Contrasting academic and lay press print coverage of the 2013-2016 Ebola Virus Disease outbreak

Introduction

Ebola virus disease (EVD) is a viral hemorrhagic disease that prior to 2013 was implicated in sporadic outbreaks in Equatorial Africa; the 2013–16 outbreak spread outside of Western Africa, and greatly heightened the lay press coverage of the disease. At the time, EVD treatment options were strictly supportive, leaving health officials with contact tracing, isolation, and behavior modification approaches to curtailing the outbreak [1]. The Crisis and Emergency Risk Communication (CERC) model for media reporting on public health emergencies was established in 2005 [2] and has subsequently been used to analyze media reporting on outbreaks of influenza [3, 4], measles [5], second hand smoke hazards [6], and medication adherence [7]. However, analysis has not been applied to the Western African outbreak of EVD despite the notable volume of media coverage and contemporaneous political debate. The need for accurate reporting and advising is paramount when attempting to tackle outbreaks through behavior change. However, today’s media environment carries the reputation of one more interested in speed to publication than accuracy of information–leading to the general public reporting a general lack of trust in the media [8] and creating the potential for the dissemination of dangerous misinformation. Completeness and accuracy are difficult to define in the fast moving world of scientific knowledge; sources viewed as correct reflections of a complete story one day may be viewed as half-truths the next. However, while it is beyond the scope of this project to attempt to provide the definitive story of EVD, it is possible to contrast the consensus information of the time with the contemporaneous reporting. This study aimed to provide novel insights into the completeness and accuracy of media reporting by applying the established CERC coding model to the 2013–2016 EVD outbreak across various levels of the written media–academic journals, news magazines, newspapers, Wikipedia, blogs, and alternative media outlets.

Methods

Results

Discussion

Under a traditional paradigm, only those with the expected background knowledge consume academic literature. The lay press then plays a complementary role, extracting findings of high interest or importance and translating them for general viewing. Preferably, the lay press would translate the academic range of opinion (often detailed in review articles) over what is possible into a tangible discussion on what the actionable items are for their readers. For example, rather than debate the academic nuances of a recent publication on heart disease, a newspaper may focus on communicating which, if any, life style modifications a reader should make when the new study is viewed in the context of the established review article recommendations. To some extent our findings support a potential synergistic dynamic of academia and the lay press. Had our results supported our initial hypothesis and indicated that comprehensive review articles could serve as a collective source of accurate information, the subsequent recommendations would have been to encourage lay press authors to access these journals for background understanding. However, we instead found that reviews could not reliably clarify confusion surrounding EVD nor could they combat disinformation in alternative media.

Additional interlocutors during the EVD outbreak were the web pages from agencies such as the CDC and WHO [127]. Resources and inaccessibility of contemporaneous versions of agency webpages precluded a similar assessment of these intermediaries, however these outlets can be important sources for writers in academia, media, as well as public policy. These agencies resources should receive their own evaluation as to whether they could have proved accurate contextualization of academic information for lay press background research.

The increased completeness seen in the academic review articles collected was likely a reflection of our study design rather than the authors of the individual manuscripts; general review articles were specifically targeted instead of those that may focus on only vaccine development or diagnostics and thus carried a selection offset in favor of completeness. Therefore comparing lay press articles on the same scale of our selected reviews is somewhat artificial. However, this comparison may still provide useful information by enumerating what portion of the total body of knowledge lay press article present.

The review article format is structured to present findings within the larger context, and is thus less likely than primary research to spark debate or be presented out of context. However, while the internet has greatly expanded the knowledge base within the proverbial ivory tower, it has also opened the tower to the pressures of the modern media environment in ways that can threaten the contextual foundation that review articles are expected to provide. The longstanding pressure in academia to ‘publish or perish’ has been heightened by online journals that print anything for a fee but cannot be distinguished from respected peer-reviewed counterparts by the untrained eye [128, 129]. Similarly, the longstanding lay press strain to produce scoops on a deadline has been magnified by numerous online sources participating in a minute-to-minute news cycle.

Well-meaning reporters that looked to academia for clarity would seem more likely to mistakenly concluding that airborne transmissibility was a possibility worthy of prompting policy changes if traditional measures of journal status like impact factor were of poor guidance, 1 in 3 academic papers failed to discuss airborne spread, and 1 in 3 of those that did cover it failed to communicated that no specific actions should stem from this negligible risk. As another example, a debate over the potential for EVD to be contracted from a bowling ball may never be settled in academia. Even with a dedicated study looking at bowling balls as EVD fomites, no researcher could test for all possible variables such as ambient temperature, porousness of the bowling ball, length on contact, skin integrity of the bowler, starting inoculum, etc. Communications to the public should stress that any actionable policy trying to curtail airborne EVD would waste resources and that no one should cancel their bowling plans. While the CDC may be tasked with the duty of communicating these nuances, academia in the internet-era may not be well served by the finding that many EVD comprehensive review articles were ripe for misinterpretation.

While we cannot assess causation, our results suggest that the ambiguity of academic papers created a potential for inadvertently feeding into misinformation, even if the academic literature was more reflective of the deference owed to scientific range or opinion. Speculation into the possible consequences of the mutation rate of Ebola virus [130] and the aforementioned pig-to-primate study was misrepresented as a cause for alarm on future airborne spread. Confusing word choice on when a person with EVD is contagious was misrepresented as justification for travel bans and prolonged quarantines for asymptomatic health care providers returning from overseas. Alternative sites (InfoWars 5, Beforeitsnews 18 and 26) linked directly to primary literature discussing the impact of traveler screening on mathematical models of spread [131, 132], contaminated saliva in EVD patients [133], and aerosols following toilet flushes [134] as support for their claims of the need for travel bans and proof of airborne transmission. These alternative citations were making erroneous extrapolations without misrepresenting the objective findings of each scientific paper.

While little can be done to prevent intentional misrepresentation by any media outlet, these examples prompt a question as to whether academicians need to take a more active role in communicating the actionable items in their findings directly within their manuscript, especially when the review format allows for synthesizing published information into a complete narrative. The simplest and perhaps most ideal approach that academicians writing about topics of public interest may consider is to summarize the current approach to the problem they are addressing. Word limits in publications may make it difficult to spend any space on what should be considered background knowledge of the reader, however scientists could also consider using social media and press releases to directly communicate the actionable items in their findings to serve as both scientific speaker and lay translator [135].

Another approach may be, when possible and appropriate, to have academicians use Bayesian prediction modeling to calculate odds on their statements of ‘possibility’ as a means of allowing for a more serious presentation regarding the need to act when translated for the public. No pathogen in the history of known biology has even mutated to change its mechanism of transmission [136, 137]; therefore there are more publications supporting the position that the universe is a hologram [138–140] than blood borne viruses spontaneously becoming airborne transmittable. Such modeling would be difficult, but could include the average viral load of EVD patients (roughly 10 million) [141] multiplied by the total documented cases in history (31,079) [142] to get an estimate of the total interactions between an Ebola virion and the human host. This may support the estimate that historically, roughly 300 billion virion-host interactions have occurred without any reported airborne transmission. It is not our intention to proffer this 1 in 300 billion estimate as the definitive pre-test odds calculation, and any post-test assertions would have to account for viral turnover, predictions of undocumented cases, animal carriage, and other factors. While a more Bayesian approach [143, 144] would itself generate debate within the scientific community, a reporter attempting to make a last minute deadline would find more than just the terms “possible” or “cannot be excluded” as stand ins for every probability between impossible and almost certain. This may better communicate whether the current EVD control measures should be modified to address the chance of airborne spread by enumerating the remoteness of the risk for their readers.

For those scientific problems for which odds could not be postulated without undesirable subjectivity, perhaps illustrative comparisons could be made; as one hypothetical example, comparing the risk of airborne Ebola virus to that of airborne HIV. An additional option may be to co-opt terms from the intelligence community wherein ‘probably not’, ‘probably’, and ‘almost certainty’ denote distinct odds calculations [145] just as the terms ‘trend’ and ‘significant’ have been used to denote mathematical value. Additionally, academic authors could look to recent evidence on clearer public communication through use of a vernacular that the public is more likely to understand [146]. For example, use of the word ‘enhance’ by scientists was meant to convey ‘intensify’ but was perceived by the public to mean ‘improve’ [146].

Even if concern over the potential perils of presenting odds in the peer-review process are insurmountable, academic writers might aide in collective understanding by specifying if changes in public policy are warranted rather than defaulting to a potentially misleading ‘possible versus impossible’ dichotomy. This approach could make it easier for media outlets to fact-check the claims of competing sources that conflate possibility with likelihood either unintentionally or for purposes of fear mongering.

While low scientific literacy [147] and over-simplified media coverage [148] bare some responsibility for the public confusion, researchers must ask themselves what degree of the public’s failure to glean actionable items from their studies is a reflection on academia itself. At minimum, academicians must be mindful of the context within which they present scientific uncertainty. Data related to aerosolization of Ebola virus within a context of bio-warfare preparation present a different risk of misinterpretation when the context of the discussion shifts to that of outbreak response; efforts must therefore be made to present the actionable implications of the data within the new context. This clear communication is especially vital during the height of an epidemic when state-enforced measures can worsen local social insecurity [120] whilst the truly “viral” spread of public attention creates a susceptibility to a fear contagion [149].

When viewed qualitatively, alternative media outlets actively presented disinformation. However, other lay press sources not only made accurate statements regarding the body fluid transmission of EVD, many flatly stated “Ebola is not an airborne disease”. This could indicate that public health officials and academicians may find a willing partner in some written press sources; those from which most Americans get their news appear to aide in fostering an accurate understanding of serious medical topics. These finding may also represent a potentially useful addition to news sourcing algorithms, such as those used by Facebook [150], to preference media outlets with objective track records of accuracy and completeness. Interestingly, there were no significant differences between new and old media for the most popular news outlets. It would be intriguing to hypothesize if popularity of these sources is a reflection of their apparent dedication to accuracy that begets selective advantage in the marketplace, or if their built-brands afford them enough cover to avoid stereotypical ‘click-bait’ or sordid sensationalism.

However, the lay press may require a re-evaluation of the approach to editorials and letters to the editor. Of the 27 errors made in the newspaper media, 19 (70%) were within the categories of letters or editorials. Furthermore, the quality of the errors within the letters and editorials were also far more misleading. While the standard news pieces mostly erred in not specifically stating that bleeding is not a universal symptom of EVD, the letters and editorials misled by stating travel bans would be a net benefit, airborne spread is an actionable concern, and patients were contagious before being symptomatic (S2 Table). While the alternative media articles used more apocalyptic verbiage, the basic themes of their errors did not differ from newspaper op-ed and letters. While it is understandable that newspapers would want to solicit input from a diverse sampling of sources, perhaps they should hold these authors the same standard of factuality that they hold their staff writers to, or consider editor annotation to point out misinformed or misleading statements.

The major limitation in this study is that the lay press collected was not all-inclusive. It was not feasible with the resources at hand to collect all media coverage, including television and less popular magazines, newspapers, and blogs. Even within the media outlets selected, many of the lay press outlets do not have an objective means of collecting all relevant publication; as such, only a sampling of lay press articles could be included in this analysis. However, the ease of accessibility of the media included did not predict the content or accuracy; newspaper articles covered in the New York Times did not differ significantly from the completely accessible Wall Street Journal except that the later contained editorials that carried an increased risk of erroneous statements. Furthermore, this study’s use of objective mechanisms of collecting the lay press sources excluded some that are specialized for scientific information (such as Science News or Scientific American). An interesting follow up study could be to assess if these science-focused outlets were equal or superior to the outlets collected in this investigation. While this would not be conclusive, it does suggest that the large sample examined, while incomplete, was reflective of the whole. An additional major limitation is the inability to combine both qualitative and quantitate analysis in an objective manner. The binary scoring of the CERC system meant that articles that simply mentioned “community outreach” were given an equal score as those that detailed the types and benefits of such practices. It could be valuable to perform subsequent analysis re-scoring papers based on depth of each major topic, if this could be done in an objective fashion.

Another limitation is that the focus on EVD may not allow readers to extrapolate to other issues of health or medicine. Furthermore, we cannot draw causation from our findings. It is unknown if any reporters, politicians, or pundits made inaccurate statements due directly to the lack of clarity in the academic reviews. However, this work may still achieve its goal of comparing the contemporaneous academic reviews available to reporters and policy makers at the time of their background research. Lastly, this analysis stops with the outbreak’s containment, which therefore overlooks the long-term chronic pains and visual changes that have plagued some EVD survivors [151].

President Taft is credited with advising, “don’t write so that you can be understood, write so that you can’t be misunderstood”. While this study in no suggests that the lay press was superior to academic works, the crux of our conclusions is that modern media access to academia makes it far more likely that a given academic author will be misunderstood. Writing within academia affords the ability to focus on novel findings and forego discussion of background knowledge that the author can safely assume the reader possesses. However, seclusion from the populace also carries a disadvantage of needing to rely upon the lay press to translate one’s findings into that which is fit for consumption in the public sphere. Given the erosion of the barriers siloing an academia increasingly pressured to produce publications, combined with the demands of today’s fast-paced media environment, contemporary researchers should realize that no study is outside the public forum and to therefore consider shifting the traditional paradigm to take personal responsibility in the process of accurately translating their scientific words into public policy actions.

Supporting information

Data Availability

All relevant data are within the paper and its Supporting Information files.

Funding Statement

The author received no specific funding for this work.