How to report on monkeypox, polio, & COVID outbreaks without transmitting misinformation

An infectious diseases expert shares five best practices to ensure education news stories are informative and helpful to parents, educators, and policymakers.

By Tim Lahey, MD, MMSc

With new plagues emerging from the shadows seemingly every week, infectious diseases physicians like me have been busy.

This means more time seeing more patients with our features obscured by gloves, gowns, and N95s.

That’s no surprise; we trained for that job for years.

The surprise has been how much time infectious diseases doctors have spent talking with journalists.

The explosion of information from virologists, epidemiologists, public health leaders, politicians, and vitamin-hawking quacks has needed translation to a fearful public.

This has been an ambivalent experience for me.

I admire journalists working under tighter and tighter deadlines to get the truth out to the public, and I have been honored to tell the story of the single greatest outpouring of science in human history. At the same time, I feel much more comfortable in the air-conditioned hush of a hospital room than under the glare of television lights.

Even in the time pressures of clinical medicine, there is time for nuance and discussion. In news coverage, a nuanced conversation with a reporter can get distilled down to a single soundbite.

Every once in a while – rarely – I cringe when my words get not only simplified but converted into sensationalist coverage or even misinformation.

So just in time for school to resume, with monkeypox and polio elbowing COVID-19 from the world’s headlines, here are five best practices for journalists to produce accurate and nuanced outbreak reporting:

1: Avoid alarming the public unnecessarily with news of new outbreaks.

News that a New York man contracted polio and that subsequently poliovirus was found in New York City wastewater is deeply concerning.

A polio-free decade just ended in the United States, bringing with it a real threat of paralyzing infection among unvaccinated people.

That said, over 90% of United States citizens have been vaccinated against polio, meaning the vast majority of students and teachers can return school without adding polio to their worries.

Helen Branswell nicely captured this juxtaposition in STAT in part by quoting a public health leader who said, “The chances of becoming paralyzed are small, but I think this case shows us that they’re not zero.”

Similarly, just in time for back-to-school season, Knvul Sheikh and Catherine Pearson of The New York Times empower readers with info about prevention of monkeypox transmission in schools while quoting a pediatric infectious diseases specialist who explains why monkeypox is not as easily transmitted as COVID-19 or other common infections.

2: Appraise evidence quality, with expert help.

Every academic institution releases breathless press releases saying that the latest paper from a star faculty member is a “game-changer” or a “breakthrough.” Most are neither.

It’s unfair to expect journalists to cull the wheat from the chaff, but expert sources can help.

Stories that report new findings along with expert contextualization can help parents and teachers distinguish between an intriguing scientific curiosity versus information they should use to stay safe.

Ed Yong regularly characterized evidence quality in his Pulitzer Prize winning coverage of COVID-19, including his essay, “Everyone Thinks They’re Right About Masks.”

In it, he describes studies of viral RNA aerosols raining down on various surfaces, after which he quotes an expert on the artificiality of some experimental setups, and then writes:

“This isn’t necessarily cause for alarm. Finding viral RNA is like finding a fingerprint at a crime scene — the culprit was once there but might be long gone. So far, the Nebraska team has failed to detect live, infectious virus in its air samples.”

3: Include diverse, credible voices.

Every expert has biases and blind spots. Stories sourced exclusively from white men cannot capture the whole community story. This is even truer during infectious diseases outbreaks, which are commonly shaped by social realities such as racial inequalities in access to testing or health care.

It is important to get comment on the latest findings not from the same recognizable (and often white male) crop of health experts, but from diverse points of view.

Journalists hoping to obtain expert contextualization of scientific findings can benefit from Abdullahi Tsanni’s advice including this useful quote from Washington Post reporter Sarah Kaplan: “I ask scientists, especially those I have a good relationship with, ‘Who else in your field is good and doesn’t get quoted enough, and deserves to be spotlighted?’”.

Those experts should include representatives of the most affected communities.

Dan Diamond and colleagues reported on missteps in the United States monkeypox response, including voices from affected patients such as Joshua Wright who described begging emergency room clinicians to give him treatment with the antiviral drug TPoxx.

4: Explain how risk factors arise.

Viral transmission risk often correlates with private behaviors, and thus a risk of stigma. Sex between men has transmitted monkeypox, for instance, so talking about monkeypox transmission can stigmatize men who have sex with men.

To short-circuit the human propensity to equate infection with moral contagion, journalists can explain how such risk associations arise.

Monkeypox entered the sexual network of men who have sex with men by chance, for instance, and due to the smaller size and highly interconnected nature of that sexual network, faster transmission and recognition of monkeypox was possible.

Kai Kupferschmidt explained the disproportionate impact of monkeypox on men who have sex with men without stigmatizing them. For example, he includes this quote from a public health expert: “We should say: It’s not about who you are. It’s about what you’re doing. And we’re not going to stigmatize it. But just know that you’re at greater risk if you fit this profile.”

5: Emphasize uncertainty and tradeoffs over polarized choices.

Controversy about medical decisions typically signals either scientific uncertainty or the presence of tradeoffs — or both. COVID vaccines can protect children from hospitalization but cause rare side effects. Vaccine proponents and detractors react to that combination quite differently, leaving teachers and parents bewildered.

Instead of focusing on the he-said-she-said fringes of that controversy, journalists can characterize areas of uncertainty and the tradeoffs being debated by the reasonable middle.

More nuanced coverage can help de-polarize dialogue and reduce parents’ sense that they have to pick sides. Apoorva Mandavilli described areas of uncertainty and the tradeoffs being debated in her coverage of pediatric COVID vaccines for the New York Times.

She wrote that parents might feel less inclined to vaccinate their kids upon hearing new viral variants can elude vaccine immunity, but then quoted expert encouragement to vaccinate kids nonetheless to reduce rates of severe disease while awaiting the results of forthcoming vaccine trials.

Careful journalism is critical to outbreak control.

Getting it right matters. The quality of journalistic coverage of outbreaks influences both public trust in public health guidance as well as private health behaviors.

Thoughtful coverage can inoculate the public against misinformation, and providing that kind of nuance does not undermine reader interest.

So, while I look forward to leaving my pandemic days in newspapers and on television behind me, I will never stop feeling grateful for journalists who, working under intense pressures, keep bringing truth and nuance to people sorely in need of both.

Tim Lahey, MD, MMSc, is an infectious diseases physician and ethicist at The University of Vermont Medical Center. He has written for the New York Times, the Atlantic, Washington Post, and beyond.