Outbreak Science | Chapter 12: Science Communication

FIGURE 12.0 | Smartphones displaying an illustration of SARS-CoV-2.

CHAPTER 12

Science Communication

Selected Key Terms

Here are a few essential terms relevant to science communication. By the end of this chapter, you should be able to apply these terms and understand how they relate to other critical concepts.

Fact-checking

Journalists

Misinformation

Paradigm

Preprint

Press Release

Risk Communication

Science Communication

Scientific Literacy

Sensationalization

Social Media

Big Concepts

12.1: Introduction to Science Communication

Science communication is the practice of sharing scientific information between groups, often by distilling technical scientific findings into accessible language. The practice of communicating information about health science has a long history, from oral exchange thousands of years ago to the sprawling global communication network we have today. Science communication is essential to the progression of science, and it enables society at large to learn crucial information during an epidemic. Past outbreaks have taught us that ineffective communication can lead to negative outcomes, but timely, accurate, and accessible messages can help prevent outbreaks, stop the spread of disease, and save lives.

12.2: Science Communicators

Scientific communication isn’t limited to a single profession; it’s routinely practiced by medical providers, scientists, public health professionals, journalists, educators, and everyday people. Of course, each of these groups accomplishes science communication through different lenses and formats, with different goals and audiences in mind. Understanding the main players in science communication and how they interact is critical for examining how science information moves through our world. In an outbreak setting, the situation and science can progress rapidly, and delivering up-to-date scientific information is a crucial task that relies on collaboration between many professionals.

12.3: Effective Science Communication

Science communication takes on special importance during an outbreak when timely information on a range of aspects of infectious disease can prove to be lifesaving. This information can include the rate of pathogen spread, the biology of the pathogen, symptoms of the disease, and the efficacy of diagnostic testing. Science communicators must take into account many considerations when crafting and delivering messages across all mediums so they can best serve a wide audience, including taking special care to manage fear and confusion in the public.

12.4: Navigating the World of Science Information

Participating in science communication is an ever-changing conversation that should include curation, feedback, and active engagement. Access to trustworthy, reliable information is a pivotal aspect of an effective outbreak response. It can be overwhelming to process the rapidly evolving public health information delivered to us and to understand what to do with it under emergency scenarios. Reviewing multiple sources, evaluating their validity and credibility, and engaging in the process of scientific inquiry are some approaches that might make it easy for you to find, vet, digest, and share accurate and helpful scientific information.

Vick’s Video Corner

Watch “ Vick’s Video Corner ” as an entry point for this chapter.

Science Communication

After reading this chapter, you will have an understanding of what science communication is and how the practice of communicating scientific information has evolved over time, from before written language to the internet age. You will learn about the different professionals practicing science communication and the roles researchers, policy-makers, journalists, and the general public play in communicating health science — and what factors influence the quality and accuracy of their communications Last, you will recognize how you can navigate the sometimes overwhelming world of scientific information in order to access the most reliable and intuitive guidance, especially during an outbreak.

It’s April 4th, 1995. In Kikwit, a city in Zaire (now the Democratic Republic of Congo), a laboratory technician at a clinic presents with fever and bloody diarrhea. Clinicians suspect a perforated bowel, and the technician undergoes surgery on April 10th and 11th. Four days later, some members of the medical team who treated the patient began to develop the same symptoms. One of them is transferred to a hospital in another city on April 20th, the same day yet another clinician in Kikwit falls ill with the same symptoms. On May 6th, federal health officials in Zaire notified the US CDC of a possible Ebola outbreak. Samples from the patients are sent to a CDC biosafety level 4 lab in Atlanta, and all test positive for Ebola. By May 13th, 93 cases are confirmed. Mitigation strategies are employed to prevent the spread of the disease, including educational and quarantine measures, but people are dying in isolation without proper medical supplies. It is a devastating moment for the 400,000 citizens living in Kikwit.

This is all unfolding just two months after you published your first major book, The Coming Plague: Newly Emerging Diseases in a World Out of Balance. For this book, you interviewed many of those involved in the 1976 Ebola outbreak, trying to understand both the microbe itself and the response to it, which connects you with this new crisis. You believe that this new story must be told. You decide to use your scientific background and your talents as a journalist to document this new Ebola outbreak. Despite the dangers

“Nothing in science has any value to society if it is not communicated”

—Anne Roe, American psychologist

and challenges posed by the political and public health crisis, you embark on a long journey to see it firsthand.

When you arrive at Kinshasa, the capital of Zaire, you find that the roads into Kikwit are blocked by the military, and air travel is banned, rendering it impossible for international aid workers and journalists to reach the city. You, along with many other reporters, are stuck. A big news channel promises to take you to Kikwit as a consultant in their private jet, but the plane never arrives. You remain determined to reach Kikwit. Eventually, you hitch a ride in a World War II-era plane with a Christian relief group, traveling alongside boxes of bandaids and aspirin tablets. You know these supplies won’t be enough for Ebola patients, but you are glad to be getting closer to your destination. After touching down on a soccer field in Kikwit, you are welcomed by a crowd of locals eager to see a plane up close. You begin your work immediately and are struck by the cultural differences. You realize that the European and American view of the outbreak has been vague and built upon racist stereotypes; you want to change that view to bring awareness of the real problem with the proper lens while acknowledging that you yourself are a white foreigner.

You set up in an empty room at a monastery and get to work. You document the lives of local residents, including those taking on the dangerous work of removing dead bodies from their relatives’ homes to prevent the spread of the disease. No protective gear is provided to you, so you rely on the single medical mask you have for the entirety of the trip and your common sense to avoid exposure. Despite the risks and challenges, you succeed in uncovering the story about this devastating outbreak.

Your main form of communication while in the field is a satellite phone, and you are unable to get your story out. You make your way back to

Kinshasa, but communicating your findings is still difficult; your anti-malaria drugs and their side effects make you feel severely ill as you write the remainder of your series. You finally complete the story, and share it with the world.

You are Laurie Garret, and you will go on to win the Pulitzer Prize for the series of articles you published about the Ebola crisis in Zaire. You belong to the new generation of science journalists who have a scientific background, and are an expert on global health systems, chronic and infectious diseases, and bioterrorism. You are renowned for your explanatory journalism. Your body of work including the Coming Plague will provide insightful analysis of global public health and global health security, bringing to light many stories and problems that would otherwise remain unseen or misunderstood by many audiences (Figure 12.1).

12.1 | Laurie Garrett, an American explanatory journalist and author. She is a leading contemporary journalist addressing global public health crises, global health security, and infectious disease. She was awarded the Pulitzer Prize for her brave and unique journalistic coverage of the 1995 Ebola outbreak in Zaire. Image credit: With permission from Laurie Garrett.

FIGURE

12.1: Introduction to Science Communication

Throughout this textbook, you have learned about many branches of science and seen how our knowledge of the world has grown through the efforts of numerous people over the course of history. To make progress, scientists need to know what others have already learned so that they are able to make new discoveries that build upon this knowledge. Additionally, science’s broader impact (on technology, health, and other areas) depends on interaction with other parts of society. Thus, science is closely intertwined with communication. Let’s first review how scientific knowledge is generated and then how it’s communicated.

In science, we refer to the specific set of theories, models, patterns, and experimental designs that define a field as a paradigm . For example, one notable paradigm in history was humorism, which you learned about in Chapter 3: Clinical Symptomatology. The four humors model was an ancient belief that the human body contained four essential fluids — blood, phlegm, yellow bile, and black bile — which caused sickness when their ratio was unbalanced. This model, although ultimately shown to be incorrect, served as the foundation of human understanding of disease for hundreds of years. When operating under this paradigm, healers tried to employ methods that we now know wouldn’t be particularly effective, like draining their patients’ blood to restore the proper ratio. Through later scientific advancement — specifically the invention of the microscope and subsequent discovery of microbes — humorism was disproven and new paradigms in the understanding of human disease took its place.

This is just one example of a key characteristic of science; it is self-correcting, with new

discoveries and technological advancements regularly replacing outdated knowledge. This process of experimentation and correction is accomplished through the scientific method This method is an empirical process — one based on finding information through experiments and observations or ‘learning by doing’ (as compared to using theory or logic). The scientific method usually begins with an unexplained observation of the world, which gives rise to a question. For example a scientist might observe that a mysterious disease outbreak is occurring and wonder how the disease is being spread. Scientists will then formulate a hypothesis, an informed prediction of what the answer to their question might be. In this disease example, our scientist might hypothesize that the outbreak is being caused by contaminated drinking water. From there, the scientist will conduct experiments to test their hypothesis, such as disabling a well they suspect is the source of the contaminated water. Finally, the scientist will analyze the results of the experiment and draw a conclusion about whether their initial hypothesis is supported or disproven. This experiment might sound familiar as the work of John Snow in the 1854 Cholera outbreak in London you learned about in Chapter 2: Epidemiology. By progressing through these steps, scientists answer unresolved questions and expand our understanding.

Importantly, a single experiment (or set of experiments) rarely provides all the answers. At a given moment in history, we might not even have the technology to conduct all the experiments that we would need to reach a definitive conclusion. Thus, as our understanding of the world evolves and our tools for experimentation and data analysis become more advanced, scientific knowledge is continuously updated.

But when a scientific breakthrough is achieved, it really isn’t of much use unless people know about it, understand it, and use it to ask new questions and design new experiments. But how do we know when to shift our approaches or even whole paradigms? And as we do, how do these discoveries and shifts make it to the general public?

The answer is through science communication, which is the sharing of scientific information, often by distilling technical, scientific findings into accessible language. This sharing can occur across many different groups including, for example, other scientists, public health professionals, and journalists. We will discuss some of the players in science communication in more detail in Section 12.2: Science Communicators.

Science communication takes place almost everywhere we look and can address a range of goals depending on the context, but the overarching aim is to spread the word about scientific findings. Applications of science communication range from sharing critical health information in an infectious disease outbreak setting all the way to entertainment — like news reports, documentaries and even video games.

As you can imagine, communicating scientific knowledge is crucial in shaping everything from our understanding of the universe to our daily health decisions. Science communication has proven invaluable for advancing our society and has seen many changes and shifts throughout human history. Let’s explore them.

History of Science Communication

Science communication has been practiced throughout human history. Our early ancestors were able to observe and communicate natural

patterns pertaining to flora, fauna, tides, and the moon. This information was passed between individuals and over generations to help them stay alive and protect the surrounding environment. Science communication allowed for major civilization milestones like the advent of the agricultural revolution, when people shared ways to best domesticate crops and animals. Over the centuries since then, the ways that science is communicated has changed. One particular turning point was the emergence of written language; this advancement allowed for communication between people separated by both time and space, as the parties involved no longer needed to be near each other for effective communication to occur.

One example of early science communication using written language is the 2700 BCE Chinese medical classic, Nei Ching. This medical book — potentially the world’s first — describes an illness caused by three demons who cause headaches, shudders, and fever. We now believe this illness to have been malaria. In addition to the characteristic symptoms, Nei Ching also describes the geographic distribution of the disease, giving us insight into how the geographic range of malaria has changed over time.

As written communication began to proliferate, new technologies to create and store text began to emerge. Codices – bound volumes of text, frequently written on papyrus, vellum, or parchment – became an increasingly popular way to share large volumes of information (Figure 12.2). You’ve actually learned about one of the key codices in science communication: The Canon of Medicine in Chapter 2: Epidemiology, which was finalized in 1025 by Sina Ibn, a Persian philosopher, physician, and scientist.

Written text became even easier to create and share with the invention of the printing press by Johannes Gutenberg around 1440. Though techniques for printing text existed previously (the Chinese were using woodblocks by the 7th century AD and moveable type by the 11th century AD), Gutenberg’s printing press was revolutionary for the speed and ease with which the type could be adjusted and prints could be produced. Skilled operators of the new printing press could produce thousands of pages per day, and generated millions of new texts by the end of the 15th century. One of these printed volumes was the Nuremberg Chronicle, a highly

detailed history book that described many of the plagues throughout history, among other important events.

The printing press and its output also had a tremendous social impact; it ushered in a new era of mass communication, bringing literature and science to a much higher percentage of the population. This technology was a fundamental advancement for the global exchange of knowledge, including scientific material, and ensured that intellectual content was no longer reserved for those who had access to scarce, expensive books, i.e. society’s most privileged. Literacy rates rose, increasing the general public’s level of education and engagement with scholarly work.

From there, print media expanded beyond just text. Books began to also include illustrations, which benefited the advancement of biology. In 1543, Andreas Vesalius published an illustrated book on anatomy that dramatically improved our knowledge of the human body. In 1665, British researcher Robert Hooke published Micrographia, filled with illustrations of microscopic objects and organisms, including previously-unseen life forms. Micrographic was one of the first publications of its kind, and went on to inform and inspire further research into microbes, hugely expanding our understanding of infectious organisms (Figure 12.3).

Another historical example of printed science communication was the first periodical scientific journal, the Philosophical Transactions of the Royal Society, in 1665. Journals like this one served — and still serve — not only to publicize prominent scientific findings, but to do so in a way that was standardized, archived, and reviewed for accuracy. Collectively, these advances changed the way that science progressed and reached the general public.

FIGURE 12.2 | Scroll texts. Before the codex and the printing press, manuscripts were preserved in scroll papyrus.

Newspapers and Print Media

With the public’s fascination with medical science and health growing, newspapers soon learned that stories about health and disease could be big hits. In one instance, a rabies exposure in New Jersey prompted nationwide press coverage featuring articles on everything from the physiology of the disease to the mechanism behind Pasteur’s vaccine, though the press was keen to indulge in the most vivid — and sometimes exaggerated — details. We will discuss this phenomenon—known as sensationalization—later in this chapter.

Radio and Television

Industrialization and the Rise of Mass Media

The Industrial Revolution, which took place between about 1760 and 1840, was a period of rapid societal change marked by an economic and technological transition to mass production and mass consumption. This period brought many new developments in our understanding of disease and our options for transmitting information around the world. This era saw the invention of the telegraph, which made it possible to rapidly transmit information across long distances, and was a first step towards the telecommunication networks that we use today. Communication technologies continued to develop in the 20th and 21st centuries—let’s take a look at some of the most impactful shifts.

Scan this QR code or click on this link to watch a video about the 1918 Flu Pandemic.

Following the end of World War I, it became easier than ever to quickly broadcast information to millions of people simultaneously, as radio and television allowed people across the world to hear and see the latest in entertainment and news. Beyond increased ease of disseminating necessary, timely scientific updates, the radio and television both provided additional avenues for engaging science education. The 1950s brought the launch of the first nationallybroadcasted science TV show: Johns Hopkins Science Review (Figure 12.4). In this program, host Lynn Poole engaged with professionals from more technical disciplines — such as chemists and engineers — as well as nontraditional science professionals like animal trainers and medical textbook illustrators. Programs like this one gained popularity during the ‘space race’ of the 1950s and ‘60s as the public became captivated with space exploration and discovery, driving an increased appetite for public science education.

Science Books and Magazines

While by no means a new invention, new books and magazines during this time increasingly

FIGURE 12.3 | Micrographia book by Robert Hooke. Hooke’s first illustrations were presented in this book published in London in 1665, documenting microscopic life for the first time. A) Book cover. B) Drawings of microscopic animals: Fig. 1 Wandering mite. Fig. 2 Crab-like insect. Fig. 3 Silver-color bookworm (right).

A) B)

FIGURE 12.4 | Lynn Poole, creator and host of the Science Review TV show. Poole is seen here presenting a model of telephone lines and water towels for the shooting of “The Peaceful Atom, Part 1,” an episode of the show in the 1950s. Image credit: Special Collections, Sheridan Libraries, Johns Hopkins University.

popularized topics of scientific research. One such book was Paul de Kruif’s 1926 book, Microbe Hunters, which summarized several major developments in the field of immunology. Instead of simply explaining the dry science, de Kruif used narratives and imagined dialogue to bring the audience into the room as major breakthroughs were made. The approach translated to massive success, including film and radio adaptations, and de Kruif’s work has been credited with attracting numerous new scientists to the field of immunology.

While acknowledging its positive impacts, it is simultaneously important to note that Microbe Hunters contains a number of racist and antisemitic passages. This serves as a reminder that all scientific communication is a product of its cultural contexts, and subject to the biases of its creators. As such, the audience must be careful to still maintain a critical eye when engaging with so-called “objective” scientific information.

The Internet

The possibilities for sharing information exploded as the internet emerged and matured. Suddenly, people could receive instantaneous, world-wide updates on any given topic.

With the rise of the internet came the advent of new fast-paced, peer-to-peer digital platforms, which eventually became prominent sources of scientific information. The late 1990s and early 2000s saw the emergence of the first social media sites — websites and applications that allow almost anyone with an internet connection to communicate with other users.

In the late 2000s, smartphones rose in popularity, providing nearly-constant access to the internet in many regions and the unprecedented ability to document any thought or event and then disseminate it across the world. This shift revolutionized how we review, share, and interpret all kinds of information, as well as the frequency with which we consume media.

A timeline highlighting a number of important events in the development of science communication is presented in Figure 12.5.

We are living in the richest, most accessible period of science communication in history thus far, with many indications that the coming decades will bring many more innovations. While this means that information is easier than ever to access, it also means that false and harmful rumors can propagate at an unprecedented pace. As we move through the rest of the chapter, we will discuss more about the specific players involved in the transfer of scientific knowledge, how they do what they do, and steps you can take to find, vet, and help spread accurate information.

3400 B.C.

2700 B.C.

1825 B.C.

Emergence of the oldest known medical book, Nei Ching. The Kahun Egyptian gynecological papyrus is written.

500-600 B.C.

The Arabic-Hindu numbering system is developed, revolutionizing the communication of mathematics. First known written language systems invented.

400-300 B.C.

Greek philosophers spread philosophy and education in the Western world.

1440

Johannes Gutenberg invents a printing press with movable type.

400-300 B.C.

Engagement and active learning of students applying the Socratic Method.

1025

The Canon of Medicine, by Ibn Sina, is finalized.

1543

On the Revolutions of the Heavenly Spheres is published by Nicolaus Copernicus, kicking o the Scientific Revolution.

1665

The Philosophical Transactions of the Royal Society, the first periodic scientific journal, begins circulation. 1683

The first purpose-built science museum opens in Oxford, England.

1798

Dr. Edward Jenner publishes his findings on a vaccine against smallpox 1837

The first commercial telegraph system is invented.

1900

Canadian inventor Reginald A. Fessenden first transmits audio through electromagnetic waves, the foundation of the radio.

1927

The first electronic television is demonstrated.

1990s

The first public web browsers emerge and the Internet gains popularity with the public.

2000s

Smartphones and social media explode in popularity, becoming a ubiquitous staple of modern society.

1948

First airing of the Johns Hopkins Science Review, a nationally-broadcast educational science program. 1986-87

Rumors TV campaign runs in the US, educating the public about HIV, with the aim of combating misinfortmation and stigma.

2020

Scientists around the world shared information about COVID-19 in real-time using the internet.

FIGURE 12.5 | Science communication timeline. Here, we summarize some of the most important breakthroughs in the history of communication technology (left) and science communication (right).

Stop to Think

1. Why do we say that science is self-correcting?

2. What does it mean to ‘trust science’ even if our knowledge is constantly evolving?

3. Name three technological breakthroughs that have revolutionized science communication.

12.2:

Science Communicators

Science communicators are a diverse group of individuals that consist of “traditional” scientists themselves, along with front line public health professionals, journalists, radio and television presenters, educators, and the broader public who use a range of media to share their messages.

New scientific findings are usually generated by research scientists at universities (who make up a community known as academia) as well as scientists in the pharmaceutical and

MAKINGSCIENCEACCESSIBLE

biotechnology industries. This new knowledge can then be applied to relevant disciplines including chemistry, biology, immunology, and health care, and eventually reach the general public through products, public health policy, education, and journalism. Science communication also mediates interaction and cooperation between different professionals, institutions, and the public, which is particularly important for the development and implementation of mitigating strategies during an outbreak (Figure 12.6).

In the outbreak setting, front line medical workers such as doctors and nurses are

FIGURE 12.6 | The network of science communication. Many of the scientific and technological advancements that we enjoy begin with their discovery and development in the scientific community. These new breakthroughs quickly spread to other communities that find them useful such as industrial, governmental, and educational institutions, as well as to the general public. Different types of communicators are shown in bright pink, and some forms of communication that they commonly engage in are shown in light pink in this figure. We note that, in reality, this network is even more complex because each sector contains many individuals in multiple roles who use many forms of media.

frequently the first ones to formally pick up on the presence of a new pathogenic threat. For example, the AIDS epidemic was first identified in the US after healthcare workers noticed an uptick in cases of a very rare skin cancer (Kaposi’s sarcoma) which we now understand to be linked to AIDS infection. Front line medical workers communicated their alarm about these new findings, which called the attention of research scientists.

Journalists – people who professionally investigate and then report on science and other topics for news outlets or magazines – play a key role investigating the facts of an outbreak and communicating them to the public.

The many different groups of science communicators each play an indispensable role in producing, communicating, receiving, and/or acting upon new scientific information, and they bring distinct approaches and goals to the table. Let’s now take a closer look at the work that scientists, public health professionals, journalists, educators, public science communicators, and the public play in science communication and how they accomplish their goals.

Scientists

As we discussed at the beginning of section 12.1: Introduction to Science Communication, the process of scientific discovery is closely linked with science communication. This is because new studies that advance a given field must be built on a foundation of existing knowledge. To maintain and update this foundation, scientists (also known as scientific researchers) share knowledge through a variety of channels. Effective use of these channels is especially important during an infectious

disease outbreak, when scientists in different locations need to rapidly share, compare, and discuss their findings.

One of the most common ways that scientists communicate is by publishing a scientific paper in a scientific journal. This process begins with scientists writing a manuscript – a draft version of the paper – that summarizes how they completed their study, as well as their findings. A scientific paper usually consists of a few sections that follow a standardized order including:

1. An abstract that gives a concise summary of whats presented in the manuscript.

2. An introduction that gives an overview of the topic, previous work in the field, and what the authors intend to accomplish.

3. A methods section that details the experimental and analytical procedures that were used.

4. A results section that presents the new data and analyses that were produced.

5. A discussion section that explores the significance and implications of the results.

6. A conclusion summarizing the study outcomes and outlook.

7. A bibliography that cites other sources used in the paper.

The process of writing a manuscript often gives scientists a new opportunity to reflect on their findings and develop a deeper understanding of them.

Once a manuscript has been written, it is submitted to a scientific journal for publication. A academic journal is a platform (online and/ or physically printed) that collects and publishes new findings, usually from a specific field; when the content is scientific-based, these typically are known as scientific journals. A large number of scientific journals exist, varying in their degree of specialization and the size of their audience, but they all aim to rigorously evaluate new knowledge and make it available to the scientific community. Importantly, some journals do not always value validity, rigor, and high-quality findings as highly as we might like; we will discuss how to evaluate the reliability of scientific information in section 12.4: Navigating the World of Science Information.

After a manuscript is submitted to a journal, it is reviewed by the journal editor. If the editor decides that the manuscript is potentially a good fit for the journal, the manuscript is sent out for peer review: evaluation by a group of other scientists who will read the manuscript and determine whether the study was well-executed and original, and whether the conclusions are valid and significant. Based on the outcomes of peer review, a manuscript may be rejected, accepted, or (more commonly) the authors may be asked to revise the manuscript to address reviewer comments. These revisions can vary, from reworking the text to conducting new experiments. If the authors are able to satisfactorily address reviewer comments, the manuscript is accepted to be published in the journal.

The traditional publication process can take a long time – median times range from 79 to 323

Scan this QR code or click on this link to see an example of the practice of sharing genomics data in real-time during the Ebola outbreak in 2014.

days in different academic journals – due to the number of steps and individuals involved. However, there are some scenarios — such as during an infectious disease outbreak — when releasing information in real-time is important. How do scientists navigate these situations? They often now make use of preprints: manuscripts that are uploaded to websites (called preprint servers) before they have been published in a journal (Figure 12.7). This means that other scientists can access and potentially use these findings before they are published in a scientific journal, keeping in mind that they have not been peer reviewed and may not be final. Preprints have an added benefit of being free, and therefore accessible to anyone (in contrast to the many scientific journals that require a paid subscription). Additionally, in some cases scientists will also upload their underlying data to online databases so that it can be accessed by other researchers quickly and easily. One example is the GenBank, hosted by the NIH, containing public genomics data for many pathogens and other organisms. The practice of publishing pathogen genomes in real-time as part of outbreak response first came to be during the West African Ebola outbreak in 2014, and has been invaluable in investigating outbreaks and developing diagnostics and other countermeasures against outbreaks.

Finally, beyond these avenues of communication within the scientific community, scientists often reach out directly to the press or the public to spread the word about new and exciting progress

&

FIGURE 12.7 | From the bench to publication. After researchers are confident in the results of their experiments, they write up their findings in a standardized manuscript format and submit them to an academic journal, where they undergo a ‘peer review’ editing process from other researchers in the field before they can be published. In the meantime, the authors may post their unreviewed findings as a preprint, a faster path to publicly share their findings with the scientific community.

in their field. One way that they accomplish this is through a press release: a detailed and informative official statement that is sent to members of the media or the public. Presentations for the general public – which may be held at libraries, museums, or other public spaces – create an opportunity to engage with communities face-to-face. Scientists can also make use of social media to make their work broadly visible to the public and provide a succinct and accessible summary of new discoveries.

Public Health Professionals

In our last chapter, Chapter 11: Public Health and Policy and Outbreak Response, we thoroughly discussed the many different roles taken and actions considered by the public health entities tasked with keeping us healthy in the face of

disease. But in addition to developing mitigation strategies, influencing legislation, and navigating public sentiment, public health professionals also must work to keep the public well informed on the state of an outbreak and the science behind decisions they make. Public health campaigns are a great tool to achieve this. These days, public health campaigns often make heavy use of media and center around a diverse range of topics including disease information, vaccination or mask-wearing, and other topics.

As a member of the public, you have probably already experienced many of the tools public health professionals use for this communication, including the public service announcements in the media providing actionable advice to stay healthy or the official bulletins — brief, official updates — put out by your local health department. You might

also remember visiting government-run websites with up-to-date statistics on the rate of disease spread in your area or watching an official speak at a press conference – a public forum where speakers from an organization address members of the media to provide information and respond to questions – on the news. Indeed, these are all examples of important science communication practices performed by public health entities. Specifically, they are examples of risk communication, or communication that delivers helpful information about a hazard and advice on how to mitigate the risk.

We will discuss more of the factors that public health communicators must consider and how they balance this difficult job in section 12.3: Effective Science Communication.

Journalists

Journalism is generally defined as the creation and distribution of reports on current events and information for consumption by the public. The essential role of a journalist is to collect, contextualize, and make accessible information for the public while bringing to light the considerations, conflicts, and human dimensions of the situation that aren’t revealed through data alone. In order to achieve this, journalists must be constantly

cognizant of, and responsive to, their own biases. During an outbreak, the work of journalists is extremely important, as it is one of the main ways information reaches the public and can serve as an important check on the effectiveness of the outbreak response and those involved.

When people think of a journalist, they may imagine writers like Laurie Garret. We typically refer to them as print journalists, though these days their work is often featured on the web as well. Their essential job is to collect and publish news, and they sometimes take on risks to their own health and safety in order to

investigate the circumstances of an outbreak, providing valuable up-to-date information and guidance to the public.

A print journalist can engage a story from many different angles. The first, and most common, is that a notable breaking news event has occurred or revelation has come to light, and it needs to be publicly reported. These stories encompass events like the approval of a new vaccine, or the rollout of new

Scan this QR code or click on this link to see an example of journalism during an outbreak in action. (USA Today)

guidelines, but they can also involve long-term investigations. Another common angle is an unresolved question, such as “How effective is the new vaccine?” or “When will restrictions ease?,” when a reporter will work to collect facts and often the opinion of experts to propose an answer or frame a range of predictions. Especially common during outbreaks is explanatory journalism, which brings in additional context and creative presentation methods to help the public understand complicated scientific or policy questions.

The journalist title, however, also describes individuals who publish primarily through books, or photographs, or who present their information on television or the radio.

Like the scientist, factual accuracy lies at the core of the journalist’s mission. Traditionally, journalists operate under the assumption that they cannot report anything that they cannot independently verify, and that their personal opinions should never influence what they report. As they craft a story, they typically work with editors to ensure that the claims they publish are fully backed up by fact. Fact-checking is the process of verifying the accuracy of information before accepting or sharing it, to ensure that it is true and reliable. This can be achieved by consulting reliable sources – individuals or entities from whom a journalist gathers information, often providing insights, quotes, or facts for news stories–cross-referencing information, checking context, and evaluating evidence.

Educators

An educator is someone who provides formal instruction to a group of people to increase their knowledge of a given subject.

The term can include teachers, professors, museum docents, multimedia creators, public speakers, and more. Here, we will focus on the classroom teachers who are the primary professionals contributing to scientific literacy — the understanding of scientific concepts by non-experts. Scientific literacy allows members of the general public to participate in scientific discourse and make informed, critical decisions based on empirical data.

During an outbreak, scientific literacy can be a strong determinant of how the public will engage with and respond to the eventual outpouring of scientific information. Welltrained teachers and school curriculums covering science in an accessible, exciting, and innovative way are key to having a scientifically literate community of students.

Educators will often deliver complex concepts into simple language or lessons. In the classroom, teachers will educate students on various topics using supportive activities and materials such as textbooks. This textbook is, in fact, an example of scientific education; we are working to expand your knowledge of a given topic, specifically the many disciplines that make up outbreak science.

Popular Science Communicators

Finally, there are many science communicators who operate outside conventional newsroom or classroom walls, but who nonetheless inform and educate the public about a variety of topics. One such figure is Jane Goodall, a worldfamous British scientist and conservationist who transformed our understanding of chimpanzee biology and behavior, inspiring numerous subsequent studies and elevating the public’s understanding of this important species. Jane Goodall was among the first pop-culture scientist-communicators to share her scientific findings with the general public. Well-known figures who have accomplished similar things for their respective fields include Carl Sagan (American astronomer and television writer), Stephen Hawking (British theoretical physicist and author), Richard Preston (American author of multiple books on infectious disease and bioterrorism), and Neil deGrasse Tyson (American astrophysicist, author, and media host). Today, many popular science communicators have taken to the internet to share ideas and information via comics, videos, and other forms of media. This includes Hank and John Green, influential online educators and creators of the YouTube channel CrashCourse, who produced a series on Outbreak Science with us to complement this textbook.

Some popular science communicators, often intellectual authority figures, also offer opinions as pundits — people in the media who deliver opinions and analysis on a certain subject. Pundits are often comfortable public speakers featured on news broadcasts, documentaries, and other productions to take stances on events related to their subject matter, like a well known researcher offering their take on how the government is responding to a smallpox outbreak. Although

it can be helpful to hear these opinions from industry experts, it’s also important to be critical of pundits, especially those claiming to speak on behalf of an entire field, industry, or profession.

As a final note, we want to point out that although popularity (such as a large number of followers on social media) can appear to be a sign of credibility, it does not always guarantee the accuracy or importance of a communicator’s message, especially when discussing topics outside their field of expertise. In section 12.4., “Navigating Science Communication”, we will provide you with tools to help you assess information that you may receive from various sources.

You

An often underappreciated but important player in the scientific communication ecosystem is you — every member of the general public has the capacity to communicate science to others. In fact, you’ve probably engaged in scientific communication many times: you may have had face-to-face conversations about diseases and vaccines with your friends or family members, explained a fun fact, or posted about an exciting new piece of technology on social media. In the rest of this chapter, and especially

in section 12.4: Navigating the World of Science Information, we will explore how you can receive and communicate science most effectively.

The First Global Pandemic Of The Internet Age: COVID-19

To get a sense of how these groups interact in our modern, connected world, let’s quickly look back to the COVID-19 pandemic.

As you may recall from Chapter 1: Emerging Pathogens, the world was first formally notified of the novel coronavirus on December 31, 2019. By January 10, just ten days later, a lab consortium of scientists from China to Australia, led by Zhang Yongzhen, had used an internet database to share the virus’s genome with scientists around the world for further research. International collaboration between genomic epidemiologists, virologists, microbiologists, and countless other scientists continued in the following months, often published rapidly as preprints, empowering researchers to discover vital information about the pathogen. This information included the unique structure of the coronavirus itself, how pathogenic it was, and how it was mutating over time.

Public health organizations such as the CDC monitored this data as it was released and

rapidly began making policy recommendations using the best information available, as did public health offices, clinicians, and politicians at the local and state levels.

The power of the internet was on full display. New, interactive web tools cropped up almost overnight, including case count heatmaps and other data visualizations. Many scientists, journalists, and educated citizens took to social media to share easily understandable, accurate, and up-to-date information about the pandemic, and people with no previous scientific experience used this newly accessible information to develop formidable knowledge about viral transmission, mutation, and therapeutics in order to better protect themselves. Graphic artists teamed up with biologists to create new, intuitive infographics on platforms like Twitter and many scientists and medical professionals volunteered their free time to answer the questions of apprehensive strangers and communicate important guidance to younger audiences using comics and videos.

Despite these success stories, communication during COVID-19 was far from perfect, especially on social media. Many accounts peddled false information that misled and even harmed people looking for genuine advice. Nevertheless, information and collaboration between scientists, journalists, public health professionals, and other science communicators had a significant impact on how the global response to the pandemic took place in different areas and at different times (Figure 12.8). We will discuss how information provided during an outbreak can impact the public in different ways and how to best understand it in section 12.4: Navigating the World of Science Information.

FIGURE 12.8 | Scientific collaboration and science communication during outbreaks. Scientific research is usually a collaborative process, and outbreak science is no exception. Outbreaks bring together a network of researchers, clinicians, data scientists, and policy experts in order to develop and communicate public health guidelines.

Stop to Think

1. What professionals typically take part in science communication?

2. Why is the general public not the target audience for scientific research publications?

3. Journalists verify information carefully before making it public. What does this practice consist of?

4. What kind of scientific communications do public health professionals and science communicators typically provide during an outbreak?

12.3: Effective Science Communication

Disseminating accurate information during an outbreak is important but challenging, especially when we consider the stress of the situation and the different groups of people receiving the information. When it comes to delivering effective communications, many factors, including the tone, content, and delivery method of a message, influence where and how it is received. Let’s dive into some of the considerations science communicators should take into account when delivering messages to the public.

Accessible

Even the highest-quality communication is useless if nobody can find it, i.e. if it is not accessible. For example, not everyone can afford subscriptions to newspapers, and news outlets might not disseminate key information in all the languages present in a given community. This disproportionately disadvantages low-income communities and groups who do not speak the dominant language of an area.

Another barrier to access is physical ability. For example, someone who remains at home most of the time will not see posters in public, and those with visual and/ or hearing impairments may be limited in their ability to access television and radio announcements. Technological barriers also exist. Despite our increasingly online world, it is critical to remember that not every individual has access to or knows how to use technology, including the internet.

These examples demonstrate that there is no one best way to present information. What may be best for one individual can be impossible to access by another. For this reason, it is important for public health communicators to distribute information through a variety of mediums, locations, and languages.

Actionable

In addition to providing important information about the status of an outbreak, often times outbreak science communications must issue advice that is actionable — something the audience can actually do, i.e. “wash your hands”, or “wear a mask.” In addition to promoting measures that can save lives and curb the spread of a disease, high quality actionable advice gives the audience a sense of control over the situation. Outbreaks are often a scary experience and people can feel powerless to protect themselves and their loved ones. Communication that offers concrete steps to improve the situation is a valuable tool for easing anxiety while saving lives.

Accurate

As you can probably tell by now, it is important for outbreak communication to be fact-based and nuanced. Although analogies, metaphors, and sensational language can be useful, they can also be easily misused to over-simplify complex situations and perpetuate stigma. A key facet of providing accurate information is also communicating how or why it is known to be accurate, as well as any questions that remain unresolved.

Clear and Concise

Public health messages appear in a wide variety of mediums, from announcements on television to placards in public, and they often have only a few moments to communicate the highest priority information.

In the context of an outbreak, this means prioritizing the most critical information, such as the predominant mode of transmission, symptoms, and prevention methods. For example, concise messaging can take the form of just a single phrase or hashtag, like the #MaskUp social media campaign that encouraged people to wear masks during the COVID-19 pandemic. The message was clear and concise, perhaps not comprehensive, but it still was an invaluable tool for reminding the public of a critical fact – that masks reduce transmission – during the pandemic.

Timely

It is particularly crucial that outbreak communication be timely in nature, meaning that the information is made available quickly enough to be useful. Think about a situation in which the department of public health finds that the brand of cucumbers provided in the salad bar of your school carries a bacteria that causes a stomach infection. Ideally, the students and staff should be notified immediately and given steps to take in case of sickness. In addition, to prevent

further sickness, the school should work to remove the brand of cucumbers from the cafeteria. When disease can spread exponentially, timeliness must be a top priority.

Relevant

Public health messaging should be relevant to the target audience. For example, while everyone might need to be reminded to wash their hands thoroughly, information on the impact of COVID-19 on pregnancy would only be important to adults aiming to have a child, and guidelines on workplace safety would be most relevant to frontline workers (e.g., healthcare, retail) and not those working from home.

One factor that heavily influences what audience will receive a message is the method by which it’s transmitted. As shown in Figure 12.9, a 2018 poll of the US population shows how people of different age groups prefer to access the news, with younger generations making greater use of smartphones and older generations making greater use of television and radio.

While it is sometimes easy to determine what subject will be most relevant to the population — e.g. an impending, lethal outbreak is relevant to everyone — determining relevance also requires continual listening on the part of the communicators. As public concerns and the viruses themselves evolve, what the public was most worried about two weeks ago can be different from their biggest concern today.

Sensitive

Our culture, background, and life experiences play a large role in how we receive and process information. As we reviewed in Chapter 10: Social Determinants of Health, public health professionals must consult with community leaders as they issue guidance to ensure the information they are providing is clear, trusted, and well-received by those they aim to inform, as well as sensitive to cultural norms.

When a message is being crafted, it is important to consider the audience’s present mindset so that the message can strike the needed balance between urgency and composure. A panicked population can be dangerous, enabling division, fights over resources, and

discrimination when unity is most important. Thus, if the population is extremely alarmed about a disease that poses little real danger to them, then communications should be crafted to calm the audience and underscore the facts of the situation. Conversely, if the public is not concerned about a very serious threat to their health, they might become apathetic to the threat and not engage with mitigation strategies. In this case, communicators should work to convey the gravity of the situation and encourage shared responsibility.

Another essential element of sensitivity is consideration of cultural contexts. Few events illustrate this need better than the 2014 Ebola outbreak in West Africa, which saw many international aid groups enter the region without a full picture of the cultural views present there and how locals might respond to certain guidance.

SOURCES USED BY ADULTS IN THE US

FIGURE 12.9 | Primary news source by age in the US population in 2018. Data from Pew Research Center show primary news sources people use vary by age group — bars represent what percentage of each age group say they “often” get news from a given source. The use of traditional media sources such as television, radio, and print publications increases with age, while the use of digital media as a primary news source decreases with age.

MEDIA

For example, foreign health care workers advised the locals to cease their traditional burial practices, which typically placed great importance on washing and touching the deceased, without offering culturally sensitive alternatives. This disconnect eroded trust between the health workers and the population they were risking their lives to help. It even contributed to worse health outcomes. Rather than have the remains of their loved ones disrespected, some locals opted to hide the bodies of deceased Ebola patients, exposing themselves to the disease in the process. Examples like this demonstrate that cultural sensitivity isn’t just a kind gesture, it’s an essential component of effective communication and response.

Transparent

Transparency is generally defined as being honest and explicit — having nothing to hide. In the world of communication, being transparent can translate to many different things, depending on the content and the messenger. In a public health context, it means being clear about what is known and not known, how the current understanding of risk has translated to guidance, and how guidance might change. However it shows up, transparency is a key step in building trust with your audience.

For an illustrative example of the importance of transparency, let’s go back to the beginning of the COVID-19 pandemic, as the US faced serious challenges in the infrastructure and supplies needed to contain the disease. At

the time, public health experts believed the disease spread primarily through symptomatic patients, like those who had been hospitalized. Concerned the general public would buy up all available protective masks and render them hard to obtain for the healthcare professionals that needed them the most, public health professionals told the general public that masks were unnecessary. Later on, it came to light that COVID-19 was often spread through asymptomatic carriers and that masks would indeed be protective for everyday citizens, and the guidance was changed to reflect this new understanding. From the public’s perspective, however, this seemed to be a complete reversal. A more transparent approach would have been to explain all of this in the first place and to acknowledge the significant benefits of masking, but request that civilians make their own at home, and reserve the medical-grade masks for healthcare workers.

Managing Trade Offs

For all of the considerations we have listed, crafting a communication strategy often requires tradeoffs. For example, it can be difficult to issue timely guidance when you have not gathered all the facts or remain uncertain what the guidance should be, or when there have been delays and breakdowns in the flow of information reaching you. For this reason, good timely public health communication will aim to be as accurate as possible within constraints and then be transparent about what limitations or uncertainty is associated with a given message.

FIGURE 12.10 | A map showing the levels of respiratory illness reported in each US state. In this map, color is used to reflect the number of cases reported in each state over the course of a week. Beside it is an excerpt of a table (the full table is 56 rows long) that contains the same information. Color-coded presentation of the data helps the human eye to rapidly observe the differences, in contrast to having to look for the activity level values on the table.

Visual Communications

When we discuss communication, we often focus on written or verbal messages, but humans are highly visual creatures, too. From traffic lights to weather maps, we are surrounded by messages that tap into our ability to quickly absorb and interpret visual signals. Science and public health are no exception. Data visualizations – such as graphs, charts, maps, diagrams, and heatmaps – help scientists view multiple pieces of data simultaneously to decipher patterns and trends. For example, Figure 12.10 shows part of a data table that lists the number of respiratory illness cases reported in different US states; beside it is a map that visualizes the same information for all states in the country. You likely find that

the map is easier to make sense of than the table, with your eye naturally distinguishing which parts of the country reported elevated levels of illness due to their darker, redder hues. Additionally, the map takes up much less space than the full table, which is 56 rows long (we had to cut most of the table to get it to fit on this page). Visual communication is a key tool when scientists and public health professionals share knowledge with a general audience, such as guidance on how to prevent the spread of a disease, for example illustrating the correct vs incorrect way of wearing a medical mask (Figure 12.11). Communicating visually, rather than relying solely on text, can make a message accessible to a larger audience by circumventing language barriers. In addition to making information more understandable,

N. Mariana Islands

FIGURE 12.11 | Illustrated guidelines for how to wear a mask effectively to reduce the spread of airborne pathogens. In addition to showing the correct way to wear a mask, the image uses colors and iconography (green checkmark vs. red “no” symbol) to distinguish correct vs. incorrect usage, and the green vs. red backgrounds further reinforce the distinction. This image communicates its message without reliance on text.

visual communication can also draw on a rich lexicon of cues to achieve specific effects, e.g., directing a viewer’s attention to a notable data point or evoking a particular reaction through deliberate use of color.

There are several different visual approaches that can be found in science communication. Data visualizations, as mentioned above, summarize data in a visual form to make it easier to analyze and understand. Photos and videos provide a real-world view of a subject or situation. Illustrations depict structures, concepts, and processes — often in a way that is impractical to capture in a photograph — and highlight relevant details. You may remember from section 12.1: Introduction to Science Communication that the scientific illustrations of Vesalius and Hooke helped to advance biology during the scientific revolution. Infographics combine

visualizations with narrative text, often with the goal of giving a simplified overview of a broad subject. Examples of different visual approaches are presented in Figure 12.12.

It is increasingly common for visual communication to also include interactive elements, which enable a user to choose which pieces of information they wish to view, and how. An example of an interactive visualization is the Johns Hopkins University COVID-19 Dashboard, active from 2020 to 2023, which allowed web users to zoom in on specific areas of a world map to view the number of COVID-19 cases in individual cities.

With the multitude of visual approaches available, we should keep in mind that differences in vision mean that not everyone is able to see a visual message the same way. Thus, as we discussed earlier, accessibility is a necessary consideration and can be supported through a variety of approaches. These approaches include colorblind-friendly color palettes and informative text descriptions of images that can be processed by screen readers, which are tools used by people with vision impairment to convert text to speech or braille.

Scan this QR code or click on this link to check out the Johns Hopkins COVID-19 Dashboard, which for three years allowed web users to monitor COVID-19 cases on a world map. (They stopped collecting data as of 03/10/2023 but you can still interact with the map.)

TAKE ON LATENT TB INFECTION

FIGURE 12.12 | Examples of different visual communication approaches used in science and public health. The illustration intuitively depicts how the disease is spread. The photograph provides a real-world example of the severity of the disease. The data visualization allows the audience to quickly determine that tuberculosis (TB) cases are decreasing over time. The infographic provides several pieces of information about latent TB infection in an easy-to-digest format.

Stop to Think

1. What are some potential negative outcomes if science communications are not done properly during an outbreak?What does it mean to ‘trust science’ even if our knowledge is constantly evolving?

2. Name three important considerations for effective scientific communications. 3. Why are visual communications particularly effective during outbreaks?

12.4: Navigating the World of Science Information

The rapid pace of technological advancement in the modern world has made it imperative that every individual learns how to navigate science and make informed decisions. In the words of American astronomer and science communicator Carl Sagan, “The consequences of scientific illiteracy are far more dangerous in our time than in any that has come before....How can we affect national policy— or even make intelligent decisions in our own lives—if we don’t grasp the underlying issues?”. Outbreak science impacts people worldwide and can be a challenging field to understand due to the complexity of pathogens and the numerous factors that influence how an outbreak unfolds. In this section, we will provide you with knowledge to help you navigate scientific information successfully.

Navigating risk information

Picture this: you’re a highschool senior in your last semester before graduation. One winter morning, you receive a news alert on your phone: a new virus is spreading in a distant country. At first, this information isn’t particularly concerning to you; it’s happening far away, and you are generally healthy. By the end of the month, however, you hear that the virus has entered your country and is spreading more rapidly than anticipated. The global death toll climbs, and you watch with rising dread as your day-to-day life begins to shift. Within a week, your parents’ employers instruct them to work from home, your older sister’s college dorm shuts down and she moves back into the family house, and finally, you

receive an email you’ve been dreading: your classes are moving online for the rest of the semester.

With your routine upended, you spend your days adjusting to online school, discussing the situation with friends and family, and trying to seek out the latest information. Every moment seems to bring new updates, but you find it hard to decide which sources to trust and how to gauge risk. You’ve heard the virus is more deadly to the elderly than it is to children or teens, but everyone seems to have different ideas of what constitutes risky behavior. As a result, your social circle begins to splinter. Some of your friends, confident that the virus doesn’t threaten them, gather in large groups just as they did before the outbreak. They send you articles and memes on social media that claim the virus is overblown or entirely made up. More cautious, you limit yourself to hanging out in small groups outdoors, which you heard is a less risky way of socializing. But as cases continue to climb and public health guidance changes—with earlier advice becoming defunct—you feel even less confident about being safe.

Time passes in a blur. When May arrives, you halfheartedly log on to your highschool’s online graduation ceremony, where the principal delivers a vague speech about hope. But a few months

later, it seems that actual hope arrives: an effective vaccine has been developed. You are relieved when it becomes available, but your parents tell you they will not get immunized, fearing the vaccine has not been properly tested for safety. They show you an official-looking scientific paper that seems to agree, but you have a hard time making sense of it. Your older sister, meanwhile, is adamant that the vaccine is completely safe and accuses your parents of being narrow-minded. Many heated arguments ensue. Even news sites, which are supposed to be objective sources of information, vary dramatically in their coverage of the disease and its effects. You want to make healthy decisions, but how can you do so when trustworthy information seems so hard to come by?

Ideally, accurate information would be available and easy to distinguish from rumor when an outbreak hits, but history has taught us that this is not always the case. Recent outbreaks have demonstrated that information coming from trusted channels can be quickly drowned out and undermined by misleading information and speculation, making it hard to tell fact from fiction. In this section, we will examine some of the most common sources of confusion and false or inaccurate risk information during a public health emergency, as well as the tools and approaches we can use to mitigate them, including how you yourself can get involved in reliable science communication.

Misinformation, which refers to false or inaccurate information, is frequently observed during outbreaks. The person sharing misinformation may believe it to be true and does not realize that it is false or misleading. When false information is intentionally spread in order to deceive its audience, it is called

disinformation. Whether intentionally or unintentionally, the spreading of false or inaccurate information can impact public health negatively, with dangerous consequences. Much of avoiding inaccurate or biased information is being able to spot it. Let’s take a look at some common communication hazards and ways to recognize them.

Misleading Visual Communications

Although often an invaluable tool for displaying and explaining data, visual communications are also a common source of misleading information. Even visualizations made by respected sources with good intentions need to be examined critically before drawing conclusions from them. For example, a 2023 document from the UK Biological Security Strategy included a figure very similar to Figure 12.13 to show the history of outbreaks and their magnitudes over the course of human history. This visualization can give an inaccurate impression of the data. The scale shrinks as the timeline goes further back (imitating the perspective that one might see in a photograph or drawing) to evoke a sense of distance. However, this element makes it difficult to compare the magnitudes of outbreaks at different points in time because outbreaks in the distant past appear smaller than those in recent times. For example, the sizes of the circles suggest that the Bubonic Plague caused fewer deaths than the Spanish Flu, but the numbers reveal that this is not the case.

Visualization communications can also be deliberately manipulated to advance a particular agenda or to make a dishonest message appear legitimate by embellishing it with sleek imagery or logos of well-trusted organizations. The growing power of generative artificial intelligence (GAI) – computer systems that

HISTORY OF PANDEMICS, EPIDEMICS AND OUTBREAKS

Antonine Plague

Japanese Smallpox Epidemic Plague of Justinian

17th Century Great Plagues

18th Century Great Plagues

WHO o cially declared COVID-19 a pandemic on Mar 11, 2020.

FIGURE 12.13 | An example of a subtly misleading illustration of the history of infectious disease outbreaks. A 2023 document discussing infectious disease outbreaks was published containing a figure very similar to this one, to show the history of outbreaks and their proportions. The size of the circles is related to the number of deaths in each outbreak, but the use of perspective makes outbreaks further in the past appear smaller, making this a somewhat misleading figure.

autonomously generate novel content, such as images, video, or text, by learning from existing data without human intervention – in image generation means that even photos and videos can be convincingly falsified. A particularly malicious form of digitally manipulating images or videos are deep fakes – when AI is used to make it appear as though a person is saying or doing something they never actually did. In this increasingly precarious digital environment, it is important to carefully examine the information presented in a visual, especially during an outbreak.

Conflicts of Interest

A conflict of interest (COI) is a risk that occurs when a personal interest might affect one’s ability to objectively perform their professional duties. COIs can lead to biases in decision-making and can undermine the trust of stakeholders. By nature it is difficult for an individual or entity to understand and mitigate their own COIs, and thus they need an external way to manage them.

For example, imagine a journalist, Sandy, who hears that the food served by a restaurant in town is making many people sick. Normally she would be eager to investigate, but the restaurant in question is owned by her parents. Understandably, she wouldn’t want to harm her family’s business with a negative story, but burying the story would be against her duty to inform the public as a journalist. Since Sandy has two interests that are in conflict, it will be nearly impossible for her to approach the situation with objectivity. Many organizations have policies for resolving conflicts of interest, for example, most publications would reassign the story to another writer who doesn’t know Sandy or her family.

But COIs don’t just exist for individuals; they can and have had significant impacts on how

organizations and governments respond to outbreaks. For example, many news channels get advertising revenue from companies on which they might need to report, such as vaccine manufacturing companies, and would be wary of reporting negative news on their products. As another example, outbreaks can be economically devastating for communities that rely heavily on tourism, and community leaders might be inclined to underplay the severity of the situation in the news so that people will continue to visit.

We obviously cannot be aware of all of the subtle conflicts of interest in the world, but when you hear information from a source, it is always a good idea to consider what they would have to gain or lose by taking certain stances.

Sensationalization

One technique that keeps people engaged with the endless barrage of a 24-hour news cycle is sensationalization, or presenting information in an intentionally shocking or exaggerated manner in order to drive interest. Science reporting can be particularly susceptible to sensationalization since the field is so broad and technical, therefore less likely to attract the average reader on its own. During health crises, public health information is frequently sensationalized due to the inherent alarm posed by outbreaks and other pressing health concerns.

Additionally, with so much coverage happening at all times, news outlets have become more likely to portray world events as urgent in order to garner views. For example, when the 2003 SARS outbreak struck, even reputable news organizations were quick to speculate that the disease could eventually kill millions worldwide, like the 1918 pandemic. In the end, fewer than 1,000 people died.

Unfortunately, irresponsible media coverage is not a new phenomenon. One striking example was actually already introduced in Chapter 2: Epidemiology. Mary Mallon was the first identified healthy carrier of typhoid in the US, and as you might recall, she was pejoratively deemed “Typhoid Mary” by the press, vilifying an already ill woman whose immigrant status posed significant challenges. In part because of this media frenzy, Mallon was forced to isolate for 26 years of her life. Her public identification and excessive isolation, on top of being an egregious violation of Mallon’s civil and human rights, was also terrible from a science communication perspective; the resulting public shame and rejection, as well as news of this extensive isolation period, likely deterred others from coming forward when ill, for fear of a similarly severe response (Figure 12.14).

False Dichotomies

Another hazard you should also be on the lookout for is the false dichotomy, a type of logical fallacy that presents two opposing options as mutually exclusive, where in fact many alternatives exist.

Common false dichotomies that emerge during outbreak events include the effectiveness of protective measures (totally effective vs useless). In another example, when considering lockdowns in the setting of an outbreak, the public discourse frequently frames staying at home against maintaining a robust economy, when in reality, these are not the only two options

Though these false dichotomies can arise from a lack of scientific understanding among journalists or pundits it is also necessary to consider that creating these debates drives controversy, viewership, and profit. No matter their origin, examining these dichotomies can

provide insight into our collective assumptions and cultural norms.

Echo Chambers and Infodemics

It is no secret that social media can harbor misinformation. Online users can even impersonate others and spread verifiably false and harmful material without repercussions. Importantly, the platforms that host false posts are similarly free from consequences. Under section 230 of the Communications Decency Act passed in 1996, social media platforms are not considered the publishers of the content of their users, which means they cannot be held legally liable for posts made on their site, even if those posts are false, dangerous, or even hateful.

This section 230 provision has contributed to the diversity of online content we enjoy today but has also reduced the incentive for companies to police the content on their sites. Social media platforms also know that their users are more likely to interact with content that aligns with their interests and will purposefully build their algorithms to expose

FIGURE 12.14 | Mary Mallon’s obituary, published in a prominent newspaper on November 13, 1938. Cruely deemed “Typhoid Mary” by the media, Mary Mallon was publicly humiliated, violating her civil and human rights and encouraging stigma toward her and other people suffering from illness.

you to content aligned with your views. This can cause social media users to become surrounded with more and more biased information that increasingly prioritizes their opinions instead of reflecting the actual facts. Such spheres of biased information are known as echo chambers and are effective at perpetuating misinformation — especially since users are often unaware that the information they are receiving has been curated. These shortcomings can lead to wholly incorrect information shared by millions of people, with no signal to viewers that the information hasn’t been verified.

Due to the sensational nature of much of its content, mis– and disinformation can often spread even faster than facts on social media platforms. You might have heard the term ‘going viral’, which is used when content — whether an image, text, or video — spreads rapidly across the internet. The content typically engages users in a way that encourages further sharing, and can unfortunately serve as a means of rapidly spreading misleading or inaccurate information.

Social media platforms are engineered to connect topics and communities and for stories to quickly pique interest and get reposted; when a post goes viral, the information becomes easily available to all internet users and even makes it to traditional media channels and newspapers. This phenomenon is compounded by the fact that many individuals don’t critically evaluate the information they see online before hitting ‘share.’ For some, the fact that their trusted friends and family posted these messages might be enough for them to feel confident in reposting, further enforcing the content as a result.

It is especially common for content to go viral in the midst of an outbreak, when people are particularly desperate for news and information. Rumors, sensationalism, and unsubstantiated

information can spread like wildfire through a terrified populace and undermine public trust in effective outbreak response strategies. This rapid flood of information — both accurate and inaccurate — creates a phenomenon known as an infodemic, making it difficult to discern reputable fact from fiction.

‘Echo chamber’ and ‘infodemic’ are two terms that help us describe how false information picks up steam, primarily on social media. When it comes to sharing helpful information and preventing the spread of it, everyone who shares information plays a role. Being critical of new information can be a way to prevent the spread of misinformation (Figure 12.15).

Considerations To Navigate Science Communication

We don’t warn you about hazards of scientific communication in order to scare you or cause you to mistrust everything you hear, see, and read; on the contrary, we hope to equip you with the knowledge to critically evaluate information so that you can find sources that you trust. In fact, just a few simple steps and considerations are sufficient to successfully vet most claims. Let’s review them.

Identifying Trusted Sources

Amid rapidly unfolding situations, it is important to not get swept up in the new, seemingly cutting-edge findings that haven’t yet been substantiated by authorities in the field. You’ve likely seen the words “a recent study has shown…” in an article, video, or social media post. When you notice a new piece of scientific information that lacks a verified source or seems to counter all the knowledge preceding it, don’t put your confidence in it right away. Do your own research

FIGURE 12.15 | Infodemic response in our connected world. Although infodemics can undermine outbreak response strategies, we have a variety of tools with which we can combat them to critically receive new information and prevent the spreading of misinformation.

to investigate how leading scientists in that field feel about the topic at hand, or follow the advice of your trusted local public health bodies if you’re not sure how to respond.

Consulting Multiple Sources

Multiple verified sources are always better than one. Consulting multiple sources has several advantages for accessing accurate information. For one, it allows you to gauge areas of consensus and disagreement. If multiple trusted sources make the same claim, it is likely to be well backed up and uncontroversial. Conversely, if multiple sources disagree, it could indicate that the current data is unreliable or subject to interpretation. Some sources also cater to specific audiences or groups that might make them more or less intuitive, and utilizing multiple sources allows you the opportunity to find information presented in a way that makes the most sense to you.

Reviewing Up-to-Date Information

During an outbreak, when guidelines are updated frequently to address an evolving situation, information can quickly become outdated. As you scan articles and bulletins, be sure to verify that they were posted recently, taking into account the latest data. Additionally, if an article or social media post you are reading cites other material, it might be worth checking how recently it was produced, and if any follow-up studies have been conducted

Carefully Navigating Primary Literature

Though it can be tempting to dive into primary scientific literature, like the scientific papers and journals that we discussed earlier in the chapter, it’s important to remember that they are often aimed at a specialized audience and are not always intended for public consumption.

going to double-check these claims before sharing them.

This seems like a biased source.

Let’s read the article carefully.

For example, the “recent studies” that occasionally make waves in the media are often preliminary findings from real scientists who hope to advance their field of study. These studies may have been published in peerreviewed journals, or they might be the preprint manuscripts

we discussed earlier. However, the general public may not be adequately trained to read and contextualize academic studies, where familiar-sounding words can have very different and precise definitions compared to what we are used to. A small study with very specific conclusions drawn from the data can be blown out of proportion and applied to areas of life for which it was never intended. This is commonly the case when scientific studies run in animal models, such as mice, report positive medical outcomes and these results are immediately extrapolated to humans. Exaggerating the implications of scientific studies can ultimately be harmful to the public and sow doubt about science as a whole.

Navigating Interpersonal Science Communication

Beyond the information we receive directly from the media and the posts we see on social media, many of us also get our information from conversations with our friends and family. Whether in-person or through emails, phone calls, and text messages, these conversations are fundamentally different from the health advice we get from the media. Though it is easy to stop reading an article you disagree with or ignore posts on social media, the opinions and habits of those close to you are hard to escape and can feel far more personal.

There are many factors that influence one’s knowledge and trust of medical science,

including their cultural beliefs, upbringing, educational background, and lived experience. Discussing health science, responding to false information from a family member, or dispelling skepticism from a close friend can be difficult and frustrating, but might be worth it. For many people, the advice they receive from friends and family is more influential than what they hear directly from public health agencies or even their physician — even if it is the same information.

Fortunately, there are several steps we can take to improve our chances of having productive interactions with each other. It is important to listen to others with empathy and not to speak down to them or use negative or dismissive body language; consider how you would want to be treated by someone who disagrees with you, and try to keep in mind that the interaction could be an opportunity for both of you to learn. You can listen to another person and make them feel heard without necessarily agreeing with them. For example, if someone you know is worried that a medication that you trust is unsafe, you could respond by agreeing that it is important to ask questions about what is being put in your body and share with them the sources of information that you choose to trust. You can

also ask open-ended questions about the logic and personal experiences behind their position, before sharing your own. This doesn’t necessarily mean that you’re looking to be convinced of their perspective, but working to understand their reasoning. These conversations may not immediately change the opinions of either party, but they are critical to helping skeptical people feel heard, and are an opportunity to learn something yourself, and their power should not be underestimated.

Getting Involved with Science

Beyond the active roles you can have in vetting the information you find and communicating it to your community, there are a growing number of opportunities for everyday people to get involved with generating important scientific insights. These include citizen science projects, which promote scientific research through the engagement of community members. One such project coordinated by multiple public research institutions in Europe is Mosquito Alert, an opensource platform that aims to track the territorial expansion of specific disease-carrying mosquitoes in order to better understand, monitor, and combat insect-borne diseases like Zika or West Nile Fever (Figure 12.16). The program engages citizen volunteers who participate by uploading photos of mosquitos in the app and indicating the location in which the mosquito was observed. Experts in mosquito identification then analyze the photos and use this information to build models and databases, including the publicly available Mosquito Alert map. Projects like this

Scan this QR code or click on this link to check out the Mosquito Alert Interactive Map website, which tracks different types of mosquitoes and sampling efforts around the globe.

one contribute to both science communication and scientific research and further demonstrate the tight connection and mutual trust needed for the development of science and public scientific literacy. In addition to being fun, engaging scientific pursuits, they also help personalize the findings, with participants being more aware of the impact of local mosquito populations than they might be otherwise.

FIGURE 12.16 | Citizen science projects. Citizen science engages the general public in the development of scientific findings. This diagram shows a citizen science project to create an interactive map tracking different mosquito species. Citizens can share observations with experts who can validate and analyze the information to create the map. The data generated by the public then informs management techniques for mosquito control, education, and communication to combat mosquito-borne diseases.

Stop to Think

1. What is the impact of misinformation on the way we respond to an outbreak?

2. What does section 230 of the Communications Decency Act refer to, and how does it impact what can be posted on social media?

3. What is interpersonal science communication? Give an example of something you have learned about through interpersonal science communication.

4. What are three considerations to navigate scientific communications as a non-expert?

Stop to Think Answers

12.1: Introduction to Science Communication

1. Through the scientific method, new knowledge is generated that supports, expands, or contradicts current beliefs, which in turn influences the questions we ask, which can then be tested with the scientific method. This process is always at work, refining our understanding of the world. Therefore, we say that science is self-correcting.

2. Because science is based on observations and evidence, we say that it is correct until new evidence can contradict or improve an idea. Trusting science means trusting the scientific method and recognizing that its results are our current best attempt at understanding the world. Trusting science does not mean believing that we already know everything.

a. Answers may vary but likely includes three of the following: (1) printing press (2) telegraph, (3) radio, (4) television, (5) internet, (6) smartphones, and (7) social media.

12.2: Science Communicators

1. Many possible answers, but some include writers, journalists, curators, academics, educators, radio and television presenters, public health professionals and social media creators.

2. Most scientific research publications describe detailed results of studies conducted under very specific conditions,

written using the technical terminology of a particular scientific field. While such publications are essential for the progress of their field, their highly specific context means that they are often not directly applicable to the everyday lives of nonscientists.

3. This practice consists of fact-checking information through consultation of reliable sources, cross-referencing information, checking context, and evaluating evidence.

4. During an outbreak, public health professionals and science communicators provide a range of communications including providing updates on public health guidelines, and sharing information on the source of the outbreak, modes of transmission, case counts and other statistics, and more.

12.3: Effective Science Communication

1. Multiple possible answers, including the spread of misinformation, stigma toward certain groups, the spread of disease, mistrust of public health authorities, mistrust in science, and preventable illnesses and deaths.

2. Multiple possible answers but should include some of these: (1) Actionable, (2) Accessible, (3) Clear and Concise, (4) Sensitive, (5) Timely, (6) Relevant, and (7) Transparent.

3. Visual communication makes it possible to summarize and understand data more quickly and intuitively, which is critical in an urgent high-stress situation. Visual communication also facilitates the sharing of scientific and public health information with broad audiences, including audiences who speak different languages and have different levels of literacy. This is particularly important as outbreaks can quickly spread to many communities.

12.4: Navigating the World of Science Information

1. Misinformation can negatively impact how we respond to public health emergencies by causing people to make poor decisions affecting their health, ultimately increasing risk of illness and death. Multiple factors can influence the impact of misinformation, such as the type of inaccuracies, when during the outbreak the misinformation is delivered, or the way the misinformation is delivered, but generally, its impact makes outbreak response slower and less effective.

2. Section 230 states that social media platforms are not considered the publishers of the content of their users, and therefore the platforms cannot be held legally liable for posts made on their site, even if those posts are false, dangerous, or hateful.

3. Interpersonal science communications refer to word of mouth communications amongst individuals. Examples include getting information through conversations with friends and family in-person or through emails, phone calls, and text messages. Examples can vary depending on individual experience.

4. Many possible answers, including three of the following: Identifying trusted sources, consulting multiple sources, reviewing up-to-date information, being cautious in interpreting primary literature without expert guidance, and carefully navigating interpersonal communications.

Glossary

Academic Journal: A platform (online and/or physically printed) that collects and publishes new research results, usually from a specific field.

Generative Artificial Intelligence (Generative AI): Computer systems that autonomously generate novel content, such as images, video, or text, by learning from existing data without human intervention

Breaking News: The most recent and urgent information about significant events or developments happening at a particular moment.

Citizen Science: Projects that promote scientific research through the engagement of community members, often in gathering and analyzing data.

Deep Fakes: Content — such as images, videos, and audio recordings — that have been produced by AI algorithms to make it appear as though a person is saying or doing something they never actually did.

Disinformation: False information that is deliberately and maliciously spread in order to mislead others.

Echo Chambers: Spaces — whether online or in the real world — in which a person encounters a curated stream of information or opinions that reinforce their own worldview without the input of opposing perspectives.

Empirical: Based on experiments or experimental procedure, as opposed to theory, logic, or belief.

Fact-Checking: The process of verifying the accuracy of information before accepting or sharing it, to ensure that it is true and reliable. This can be achieved by consulting reliable sources, cross-referencing information, checking context, and evaluating evidence.

False Dichotomy: A logical fallacy that presents two opposing options as mutually exclusive, where, in fact, many alternatives exist.

Generative Artificial Intelligence (Generative AI): Computer systems that autonomously generate novel content, such as images, video, or text, by learning from existing data without human intervention.

Going Viral: When content on the internet, whether an image, text or a video, spreads rapidly all across social media platforms.

Infodemic: A phenomenon characterized by a rapid flood of information — both accurate and inaccurate — as can occur during an infectious disease outbreak, rendering it difficult to discern reputable fact from fiction.

Information Age: Our current era, beginning in the mid-twentieth-century, marked by rapid technological advancements in information technology.

Infographics: A type of visual communication that combines visualizations with narrative text, often with the goal of giving a simplified overview of a broad subject.

Journalists: People who professionally investigate and then publish informational pieces for news outlets or magazines, providing up-todate information and guidance to the public.

Manuscript: A draft version of a scientific paper.

Misinformation: Any inaccurate or misleading information.

Paradigm: The specific set of theories, models, patterns, and experimental designs that define a scientific field.

Peer Review: An evaluation process undertaken by an editor and group of scientists not involved in a given research work who will read the manuscript and determine whether the study was well-executed and original, and whether the conclusions are valid and significant.

Preprints: Manuscripts that are uploaded to websites (called preprint servers) before they have been peer-reviewed or published in an academic journal in order to make them more immediately accessible to the scientific community.

Press Conference: A public forum where speakers from an organization address members of the media to provide information and respond to questions.

Press Release: An official statement that is sent to members of the media or the public on a particular matter, typically aiming to generate favorable media coverage. For scientific papers, press releases often aim to make the research more accessible to a broad audience.

Pundits: People in the media who deliver opinions and analysis on a certain subject, typically as an expert or authority on the subject.

Risk Communication: The real-time, measured communication of information about the danger posed by health crises in order to help the audience make informed decisions.

Section 230 of the Communications Decency Act: A portion of the Communications Decency Act of 1996 which says that social media companies are not considered the publishers of the content of their users and cannot be held legally liable for posts made on their site, even if those posts are false, misleading, or even hateful.

Science Communication: The sharing of scientific or health information between groups, often by distilling technical scientific findings into accessible language.

Science Communicators: Professionals dedicated to spreading scientific and health information, including scientists, public health professionals, journalists, writers, radio and television presenters, curators, academics, educators, and social media creators.

Scientific Literacy: A general knowledge of scientific concepts that is sufficient to allow citizens to participate in scientific discourse and make informed, critical decisions based on empirical data.

Scientific Method: A standardized model of experimentation and knowledge used to gather empirical data and answer questions in the field of science, which typically consists of several defined steps from making an observation to forming and testing a hypothesis to forming a conclusion.

Scientific Paper: A written report that uses a standardized format to summarize the context, methods and results of a scientific research work.

Sensationalization: The practice of presenting information in an intentionally shocking or exaggerated manner to drive interest, particularly by members of the media.

Social Media: Internet-based websites and applications that allow a group of users to interact, communicate, and exchange information.

Sources: Individuals or entities from whom a journalist gathers information, often providing insights, quotes, or facts for news stories.