San Diego County ‘Declares Health Misinformation To Be A Public Health Crisis’

DATE: August 31, 2021

TO: Board of Supervisors

SUBJECT: FRAMEWORK FOR OUR FUTURE: DECLARING HEALTH MISINFORMATION A PUBLIC HEALTH CRISIS (DISTRICTS: ALL)

OVERVIEW

The resurging pandemic has led to more infections and hospitalizations than the region has seen since the beginning of the year and ICU capacity is once again being tested. The U.S. Surgeon General has recently warned that health misinformation presents an urgent threat to public health.

Therefore, urgent action is needed to curb the spread of the Delta variant by combatting misinformation, thereby supporting our health care system and, in turn, saving lives. There would be a substantial detrimental effect on the County and public if nof acted upon immediately. For these reasons, this Board Letter requires immediate action at the next Board meeting.

This Board Letter declares health misinformation to be a public health crisis. At a pivotal time in our history, with an FDA-approved vaccine available to all San Diegans free of charge and booster shots recommended later this year, health misinformation now presents a greater threat to public health than a variant of COVID-19. In response, the Board of Supervisors of the County of San Diego recognizes the vaccine hesitancy, that stands in the way of the County moving beyond the COVID-19 pandemic, is being fueled by the spread of health misinformation, and commits to developing strategies to actively combat health misinformation. Following the recommendations of the U.S. Surgeon General Vivek H. Murthy in his advisory entitled “Confronting Health Misinformation,” 1 this board letter acknowledges the role misinformation has had in the resurgence of CO VID-19 infections, once again filling hospital capacity, and driving the deaths and hospitalizations of thousands, including San Diegans2 and committing County resources to work with trusted stakeholders to aggressively counter misinformation in our community and engage in outreach based on best practices.

We strongly urge your support for the recommendations in this letter to recognize health misinformation as the threat to public health that it is, and take the necessary steps towards a stronger, healthier future.

RECOMMENDATION(S)

CHAIR NATHAN FLETCHER

I.) Approve resolution titled “Resolution of the Board of Supervisors of the County of San Diego Declaring Health Misinformation a Public Health Crisis.”

2.) Direct the Chief Administrative Officer (CAO) to implement the following strategies cited by the U.S. Surgeon General Vivek H. Murthy in his advisory entitled “Confronting Health Misinformation,” and report back within 90 days on the status of implementation and within 180 days upon completion:

a.) Devote resources to identify and label health misinformation and disseminate timely health information to counter misinformation that is impeding our ability to keep our community safe,

b.) Modernize public health communications with investments to better understand gaps in health information, and questions and concerns of the community, especially in hardto- reach communities. Develop targeted community engagement strategies, including partnerships with trusted messengers,

c.) Expand our research efforts to better define and understand the sources of health misinformation, document and trace its costs and negative impacts, and develop strategies to address and counter it across mediums and diverse communities,

d.) Invest in resilience against health misinformation including digital resources and training for health practitioners and health workers. Explore educational programs to help our communities distinguish evidence-based information from opinion and personal stories.

e.) Partner with federal, state, territorial, tribal, private, nonprofit, research, and other local entities to identify best practices to stop the spread of health misinformation and develop and implement coordinated recommendations.

f.) Identify resource gaps to combating health misinformation and working with state and federal partners to meet ongoing needs.

g.) Work with the medical community and local partners to develop a website that will serve as a central resource for combating health misinformation in our community.

EQUITY IMPACT STATEMENT

The COVID-19 pandemic has had a significant impact on the lives of individuals, businesses, and communities across San Diego County. Recent studies have found that online misinformation campaigns are associated with a decrease in vaccinations over time, which impacts all communities’ ability to reach herd immunity.3 But, the impacts are greater in ethnic minority communities as a majority of non-white adults were found to be hesitant to receive the Covid-19 vaccine. 4 Studies have found vaccine and healthcare distrust continue to serve as major barriers to addressing racial equity in Covid-19 vaccine efforts. 5 It is believed that developing sustainable and sound strategies to mitigate and combat misinformation, such through the actions proposed in this Board action, is crucial to closing health outcomes gaps within Black and Hispanic communities and achieving overall public health goals.

FISCAL IMPACT

There is no fiscal impact associated with this action. There may be future fiscal impacts associated with final recommendations which would need to be approved by the Board

BACKGROUND

This Board Letter declares health misinformation to be a public health crisis. At a pivotal time in our history, with an FDA-approved vaccine available to all San Diegans free of charge, health misinformation now presents a greater threat to public health than a variant of COVID-19. In response, the Board of Supervisors of the County of San Diego recognizes the vaccine hesitancy, that stands in the way of the County moving beyond the COVID-19 pandemic, is being fueled by the spread of health misinformation, and commits to developing strategies to actively combat health misinformation.

Since vaccines became widely available in mid-April, there has been a local and national surge in COVID-19 infections and hospitalizations that has once again threatened to strain hospital resources and put the health and safety of our community at risk. Slowing vaccination rates have made more San Diegans susceptible to contracting the more contagious Delta variant which has led to infection rates not seen since January of 2021. 7

Research has shown that people are increasingly turning to the internet and social media channels for health information which has enabled public health professionals, including local health departments, to expand their reach but it has also facilitated the rapid spread of misinformation and disinformation. 8 The prevalence of falsehoods undermining confidence in the vaccine has surged in recent months fueling unfounded notions that vaccines don’t work, that they contain microchips, that people should rely on their “natural immunity” instead of getting vaccinated, that the vaccines cause miscarriages, among other erroneous assertions.9

While empirical data and the broad scientific consensus point to the fact that COVID-19 vaccines are safe and effective against preventing severe disease, hospitalization, and death from the Delta variant, 10 misinformation and disinformation has played a significant role in undermining vaccine utilization and compliance with public health guidelines, such as those related to masks. 11 Misinformed beliefs about vaccines and public health guidelines have turned this into what many have labeled a “pandemic of the unvaccinated.” 12

On August 23rd, the Food and Drug Administration granted full approval to Pfizer-BioNTech’s coronavirus vaccine for people 16 and older. 13 As our community and our country looks to tum the page on the pandemic, and as booster shots become more important to maintaining our recovery, confronting and combating misinformation becomes vital to saving lives and realizing our shared public health goals.

The Surgeon General has said “health misinformation is a serious threat to public health. It can cause confusion, sow mistrust, harm people’s health, and undermine public health efforts. Limiting the spread of health misinformation is a moral and civic imperative.” 14 This board letter signals the Board’s agreement with the Surgeon General and affirms the Board’s commitment to taking action to combat misinformation. We strongly urge your support for the recommendations in this letter to recognize health misinformation as the threat to public health that it is, and take the necessary steps towards a stronger, healthier future.

LINKAGE TO THE COUNTY OF SAN DIEGO STRATEGIC PLAN

Today’s proposed actions support the Live Well San Diego Initiative in the County’s Strategic Plan, and its vision for San Diego that is Building Better Health, Living Safely, Thriving, by supporting and defending public health efforts.

Respectfully submitted,

NATHAN FLETCHER

Supervisor, Fourth District

1 “Confronting Health Misinformation, The U.S. Surgeon General’s Advisory on Building a Healthy Information Environment,” Surgeon General Vivek H. Murthy, July 2021

2 “Coronavirus Doctors Battle Another Scourge: Misinformation,” August 17, 2020, New York Times

3 Wilson S.L., Wiysonge C. Social media and vaccine hesitancy. BMJ Global Health. 2020;5(10)

4 Reinhart R.J. Gallup; 2020. More Americans now willing to get COVID-19 vaccine.

5 Ndugga N., Artiga S., Pham 0. Kaiser Family Foundation; 2021. How are states addressing racial equity in COVID-19 vaccine efforts? https://www .ncbi.nlm.nih.gov/pmc/articles/PMCS I l 74 78/

6 Xiang D, Lehmann L., Health Policy Technol. 2021 Sep; 10(3): 100520. Confronting the misinformation pandemic

7 August 19th case numbers in San Diego are the highest one-day total since late January, NBC San Diego

8 “Misinformation: A Threat to the Public’s Health and the Public Health System,” Journal of Public Health Management and Practice: May/June 2020

9 “Virus Misinformation Spikes as Delta Cases Surge,” August 10, 2021, New York Times

10 Safety and Effectiveness ofCOVID-19 Vaccines, Johns Hopkins Medicine

11 Health-related misinformation dan erousl undermines res nse to ublic health crisis, Center for Health Security

12 Dr. Rochelle Walensky, CDC director, on July 16th at briefing of the White House COVID-19 Response Team

13 Full FDA-approval of Pfizer COVID-19 vaccine, August 23, 2021, New York Times

14 “Misinformation is ‘serious threat to public health,’ surgeon general warns,” July 15, 2021, NBC News