomings in future, potentially more challenging situations.

According to the World Health Organization, the coverage of vaccine-preventable diseases rests at 86% with nearly 20 million children worldwide who have not received basic vaccines. Vaccine-hesitant individuals are a heterogeneous group who hold varying degrees of indecision about specific vaccines or vaccination in general. Vaccine hesitancy is a behavior influenced by several factors including issues of confidence, complacency, and convenience. In countries where access is not the main issue for lack of vaccination, there are many cultural influences that affect the decision for parents to seek vaccination for their children or themselves. Media and social media can create a negative or positive vaccine sentiment and can provide a platform for lobbies and key opinion leaders to influence others. Community leaders and influencers, including religious leaders in some settings, celebrities in others, can all have a significant influence on vaccine acceptance or hesitancy. Vaccine mandates can provoke vaccine hesitancy not necessarily because of safety or other concerns, but due to resistance to the notion of forced vaccination. Lastly, the pharmaceutical industry may be distrusted and influence vaccine hesitancy when perceived as driven only by financial motives and not by public health interest. This can extend to distrust in government when perceived that it also is being pushed by industry and is not transparent. When working with patients faced with the decision of whether vaccination will be undertaken, it is imperative to understand the cultural, ethical, and legal implications that may affect their decision. Working from a place of understanding and acceptance of various views and beliefs about vaccination, nurses can be better advocates for the wishes of their patients.