Stopping COVID-19 Misinformation: Why Call People Out?

As we enter the fall, I admit that I am feeling a bit defeated. The pandemic raged through the summer in many parts of the US and the world. Vaccine hesitancy continued and was perhaps inflamed by discussions surrounding vaccine passports and, more recently, vaccine mandates. All the while, voices on social media platforms touted vaccine misinformation, dangerous COVID-19 treatments, proudly calling themselves "purebloods." The spread of COVID-19 misinformation is enough to drive anyone in medicine and public health to frustration at best and to burnout at worst.

This issue came into striking focus for me when rapper Nicki Minaj took to Twitter on September 13 to comment on the Met Gala's requirement that all guests be vaccinated. To be clear, she did not state she would not get vaccinated — just that she would not get vaccinated simply to go to the Met Gala.

However, later that day, she also shared an anecdote on Twitter about a friend of a cousin who developed a purported side effect from the COVID vaccine.

Minaj received intense criticism for her tweets. Across social and news media platforms, people challenged her comments. Some provided evidence-based corrections while others made a more personal attack, calling her an anti-vaxxer and mocking her for spreading misinformation.

This viral moment reflects something I have seen play out again and again during this pandemic and raises two important questions for me.

First, how much did Minaj stoke vaccine hesitancy among her almost 23 million Twitter followers and set back efforts to reach those who remain unsure about getting vaccinated? While perhaps not her intention, we in public health fear that may have been the consequence.

The other worry: What were the intentions of those who took a public shaming approach? Was it to provide evidence-based information about COVID-19 vaccines or to gain followers?

More generally, the firestorm following Minaj's tweets made me wonder whether there is a better approach that healthcare professionals in particular can take to engage COVID-19 misinformation on TikTok and Twitter in a way that sets the record straight, mitigates concerns, even changes minds.

Healthcare Professionals Who Call Out Misinformation

Healthcare professionals on TikTok who post medical content seem to fall in to two categories: those who seek to educate and those who seek to entertain. Some do both. (Disclosure: I'm guilty of this!)

For the most part, the healthcare provider response to Minaj fell into the first category. Many used this moment to educate, call out what was unverified or false about her statement, and use data to highlight vaccine safety. Others reached out their social media hand to Minaj to have a conversation and review the literature on vaccine safety and effectiveness.

But from my vantage point, this isn't always the response, especially when the misinformation spreader is themselves a healthcare professional. I've seen doctors, nurses, and others in healthcare called out with the social media equivalent of "off with their heads." In fact, people without, and with, a medical or public health background have built platforms on vilifying anyone — including members of the medical community — who spreads misinformation about COVID-19.

I've observed this call and response mostly on TikTok, as content creators take advantage of the medium's opportunity to react to another's video in split-screen mode (duet), to add to another's video (stitch), or to comment more directly using various green-screen features. The videos can rack up thousands of likes and tens of thousands of views.

Indeed, it's shocking to see a hospital worker angrily declaring, "I'd rather get fired than get that vaccine." I assume these were people posting for their own followers who agreed with them, essentially feeding their own personal echo chambers. They probably did not really consider that they themselves would be subject of a critical video. But those response videos can be entertaining and, truth be told, satisfying to watch — especially given the toxicity directed to healthcare workers in this pandemic.

Indeed, the responses where experts call out the misinformation and fight for truth come as a relief. But are they fighting for truth?

It didn't take long for me to realize that many of these response videos, which are personally directed against another content creator, are very popular. Were they helping change minds? Or, perhaps in some ways, morphing into part of the problem?

Why Call People Out?

TikTok is a tempting medium to use to respond to misinformation. These short-form videos can reach a wide audience, including viewers who you would never interact with otherwise. The lure of using infotainment to further a public health or scientific agenda holds great promise as an educational tool, but it also can be used for personal gain or fame. To grow a fanbase and know that thousands, even millions, have seen what you've created can be an enthralling feeling — and if one is not careful, toxic.

I asked Christina Kim, NP, who I have known for many years, for her thoughts. Kim is active on social media, with 67,000 Twitter followers and 326,000 followers on TikTok. When I joined TikTok, she was one of the first people I followed.

Kim said, "I definitely made use of this approach [of] calling out individual creators or videos. Admittedly, many of these posts received the most views and likely resulted in a growth of followers. I notice many creators who use this approach consistently have grown their followers, sometimes significantly. … I asked myself the same questions you bring up. Am I doing these posts to publicly shame? Is this an appropriate or effective approach as a healthcare professional? Am I doing this for clout, views, or followers?"

"On the other hand," she continued, "I do think that these posts are helpful to some followers. I view a large part of science communication on social media as trying to provide verbiage and language to those who are already, say, pro-vaccine, to then use and bring to their own community, family, friends. I have received feedback from followers saying things like 'Your posts have helped me understand this study, or these data, which I then used to reach my own family.' The posts/creators who I stitched or duetted are often spouting the same misinformation and theories that people hear daily in their personal lives. Many people don't feel empowered with the data or verbiage they need to combat these issues in their own communities. But then the question is, do I need to take this 'public shaming' route in order to achieve that? Maybe not."

In fact, Kim said, "I have moved away from calling out specific people. I try ('try' is the operative word!) instead to address the specific misinformation that someone may be presenting. I realized it isn't effective to call out people . There really isn't anything to be gained from that except for some self-gratification or creation of drama for views." Although Kim noted that many of her followers came from those "calling out" videos, "I figure, now I have them as followers, maybe I can still reach them despite a change in the style of my content."

I also asked Zachary Rubin, MD, for his thoughts. Rubin, a pediatric allergist-immunologist, is a twiend (Twitter friend) and bow-tie enthusiast like me. He recently joined TikTok and has 32,000 followers. His posts tout science and show off his creative spirit too.

Rubin said, "Misinformation that circulates widely throughout various social media platforms is scaring people away from getting a COVID-19 vaccine, which is the safest, most effective way for society to move forward from this pandemic. There are also individuals with valid credentials who are spreading doubt about wearing masks and getting vaccinated. I believe that this type of information has to be called out in order to clarify and correct the inaccurate or misleading statements. I hope that it will help ease people's fears when a physician debunks misinformation."

Addressing Misinformation: Is There a Better Way?

Data from the Health Information National Trends Survey (HINTS) show that while the public is accessing health information online more and more, trust in physicians remains high — far beyond trust in the government agencies or the internet (94% for physicians vs 71% and 64%, respectively). Maybe, just maybe, seeing a doctor respond to misinformation can change peoples' minds and behavior.

But how to tell?

I suppose the best way is through engagement. I use social media not only to create content but also to interact with others. I read through the comments and try my best to respond. On one of my videos someone commented that I had helped them decide to get vaccinated. This doesn't happen often, but for me, it was important. It showed I could reach people and help them decide.

In that particular video, I talked about the Vaccine Adverse Event Reporting System (VAERS), its objectives and limitations. I had made that video in response to a comment citing VAERS data inappropriately. To me, it reflected an important learning opportunity. What I didn't do was look into who posted the comment, search through their social media profiles, and "out" them.

As healthcare professionals, we have a responsibility to try to maintain public trust. I think this holds true in social media, which is why I advise others to post intentionally, not reactively or driven by emotions. Our posts carry weight. While we may not go viral or trend on social media, those who see our content may be more apt to listen. Let's make sure the message is clear.

Don S. Dizon, MD, is the director of women's cancers at Lifespan Cancer Institute and director of medical oncology at Rhode Island Hospital. He is also a professor of medicine at The Warren Alpert Medical School of Brown University. His research interests are in novel treatments of women's cancers and issues related to survivorship, particularly as they relate to sexual health after cancer for both men and women.

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