While debate continues between the Indonesian Ministry of Health and researchers in Indonesia and internationally on Indonesia's capacity to detect and identify coronavirus infections, social media runs hot with various theories. This even includes the spokesperson for the Indonesian National Disaster Management Agency (BNPB), who retweeted fake claims that the virus originated as a biological weapon, then deleted them after criticism.
It will take time before we know whether Indonesia has been lucky and escaped any infections, or whether there are undetected infections already occurring. In either case, Indonesia's experience demonstrates the importance of information and communication in the management of infectious disease outbreaks.
As Wisnu Prasetya Utomo noted in his Indonesia at Melbourne blog on 4 February, "A key element of responding to the coronavirus outbreak must also involve efforts to eliminate or challenge misinformation. Minimising fear and panic as a result of hoaxes and misinformation is half the job in responding to this evolving crisis, which as yet has no end in sight."
The importance of communicating accurate information to the public in managing infectious disease outbreaks is well recognised, as are the challenges. This is because a key element of the communication is the extent of risk. Generally, risks that are unknown or new are perceived as more threatening, and the perceived risk is magnified.
Good risk communication is required to help people become informed so they can make concrete decisions to protect their health, understand response activities and potentially help in community efforts to deal with an outbreak.
Enter social media with millions of users, keen to follow any story or information, particularly if it challenges or criticises formal government issued messages. This effect is further enhanced by social media algorithms that prioritise content that has been viewed more often, stimulating yet further views.
Who should the public trust? Conversely, how do the government agencies charged with managing outbreaks ensure they are seen as trustworthy sources of information? In crisis situations, a simple statistic that attempts to portray a threat as low-risk or a crisis as well-managed may do little to allay the public's fears. Additionally, the public tends to poorly interpret overly complex, inconsistent, contradictory messages or ones that arrive late. They often just hold on to existing beliefs or reframe new messages to fit existing views.
Social media plays on all these factors. Its use among Indonesians is massive – 150 million avid users who are more active than the global average. In an emergency, including the current COVID-19 outbreak, social media has an important role both in provision of information but also in influencing public awareness and perceptions. Social media users who are influential during outbreaks, who are popular, authoritative or serve as bridges between different social media communities, can vitally help or hinder successful risk communication.
How has the Indonesian government responded? Has it adopted the US Centres for Disease Control and Prevention (CDC) manta of "Be first, be right, be credible"?
Since mid-January, the Ministry of Health has disseminated multiple media releases and updates to provide information to the public on coronavirus, and has been much more active than during the Avian Influenza outbreaks of 2006. Full information on the coronavirus, and situation updates, are available on the ministry's website, although they are not well publicised on social media platforms. However, there has been limited use of televised media by the government during this outbreak, either for health promotion or for simply addressing the nation during this uncertain period. This stands in contrast, for example, to Singapore's Prime Minister Lee Hsien Loong.
In addition, some statements made by government officials have been less than open and informative and had a defensive tone. For example, the report by a Harvard-based research team that suggested possible underreporting of coronavirus is Indonesia was deemed as trumped up and insulting (link is external) by Minister of Health Terawan Agus Putranto. This has encouraged public perception that the government may not have made all the necessary precautions to handle the outbreak.
However, the media has not always conveyed information in the most responsible manner. First, hoaxes around the outbreak spread more rapidly than the speed and quality of information provided by government institutions. Traditional media has also amplified the spread of misleading information, which is then vastly distributed through different social media platforms like WhastApp, Twitter, and Facebook.
Second, social media has also encouraged and enabled the spread of inappropriate and divisive comments, such as those targeting Chinese nationals, for example, the hashtag #TolakSementaraTurisChina (#TemporarilyBanChineseTourists) on Twitter. The conversation evolved to include even more racist tweets, with netizens calling on the Indonesian government to deny entry to all Chinese nationals.
There are complex dynamics among social media use, hoaxes, media professionalism and government efforts to address the public during outbreak. Given current practices and conditions, we see gaps in the quality of information provided, and the ways that information has been disseminated. The Indonesian government has struggled to achieve the CDC's recommendation to "Be first, be right and be credible."
How should the government respond?
The response so far has focused on identifying and seeking to remove hoaxes and false information from the internet. The Communications and Information Ministry states it has discovered and rebutted 54 false pieces of information about the virus, with the list of the falsehoods and counter-narratives posted on the ministry's website.
The minister for communications has called on people to stop spreading hoaxes. "Please don't immediately forward any posts and messages about the coronavirus that is not verified yet," he said.
But this may not be enough to counter or control hoaxes and false messages, which are amplified and encouraged by the algorithms used by Twitter and other social media.
Other steps the government could consider include:
(1) Take a more active role on social media to provide accurate information. It is the absence of accurate and reliable information that provides the space for rumours and false information to develop and spread. Government agencies and trusted social media informants need to be active on social media, not only in traditional media.
(2) Avoid false reassurance. It is impossible to know exactly how an infectious disease health crisis will unfold, especially in the event of a new or deliberate release of an infectious agent. Communication that is overly certain and then is perceived as "wrong" can significantly undermine public trust and the likelihood that future messages will be accepted and acted upon. Being clear about what is unknown, what work is still being done to increase understanding, and that information may change helps increase acceptance of messages.
(3) Pay more attention to creating public trust in government institutions and messages. It is an interesting paradox that although Indonesia and China report high levels of trust in government institutions (higher than any other countries in the latest Edelman trust barometer), trust in public information remains low.
How can government agencies be seen as trustworthy sources of information? As the WHO notes in its Guidance for Managing Ethical Issues in Infectious Disease Outbreaks, gaining trust takes time and extends beyond just providing information. Trust is also based on the public's assessment of the past and present practices and behaviour of the individuals and institutions providing that information.
Building trust in ordinary situations, and particularly in crises, is based on being seen to make decisions and act in a trustworthy manner. To achieve the public's trust, WHO recommends that "policy makers and response workers... apply procedural principles fairly and consistently, [are] open to review based on new relevant information, and [act] with the genuine input of affected communities."
If it is to demonstrate trustworthiness, the government needs to place more emphasis on explaining and justifying its actions, and ensuring transparency in decision making processes.