Disinformation, Misinformation and Inequality-Driven Mistrust in the Time of COVID-19: Lessons Unlearned from AIDS Denialism

During a pandemic about which too little is known, public health is facing a crisis on multiple levels, including regarding COVID-19 relatedhealth messaging. With the federal government’s inadequate, inconsistent and largely nonevidence-based response [1–3], and the far reach of social media “armchair experts” [4, 5], tremendous uncertainty, fear, and anger has emerged with respect to the origins, treatments and prevention methods regarding COVID-19. Much of the evidence needed to fully inform clinical and public health responses is not yet available, making COVID19 uniquely vulnerable to a proliferation of disinformation, misinformation, and medical mistrust, including what are often called “conspiracy beliefs” [6, 7]. Disinformation (strategically and deliberately spread false information), misinformation (false information, not necessarily with intent to mislead), and mistrust (more than the lack of trust; suspicion of ill intent) are multi-faceted phenomena, with heterogeneous underlying motivating factors. The purpose of this commentary is to suggest that understanding the etiologies of disinformation, misinformation, and medical mistrust must be an important component of the public health response to COVID-19. This is especially critical when considering how the pandemic has affected communities of color, including Asian communities who have been blamed for the introduction of SARS-CoV-2 to the U.S. [8, 9] and Black communities who have been blamed for higher fatality rates among Black populations [10]. We propose that two main forms of pushback against dominant scientific evidence have become prominent during COVID-19: (1) disinformation propagated at the institutional/federal government level to preserve power and undermine already marginalized groups, and (2) inequality-driven mistrust among communities that have been made vulnerable by historical and ongoing structural inequities. While these two forms do not constitute a strict dichotomy, this distinction can help inform strategies to address erroneous information and mistrust and inform public health messaging. “Conspiracy beliefs,” characterized as “attempts to explain the ultimate cause of an event...as a secret plot by a covert alliance of powerful individuals or organizations, rather than as an overt activity or natural occurrence” [11], feature prominently in disinformation, misinformation, and inequality-driven mistrust. It can be difficult to persuasively present evidence to refute these types of ideas, especially because experts are often seen as part of the conspiracy [12], and new pieces of contrary evidence can be rationalized into an existing narrative [13]. For example, a Pew Research Center survey conducted in March 2020 found that 29% of Americans believed that SARS-CoV-2 was developed intentionally in a lab [14], with many pointing to Wuhan, China as the source [15]; President Trump has given this theory institutional legitimacy [16], despite scientific consensus [17–20] and the consensus of the U.S Intelligence services that SARS-CoV-2 is not human-made [21]. This strategic disinformation has served several agendas: casting doubt on evidence presented by Dr. Anthony Fauci, the Director of the National Institute of Allergy and Infectious Diseases and member of the White House Coronavirus Task Force, validating and reinforcing pre-existing xenophobia and racism [22], and redirecting attention away from the White House’s inadequate and delayed response to COVID-19. * J. Jaiswal [email protected]