From COVID-19 Treatment to Miracle Cure : The Role of Influencers and Public Figures in Amplifying the Hydroxychloroquine and Ivermectin Conspiracy Theories during the Pandemic

Introduction Medical misinformation and conspiracies have thrived during the current infodemic as a result of the volume of information people have been exposed to during the disease outbreak. Given that SARS-CoV-2 (COVID-19) is a novel coronavirus discovered in 2019, much remains unknown about the disease. Moreover, a considerable amount of what was originally thought to be known has turned out to be inaccurate, incomplete, or based on an obsolete knowledge of the virus. It is in this context of uncertainty and confusion that conspiracies flourish. Michael Golebiewski and danah boyd’s work on ‘data voids’ highlights the ways that actors can work quickly to produce conspiratorial content to fill a void. The data void absent of high-quality data surrounding COVID-19 provides a fertile information environment for conspiracies to prosper (Chou et al.). Conspiracism is the belief that society and social institutions are secretly controlled by a powerful group of corrupt elites (Douglas et al.). Michael Barkun’s typology of conspiracy reveals three components: 1) the belief that nothing happens by accident or coincidence; 2) nothing is as it seems: the "appearance of innocence" is to be suspected; 3) the belief that everything is connected through a hidden pattern. At the heart of conspiracy theories is narrative storytelling, in particular plots involving influential elites secretly colluding to control society (Fenster). Conspiracies following this narrative playbook have flourished during the pandemic. Pharmaceutical corporations profiting from national vaccine rollouts, and the emergency powers given to governments around the world to curb the spread of coronavirus, have led some to cast these powerful commercial and State organisations as nefarious actors – 'big evil' drug companies and the ‘Deep State’ – in conspiratorial narratives. Several drugs believed to be potential treatments for COVID-19 have become entangled with conspiracy. At the start of the pandemic scientists experimented with repurposing existing drugs as potential treatments for COVID-19 because safe and effective vaccines were not yet available. A series of antimicrobials with potential activity against SARS-CoV-2 were tested in clinical trials, including lopinavir/ritonavir, favipiravir and remdesivir (Smith et al.). Only hydroxychloroquine and ivermectin transformed from potential COVID treatments into conspiracy objects. This article traces how the hydroxychloroquine and ivermectin conspiracy theories were amplified in the news media and online. It highlights how debunking processes contribute to amplification effects due to audience segmentation in the current media ecology. We conceive of these amplification and debunking processes as key components of a ‘Conspiracy Course’ (Baker and Maddox), identifying the interrelations and tensions between amplification and debunking practices as a conspiracy develops, particularly through mainstream news, social media and alternative media spaces. We do this in order to understand how medical claims about potential treatments for COVID-19 succumb to conspiracism and how we can intervene in their development and dissemination. In this article we present a commentary on how public discourse and actors surrounding two potential treatments for COVID-19: the anti-malarial drug hydroxychloroquine and the anti-parasitic drug ivermectin became embroiled in conspiracy. We examine public discourse and events surrounding these treatments over a 24-month period from January 2020, when the virus gained global attention, to January 2022, the time this article was submitted. Our analysis is contextually informed by an extended digital ethnography into medical misinformation, which has included social media monitoring and observational digital field work of social media sites, news media, and digital media such as blogs, podcasts, and newsletters. Our analysis focusses on the role that public figures and influencers play in amplifying these conspiracies, as well as their amplification by some wellness influencers, referred to as “alt.health influencers” (Baker), and those affiliated with the Intellectual Dark Web, many of whom occupy status in alternative media spaces. The Intellectual Dark Web (IDW) is a term used to describe an alternative influence network comprised of public intellectuals including the Canadian psychologist Jordan Peterson and the British political commentator Douglas Murray. The term was coined by the American mathematician and podcast host Eric Weinstein, who described the IDW as a group opposed to “the gated institutional narrative” of the mainstream media and the political establishment (Kelsey). As a consequence, many associated with the IDW use alternative media, including podcasts and newsletters, as an "eclectic conversational space" where those intellectual thinkers excluded from mainstream conversational spaces in media, politics, and academia can “have a much easier time talking amongst ourselves” (Kelsey). In his analysis of the IDW, Parks describes these figures as "organic" intellectuals who build identification with their audiences by branding themselves as "reasonable thinkers" and reinforcing dominant narratives of polarisation. Hence, while these influential figures are influencers in so far as they cultivate an online audience as a vocation in exchange for social, economic and political gain, they are distinct from earlier forms of micro-celebrity (Senft; Marwick) in that they do not merely achieve fame on social media among a niche community of followers, but appeal to those disillusioned with the mainstream media and politics. The IDW are contrasted not with mainstream celebrities, as is the case with earlier forms of micro-celebrity (Abidin Internet Celebrity), but with the mainstream media and politics. A public figure, on the other hand, is a “famous person” broadcast in the media. While celebrities are public figures, public figures are not necessarily celebrities; a public figure is ‘a person of great public interest or familiarity’, such as a government official, politician, entrepreneur, celebrity, or athlete. Analysis In what follows we explore the role of influencers and public figures in amplifying the hydroxychloroquine and ivermectin conspiracy theories during the pandemic. As part of this analysis, we consider how debunking processes can further amplify these conspiracies, raising important questions about how to most effectively respond to conspiracies in the current media ecology. Discussions around hydroxychloroquine and ivermectin as potential treatments for COVID-19 emerged in early 2020 at the start of the pandemic when people were desperate for a cure, and safe and effective vaccines for the virus were not yet publicly available. While claims concerning the promising effects of both treatments emerged in the mainstream, the drugs remained experimental COVID treatments and had not yet received widespread acceptance among scientific and medical professionals. Much of the hype around these drugs as COVID “cures” emerged from preprints not yet subject to peer review and scientific studies based on unreliable data, which were retracted due to quality issues (Mehra et al.). Public figures, influencers, and news media organisations played a key role in amplifying these narratives in the mainstream, thereby extending the audience reach of these claims. However, their transformation into conspiracy objects followed different amplification processes for each drug. Hydroxychloroquine, the “Game Changer” Hydroxychloroquine gained public attention on 17 March 2020 when the US tech entrepreneur Elon Musk shared a Google Doc with his 40 million followers on Twitter, proposing “maybe worth considering chloroquine for C19”. Musk’s tweet was liked over 50,200 times and received more than 13,500 retweets. The tweet was followed by several other tweets that day in which Musk shared a series of graphs and a paper alluding to the “potential benefit” of hydroxychloroquine in in vitro and early clinical data. Although Musk is not a medical expert, he is a public figure with status and large online following, which contributed to the hype around hydroxychloroquine as a potential treatment for COVID-19. Following Musk’s comments, search interest in chloroquine soared and mainstream media outlets covered his apparent endorsement of the drug. On 19 March 2020, the Fox News programme Tucker Carlson Tonight cited a study declaring hydroxychloroquine to have a “100% cure rate against coronavirus” (Gautret et al.). Within hours another public figure, the then-US President Donald Trump, announced at a White House Coronavirus Task Force briefing that the FDA would fast-track approval of hydroxychloroquine, a drug used to treat malaria and arthritis, which he said had, “tremendous promise based on the results and other tests”. Despite the Chief Medical Advisor to the President, Dr Anthony Fauci, disputing claims concerning the efficacy of hydroxychloroquine as a potential therapy for coronavirus as “anecdotal evidence”, Trump continued to endorse hydroxychloroquine describing the drug as a “game changer”: HYDROXYCHLOROQUINE & AZITHROMYCIN, taken together, have a real chance to be one of the biggest game changers in the history of medicine. He said that the drugs should be put in use IMMEDIATELY. PEOPLE ARE DYING, MOVE FAST, and GOD BLESS EVERYONE! Trump’s tweet was shared over 102,800 times and liked over 384,800 times. His statements correlated with a 2000% increase in prescriptions for the anti-malarial drugs hydroxychloroquine and chloroquine in the US between 15 and 21 March 2020, resulting in many lupus patients unable to source the drug. There were also reports of overdoses as individuals sought to self-medicate with the drug to treat the virus. Once Trump declared himself a proponent of hydroxychloroquine, scientific inquiry into the drug was eclipsed by an overtl