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Fake news: misinformation and COVID-19

Spirit explores the most pressing challenges related to the misinformation crisis, investigating their roots, the risks they pose, and our recommendations for corrective action.

Over the past few decades, as internet use has become increasingly ubiquitous, the accessibility of information and our ability to share it rapidly and widely has become correspondingly easier. However, the digitisation of news and the growing adoption of social media as a means of communication has brought a dramatic increase in the proliferation of inaccurate and false news articles. This ‘fake news’ phenomenon – encompassing both deliberate and inadvertent misinformation – can be attributed to a number of factors:

  • It is now easier than ever to establish a news website or platform, and the online media sphere is virtually impossible to regulate – in effect, this means that false and unsubstantiated claims can be published and shared with impunity.
  • The media shift to online content has resulted in functional restructuring of traditional newsrooms, with heightened focus on online engagement and algorithms diminishing the importance of editors and subeditors.
  • The demands of a global online audience necessitate a continuous flow of news, leading to a shorter production cycle with less time and fewer resources available for quality control and fact-checking.
  • The advent of social media, and the evolution of its users from passive consumers to creators and curators of their own news intake, has meant that authentic and verified content increasingly has to compete with ‘fake’ or sensationalised headlines and articles.
  • The dissemination of news through social media platforms confers an advantage on producers of ‘fake news’ stories, in that content that is ‘likeable’ and ‘shareable’ – and that is not necessarily ‘authentic’ or ‘true’ – is more widely shared than accurate news.

A significant proportion of consumers do not wholly trust ‘mainstream’ media outlets, believing them to represent and defend the interests of a privileged few. This sentiment appears to be more common among younger consumers, who are also more likely than older demographics to be active users of social media platforms, although it is unclear whether these observations are related. Meanwhile, social media users are more likely to trust news articles that are recommended by their friends or contacts on the platform. The growing distrust in conventional news media, when combined with a widespread lack of education on media literacy and a public discourse increasingly driven by political and sociodemographic polarisation, further motivates the consumption and sharing of inaccurate content from unverified sources.

COVID-19 and the ‘infodemic’

At the best of times, fake news can be unhelpful and damaging, leading to the misallocation of resources in emergency situations, as well as artificially inflated support for – and adoption of – policy based on misinformation.

During a global pandemic, at a time when scientific accuracy is paramount and developments have moved very quickly, fake news has been destructively harmful. On 15 February 2020, just over two weeks after the World Health Organization (WHO) officially announced that COVID-19 had become a Public Health Emergency of International Concern, WHO Director-General Tedros Adhanom Ghebreyesus told the annual Munich Security Conference: “We're not just fighting a pandemic – we're fighting an infodemic. Fake news spreads faster and more easily than this virus and is just as dangerous.”

The breadth and scope of the COVID-19 infodemic has been aggravated by several circumstances. Lockdowns and shelter-in-place measures, along with furloughs and reductions in commuting, often meant that people had greater amounts of free time yet fewer available activities on which to spend it. This resulted in a considerable increase in usage of the internet and social media by people wishing to inform themselves and stay in touch with each other.

Meanwhile, the swiftly evolving information landscape – particularly in the early days of the pandemic, when lockdowns were at their strictest and the empirical knowledge base surrounding the virus was in a constant state of flux – contributed further to a broad sense of perpetual uncertainty and a heightened demand for news about the virus. News consumption overall increased substantially during 2020, but the greatest increases in readership occurred amongst outlets that were subsequently found to be untrustworthy or misleading.

In this white paper, we will explore the most pressing challenges related to the misinformation crisis, investigating their roots, the risks they pose, and – where feasible – Spirit’s recommendations for corrective action.

© iStock/smolaw11

Preprint use and abuse

In 2020, with much of the news landscape focused on developments around COVID-19 and demand for updates far outstripping the natural pace at which scientific research is published, a marked escalation in the use of preprints as a source for news stories was observed. Preprints are academic papers that have not yet been subject to peer review by journals, and that have been submitted for publication on open-access preprint servers.

These articles offer a number of distinct benefits, not least of which is the rapidity (and therefore the timeliness) with which they can be published, ahead of the often lengthy peer review process. By acting as a public record of academic work, authors can use preprints to establish priority in applications for funding. Meanwhile, as they are open access by default, they can be more easily accessible by readers – particularly lay readers, including journalists, who may not have access to paid journal subscriptions.

In the first 10 months of the pandemic, around a quarter of all published scientific research pertaining to COVID-19 was hosted on the preprint servers medRxiv and bioRxiv, and 23% of all preprints published on medRxiv and bioRxiv in the same period were COVID-19-related.

© iStock/OstapenkoOlena

Preprints serve a specific and valid purpose, but an increased reliance on them as a source of information for news articles carries a distinct risk of misinforming or misleading readers. Newspaper audiences may not be fully aware of the difference between preprints and robust, balanced, accurate peer-reviewed articles.

Spirit’s own research, showcased in posters at the International Society for Medical Publication Professionals (ISMPP)’s US and EU annual meetings, has found that the difference between the two article types, and the implications of producing news solely based on preprints, is more likely to be mentioned in content targeted at scientific audiences than in pieces aimed at a more general audience. In two separate studies covering media in the US and the UK, our team analysed online news articles citing medRxiv in 2020. The team’s findings indicated that news reporters habitually made use of preprint articles to drive and inform news, with a total of 555 news articles from UK-based outlets and 1 090 from US sources directly referencing preprints.

Many news stories that were based on preprint papers (around 50% in the US and around 40% in the UK) did not make this clear to their readers, risking giving the audience the erroneous impression that the preprints’ claims were established scientific fact. However, the degree of sensationalism exhibited in the news stories themselves differed significantly between US and UK outlets, with American media presenting information in a more balanced way than its UK counterpart. As a whole, the UK’s tabloid media has been consistently found to be more sensationalist in its reporting than US outlets; a phenomenon largely attributed to comparatively ineffective regulation, irresponsible ownership and cultural differences amongst readers, all of which have contributed to a longstanding tradition of tabloid media whose extremes are rarely replicated elsewhere.

Like academic journals, preprint servers, which host and archive preprint studies, typically have some form of screening policies in place; servers dedicated to health and medical sciences are more likely to have more rigorous screening practices than servers for other sectors. However, while these servers commonly offer guidance on key concerns such as plagiarism, corrections, reporting conflicts of interest and other ethical issues, they tend to offer fewer recommendations on matters including authorship, the study’s use of statistical analysis and its limitations. Similarly, very few preprint servers advise contributors of external recommendations such as those of the Committee on Public Ethics or the International Committee of Medical Journal Editors.

Before the COVID-19 pandemic, only a ‘tiny fraction’ of preprints dealt with health-related topics, although science reporters were already concerned over the effect of preprint-based news on the public understanding of science and medicine. One growing concern, which has only become more pressing since the onset of the pandemic, was the citation of preprint articles in peer-reviewed clinical research. The key risk here is that, if a fully peer-reviewed study relies in part on a preprint which is not eventually published in a peer-reviewed journal – which is the case for up to 50% of preprint articles – or if the preprint is debunked or shown to be misleading, the accuracy of any article that cites it as a source is thrown into question. When a study is published in a peer-reviewed journal, there are mechanisms in place for retraction or correction; preprints are less strictly bound to these mechanisms.

Meanwhile, the ‘irresponsible dissemination’ of flawed preprint study data has actively led to a shift in research priorities. Following a substantial wave of media attention on a non-randomised preprint study of 46 subjects, which purported to show that hydroxychloroquine was a functional treatment for COVID-19, 135 further studies on the drug were registered through the website between March and May 2020. This was in spite of the fact that a much larger, but less well-publicised, randomised trial published in April 2020 indicated that hydroxychloroquine had no effective benefits for COVID-19 patients.


The COVID-19 pandemic has triggered an extensive rise in demand on the part of the public for scientific data and medical news. Much of this demand has been met, both on the part of news reporters and scientists themselves, by an increased reliance on preprint servers as a means of sourcing and disseminating new information concerning the virus. However, news stories which rely on preprints – particularly those aimed at a lay audience, which is unlikely to appreciate the complexities of academic publishing – risk oversimplifying or sensationalising early-stage academic and clinical studies.

Preprints are a step in the right direction in terms of improving the availability of research, but they have distinct limitations, including the lack of peer review, the uncertainty of citation, and the implications of relying on potentially misleading preprint studies when determining priorities within the health research sector. Spirit recommends that all potential drawbacks be investigated thoroughly prior to choosing preprint as a publication vehicle.

© iStock/zubada

Misinformation, vaccine hesitancy and harm

False claims around the efficacy or alleged harms associated with COVID-19 vaccines have been shown to contribute to a decline in intent to receive the vaccine, with ‘scientific-sounding’ misinformation more strongly associated with reduced intent. It is therefore imperative that both journals and media outlets take all possible steps to ensure that misleading claims – particularly those pertaining to COVID-19 vaccines – be filtered out of the news chain long before they reach susceptible readers. One recent incident highlighted a number of particularly pressing issues around misinformation in academia and medical reporting.

© iStock/Foxeel

Over a period of a week in late June and early July 2021, a study published in the MDPI Vaccines journal briefly became the centre of several overlapping discussions about science communication, misinformation, the safety of vaccines and the role of peer review in medical publishing. The paper in question, titled ‘The Safety of COVID-19 Vaccinations—We Should Rethink the Policy’, asserted that for every three COVID-19 deaths prevented by a vaccine, two deaths would actually occur as a direct result of receiving the vaccine. It was published on 24 June but retracted just over a week later, on 2 July, following widespread criticism from both inside and outside the journal organisation.

Critics of the study drew attention to its inaccurate interpretation of the available data, which led to starkly erroneous conclusions that could only have been reached by actively ignoring the context in which the data appeared. Questions were raised about the authors’ academic backgrounds – lead author Dr Harald Walach, a psychologist, is a long-time advocate of complementary medicine and homeopathy with a background in parapsychology. Co-authors Wouter Aukema and Dr Rainer J Klement are affiliated with a ‘consortium’ aiming to ‘debunk’ scientific evidence around COVID-19. The consortium is led by Pieter Borger, a molecular biologist but also a creationist.

Taken in isolation, each of these issues – the elision of correlation and causation regarding deaths occurring following vaccination, the use of limited data to extrapolate misleading conclusions, and the authors’ backgrounds – could individually justify significant queries at the review stage. However, Walach et al’s paper passed through two rounds of peer review by three reviewers, with one reviewer calling the study ‘urgently awaited’ and another saying that the manuscript was ‘very important and should be published urgently’. This formed the basis of the single most prevalent criticism levelled at the paper itself and, by extension, MDPI Vaccines: how did it come to be published in the first place?

© iStock/OlFedv

Peer review

Peer review, commonly conducted by uncompensated scientific colleagues, has structural problems that have become increasingly evident as the volume of published studies has grown. Critics have highlighted the lack of standardisation in the practice, with different journals mandating different forms or standards of peer review, the inability of peer reviewers to detect key issues such as plagiarism and the limited base of reviewers available for the extensive range of academic content in need of review.

In some cases, fraudulent study authors have impersonated peer reviewers – either by posing as an imaginary academic or by submitting a fake email address for a real reviewer – while in others, authors offer payments to reviewers for a positive review. This behaviour is facilitated by the growing ratio of articles in need of review to available reviewers, which has the dual effect of extending the amount of time an article spends in review and leaving the process more open to abuse.

One proposed solution to the more pressing concerns around peer review is the adoption of incentives. As it stands, researchers are typically expected to participate in the peer review process out of academic generosity and with a ‘quid pro quo understanding’ that their colleagues will do the same for them. By incentivising peer review, either through the offer of academic recognition or through (well-regulated) financial rewards, researchers are more likely to volunteer their time. Reviewers themselves have expressed a preference for professional acknowledgement, rather than cash or in-kind rewards. Other solutions may involve establishing cross-disciplinary standards to assess the quality of reviewers, automating certain review processes or employing additional, field-specific reviewers. For example, using a dedicated statistical peer reviewer, who is able to identify and correct data inaccuracies and misinterpretations, has been shown to be markedly beneficial for the overall quality of published manuscripts.

A significant issue overshadowing the peer review process as a whole is that, while some hold up peer review as a ‘gold standard’ and others allege that it is irretrievably broken, research into peer review itself is sparse. While the system is clearly in need of reform, there is a dearth of academic evidence that could inform the direction of change.


The peer-review model is functional, but it is at breaking point in terms of capacity. The growing quantity of academic manuscripts submitted for publication is rapidly outpacing the capacities of peer reviewers, who typically contribute their time for free. Potential solutions to this could include paying peer reviewers or the adoption of additional incentives, provided by a reviewer’s employer or the publisher or journal for which they are reviewing. Fraudulent peer review can be addressed with improved verification, both of reviewers and contributors.

In addition, peer review is troubled because of a lack of quality. Standards vary between journals, with some publications adopting peer reviewers who specialise in statistical analysis – a practice that appears to have had a tangible benefit on the published content. Training academicians for peer review early in their career may help, while alternatives include increased use of technologies such as AI to augment the review process. The Committee on Publication Ethics has developed a comprehensive, cross-disciplinary guide for ensuring that the peer-review process is both effective and ethically sound, which may be of use as a reference for both peer reviewers and observers assessing the peer review of a manuscript.

Corrections and retractions

In the eight days between the publication and retraction of Walach et al’s study, the original manuscript was shared widely on social media and online forums by people sceptical of vaccines or of COVID-19 itself. Once a story such as this spreads beyond its original source, secondary and tertiary sources are far less compelled to report corrections or retractions, and where readers do encounter a correction to a news story, in some cases the correction can have the effect of further embedding the original, inaccurate information in the reader’s memory.

© iStock/SiberianArt

Similarly, under the ‘boomerang’ or ‘backfire effect’, when people who already hold strong opinions about a subject – such as COVID-19 vaccines – are exposed to material that purports to correct or debunk messages that are in alignment with their worldview, they may either ignore the correction or become more entrenched in their views. In the cases of topics that are particularly vulnerable to misinformation, such as the COVID-19 pandemic and vaccines, platforms and actors attempting to correct misinformation are met with accusations of a cover-up by malign authorities.

Between 100 000 and 200 000 scientific articles about COVID-19 were published in the first year of the pandemic. This glut of studies was followed by a correspondingly large wave of retractions; studies that were retracted included the ‘worst study of 2020’, which claimed 5G technology caused COVID-19 infection, an article advocating the use of nephrite-jade ‘amulets’ as a means of preventing infection and a paper calling for the adoption of homeopathy to treat patients with COVID-19.

In some cases, the need to retract flawed studies led publishers to reconsider their processes for data verification and review. Elsewhere, scientists have reported that high-profile retractions of studies involving a specific drug can make it more difficult to conduct further research on that drug, as support and enthusiasm from institutions and trial participants may be lowered.


Issuing a correction or retracting incorrect information is by no means as effective as ensuring that inaccurate claims are not published in the first place. Where a correction is needed, particularly in the case of articles that have been extensively shared elsewhere, it should be made widely available. In addition to a robust editorial and review policy, it is essential for a publisher to have thorough correction and retraction systems in place – in particular, journals should welcome feedback from readers and contributors in the event that they come across an error. However, researchers and publishers should be aware that corrections attached to contentious subjects may not always be taken in good faith.

Spirit offers a rigorous publications process, including robust data checking, author tracking via Datavision and ensuring research is sent to appropriate journals. We can boast a high proportion of ISMPP CMPP-certified staff and are closely involved with ISMPP meetings, which enables us to keep abreast of evolving processes. This results in a consistently high standard of quality in the publications we work with.

Checking and verifying

One key criticism of the Walach et al paper is that no background checks appeared to have been conducted on the authors. No-one involved with the study was affiliated with epidemiology, virology or vaccinology: Dr Walach is a psychologist, Dr Klement is a medical physicist and Aukema is a data scientist. The only named peer reviewer for the article, Professor Anne Ulrich, is a biochemist. A basic search engine check would have indicated that the study’s authors are not experts in any field pertaining to COVID-19 vaccines.

© iStock/dmark

The pandemic has prompted multiple academic journals to move to open access for some or all of their content, in preference to paid subscriptions or charges per individual article. With multiple sources describing the paywall model as no longer fit for purpose, open access advocates are drawing on the success of free-to-view COVID-19 content to call for all research to be made freely available to users, arguing that open publishing is essential to ensure prompt sharing of scientific data. The concept has support at high levels: the Plan S programme, which came into effect as of 2021, mandates that research which is funded by participating national, regional and international bodies (including the WHO, the Bill and Melinda Gates Foundation and the European Union) must be published on open access platforms.

The private sector is similarly in favour of adopting open access models; in 2018, the pharmaceutical manufacturer Shire plc became the first private enterprise to adopt a comprehensive, policy of mandatory open access for all its funded research. A 2019 review found that the pharmaceutical industry is now responsible for a higher proportion of medicine-related open access papers than researchers outside the industry.

However, open access and pay-to-publish platforms have come under criticism for taking a light-touch approach to reviewing and editing manuscripts, meaning that – as with the issue of preprints – the scientific and medical stories that are most easily available to journalists and lay audiences are not always the most reliable. Without the requisite scientific background to determine how feasible a study is, these audiences are at risk of accepting unsubstantiated or inaccurate information. Pay-to-publish has also been highlighted as a detriment to researchers in low- and middle-income countries, who may not be able to pay the fees to showcase their work.

The pay-to-publish model also risks opening the door to predatory publishers, particularly at a time when more researchers than ever before are rushing to publish their work. In the same way that lay readers may not immediately be able to detect flaws in academic publishing, scientific researchers are not always well-equipped to filter out predatory journals, which solicit articles for high publication costs without delivering the quality, coverage or stringency of reviews contributors might expect from a reputable publication.


Open access as a whole is a positive step in scientific publishing – increasing access to scientific research and data is highly beneficial for scientists, journalists and the public audience – and open access publishing is increasingly mandated by pharmaceutical companies. However, the growing consensus for open access facilitates the pay-to-publish model, which carries a heightened risk of exploitation and flawed data.

Spirit delivers an extensive base of knowledge in how to identify appropriate journals, open access policies and processes, and ethical publication principles. Our expertise and integrity make the process simpler, less stressful and more effective, with comprehensive, incisive publication plans that cut through the noise to deliver substantive and reliable content.


The creation and dissemination of fake news has exploded in the wake of the COVID-19 pandemic, as more and more audiences demand more information. Never has the need to formulate a comprehensive publication plan for the optimum delivery of timely, accurate information been more crucial. Publication planning is an essential aspect of communicating clinical and medical information to ensure reach and resonance with the widest audience possible, without becoming distorted. Please contact us if you would like to know more about Spirit’s Precision Publication Planning Process:


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10th September 2021



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