Winning the Battle Against COVID-19 Requires More Belief in Reality

Health behaviors should not be guided by false beliefs

Joe Pierre


Photo by GoToVan (flickr).

In February, the World Health Organization warned of a pending “infodemic” of COVID-19 misinformation. Four months later, it would be hard to deny that a misinformation pandemic now exists that is characterized by informational uncertainty, factual inaccuracies, and delusion-like beliefs about COVID-19.

Conspiracy theories are a prime example of delusion-like beliefs that exist in the grey area between mental illness and mental health. With about 50% of the US population and other countries endorsing at least one, conspiracy theory beliefs are normal phenomena that are not generally considered to be evidence of mental illness. Nonetheless, belief in misinformation always has the potential to harm, and belief in medical conspiracy theories has been shown to have significant practical health consequences including avoiding routine check-ups, refusing vaccinations, or eschewing care for HIV infection.

COVID-19 has provided the opportunity to witness the genesis and evolution of medical conspiracy theories in real-time, such as the belief that SARS-CoV-2 was manufactured in a lab as a bioweapon; that the pandemic was orchestrated by the likes of Bill Gates or Dr. Anthony Fauci to profit from a vaccine or to implant people with microchips; or that 5G technology is the real cause of COVID-19.

With COVID-19 conspiracy theories converging with more established falsehoods about vaccines (e.g. that governments are aware of serious side effects like autism but mandate vaccination anyway), 23% of US survey respondents already claim that they won’t get a SARS-CoV-2 vaccine if or when one becomes available.

This unholy alliance of false conspiracy beliefs now casts a looming shadow on hopes of safely developing immunity against COVID-19 through vaccination.

Conspiracy theories reject authoritative accounts of reality in favor of some plot involving a group of people with malevolent intentions that are deliberately kept secret from the public. The psychological underpinnings of belief in conspiracy theories include a long list of associated cognitive quirks including lack of analytic thinking and heightened “bullshit receptivity;” need for control, certainty, and closure; and various attributional biases such as the tendency to ascribe random events to ultimate “teleologic” causes.

Conspiracy theories often arise during times of societal upheaval and can serve a blaming or scapegoating role intended to “self-medicate” fears arising from chaos and uncertainty. Belief in conspiracy theories can also be understood within an overarching “socio-epistemic” framework whereby mistrust in authoritative sources of information leaves us vulnerable to biased misinformation processing when searching for alternative explanations.

During this novel pandemic, many unknowns about COVID-19 remain to be resolved through scientific inquiry. This iterative process has meant that forthcoming information has been inconsistent, with revised initial claims that SARS-CoV-2 could not be spread by aerosols and recommendations that masks need not be worn in public. Along with a backdrop of mounting fear, such informational gaps and inconsistencies contribute to mistrust and an urge to blame that in turn makes us susceptible to misinformation. Belief in conspiracy theories is an unfortunate if unsurprising result.

In a mentally healthy society, health behaviors should not be guided by false beliefs. The likening of misinformation to a deadly contagion is therefore apt, especially with regard to exposure and spread on social media. Researchers found that in October 2019, anti-vaccine pages on Facebook outnumbered pro-vaccine pages more than 2:1 with followers growing more rapidly and interacting with other groups with potential ideological overlaps, such as those focused on “wellness” or more generalized safety concerns.

Meanwhile, followers of pro-vaccine groups were more static, without evidence of nearly as much interaction or ideological conversion of vaccine “fence-sitters.” More recently, researchers determined that of the 150 most-viewed videos identified about COVID-19 on YouTube as of March, 27.5% contained false information and were seen by over 62 million viewers worldwide. Just this past month, the conspiracy theory video Plandemic went viral within a matter of days before it was taken down by the major social media sites.

No doubt, however, many conspiratorially-minded people took its removal as censorship that meant its content must be true, rather than seeing it for what it was — a necessary safeguard against the potential harms of misinformation.

Just yesterday, Vice President Pence wrote an op-ed that dismissed the risks of COVID-19 as fake news and promoted the Trump administration’s policy of denial as our best remedy against the pandemic. Meanwhile, the satirical news site, The Onion, once again nailed reality in a way that mainstream news sites have yet to master with its headline, “City Enters Phase 4 of Pretending Coronavirus Over.”

Such a mismatch between belief and reality suggests that we will lose the battle against COVID-19 misinformation and conspiracy theories if we — not only as members of the medical community and the media but as individual citizens — don’t take further action against it.

As with vaccines themselves, strategies that “inoculate” against misinformation are among the most evidence-based interventions, but they will prove futile if people don’t receive the inoculant.

Effective mitigation requires that beyond treating patients sick with COVID-19, medical institutions and healthcare providers must work harder on 1) building and earning trust through honesty and transparency; 2) promoting greater science literacy through education; and 3) countering misinformation where it occurs online, preemptively warning people about exposure, and reaching out to “fence-sitters” looking for answers.

If we are to prevail over COVID-19 as a society, we must continue to investigate and implement effective interventions and promote immunity not only against the medical disease but against belief in misinformation about it.



Joe Pierre

Dr. Joe Pierre is a professor of psychiatry at UCSF and author of the Psych Unseen blog at Psychology Today. Twitter @psychunseen.