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New figures show deteriorating press freedom in 2020, which health experts say will have hampered the COVID-19 response. Ed Holt reports. Public health experts and press freedom advocates have warned of the potentially damaging effects of growing restrictions on media freedom during the COVID-19 pandemic. A report from Reporters Without Borders (RSF) shows that press freedom is restricted in almost three-quarters of the world and documents what it describes as a dramatic deterioration in press freedom during the pandemic. Other studies published in recent months have documented hundreds of media freedom abuses over the past year, including physical attacks on, and arrests, and jailing of journalists. Health policy experts and doctors have emphasised the crucial role that the media plays during public health emergencies, and how restricting its access to full and accurate information can cost lives. “There is no doubt that restrictions on media [being able to report accurate information], and misinformation being given out by governments, has cost lives during this pandemic”, Tom Frieden, former head of the US Centers for Disease Control and Prevention (CDC) and CEO of the public health initiative Resolve to Save Lives, told The Lancet. From the very start of the COVID-19 pandemic, press freedom watchdogs raised the alarm about repression of reporting on the spread of SARS-CoV-2, emphasising in particular the Chinese authorities' repression, including the arrests, of journalists for coverage questioning the official narrative of Beijing's response to the outbreak.

start of the COVID-19 pandemic, press freedom watchdogs raised the alarm about repression of reporting on the spread of SARS-CoV-2, emphasising in particular the Chinese authorities' repression, including the arrests, of journalists for coverage questioning the official narrative of Beijing's response to the outbreak. As the virus spread across the world, international rights bodies, alarmed about the potential use of emergency powers and legislation by governments to stifle critics, issued statements reminding governments of their obligations to full and accurate disclosure of information on the threat of the virus. However, governments in countries including Russia, Turkey, Hungary, Philippines, Saudi Arabia, and Malaysia have implemented new legislation or strengthened existing laws, which groups including RSF, the International Press Institute, and Human Rights Watch say are masquerading as measures to combat COVID-19 conspiracy theories. These include, they say, laws criminalising publishing of so-called fake news relating to coronavirus reporting and enhancing existing internet censorship and surveillance under the pretence of fighting the spread of the virus.

Human Rights Watch say are masquerading as measures to combat COVID-19 conspiracy theories. These include, they say, laws criminalising publishing of so-called fake news relating to coronavirus reporting and enhancing existing internet censorship and surveillance under the pretence of fighting the spread of the virus. In India, last week Twitter complied with a government request to remove more than 50 tweets appearing to criticise the government's handling of the pandemic, including some from reporters. Local journalists told The Lancet how media restrictions have severely affected dissemination of accurate information about the spread of the virus in some places. Stella Paul, a Delhi-based journalist, told The Lancet: “The authorities arrested journalists for trying to report the truth. This was especially the case in more remote places where there was absolutely no information given out about COVID-19 and journalists were trying to get that information.” In Tanzania, the authorities have not given out any official information on COVID-19, including deaths or infection numbers, since April, 2020. They have said that keeping information for government scientists to analyse is better than spreading panic. In March, 2021, international media reported how the severe information blackout was still in place, with doctors forbidden from acknowledging the disease.

cluding deaths or infection numbers, since April, 2020. They have said that keeping information for government scientists to analyse is better than spreading panic. In March, 2021, international media reported how the severe information blackout was still in place, with doctors forbidden from acknowledging the disease. Public health experts say authorities withholding information or stopping media trying to report accurate data or information only worsens any health crisis. Jennifer Pomeranz, assistant professor of public health policy and management at NYU School of Global Public Health, who authored a study on government responses to misinformation during the pandemic, told The Lancet: “In some places authorities completely shut down any reporting of COVID data, even official information. This meant that people did not even have basic information they needed, such as where to go for help or treatment.” “What happens in these kinds of situations is that people then do not have access to any proper information and start relying on rumours. It also creates distrust”, she added. This distrust can affect crucial decisions people take during a public health emergency. Cristiana Salvi, Programme Manager External Relations, Health Emergencies, at WHO, told The Lancet: “When people get differing information from different sources, it is difficult for them to then make decisions about what they should do. Trust in authorities needs to be kept high in an emergency. If you kill the trust, you kill the response.”

me Manager External Relations, Health Emergencies, at WHO, told The Lancet: “When people get differing information from different sources, it is difficult for them to then make decisions about what they should do. Trust in authorities needs to be kept high in an emergency. If you kill the trust, you kill the response.” This breakdown in trust can also fuel dangerous conspiracy theories. Prof Heidi Larson, director of the Vaccine Confidence Project at the London School of Hygiene & Tropical Medicine, told The Lancet that governments not providing full, accurate information about COVID-19 were “certainly contributing to mistrust, but also add credibility to anti-vaccine rhetoric that governments or authorities don't tell the truth”. Press freedom advocates suggest maintaining trust between people and authorities is especially crucial as countries roll out vaccination programmes. Ron Mahoney, deputy executive director of the Committee to Protect Journalists, told The Lancet: “The lack of accurate, timely information throughout the first waves of the pandemic certainly added to the confusion that people experienced about how or even whether to protect themselves. One can only speculate that more people would have been spared infection if they had been better informed. The same is true about the new vaccines that are now being rolled out. We need accurate, independent, and timely information once more to counter the waves of misinformation and ignorance that are washing over us.”

ne can only speculate that more people would have been spared infection if they had been better informed. The same is true about the new vaccines that are now being rolled out. We need accurate, independent, and timely information once more to counter the waves of misinformation and ignorance that are washing over us.” Although media restrictions are often associated with repressive regimes—RSF says that media freedom is often most severely curtailed in dictatorships or one-party states—this was not always the case during the pandemic. “We have seen restrictions on media reporting in many countries, including in democracies”, Rebecca Vincent, director of International Campaigns at RSF, told The Lancet. Media in Greece, Hungary, Slovenia, Poland, and Bulgaria, for example, have faced smear campaigns after critical reporting, had to deal with the introduction of legislation criminalising “fake news” with strict jail terms, have been prevented from reporting from hospitals and speaking to medical workers, and have been arrested for covering anti-lockdown and other protests for allegedly breaking COVID-19 restrictions.

ter critical reporting, had to deal with the introduction of legislation criminalising “fake news” with strict jail terms, have been prevented from reporting from hospitals and speaking to medical workers, and have been arrested for covering anti-lockdown and other protests for allegedly breaking COVID-19 restrictions. In the USA, many journalists last year reported problems in obtaining full and accurate information from the White House about COVID-19 and having restricted access to key scientific figures. John Swartzberg, an infectious disease and public policy expert at the University of California Berkeley, said that under President Donald Trump's administration “we could not believe what the government was saying, nor could we trust the CDC, or the Food and Drug Administration, because they had been politicised”. He added: “The media and the public had to dig deeper to ascertain what the science was teaching. Without a free media, our entire society would have become unmoored. Our death count would have been even greater than what we saw.” He also said that restrictions on media reporting on COVID-19 had “most certainly” led to lives being lost around the world during the pandemic.

o ascertain what the science was teaching. Without a free media, our entire society would have become unmoored. Our death count would have been even greater than what we saw.” He also said that restrictions on media reporting on COVID-19 had “most certainly” led to lives being lost around the world during the pandemic. In April, 2021, Vincent told the UK newspaper The Guardian that “if the press had been freer in China, then it's possible a global pandemic could have been averted”. Speaking to The Lancet, she explained: “Had there been a freer press in China at the time when the outbreak began there, and had information been passed on freely by the authorities, the information would have got out to other parts of the world, and other countries may have been able to prepare better, earlier.” The Chinese Government has repeatedly denied claims that it deliberately concealed information relating to the virus at any time in its outbreak. Experts on public health emergencies, including all those who spoke to The Lancet for this article, suggest that proving any claim that a freer media in China would have averted a pandemic would be impossible.

ly denied claims that it deliberately concealed information relating to the virus at any time in its outbreak. Experts on public health emergencies, including all those who spoke to The Lancet for this article, suggest that proving any claim that a freer media in China would have averted a pandemic would be impossible. Some also point out that China's response to the pandemic suggests that having a free media does not inevitably mean the outcome of a pandemic will be better than anywhere else. “China is a good example [of this]”, said Swartzberg. “Government pronouncements cannot be trusted, the media is muzzled. Yet, the country has done remarkably well during the pandemic. I attribute this to the observation that their government's prime goal is to control the pandemic.” Salvi also pointed out that the outcome of any health emergency depended on several factors, not just media communication. “The media are just one component, albeit a critical one, of a wider communication effort which itself is part of an entire pandemic response.” However, she stressed that disseminating crucial information through media was key to any response to a public health emergency. “A government has a responsibility to allow the correct, accurate information to be disseminated—also through a free press—to the public as this will help in the response to the public health emergency”, she said.

that disseminating crucial information through media was key to any response to a public health emergency. “A government has a responsibility to allow the correct, accurate information to be disseminated—also through a free press—to the public as this will help in the response to the public health emergency”, she said. Frieden added: “There are two key parts to a successful response to a public health emergency—the first is trust, and the second is accurate scientific information being provided. A free and responsible media can enable an effective response to a public health emergency. If a government is not giving out accurate information, a free media can look to alternative sources to get the correct information.” Regardless of the exact effect media freedom, or lack of it, will have had on COVID-19 pandemic outcomes in various countries, it seems clear that the crisis has underlined the important role media plays in public health emergencies. Salvi said: “It has never been clearer that media communication is an obvious public health intervention.” RSF's Vincent went further, saying: “There is an interconnection between freedom of information and public health, and this pandemic has highlighted how important freedom of information is in a public health emergency. Journalists need to be allowed to report the truth and give accurate information freely to the public so that people can inform themselves and take appropriate steps in an emergency.”