4. Discussion: Lessons for Global Health
infectious disease
INFECTIOUS DISEASE, COMPLICATIONS
Our experience with the spread of fake news via WhatsApp during the COESA study in Brazil stresses the importance of reflecting on the broader implications of contexts with intensive social media use and high levels of circulation of health-related misinformation. Countries in which there is a high use of social media, low health literacy, low government trust, and limited access to accredited sources of information are particularly susceptible to the spread of health-related misinformation [A literature review highlighted that misinformation was common on all aspects (i.e., prevention, treatments, risk factors, transmission modes, complications, vaccines) of large-scale infectious disease outbreaks since 2000 [The increased spread of misinformation about health calls out for the development of guidelines to support researchers and practitioners in preventing and addressing issues related to social media usage and public mistrust. Existing recommendations for refuting misleading information on pressing public and global health issues include developing a clear messaging strategy and providing appropriate sources of information; improving risk communication by addressing public concerns and needs; engaging community members and working with community leaders; leveraging information technology and partnering with social media platforms to encourage fact checking; and using social media to reach the population [With hindsight, there are a few crucial steps that we should have taken prior to the implementation of the COESA study to lessen the risk of mistrust from the population. We should have conducted a thorough assessment of social media use in Fortaleza to better understand its role in disseminating and accessing health information, which should also have included looking for accounts of similar situations experienced by local researchers and authorities, to learn from the solutions they developed. This would have provided us with the blueprint to build and pilot test a robust communication strategy prior to beginning the study, to anticipate potential repercussions.We should also have included community leaders and other community members in the study prior to baseline data collection. The initial problems with resistance to data collection were unanticipated, despite having several local researchers as part of the investigation team. The original plan was to include these stakeholders once the baseline collection was finished, in order to present the baseline results, obtain their feedback, and encourage their support and potential participation in the community mobilization activities. Having their input and support prior to the baseline would have likely helped with the acceptability of the study and would have potentially reduced the reach of the fake news. 