Fighting an epidemic of misinformation

Imperial’s expertise in the field of disease and outbreak planning is genuinely world-leading. Researchers from the College have previously worked on outbreaks and pandemics, including SARS, bird flu, swine flu, MERS and Ebola.

Expertise is now chiefly delivered through the MRC Centre for Global Infectious Disease Analysis (MRC GIDA) and Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), both based in the School of Public Health, but also various groups across the College.

In 2018, the WHO added a new item to its watchlist of threats, the ominously and portentously named ‘Disease X’ which ‘represents the knowledge that a serious international epidemic could be caused by a pathogen currently unknown to cause human disease’.

Dr Nabarro has held leadership roles on outbreak and pandemic response and planning at both the United Nations and the WHO - dating back to 2005 as UN System Senior Coordinator for Avian and Human Influenza. He said of Disease X:

“Among a community of us, the inevitability of a major pandemic was definitely there. Our line was ‘we don’t know when it will come but we know it will come’. However, that perception was not necessarily felt by everybody.  Although a pandemic would always appear in analyses of global risks, there was a big uncertainly about its timing and its nature.  That has made it hard for governments to invest significantly in preparedness. There seems to have been a reduction in the expectation of a pandemic in some quarters in more recent years.  This is for a mix of reasons, but there has been a general sense that science would be able to get on top of any disease threats that might emerge.”

In December 2018, Imperial and the Coalition for Epidemic Preparedness Innovations formed a partnership to help protect against Disease X.

Then in late 2019, J-IDEA was setup to rapidly respond to emergencies such as pandemics, extreme climate events, and natural and humanitarian disasters. Just weeks after J-IDEA launched, reports of the first cases of a novel coronavirus emerged from Asia.

Since January, the MRC-GIDA and J-IDEA teams have responded rapidly to the emerging coronavirus threat as the Imperial College COVID-19 Response Team – led by Professor Neil Ferguson alongside other world-leading professors including Christl Donnelly, Azra Ghani and Steven Riley, and later joined by Nick Grassly, Timothy Hallett and Katharina Hauck.

Professor Ghani, who is Chair in Infectious Disease Epidemiology, says: “It started when we saw the first cases emerging from China. Early on we were thinking about what information we could get and that actually required an awful lot of scraping data from various websites, including the Ministry of Health website in China and regional websites [in the country]. We got together a very large team to do that. Once cases started to emerge outside of China, we kept track of these, looking at when they flew from China and returned home, to get some sense of when they must have been infected and the time between being infected and developing symptoms.”

_{(Listen above to Professor Azra Ghani (Chair in infectious disease epidemiology at Imperial) giving insights into how mathematical models are providing vital insights into the nature of the outbreak.)}

Epidemiological disease modelling is perhaps the central supporting pillar that allows public health officials to plan societal interventions. Imperial’s teams have developed and refined the computer code that underpins their epidemiological models over several years, through previous epidemics. That work has been published widely and validated externally. The models have also be used in pandemic planning and simulation scenarios. Nevertheless, when a pandemic of the magnitude of coronavirus hits, there is still considerable work to be done and new data to incorporate.

Professor Ghani explains: “Early on in the pandemic, there was an agreement amongst funders and academic journals, which led to a huge amount of information being put up on websites and it is challenging even for those of us in this field of academic research to search through these. The only way we can really approach it is to have a very large team of people, including PhD and postdoctoral researchers – performing data entry or reading a paper and summarising it, trying to give us the best possible sense of all the scientific information that’s out there.

“A lot of the tools are there, but what we find is that every little aspect of a new disease is slightly different: the data will have a slightly different format or the statistics that we need to use must be very slightly modified. So whilst we have a lot of this machinery ready to go, it isn’t really a case of just pressing a button, it requires quite a lot of scientific input.”

The Imperial team has published regular reports detailing the latest outputs from their epidemiological models. As one of the most prominent academic teams on the UK government’s Scientific Advisory Group for Emergencies (SAGE) and Science and Technology Committee, these have had a significant influence on policy.

A landmark report published on the 16 March detailed the latest results of the model, showing that extensive social distance and quarantine measures would be required to supress transmission, retain vital capacity in intensive care units and keep the number of fatalities to around 20,000. Without these strict measures the NHS would have been totally overwhelmed, with fatalities between 200,000 and 500,000, according to the models.

The team continues to publish reports as new data become available for analysis – attempting to strike a balance between the rigorous, methodical scientific method and the pressing public and government need for new information.

As well as publishing rapid response reports, the Imperial College COVID-19 Response Team has continued to work on deep analysis, publishing in peer-reviewed journals.

There is a strong likelihood that we are all going to have to live with and adapt to the reality of COVID for some time to come – perhaps even years. After the initial spikes have peaked and transmission is under control, there will continue be sporadic outbreaks.

The development of a vaccine will have an important role to play and several teams, including a group at Imperial are actively working towards that goal. Yet that will take some time to roll out on a large scale, and Dr Nabarro says that the role of communities will continue be absolutely essential in preventing larger flare-ups.

“The only way to deal with this is to find outbreaks of the disease as they start and to really close them down by prompt action in communities. If you can do that, then life can go on, but this will require a new style of public health, almost akin to a neighbourhood watch scheme. That requires a really informed population.”

Important lessons were learned during the Ebola outbreak of 2014 in West Africa, as well as during subsequent flare-ups. There was widespread mistrust of government, and also a belief in some quarters that Ebola didn’t really exist, that it was a hoax by the government to gain aid money or that people were being taken to treatment centres for organ harvesting. There was also an issue around traditional burial and funeral rites, which were contributing to ongoing disease transmission. Dr Nabarro served as UN Special Envoy on Ebola at the time.

“We had to not only encourage people to trust those responsible for outbreak control but we had to learn to trust them too. This meant sharing the challenge with community leaders. We found that once they understood what we were saying and why, they were able to convey it to their people and implement behaviour changes in their way. We’re finding the same in Kenya with COVID – religious leaders are playing a vital role in sharing the message about transmission. Similarly in Egypt and other parts of the Middle East the mosques are so important.”

The fast evolving science of the current coronavirus pandemic and the established science of climate change and the environment intersect at numerous points of interest – from the consequences of increasing proximity between humans and animals in terms of cross-species virus jumps to the alleviation of carbon emissions and air pollution from grounded flights and quiets roads during lockdown.

There are also some interesting parallels in terms of misinformation. Most obvious is the apparent tendency in some quarters to downplay the severity or even the very existence of the pandemic in the same way some have downplayed the veracity of climate change. Both are looming threats supported by a great body of evidence, but which for many people still feel quite remote and nebulous from their own day-to-day lives.

In many cases it’s the same actors peddling misinformation and disinformation about both coronavirus and climate change.

Misunderstanding about modelling is also a common strand at play here, and something climate scientists have been struggling to grapple with for many years – specifically the fact that models can produce a range of possible outcomes depending on inputs such as mitigation measures. That doesn’t mean models lack credibility and doesn’t mean there aren’t overarching certainties – such as the inevitability of health services being crippled without suppression measures or catastrophic consequences for ecosystems unless we limit global warming to an increase of 1.5 degrees or less from current levels.

Dr Nabarro previously served as Special Adviser to the UN on Sustainable Development and Climate Change. He says:

“There’s a question around how a scientist portrays herself or himself as authoritative but at the same time being both authentic and accountable. We’re all accountable for what advice we give. I think these are constant issues for scientists. One of the things you have to do when you’re accountable is to be clear when you don’t know something, be clear why you don’t know, and be clear what might change your position. Linked to that you have to be authentic, and try and find a way to connect with your listeners, not to treat them with any kind of disrespect. These are all things that I am looking at with great interest in the current pandemic as governments and communities do their best to try to implement the guidance of the WHO in very different settings.”

There is perhaps some hope in all of this though. The Imperial team has already published evidence that interventions in 11 European countries to counter the coronavirus pandemic, including school closures and national lockdowns, are working effectively and, that up to 120,000 deaths may have already been averted.

If we can demonstrate a successful, coordinated and transparent response in getting the initial coronavirus peak under control and the importance of behaviour change based on sound evidence it may help to restore more faith in the scientific process among those who are inclined to question it. That will stand us in good stead for future existential crises, such as climate change or indeed the next disease pandemic, when it inevitably comes.

Dr Ajay Gambhir from Imperial’s Grantham Institute – Climate Change and the Environment explored these themes in a recent commentary about the pandemic.

He said: “The central importance of behaviour change has been brought to the fore. The ability of people and societies to respond to threats affecting their wellbeing – as is being demonstrated across the world – is a potentially powerful response mechanism. If we can heed the importance of science, behaviour change and resilient planning this would place humanity on a firmer footing to tackle the multiple challenges that we will face this century – including climate change.”

In the meantime, we will all have to learn to live with this disease and adapt, just as we have had to do in the past.

Dr Nabarro says: “After we learned about cholera from John Snow, we had to adapt our lives so we weren’t reliant on dirty water sources and didn’t have regular cholera outbreaks. Or 25 years ago after we learned that HIV was carried through sex and had to adapt intimacy so it was still possible despite the threat of HIV – I think humanity is amazingly resilient, so we’ll learn to live with this virus, but it’s going to be really tough at the beginning.”