Public health approaches to health disinformation

1. HEALTH
DISINFORMATION 201
RISKS, INSIGHTS AND STRATEGIES
TO PROMOTE TRUST
Tina D Purnat, TH Chan School of Public Health, Harvard University, USA
Elisabeth Wilhelm, School of Healthcare and Care Sciences, University of West Attica, Greece

2. This presentation (c) 2025 by Tina D Purnat and
Elisabeth Wilhelm is licensed under Attribution-
NonCommercial-ShareAlike 4.0 International

3. AGENDA
Introduction to Health Narratives
Effectively Addressing Health
Drisinformation Drivers
Why Health Disinformation Successfully
Hijacks Narratives
Relationship Between Health
Information, Services and Trust
01
02
03
04
Partnering Across Sectors to
Address Health Disinformation
05

4. HEALTH MIS- AND
DISINFORMATION ARE HERE TO
STAY

5. Harmful narratives are common in many
areas of health
Vaccinations Alternative
Medicine
Nutrition and
Diet
Mental Health Sexual and
Reproductive
Health
Chronic
Diseases
HIV/AIDS
Cancer
Exercise and
Fitness
Allergies and
Intolerances
Chronic Pain Substance
Abuse
Sleep Health Aging and Anti-
Aging
Genetic Testing
and
Personalized
Medicine
Environmental
Health
Health topic areas that are represented in health misinformation research

6. Protecting
public health
relies on people
collectively
behaving in a
certain way
Smoking
cessation
Vaccination
Handwashing
Healthy
eating
Healthy
public
spaces

7. Individual
health
decisions have
population level
impacts...
...and these can
be influenced
by mis- and
disinformation.
Smoking
in public
places
Adherence to medication
and treatment plans
Transportation
choices
Safe
sexual
practices
Contact
tracing and
quarantine

8. Stewart, R., Madonsela, A., Tshabalala, N., Etale, L., & Theunissen, N. (2022). The importance of social media users’ responses in tackling digital COVID-19 misinformation
in Africa. Digital Health, 8, 20552076221085070.
Domain of impact - harms Consequence
Physical
• Limited accurate knowledge about available treatments
• Misplaced actions
Social • Victimization and stigma
Economic
• Falling for scams
• Panic buying
Political
• Limited trust in officials
• Rejection of official guidelines
• Disregard of government-led responses
Psychological
• Mental health epidemic
• Extreme anxiety
• Long-term depression
TYPES OF HARM HEALTH MIS- AND
DISINFORMATION CAN CONTRIBUTE TO

9. https://youtu.be/

10. Health systems tend to be:
• slow-moving
• conservative
• risk-averse (including focus on
reputation management)
• not technology-forward
• not sufficiently active online
• focused on epidemiological
surveillance instead of
monitoring information
environment
...which makes them uniquely
vulnerable and unprepared to
address mis- and disinformation
(you would want your health
service to be effective, but not
chaotic and fast-moving)

11. WHEN HEALTH MISINFORMATION BECOMES
DISINFORMATION, NARRATIVES SHIFT AND ARE
HIJACKED, AND THEY BECOME A WIDER PROBLEM
A community
expresses confusion
about why a foreign-
made vaccine is
recommended to
them, expressing
preference for locally
made vaccines
Concerns gain
momentum,
becoming
misinformation that
foreign vaccine
supplies were chosen
due to hidden
financial motives by
leadership
Negative sentiment and
misinformation about vaccine
origin is amplified with
disinformation narratives
undermining trust in
government and becomes a
talking point by a political
candidate
Questions, concerns,
information voids
Misinformaton Disinformation

12. HEALTH SYSTEMS CAN ONLY RESPOND EFFECTIVELY TO SOME PARTS OF
THE INFORMATION ENVIRONMENT, PARTICULARLY QUESTIONS,
CONCERNS, INFORMATION VOIDS AND SOME MISINFORMATION
Questions Concerns Information
voids
Misinformation Disinformation
More common, easier to address by health
authorities
PREVENTIVE action
Less common, harder to address by
health departments; other
organizations are better placed to
address these
REACTIVE action
See: Managing Infodemics in the 21st Century: https://link.springer.com/book/10.1007/978-3-031-27789-4

13. Information
impacts all four
determinants of
health outcomes.
Relative contributions of multiple
determinants to health outcomes
CLINICAL CARE
SOCIAL AND
ECONOMIC
ENVIRONMENT
HEALTH BEHAVIORS
PHYSICAL
ENVIRONMENT
30% 40%
10%
20%
McGovern, L., Miller, G., & Hughes-Cromwick, P. (2014). The relative contribution of multiple determinants to health. Health Affairs Health Policy Brief, 10(10.1377).

14. But we will talk about
why narratives stick
and amplify.
There are plenty of
resources and discussion
of content and actors in
the information
environment.

15. Profit
Profit and
influence/power over a
health agenda
Sowing wider distrust
for political influence,
health is hijacked
• Industry or organized
fraudsters
• Can include deceptive
marketing and marketing
on health, lifestyle, food
topics
• Agenda setting groups (like
vocal vaccine deniers) who also
earn money to support their
activities
• Can include legal organizing to
counter judicial or regulatory
decisions
• Infleunce campaigns,
propaganda, disinformation
in hybrid threats,
cyberattacks
• Mistrust in humanitarian
assistance and response
Motivations for spreading health disinformation

16. hijack health-conscious
communities
Industry
marketing and
influencers
https://www.washingtonpost.com/wellness/2024/04/03/diet-culture-nutrition-influencers-general-mills-processed-food/ https://www.wired.com/story/beef-industry-school-education/
https://www.nytimes.com/2023/05/10/well/move/fitness-influencers.html
Source:
Profit

17. Health fraud, scams and
deceptive marketing
exploit vulnerabilities
within the information
environment
Source:
hhttps://www.forbes.com/sites/alexandralevine/2024/03/04/tiktok-supplements-nurses-doctors-influencers-bytedance-healthcare/
https://www.theguardian.com/science/2024/feb/03/the-situation-has-become-appalling-fake-scientific-papers-push-research-credibility-to-crisis-point
https://www.wired.com/story/telegram-covid-19-vaccination-fakes/
https://www.reuters.com/business/healthcare-pharmaceuticals/novo-nordisk-warns-online-offers-fake-ozempic-wegovy-are-rise-2023-10-12/
Profit

18. Well-funded and
well-organized
“anti” movement
counters health
advice and
politicizes health.
Source:
https://www.washingtonpost.com/technology/2023/09/23/online-misinformation-jim-jordan/ ;
https://link.springer.com/article/10.1057/s41271-021-00318-6;
https://www.politico.com/news/2023/09/24/anti-vaxxers-political-power-00116527 ;
https://www.washingtonpost.com/nation/2024/02/21/covid-misinformation-earnings/
https://www.npr.org/2023/05/04/1173697394/as-the-pandemic-winds-down-anti-vaccine-
activists-are-building-a-legal-network
https://www.marketplace.org/2023/07/14/covid-19-lawsuits-media-coverage-misinformation/
Profit and
influence/power over a
health agenda

19. Disinformation and cyber threats
weaken global health security and health systems.
Source:
https://docs.house.gov/meetings/VR/VR00/20191113/110183/HHRG-116-VR00-Wstate-BarashV-20191113.pdf
https://www.340ftg.afrc.af.mil/News/Article-Display/Article/2343192/disinformation-and-disease-operating-in-the-information-environment-during-fore/
https://jcom.sissa.it/article/pubid/JCOM_1905_2020_A02/
Sowing wider distrust
for political influence,
health is hijacked

20. Key takeaway #1
Health disinformation
successfully hijacks
people’s identity,
values and previous
experience.

21. “Mistrust is the outgrowth of the
perception that promises were
broken and values were
violated.”
--Dr. Barbara Reynolds

22. A person’s values can shape and predict the type of
narratives that they perpetuate or resist
Tells a story Uses humor or satire
Pushes emotional buttons
and appeals to audience
values
Contains images or video
specifically formatted for a
particular audience and
channel
Provides a simple
explanation for a complex
problem
Uses language that is
appealing to the audience
(e.g. slang, memes)
A “viral” narrative:

23. Vaccines aren’t safe.
That diseases stem from “over there.”
Vaccines can damage your future.
They keep coming back because they are emotionally
resonant and seem easy to believe, often because they are
shared by people you trust.
“Zombie” health narratives are pre-existing “hooks” that can
be hijacked again and again to propagate disinformation

24. https://apnews.com/article/archive-fact-checking-8631011043
https://www.washingtonpost.com/news/the-intersect/wp/2015/11/13/what-was-fake-on-the-internet-this-week-hiv-
blood-in-bananas-and-seaworld-whales-in-plastic-bags/
https://mythdetector.ge/en/banana-conspiracy-
timeline-from-ebola-to-coronaviruses/
https://leadstories.com/hoax-alert/2019/06/fake-news-zika-virus-shipment-
bananas-cdc-warns.html

25. Hall Jamieson K. Marshaling the gist of and gists in messages to protect science and counter misinformation. Journal of Applied Research in Memory and
Cognition. 2021 Dec 1;10(4). https://psycnet.apa.org/record/2022-15515-004
The gist in effective communication
“mental representations capturing the bottom-line meaning of
information” or experience
“the gist of a message” “the gist(s) in a message”
Why messages alone won't save us from circulating misinformation https://www.linkedin.com/pulse/why-messages-alone-wont-save-us-from-circulating-
tina-d-purnat/

26. Understanding gist: What is the real, underlying meaning of a narrative?
Understanding gist can also help you identify underlying meanings and
values that may be propelling a narrative.
Vaccines aren’t safe.
That diseases stem from “over there.”
Vaccines can damage your future.
The government and health system don’t
have our best interests at heart.
Example Narrative Example Gist
The diseases come from less developed
places but it doesn’t really affect us.
Someone is gaining a short term benefit
at the risk of our future health.
what is said what is heard

27. Odds ratio predicting at least one share
High gist: 12869 shares
Parents who don’t vaccinate their
children due to concerns about side
effects can put others at risk -- even
those who have been vaccinated.
https://www.pbs.org/newshour/
show/opting-vaccination-recipe-
outbreak
V.F. Reyna, A scientific theory of gist communication and misinformation resistance, with implications for health, education, and policy,
Proc. Natl. Acad. Sci. U.S.A. 118 (15) e1912441117, https://doi.org/10.1073/pnas.1912441117 (2021).

28. Knotted Web
The Nine Devious Frames for Health Disinformation
Denialis
m
Post-Denialism Normalizatio
n
Silver
Boomerangs
Magic Solutions
The Treatment
Trap
Victim
Blaming
Multifactorial
Confusion
Ennis, G. (2024) Dark PR: How corporate disinformation undermines our health and the environment. DarajaPress. https://darajapress.com/publication/dark-pr-how-corporate-disinformation-harms-our-health-
and-the-environment?srsltid=AfmBOopHsl_9Wyi6XKxrOF9BzbXGrrrjqmVvOEsWas4KtXFjGCkDPrPh

29. Schmid, P., Betsch, C. Effective strategies for rebutting science denialism in public discussions. Nat Hum Behav 3, 931–939 (2019). https://doi.org/10.1038/s41562-019-0632-4
5 × 5 matrix of rebutting science denialism in public
discussions about vaccination
5 denial techniques
1.Fake experts (Using
unqualified sources)
2.Impossible expectations
(demanding 100% certainty)
3.Conspiracy theories (hidden
motives, secret agendas)
4.Cherry-picking (Selecting
misleading data)
5.False logic /
misrepresentation (twisting
scientific principles)
5 topics
1.Safety (e.g., vaccines, drugs)
2.Effectiveness (e.g., climate
change, Public Health and
social measures)
3.Trust (e.g., pharma, scientists,
WHO)
4.Alternatives (e.g.,
homeopathy, anti-vax
narratives)
5.Threat of disease (e.g., COVID,
pandemics)

30. Topic →
Denial Technique ↓
Safety (e.g., Vaccines,
Drugs)
Effectiveness (e.g.,
Climate Change, Public
Health Measures)
Trust (e.g., Pharma,
Scientists, WHO)
Alternatives (e.g.,
Homeopathy, Anti-vax
narratives)
Threat of Disease
(e.g., COVID,
Pandemics)
Fake Experts (Using
unqualified sources)
"This doctor says vaccines
cause autism." (Topic:
→
99% scientific consensus
disproves this.)
"One scientist disagrees with
climate change." (Topic:
→
Global data trends show
otherwise.)
"WHO is corrupt!" →
(Technique: This is an ad
hominem attack.)
"Doctors are lying to you
about natural cures!" →
(Technique: False
equivalence.)
"Big Pharma profits from
pandemics." →
(Technique: Conspiracy
thinking.)
Impossible
Expectations
(Demanding 100%
certainty)
"Vaccines should be 100%
safe!" (Technique:
→
Impossible standard—no
medical product is.)
"Masks must be 100%
effective." (Technique:
→
Perfection fallacy.)
"Scientists can’t predict
everything." (Topic: Science
→
improves over time.)
"Only natural immunity is
perfect." (Technique: False
→
dichotomy.)
"No outbreak model is
100% accurate." →
(Technique:
Misrepresentation of
uncertainty.)
Conspiracy Theories
(Hidden motives,
secret agendas)
"COVID vaccines contain
microchips!" (Technique:
→
No evidence—wild
speculation.)
"Climate change is a hoax!"
(Technique: Funded by
→
fossil fuel industry.)
"Doctors hide natural cures."
(Technique: Illogical secrecy
→
claim.)
"Cancer cures are being
suppressed!" (Technique:
→
Requires impossible
coordination.)
"The pandemic was
planned!" (Technique:
→
No factual basis.)
Cherry-picking
(Selecting misleading
data)
"This study shows vaccine
harm." (Topic: Single
→
studies don’t outweigh
1000+ confirming safety.)
"One cold winter disproves
global warming." →
(Technique: Misusing short-
term trends.)
"This doctor disagrees with
CDC." (Technique: False
→
balance.)
"Natural treatments work
better than medicine." →
(Topic: Evidence-based
medicine is rigorously
tested.)
"COVID only affects old
people." (Topic: Long
→
COVID affects all ages.)
False Logic /
Misrepresentation
(Twisting scientific
principles)
"Correlation means
causation—vaccines cause
autism!" (Technique:
→
Correlation ≠ causation.)
"If climate models have
errors, they’re useless." →
(Technique: Science adjusts
for uncertainty.)
"Scientists are divided!" →
(Technique: Manufactured
doubt.)
"Big Pharma just wants
profits." (Technique:
→
Oversimplification.)
"The flu is deadlier than
COVID!" (Topic: Data
→
shows otherwise.)
Schmid, P., Betsch, C. Effective strategies for rebutting science denialism in public discussions. Nat Hum Behav 3, 931–939 (2019). https://doi.org/10.1038/s41562-019-0632-4
5 × 5 matrix of rebutting science denialism in public discussions about vaccination

31. Key takeaway #2
Effectively addressing
drivers of mis- and
disinformation over
time is key to
promoting long-term
resilience.

32. Demand for health and social services need to
be met with trustworthy services, overseen by a
health system worthy of trust
Demand for
health
information
Demand
for
health
services
and
products
Adherence
to health
guidance
PULL – people want
something from the system
PUSH - the system wants
something from the people

33. When people lose
trust in a
government’s
expertise, that
expertise will be
found elsewhere,
and may be
redefined by
disinformation.
Source: Cartoon by Will McPhail for the New Yorker, 2017

34. • Overgeneralized skepticism
• Language and accessibility gaps
• Structural inequities in society, not
only information environment
https://nap.nationalacademies.org/catalog/27894/understanding-and-addressing-misinformation-about-science
Structural drivers of harm from misinformation

35. Key takeaway #3
Health disinformation is harmful
because it goes beyond influencing
opinions--it negatively affects
behavior, which can have
population-level impacts if left
unaddressed

36. HEALTH
DISINFORMATION
It takes many different
kinds of expertise to
understand the issue of
health disinformation fully,
and to be able to respond to
it effectively

37. 📌 Key Difference:
• Strategic communications is short-term, reactive, and persuasion-focused.
• Health systems & promotion are long-term, structural, and behavior-oriented.
Approach Primary Goal
Strategic Communications & Anti-
Disinformation
Address narratives, shape public opinion, and
counteract false or harmful information.
Health System & Health Promotion
Improve public health outcomes by increasing
health literacy, access to care, and sustainable
behavior change.
Various approaches to addressing health disinformation

38. The EU Disinformation Code of Conduct is built for tech
governance and does not support public health resilience.
• Designed for tech platforms, not health
systems
• Lacks structured collaboration with public
health agencies
• Focused on digital governance, doesn’t help
with health system vulnerabilities
• No direct protections for health workers &
institutions
• Does not recognize health mis- and
disinformation as a national security risk
https://digital-strategy.ec.europa.eu/en/library/code-conduct-disinformation

39. 1.Integrate health perspectives into disinformation response
strategies
2.Support proactive storytelling and narrative prebunking
strategies
3.Establish partnerships with health agencies, researchers, and
frontline workers
4.Work with public health experts
5.Advocate for media literacy programs, community
engagement initiatives, and regulatory measures that reinforce
long-term trust in health information sources.
Key Actions for StratCom Experts to Strengthen Addressing
Health Disinformation

40. 1.Assess the health information environment regularly, identifying emerging
false narratives and vulnerabilities before they spread widely.
2.Develop training programs, response toolkits, and clear guidance for
healthcare providers to address patient concerns, debunk myths, and build trust
through dialogue.
3.Ensure consistent, transparent communication, invest in patient-centered care,
and address barriers to health access that fuel disinformation vulnerability.
4.Work with religious leaders, local influencers, journalists, and educators to co-
create relevant health messaging and counter falsehoods where they originate.
5.Push for health professionals to be integrated into government and platform-
level information integrity and mis/disinformation response teams
Key Actions for Public Health Experts to Strengthen
Addressing Health Disinformation

41. Key Takeaway #5
No one strategy or organization can
alone address a complex issue like
health disinformation over time.
Partnerships are critical to building
more effective health disinformation
mitigation strategies and build
population and systems resilience.

42. Thank you very
much!
me@tinapurnat.com
Resources for
infodemic managers

43. Annex

44. Deploying Corrective Public Health Gists in Factchecking Headlines
Hall Jamieson K. Marshaling the gist of and gists in messages to protect science and counter misinformation. Journal of Applied Research in Memory and
Cognition. 2021 Dec 1;10(4). https://psycnet.apa.org/record/2022-15515-004
Gratton, C., Béghin, G., Gagnon-St-Pierre, É., & Markovits, H. (2024). False information is harder to debunk after gist repetitions than verbatim repetitions.
Journal of Cognitive Psychology, 36(3), 309–321. https://doi.org/10.1080/20445911.2024.2314975