Information Asymmetry and its impact during the COVID 19 pandemic

 Information Asymmetry and its impact during the COVID 19 pandemic

Co written with - Sabari Girish K, Sudiksha K R, Jeshma D

We find ourselves in the midst of the worst health crisis of the twenty-first century: a pandemic on an unprecedented scale. The COVID 19 pandemic has disturbed global health from late 2019 and is still ongoing.(1) It has led to substantial loss of life and revealed the inherent weaknesses of even some of the strongest health care systems in the world. During this pandemic, one of the most important elements is the need for credible information on a timely basis. The World Health Organization (WHO) and other health agencies are working hard to keep people up to date on emerging information about the pandemic.(2)  Misinformation is a consequence of the panic associated with the pandemic and the inherent information asymmetry between the health care team  on one side, and people on the other.(3) 

What is Information asymmetry? 

Information asymmetry is a condition wherein one party in a relationship has more or better information than the other.(3) Considering a healthcare setting with the healthcare team on one end and patients on the other, the healthcare team has a better understanding about the structure and functioning of the human body and the genesis of the disease, whereas the people do not. While health care providers largely view the human body and its illnesses from a biomedical point of view, people perceive it through a broader psycho-social model. This is a major reason for the asymmetry. Furthermore, the resources that each of these groups use to obtain information are drastically different. Healthcare practitioners access peer-reviewed and scholarly sources for information. In contrast, patients usually get access to information from sources that lack accountability, and often tend to be inaccurate. Existing and emerging beliefs present in the various social groups are also factors that contribute to information asymmetry. Superstitious beliefs and other social factors like stigma mould the attitudes of people and influence the way information is obtained and interpreted. The social scenarios of patients determine their behaviour. Even the kind of first aid that is given to a small wound varies drastically; the solutions and dressings that are applied on it, even the injection of tetanus toxoid that is given, vary drastically from an apartment colony to a village to an industrial park. Essentially, an information asymmetry leads on to behaviour asymmetry, trapping the health care provider and the patient in two different worlds.

With the spread of the internet and the subsequent blooming of online resources, there is a metamorphosis of information asymmetry between the health care providers and people. Internet sources that health care providers refer to are drastically different from those that people do. This is an asymmetry in itself leading to further asymmetries. On one hand, internet sources are readily available and cheap sources of what used to be a precious commodity - medical information. In some ways, it presents an opportunity to overcome the very source of the power dynamic. From a power perspective, the health care provider’s role may never be overcome due to their ability to link medical factors with the social context and personal preferences of people, and to tailor efficient treatments and preventive strategies for each person. The clinical experience of the health care provider plays a pivotal role in analysing a scenario from multiple angles and linking them together to identify the most appropriate management.(4) Even for educated people, access to relevant medical information doesn’t overshadow being able to process it and make choices independent of their health care providers. 

Why is information asymmetry problematic? 

Information asymmetry is problematic on several counts. For instance, it is contributory to the power dynamic extant between health care providers and people. Medical encounters are drastically different affairs for patients and clinicians. Amongst other entities, patients weigh the financial burden and opportunity cost in terms of time and loss of pay against their perceived benefits from a potential clinical contact. Therefore, the information they need tends to be different from the information that the health care provider is comfortable providing. For example, a patient who has a hernia and needs to undergo surgery is more interested in knowing how much the surgery would cost in different hospitals, which technique is the most cost effective one, can he/she wait for some more time to have the procedure, for how many days he/she may have to take leave from their job etc. However, the doctor may not be fully equipped to provide answers for these questions. This creates a divide between the health care providers and the people and results in seeking out treatment later, neglect of symptoms, and progression and disability due to potentially preventable diseases. Extending these arguments, information asymmetry worsens the problem of social injustice in health. There is a profound access inequality to healthcare with information inequality being key in its structure.(5)

Ethically, information asymmetry compromises the depth of informed consent. Consent for a prospective medical intervention, solicited without explaining the risks, benefits, alternative options and costs is not valid. In many cases, patients consent simply because they want to alleviate their suffering without fully understanding the information provided to them. The information asymmetry leads to poor understanding of the procedure, this keeps the patient skeptical and without full trust. This keeps the patient disengaged, which further impairs understanding and leads to poor trust. Information asymmetry perpetuates this cycle of poor understanding – inadequate trust – poor engagement.(6)

Information Asymmetry during the Pandemic

When the pandemic broke out, researchers all over the world were desperately trying to understand how the virus affects the body.  At the time, there was much contestation over which drugs to administer to combat the virus and minimise complications. During such desperate times, it is understandable that there was a rush to discover anything to alleviate the anguish of the people. With rapid advancements in technology, people must have expected that it would only be a matter of time before such crucial information is uncovered. With the massive inflow of information desperate to plug this gap of uncertainty between the worlds of  healthcare workers and the public, it is difficult to know which source can be credible and trusted. This is further amplified by the situational circumstances of this pandemic. In order to minimise the transmission of the virus and deal with the overwhelming numbers of those affected, people faced a massive plummeting in the time that is spent with the health care provider. Coupled with the requirement of personal protective equipment and the physical distance with which the physician must conduct themselves, it creates an alien environment that further invokes anxiety and widens this gap by making the health care provider seem inaccessible and unapproachable.(7)

One example of information asymmetry during the COVID-19 pandemic was the treatment with convalescent plasma.(8) In 2020, there were preliminary reports that it may be helpful in treatment of patients with severe COVID 19. Information spread rapidly and the plasma of recovered patients was sold through the dark web as a cure for COVID 19. Subsequent research showed that plasma convalescent therapy has no effect on decelerating the disease progression and does not have an impact on death due to COVID 19.(9) Regardless, people flocked to obtain it. This is because information regarding these studies did not reach people as fast and effectively as the previously believed information about plasma therapy. 

The eruption of Taal Volcano in the Philippines on January 12, 2020, was erroneously linked with the low number of COVID 19 cases in the country which stirred up speculations that the volcanic ash had antiviral properties. In March 2020, people in Sri Lanka were using red soaps and white handkerchiefs for protection following a misleading Facebook article. These claims were propagated and believed by the masses. In early April, a concoction of alkaloids, including nicotine and cocaine, was sold on the dark web as a potential cure for COVID 19. In April 2020, the then-American president, Donald Trump, put forward an imprudent suggestion of using Lysol, Dettol, and other disinfectants as a way to cleanse the body of the virus. Such statements, coming  from a position of authority and influence, were readily accepted by some of the public, leading to lethal fatalities.

The pandemic brought forth a situation of immense uncertainty. States of vulnerability such as these further increase the deleterious impact of information asymmetry. This led to the spread of misinformation and the infodemic. Countries that were battling COVID 19 also had to battle this infodemic and provide people with credible information. 

Increasing Health Literacy is the solution for Information Asymmetry

The most important strategy for managing the harmful effect of information asymmetry is increasing the ‘health literacy’ of people. The definition of health literacy given by the National Library of Medicine states, “Health literacy is the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.”(10) Health literacy varies from person to person, and is impacted by cultural, political, ethical, environmental, and educational backgrounds. People with disabilities, the illiterate, and people who are socially isolated due to other factors are more vulnerable owing to their decreased ability to comprehend and convey health information. They have poorer health literacy and therefore are more vulnerable to the harmful effects of information asymmetry.(11) The responsibility of increasing the health literacy of people lies with the government and the people. Good quality education with emphasis on health and health care right from school years can greatly contribute to health literacy. Basic skills of identifying credible websites, sources of information online should be imparted to people. Finally, there should be a change in how people perceive their health. The final facet to health literacy is the reinforcement of health being an individual’s right, an idea that will invigorate them to pursue health information.(12) 

Information asymmetry is not something that can be completely removed. It is inherent in the health care provider-people relationship. However, the COVID-19 pandemic has taught us that improving health literacy and enabling people to access credible sources of information is important to prevent harm and avoid panic. It is time now for us to build the health literacy of people so that we are armed to face any such future health catastrophe with a sense of level-headedness. 

Acknowledgements

The authors would like to acknowledge the contributions of Prof. Vijayaprasad Gopichandran in linking their writings and providing suggestions.

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