In 2014, the world watched as the Ebola virus raged across West Africa. With remarkable surprise and strength, the regionalized Ebola outbreak grew into an international crisis fueled by globalized systems of travel, trade, and food distribution.[1] Thereafter, global recognition for the need to prevent, detect, and respond to health threats emerged, and global health security rose to international prominence. Five years later, the 2019 Global Health Security Index still offered a lack of collective preparedness for high-consequence disease outbreaks, and its assessment proved accurate during the initial response to the COVID-19 pandemic.[2] The U.S. Government Global Health Security Strategy is an important and comprehensive foundational framework aimed to strengthen global health security and respond to infectious disease outbreaks, but the COVID-19 pandemic exposed a significant threat absent from the strategy—disinformation.

As written, the Global Health Security Strategy lacks an organized approach to combat disinformation and therefore renders the strategy unable to meet the expected outcome of “A Homeland Prepared for and Resilient against Global Health Security Threats.”[3] The overwhelming virality of disinformation during the COVID-19 pandemic exposes the glaring omission of a cogent strategy to combat disinformation in the Global Health Security Strategy, is a threat to the national security and democracy of the United States, and warrants future inclusion.

A Brief History of Global Health Security

The need for an organized global health security effort dates to 1851 when twelve global powers met in Paris for the International Sanitary Conference to create a governance structure to mitigate biological threats.[4] Despite early efforts, significant resources are not commonly devoted to build the capacity to identify and respond to health threats. For example, while the 2017 National Security Strategy identifies the potential impact of naturally emerging outbreaks of viruses, other aspects of the rivalries facing the United States demanded greater attention and resources.[5] Despite these choices, in late 2019, the U.S. published a Global Health Security Strategy.[6]

The strategy describes how the United States will prevent, detect, and respond to infectious disease threats and outbreaks both globally and domestically and was designed to work in concert with guidance from the National Security Strategy, National Biodefense Strategy, and the executive order on “Advancing the Global Health Agenda to Achieve a World Safe and Secure from Infectious Disease Threats.”[7] The approach articulated in the strategy was acceptable prior to the COVID-19 pandemic and supported the first core pillar of the National Security Strategy by protecting the American people, the homeland, and the American way of life.[8] However, China, Russia, and Iran seized and exploited the glaring omission of a strategy to combat disinformation campaigns in the midst of COVID-induced global disorder.[9] As a result, America’s adversaries have aggressively and successfully, advanced their strategic interests through the false and destructive narrative the U.S. is to blame as the international community struggles to respond to the COVID-19 virus.[10]

Disinformation and Global Health Security

Although the proliferation of disinformation during a disease outbreak is a serious threat to global health because “it undermines confidence in the underlying science, questions the motivations of health professionals, politicizes health activities, and creates problems for responses to disease challenges,” this tactic is not new.[11] The use of disinformation by governments amidst actual and feared disease outbreaks predates the internet and social media, and state actors have previously weaponized health communication to exploit “anti-immigrant prejudice, xenophobia, politically-polarized populations, and geopolitical competition.”[12]

Throughout the Cold War, the Soviet Committee for State Security (Komitet Gosudarstvennoy Bezopasnosti, KGB) led elaborate and successful disinformation campaigns as part of its covert psychological warfare strategy.[13] With the assistance of the Novosti Press Agency, one of the KGB’s most successful disinformation campaigns during the mid-1980s, dubbed Operation Denver, spread the narrative that the Pentagon had genetically engineered the human immunodeficiency virus (HIV) that causes Acquired Immunodeficiency Syndrome (AIDS) as a bioweapon, thus blaming the U.S. for the spread of HIV/AIDS in Africa.[14] Although the Russian government disavowed the KGB’s HIV/AIDS disinformation campaign in 1992, Douglas Selvage and Christopher Nehring suggested the Kremlin tends to recycle former successful disinformation operations. This so-called recycling is illustrated in the 2014 Ebola crisis where Russian propaganda outlets substituted the Ebola virus for HIV, promoting the narrative the U.S. engineered a new bioweapon to kill black Africans.[15]

The weaponization of health communication is not limited to Russia. In November 2002, Guangdong province in China became the epicenter of a form of severe acute respiratory syndrome (SARS), and the Chinese government faced not only a public health challenge, but also a socio-political crisis.[16] Instead of using disinformation to deface the U.S., China focused its efforts on maintaining internal stability. The initial epidemiologic reports for SARS were only circulated amongst a very few top provincial health officials, and the public was kept uninformed. However, the government’s initial failure to inform the public “spawned anxiety, panic, and rumor-mongering and undermined the government’s efforts to create a milder image of itself in the international arena.”[17] To diffuse the scrutiny, the Guangdong provincial propaganda bureau halted reporting on SARS during the run-up to the National People’s Congress.[18] Additionally, the China Youth Daily, one of China’s best-selling newspapers, went so far as to spread the narrative “that SARS was a genetic weapon developed by the National Institutes of Health in the United States.”[19] Based on China’s mishandling of the SARS epidemic, its initial negligence, ensuing disinformation campaign to deflect responsibility, and brazen distortion of the facts surrounding COVID-19 is not a surprise.[20]

Disinformation and the COVID-19 Pandemic

Past weaponization of health communication and its proven efficacy to rapidly spread false narratives led numerous cyber experts, health professionals, and global leaders to offer worrisome foreshadowing of the severity of the threat posed by disinformation during a public health crisis long before the emergence of COVID-19.[21] Bruce Schneier, a cybersecurity expert at the Harvard Kennedy School, argued in mid-2019 the next pandemic would require not only “understanding the disease, researching a cure and inoculating the population,” but also “fighting the deluge of rumors, misinformation and flat-out lies that will appear on the internet.”[22] Doctor Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, mirrored Schneier’s forewarning when he stated at the Munich Security Conference on February 15, 2020 that “we’re not just fighting an epidemic; we’re fighting an infodemic.”[23]

To understand, monitor, and fight the so-called infodemic, in January 2020, the U.S. State Department’s Global Engagement Center started tracking Russian, Chinese, and Iranian-sponsored COVID-19 disinformation sites. While each nation’s approach differs based on internal agendas and priorities, Lea Gabrielle, the Special Envoy and Coordinator of the Global Engagement Center, noted “the COVID-19 crisis has really provided an opportunity for malign actors to exploit the information space for harmful purposes, and really been providing unnecessary distractions from the global communities focused on this crisis.”[24]

Guided by the framework of the Gerasimov Doctrine, Russia’s COVID-19 disinformation campaign is emblematic of the Kremlin’s overarching strategy of creating chaos with the objective of achieving an environment of permanent unrest and conflict within an enemy state.[25] Russia’s specific objectives in spreading disinformation related to COVID-19 are twofold and targeted towards foreign and domestic audiences. First, Russia is concerned about its image on the global stage and wants to overshadow its initial blundering mismanagement of the early phases of the pandemic. Secondly, Russia seeks to call the response of the West into question and confuse international opinion.[26] To achieve these objectives, Russia has employed tactics used in other disinformation campaigns to sow distrust including sophisticated social media campaigns, state-funded multilingual television networks, and Kremlin-supporting news websites.[27] Russia heavily influences online conversations by injecting Kremlin talking points into targeted agencies and undermining global organizations, such as the World Health Organization, that are widely trusted to provide accurate and authoritative information.[28] By creating a “firehose of falsehood”—a rapid and overwhelming stream of misleading, contradictory narratives—targeted audiences are left overwhelmed, vulnerable, confused, and susceptible to believing disinformation.[29]

China’s approach to disinformation operations related to COVID-19 has been more deliberate than Russia’s. Since two Wuhan doctors, Li Wenliang and Xie Linka, raised concerns of a SARS-like outbreak on December 30, 2019, China has consistently lied, suppressed, and censored all information related to what is now known as COVID-19.[30] The deliberate approach is largely due to China’s concern not only about managing external perceptions, but also, more importantly, for the survival of the Communist Party and maintaining internal stability. China’s disinformation campaign is spread through a variety of social media platforms, promoted by fake accounts through either posts or comments that can be traced back to Chinese online forums.[31] Although the narratives have shifted based on rising levels of internal discontent and external scrutiny from a wide range of international actors, two primary narratives guide China’s broad approach. First, like Russia, China is using disinformation to falsely suggest the virus came from U.S. troops and that COVID-19 is an American bioweapon used for political purposes. Secondly, China is attempting to spin the crisis into a good news story for the Communist Party to highlight its role in handling the crisis better than the rest of the world, specifically the United States.[32] By pursuing both narratives, China is making a concerted effort to re-shape the narrative to not only justify its domestic return-to-work order, but also to demonstrate its superior capabilities as a global leader in fighting the virus.[33]

Countering Disinformation’s Impact on Global Health Security

To date, American efforts to combat COVID-19 disinformation have proven no more successful than previous attempts to curb other incidents of weaponized health communication, and thus a new approach is warranted.[34] The U.S. is losing the global narrative over COVID-19, and there is too much at stake to not take aggressive action.[35] Since much of China’s success in controlling the COVID-19 narrative can be attributed to its rapid seizure of the initiative while the world watched, the U.S. must change its paradigm and preemptively fight and win the inevitable disinformation battles of tomorrow. While there is no single solution, a deliberate approach to combating disinformation is necessary, and the Global Health Security Strategy provides a sufficient framework to develop and integrate efforts. The inclusion of the following recommendations in the next Global Health Security Strategy will provide initial direction for the United States to combat future health-focused disinformation campaigns: first, before a crisis, coordinate roles and responsibilities; next, during a crisis, overwhelm the narrative with a constant flow of science and truth, and; finally, after a crisis, deliberately assess lessons learned and adjust strategy.

Coordinate Roles and Responsibilities

The multi-sectoral approach outlined in the Global Health Security Strategy provides the foundational roles and responsibilities of key government agencies to strengthen global health security.[36] However, the strategy makes no mention of disinformation or the necessary inter-agency coordination required to combat false narratives. Thus, the roles and responsibilities section of the strategy must expand and integrate organizations like the Department of State’s Global Engagement Center. Focusing on coordination across entities before a crisis reduces the reaction time to mobilize and affords the U.S. the opportunity to take control of the narrative before its adversaries. While the expanded coordination of roles and responsibilities should start at the national level, to respond effectively and seamlessly in crisis, it must extend down to the local levels and laterally across a broad range of sectors to include health, technology, education, and the media.

Overwhelm the Narrative with a Constant Flow of Science and Truth.

As a leader on the world stage, the U.S. should not resort to spreading lies, distorting facts, pointing fingers, or promulgating racist rhetoric like China, Russia, and Iran. Instead, the United States should rise above the urge to counter disinformation with disinformation and instead build “powerful narratives around American companies, scientists and government experts leading scientific and technological innovations for overcoming the crisis” and overwhelm the information space with facts.[37] While the urge to counter disinformation with further disinformation amidst a crisis can be enticing, Taiwan attributes its success in deflecting China’s COVID-19 disinformation campaign to its high levels of transparency and responsiveness throughout the crisis.[38]

Deliberately Assess Lessons Learned and Adjust Strategy as Necessary

Since the onset of another pandemic is not a matter of if, but when, it is critical the U.S. learns from the COVID-19 crisis to guide future decision-making and global health security activities.[39] The Global Health Security Strategy should be updated to include the challenges posed by the disinformation campaigns led by Russia, China, and Iran.

Looking Towards the Future

Although it has been over five years since the Ebola crisis devastated West Africa and energized the global community to more effectively prevent, detect, and respond to health threats, the COVID-19 pandemic exposed America’s lack of preparedness for high-consequence disease outbreaks. While America’s Global Health Security Strategy is an important framework to strengthen global health security, as written, the strategy is insufficient. Its lack of an approach to combat disinformation renders the strategy unable to meet the expected outcome of “A Homeland Prepared for and Resilient against Global Health Security Threats.”[40] Since future pandemics are an inevitability, failure to learn from the Russian, Chinese, and Iranian COVID-19 disinformation campaigns will adversely impact public health outcomes, and “in extreme cases could lead to total social collapse.”[41] The glaring omission to combat disinformation is a threat to the national security and democracy of the United States and warrants future action.

Jennifer Bales is a U.S. Army officer. She is a graduate of the U.S. Military Academy and holds a Master of International Public Policy from the Johns Hopkins School of Advanced International Studies (SAIS), a Master of Public Health from the Geisel School of Medicine at Dartmouth College, and a Master of Science in Organizational Leadership from Norwich University. The views expressed are the author’s alone and do not reflect the official position of the U.S. Army, the Department of Defense, or the U.S. Government.

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Notes:

[1] The Lancet Infectious Diseases, “Addressing the global health security agenda,” The Lancet Infectious Diseases 14, no. 4 (2014): 257, https://doi.org/10.1016/s1473-3099(14)70719-4.

[2] Nuclear Threat Initiative and the Johns Hopkins Center for Health Security, Global Health Security Index (2019), https://www.ghsindex.org/wp-content/uploads/2020/04/2019-Global-Health-Security-Index.pdf.

[3] White House, United States Government Global Health Security Strategy (Washington, DC: White House, 2019), https://www.whitehouse.gov/wp-content/uploads/2019/05/GHSS.pdf.

[4] Rebecca Katz, Global Governance of Disease (Washington, DC: Georgetown University, 2017), https://isd-georgetown-university.myshopify.com/products/case-342-global-governance-of-disease, 2.

[5] White House, National Security Strategy (Washington, DC: White House, 2017), https://www.whitehouse.gov/wp-content/uploads/2017/12/NSS-Final-12-18-2017-0905.pdf, 3 and 9.

[6] Department of Defense, Summary of the 2018 National Defense Strategy of the United States of America (Washington, DC: Department of Defense, 2018), https://dod.defense.gov/Portals/1/Documents/pubs/2018-National-Defense-Strategy-Summary.pdf, 1.

[7] White House, United States Government Global Health Security Strategy.

[8] White House, National Security Strategy.

[9] White House, National Security Strategy.

[10] Sarah Jacobs Gamberini and Amanda Moody, “The Virus of Disinformation: Echoes of Past Bioweapons Accusations in Today’s COVID-19 Conspiracy Theories,” War on the Rocks, April 6, 2020, https://warontherocks.com/2020/04/the-virus-of-disinformation-echoes-of-past-bioweapons-accusations-in-todays-covid-19-conspiracy-theories/.

[11] David P. Fidler, “Disinformation and Disease: Social Media and the Ebola Epidemic in the Democratic Republic of the Congo,” Council on Foreign Relations, August 20, 2019, https://www.cfr.org/blog/disinformation-and-disease-social-media-and-ebola-epidemic-democratic-republic-congo.

[12] Fidler, “Disinformation and Disease: Social Media and the Ebola Epidemic in the Democratic Republic of the Congo.”

[13] Douglas Selvage and Christopher Nehring, “Operation ‘Denver’: KGB and Stasi Disinformation regarding AIDS,” Wilson Center, July 22, 2019, https://www.wilsoncenter.org/blog-post/operation-denver-kgb-and-stasi-disinformation-regarding-aids.

[14] Selvage and Nehring, “Operation ‘Denver’: KGB and Stasi Disinformation regarding AIDS;” Fidler, “Disinformation and Disease: Social Media and the Ebola Epidemic in the Democratic Republic of the Congo.”

[15] Selvage and Nehring, “Operation ‘Denver’: KGB and Stasi Disinformation regarding AIDS.”

[16] Yanzhong Huang, “The SARS Epidemic and its Aftermath in China: A Political Perspective,” in Institute of Medicine (US) Forum on Microbial Threats, ed. Stacey Knobler, Adel Mahmoud, Stanley Lemon, et al. (Washington, DC: National Academies Press, 2004), https://www.ncbi.nlm.nih.gov/books/NBK92479/.

[17] Huang, “The SARS Epidemic and its Aftermath in China: A Political Perspective.”

[18] Huang, “The SARS Epidemic and its Aftermath in China: A Political Perspective.”

[19] “Brief Introduction of China Youth Daily,” China Youth On Line, accessed April 18, 2020, http://www.cyol.net/home/english/intro/daily.htm; Natasha Bajema and Christine Parthemore, “How to Counter China’s Coronavirus Disinformation Campaign,” Defense One, March 29, 2020, https://www.defenseone.com/ideas/2020/03/how-counter-chinas-covid-19-disinformation-campaign/164188/.

[20] Bajema and Parthemore, “How to Counter China’s Coronavirus Disinformation Campaign.”

[21] Fidler, “Disinformation and Disease: Social Media and the Ebola Epidemic in the Democratic Republic of the Congo.”

[22] Bruce Schneir, “We Must Prepare for the Next Pandemic,” The New York Times, June 17, 2019, https://www.nytimes.com/2019/06/17/opinion/pandemic-fake-news.html?auth=login-email&login=email.

[23] Tedros Adhanom Ghebreyesus, “Munich Security Conference,” World Health Organization, February 15, 2020, https://www.who.int/dg/speeches/detail/munich-security-conference.

[24] Lea Gabrielle, “Briefing on Disinformation and Propaganda Related to COVID-19,” U.S. Department of State, March 27, 2020, https://www.state.gov/briefing-with-special-envoy-lea-gabrielle-global-engagement-center-on-disinformation-and-propaganda-related-to-covid-19/.

[25] Molly K. McKew, “The Gerasimov Doctrine,” Politico Magazine, September/October 2017, https://www.politico.com/magazine/story/2017/09/05/gerasimov-doctrine-russia-foreign-policy-215538.

[26] Jeffrey Mankoff, “Russia’s Response to Covid-19,” Center for Strategic & International Studies, April 10, 2020, https://www.csis.org/analysis/russias-response-covid-19.

[27] Fergal Gallagher and Benjamin Bell, “Coronavirus misinformation is widespread, according to new report that calls it an ‘infodemic,’” ABC News, April 23, 2020, https://abcnews.go.com/US/coronavirus-misinformation-widespread-report-calls-infodemic/story?id=70249400. Todd C. Helmus, Elizabeth Bodine-Baron, Andrew Radin, et al., Russian Social Media Influence: Understanding Russian Propaganda in Eastern Europe (Santa Monica, CA: RAND Corporation, 2018), https://www.rand.org/content/dam/rand/pubs/research_reports/RR2200/RR2237/RAND_RR2237.pdf.

[28] Gabrielle, “Briefing on Disinformation and Propaganda Related to COVID-19.”

[29] Christopher Paul and Miriam Matthews, The Russian “Firehose of Falsehood” Propaganda Model: Why It Might Work and Options to Counter It (Santa Monica, CA: RAND Corporation, 2016), https://doi.org/10.7249/PE198.

[30] Jed Babbin, “China and Russia play COVID-19 pandemic disinformation games,” The Washington Times, April 6, 2020, https://www.washingtontimes.com/news/2020/apr/6/china-and-russia-play-covid-19-pandemic-disinforma/.

[31] Yi-Ting Lien, “Why China’s COVID-19 Disinformation Campaign Isn’t Working in Taiwan,” The Diplomat, March 20, 2020, https://thediplomat.com/2020/03/why-chinas-covid-19-disinformation-campaign-isnt-working-in-taiwan/.

[32] Gabrielle, “Briefing on Disinformation and Propaganda Related to COVID-19.”

[33] Babbin, “China and Russia play COVID-19 pandemic disinformation games.”

[34] Fidler, “Disinformation and Disease: Social Media and the Ebola Epidemic in the Democratic Republic of the Congo.”

[35] Bajema and Parthemore, “How to Counter China’s Coronavirus Disinformation Campaign.”

[36] White House, United States Government Global Health Security Strategy.

[37] Bajema and Parthemore, “How to Counter China’s Coronavirus Disinformation Campaign.”

[38] Lien, “Why China’s COVID-19 Disinformation Campaign Isn’t Working in Taiwan.”

[39] White House, United States Government Global Health Security Strategy.

[40] White House, United States Government Global Health Security Strategy.

[41] Schneir, “We Must Prepare for the Next Pandemic.”