Background
Since the start of 2020, the world has been experiencing the COVID-19 pandemic [
1]. The implications of COVID-19 have been felt globally. Multiple public health and social measures (PHSM) have been introduced at different times, restrictions have been placed on movement and travel, and the development of COVID-19 vaccines has been observed in real time. As we have learnt more about the pandemic and what we can do to protect populations, people have been faced with an infodemic, an overwhelming amount of information, including misinformation, disinformation and rumours [
2]. The infodemic can make it difficult for people to identify credible health information, lead to questions or concerns, and negatively affect their health behaviors, including with potentially fatal outcomes [
3]. During the COVID-19 pandemic the sheer amount of information being shared on social and other media, as well as via offline community sources (such as community feedback data, or information from hotlines), has impacted people’s ability to be able to filter reliable and important information and to protect themselves in turn [
4]. As a result, the infodemic may prolong or reduce effectiveness of the public health response to emergencies. As we look to future preparedness and prevention, evidence-based solutions to tackle the infodemic are needed [
5].
Pandemic fatigue
Pandemic fatigue has been defined in different ways in the literature. A 2020 WHO European Regional Office report defined pandemic fatigue as “demotivation to engage in protection behaviours and seek COVID-19-related information, and as complacency, alienation and hopelessness” [
6]. Other papers have defined pandemic fatigue as the ‘notion of behavioural fatigue associated with adherence to covid restrictions’ [
7] or as a type of behavioural fatigue ‘characterized by reduced compliance with public health directives over time’ [
8]. How pandemic fatigue has been measured in the literature points to further different ways of defining. One study used comparisons of the use of protective measures at different time points as a proxy for pandemic fatigue [
9]. It reported that younger people and being of male gender was predictive of pandemic fatigue (reduced protective measure use) highlighting this as a key focus for risk communication messaging [
9]. Another study in the Central Philippines investigated the link between pandemic fatigue and front-line healthcare workers in terms of impact on resilience, mental health, and job contentment [
10]. This study used a 10-item Lockdown / Pandemic Fatigue scale, covering feelings of worry, distress, loss of interest in usual activities and experience of headache, among others [
11]. A cross-sectional study in Israel did not report a specific measure for pandemic fatigue, rather used a multivariate analysis to look at the impact of a range of factors on vaccine hesitancy [
12]. The perception of the importance and efficacy of COVID-19 vaccines was a significant predictor of vaccine uptake, with the authors concluding this ‘effectively demonstrated pandemic fatigue is at play’ [
12]. Evidence is emerging of the impact and prevalence of COVID-19-related pandemic fatigue. At the end of 2021 a Monmouth University Poll reported 60% of Americans felt ‘worn out’ by COVID-19, with 45% reporting feeling angry about how COVID-19 had impacted their lives [
13].
Global situation
Pandemic fatigue has been identified as a concern from very early on in the COVID-19 pandemic due to the potential impact on risk perceptions and adherence to recommended PHSM. In 2020, at the request of Member States the WHO Regional Office for Europe released a policy document on managing and mitigating pandemic fatigue [
6]. The situation now, 3 years since the COVID-19 onset, is significantly more complex. COVID-19 continues to be a public health emergency with some countries experiencing higher case numbers and deaths in 2022 than at any other time [
14]. New variants and frequency of COVID-19 vaccination recommendations has led to continued vaccine misinformation and vaccine hesitancy [
15] and has affected routine immunization programmes [
16]. There are reports of exhaustion in the healthcare workforce [
17]. In 2022, mpox was declared a public health emergency of international concern (PHEIC) [
18], New York State in the USA declared polio a public health emergency [
19], the war in Ukraine intensified [
20], devastating flooding was seen in Pakistan [
21], and geographically-specific concerns such as Marburg disease in Ghana [
22], and Ebola outbreaks in Sudan [
23] and Uganda [
24] have contributed to people's sense of feeling overwhelmed and fatigued with health emergencies and health information. In September 2022, the WHO Regional Director for Europe, Dr Hans Kluge, declared the European Region was in a ‘permacrisis’ due to the multiple and ongoing emergencies [
25].
Social listening and integrated analysis for infodemic preparedness and response
Social listening and integrated analysis to produce infodemic insights is the first step in managing the infodemic [
26]. It can help to identify the concerns and narratives expressed by users, including information voids, misinformation, or periods of overwhelming amounts of information. During health emergencies, social media can be an important communication tool, yet it can also provide a platform for the spread of misinformation [
27]. One analysis of data from 24 countries found social media was the most used source for COVID-19 information for those aged 18–40 years [
28]. Narrative analysis of social media data can provide an important data source yet it is important to combine multiple data sources in a process of integrated analysis for infodemic insights [
29]. This can enable the analyst to formulate actionable infodemic insights to guide emergency response and inform epidemic management and prevention strategies [
29]. Throughout the pandemic the WHO COVID-19 Incident Management Support Teams globally and regionally have worked with an external service provider to develop weekly digital social listening reports to inform infodemic response to the pandemic [
30]. The team was detecting regular expressions of pandemic fatigue in the publicly available narratives, both focused directly on pandemic fatigue, and those interwoven with other narratives. These narratives appeared to increase in volume and intensity as the mpox emergency started to evolve, and as other crises impacted different geographical regions on a more local level.
Defining expressions of pandemic fatigue is complex as it can manifest differently in different situations and contexts. The digital information ecosystem plays a role in how pandemic fatigue narratives are amplified, shared and received individually and through online communities and networks, and understanding this is important in analyzing the infodemic for prevention and preparedness. There is currently little known about how users express pandemic fatigue through sentiment and narratives on social media and how they can be addressed by the health authorities. To further explore and understand how these narratives were being expressed, this analysis was undertaken, seeking to identify and classify pandemic fatigue narratives into themes. This study aims to add to the overall understanding of pandemic fatigue by exploring and reporting on key narrative themes associated with expressions of pandemic fatigue by users on digital platforms.
Discussion
This paper has identified different ways users express pandemic fatigue on social media. Although pandemic fatigue is a significant concern for health authorities, this paper is the first that we are aware that has sought to define and categorise expressions of pandemic fatigue by digital online users in relation to health emergencies. The themes we identified provide insight into the different ways fatigue is expressed and how it is often conflated with other narrative types. This paper adds several interesting findings to the knowledge of pandemic fatigue.
While pandemic fatigue narrative volume increased around the time of the mpox PHEIC announcement, conversation was not always directly related to mpox, as some of the peaks were driven by COVID-19 content, and this could have been related to other factors. However, this narrative crossover was also observed in the themes of ‘
Overwhelmed with multiple or sustained emergencies’ and ‘
Comparisons with multiple or sustained emergencies’ where different health emergencies were driving fatigue across adjacent issues. There were instances of users bringing several health emergencies together to express feeling overwhelmed by the sheer number of crises the world is facing. Other research has reported on ways of building community resilience to recover from the COVID-19 pandemic, including through social media [
36], and this is an important area of research. There is a need for a nuanced approach to information delivery during the time of emerging health concerns. A range of factors impact how users receive and response to information such as psychological factors, perceived credibility of source, and user digital and health literacy [
37]. Further, the social and commercial determinants of health influence how people experience and interact with the information environment [
38]. Rather than just adding more information, researchers and health authorities can consider how information is likely to be received and be guided by principles of codesign and community engagement.
Infodemic insights can be used to understand community responses and reactions. As well as offering immediate insights for actions during an emergency, analyzing patterns of infodemic insights and narratives overtime, such as this research, can offer insights into user expression and help guide prevention, preparedness and readiness. Expressions of pandemic fatigue were interwoven with distrust in authorities, demotivation to use PHSM and feelings of being overwhelmed, angry or dismissive. These are important considerations when a health emergency is evolving, and targeted work is needed to respond effectively. Research has shown that greater trust in government is associated with greater acceptance of health guidelines [
39]. Analysis of trust-related narratives on digital platforms during an emerging health emergency found that these narratives manifested in different ways and that there were more mistrust related narratives associated with a country with a lower trust in government score [
40]. Trust in authorities during a health emergency is complex and multi-faceted [
41] and building trust and health literacy prior to an emergency are key preventative strategies. Other research has found an association with high levels of social media exposure and information overload, information anxiety, and information avoidance [
42]. Although we did not look at volume of narratives by theme for this study, looking at patterns of narrative expressions by theme (i.e., by information avoidance or dismissal) mapped to total volume and key events may provide further interesting insights.
The use of emoji, in particular eyeroll, yawn and confused faces, to express pandemic fatigue shows the challenges in finding and identifying narratives by using only text-based analysis. Further research may be enhanced by including emoji, meme, image and video analysis. The complexity in defining the search strategy for this research shows the nuanced approach that is needed, and our search strategy benefited from rounds of iteration and testing. The work done in defining both pandemic fatigue search terms as well as themes of expression will be useful for further research. More research is needed in languages other than English and over a longer timeframe.
Guidance for action on mitigating pandemic fatigue includes risk communication and community engagement and consultation, risk reduction, and acknowledgement of the situations [
6]. As the science and public health recommendations change throughout a health emergency, there is a need to carefully consider how the information environment impacts users, to effectively manage narratives regarding trust in health authorities. There are lessons to be learnt from the COVID-19 pandemic that can be applied to future infodemic planning. Infodemic management is a key component in the recently released WHO report, ‘Strengthening the global architecture for health emergency prevention, preparedness, response and resilience’ [
43]. Using digital and offline data to create infodemic insights for action, guided by appropriate frameworks, can help to enhance timely response and work towards the prevention and mitigation of the infodemic.
Limitations
The themes we identified in our analysis describe the different way users’ express pandemic fatigue, however, our work was only conducted over a short time-period and only from online sources that had publicly accessible data. As this was an exploratory exercise, with significant testing of keywords, the search was conducted only in the English language. The analysis was done on the dataset as a whole and we did not breakdown data or themes by geographical origin or social media platform. There is a need for broader investigations including in other languages and with offline sources. This research identified six themes of pandemic fatigue expression, but additional, or different themes may be identified using longer search periods or refined search terms. Due to the various ways user’s express narratives of fatigue, and how they cross-over with other more specific narratives, defining and understanding pandemic fatigue is complex. This work adds to the evidence by outlining some themes of expression.
Conclusion
This paper is the first that we are aware that has sought to define and categorise expression of pandemic fatigue by digital online users during a defined period. It has shown the different ways pandemic fatigue is expressed and how it is interwoven with issues of trust, PHSM acceptance and users expressing being overwhelmed. There are clear pathways for future research in this area, in particular looking to understand how this concept is expressed in other languages, in offline settings and what impact pandemic fatigue has on actual PHSM, vaccines, treatments, or diagnostics uptake and adherence. As we move to strengthen the global architecture for health emergency preparedness, prevention, readiness, and resilience, better understanding the implications of the information environment on user’s perceptions, questions and concerns is vital.
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