A multitude of social information networks – creating what have been called ‘epistemic bubbles’ or ‘echo chambers’ – have undermined global collective efforts to overcome the COVID-19 pandemic. At a time of high uncertainty and complexity, trust has faltered, not just in health authorities and governments, but also in scientists, due to a lack of clear communication and citizen engagement. Questions have been raised about the management of the COVID-19 pandemic, and about the certainty of knowledge more generally. We have arrived at a conflictive epistemic climate for both citizens and politicians about the decisions taken – all this in a fog of multiple information sources, changing opinions about the best available ‘truth’, and questions about whose knowledge should count, and whom to trust.
In response, individuals – deliberately or otherwise – may seek information on the coronavirus from people and sources they feel aligned to (‘like-minded peers’), while shunning diversity and difference1. In this way, epistemic bubbles may be formed within informational networks1. In the social media, the bubbles are further fed by the algorithms of the social media services (e.g. Twitter, Facebook), which are based on the user’s media behaviour. This delivery of selective information, and the ever-growing exposure to it, reinforces bias2. Especially if combined with poor cognitive reflective skills3, the epistemic bubbles may hinder the adoption of protective measures and timely access to health care. The impact is then manifested as a health crisis or even a life-threatening ‘infodemic’4. Offering additional and differentiated evidence might burst those fairly fragile epistemic bubbles, but could paradoxically tighten other epistemic structures – the ones referred to as echo chambers1.
Echo chambers are stronger social epistemic structures. They systematically and deliberately create distrust toward the outside world, excluding empirical evidence and sources with different viewpoints by manipulating trust and credence1, for instance, regarding governmental or global recommendations on vaccines and face-masks. They inform people what to think and believe, not how to think for themselves – a point made vividly by Tara Westover5 in her novel Educated, where she describes how the words of certain men had become ‘a cast into which I ought to pour the plaster of my own mind’. According to Nguyen1, ‘echo chambers are excellent tools to maintain, reinforce, and expand power through epistemic control’. Once trapped in such a social information network, escape from it calls for ‘a radical rebooting of one’s belief system’1.
Epistemic challenges are of concern not only to citizens, but also to those who make political decisions or issue information concerning them. Indeed, policymakers and medical experts should critically evaluate whether they themselves unintentionally or intentionally build epistemic bubbles or echo chambers, leaving no space for trust, policy learning and consensus building6, and giving no quarter to epistemic dissent or civic engagement. In so doing they hinder regional and global efforts to deal with the pandemic, via for instance a joint vaccination policy aimed at reaching herd immunity. The Lancet Commission, ‘Public policy and health in the Trump era’7, gives several examples of political echo chambers and their practices – such as issuing misleading public health communications and promoting unproven theories about COVID-19 – and their serious consequences for population health.
Due to self-interested nationalism8 and the unequal distribution of vaccines, it can be claimed that the world is ‘on the brink of a catastrophic moral failure’, the price of which will be paid by the poorest countries9. It will be crucial to understand the reasons for mistrust and discredit, and to build trust between members of the echo chambers and the world outside1 – for the collective good, within and between countries. Mutual trust and mutual accountability9 should be built on shared, transparent, and responsive information-sharing and decision-making10,11. This means emphasizing that knowledge is something that is constantly under development – and hence that not everything is or can be known9.
Rebooting epistemic belief systems can be achieved by developing health literacy – as part of which people are exposed to alternative views, and encouraged to reflect, appraise and apply information12,13, both according to their own values and in line with societal needs. Citizens need the courage to experience epistemic doubt, think critically, and understand diverse views if they are to face the pandemic and infodemic from a position of solidarity. As Mosleh et al.3 have argued, ‘the human capacity to reason is hugely consequential and something that should be cultivated and improved rather than ignored’. Proactive epistemic rebooting by decision-makers will be crucial, to overcome the impact of echo-chambers, to build trust and to address ‘global collective action challenges’7 in times of pandemics and infodemics.
- Nguyen CT. Echo chambers and epistemic bubbles. Episteme 2020;17: 141–161.
- Cossard A, Morales GDF, Kalimeri K, Mejova Y, Paolotti D, Starnini M. Falling into the echo chamber: the Italian vaccination debate on Twitter. In Proceedings of the International AAAI Conference on Web and Social Media 2020;14: 130–140.
- Mosleh M, Pennycook G, Arechar AA, Rand DG. Cognitive reflection correlates with behavior on Twitter. Nat Commun 2020;12: 1–10.
- Galvão J. COVID-19: the deadly threat of misinformation. Lancet Infect Dis 2020; doi: https://doi.org/10.1016/S1473-3099(20)30721-0
- Westover T. Educated: A memoir. New York: Penquin Random House, 2018.
- Wagner P, Ylä-Anttila MT. Can policy forums overcome echo chamber effects by enabling policy learning? Evidence from the Irish climate change policy network. J Public Policy 2020;40: 194–211.
- Woolhandler S, Himmelstein DU, Ahmed S. et al. Public policy and health in the Trump era. Lancet 2021;397: 705–753.
- Bump JB, Friberg P, Harper DR. International collaboration and covid-19: what are we doing and where are we going? BMJ 2021;372: n180.
- World Health Organization. WHO Director-General's opening remarks at 148th session of the Executive Board. January 18, 2021. Available from: https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-148th-session-of-the-executive-board
- Larson HJ, Heymann DL. Public health response to influenza A (H1N1) as an opportunity to build public trust. Jama 2010;303: 271–272.
- Marston C, Renedo A, Miles S. Community participation is crucial in a pandemic. Lancet 2020;395: 1676–1678.
- Paakkari L, Okan O. COVID-19: health literacy is an underestimated problem. Lancet Public Health 2020;5: e249–e250
- Okan O, Bauer U, Levin-Zamir D, Pinheiro P, Sørensen K. International handbook of health literacy: research, practice and policy across the lifespan. Bristol: Policy Press, 2019. Available at: http://library.oapen.org/handle/20.500.12657/24879