Mary Petrone • 2020 Issue
From The Editors:
In the midst of the ongoing COVID-19 outbreak, Petrone’s call for accurate and effective science communication has become even more timely. In BEYOND THE IVORY TOWER, Petrone explores the pitfalls of hasty or inaccurate science communication through the lens of the 2018 Zika virus outbreak in India. The ability to accurately convey one’s research to the public is becoming an essential part of being a scientist, and Petrone provides a roadmap for graduate programs on how to better equip young scientists with the communication skills necessary to do so.
Two years after Zika virus swept through Brazil and the Americas, this same mosquito-borne pathogen emerged in India. The 2015-2016 Zika epidemic in the Americas was considered an international public health emergency because, for the first time, the virus caused devastating birth defects in developing fetuses. In late 2018, India faced a similar plight. Yet, there was hope. Soon after the first Zika cases were reported in Rajasthan, a group of scientists in China, publishing in the prestigious journal Science, identified the mutation in the virus’ genetic code that seemed responsible for one of the most severe birth defects, microcephaly . The Indian government acted quickly on these findings, and the Ministry of Health oversaw the analysis of viruses collected from patients around the country to test for the culpable mutation. In November of 2018, the Ministry of Health published a press release proclaiming: “Zika virus strain that causes microcephaly not found in Rajasthan” . These findings came not only as a relief to the general population, but also to professionals in the tourism industry. Prior to the revelation that Rajasthan was likely safe from microcephaly, the U.S. Centers for Disease Control and Prevention (CDC) had issued a Level 2 travel advisory for India, warning travelers to avoid visiting the country. Given the outcome of their investigation, the Indian government asked the CDC to rescind its advisory. Out of an abundance of caution, the Ministry of Health continued to monitor pregnant women diagnosed with Zika, but Indian families affected by the virus appeared to have escaped the tragic fate of their Brazilian counterparts.
The molecular epidemiology narrative that unfolded in India was perhaps a little too neat. One mutation reported in one paper led to one conclusion: there was no cause for concern about the Rajasthan viral strain. However, the simplicity of this story was cause for concern among virologists and epidemiologists. Although the epidemic in the Americas provided convincing evidence that Zika virus can cause neurodevelopmental birth defects like microcephaly in developing fetuses, the underlying biological mechanism explaining this phenomenon is complex and poorly understood. Moreover, the study reported in Science utilized two model systems, tissue culture and mice, to connect mutation and outcome, but had not yet confirmed their findings in humans.
Model organisms like mice are used to study human diseases in the early stages of biomedical research, but to assume that such findings are directly translatable to the inner workings of Homo sapiens may be spurious. Allowing policy decisions to hinge on mouse experiments is irresponsible and potentially dangerous. Only a few months into the outbreak, more than 30 pregnant women had been diagnosed with Zika . Mercifully, there have been no reports of children born with microcephaly in India, but the long-term effects of congenital Zika syndrome (CZS), a catch-all for the spectrum of developmental conditions the virus can cause, have yet to be seen . In its haste to quell fear and prevent significant damage to its economy, the Indian government grossly overstated the implications of primary biomedical research and, in doing so, risked the health and safety of its citizens.
The Indian government grossly overstated the implications of primary biomedical research and, in doing so, risked the health and safety of its citizens.
What transpired in India is merely one example of an overly simplified public health narrative run amuck. When West Africa battled the Ebola crisis in 2014, the U.S. faced what Dr. Anthony Fauci, M.D., Director of the National Institute of Allergy and Infectious Diseases, aptly called an “epidemic of fear.” Unfounded theories, including one that Ebola could mutate to become airborne , circulated in the popular press. Strict quarantines were imposed in New Jersey and Connecticut on travelers returning from West Africa despite robust epidemiological evidence showing that only individuals experiencing the graphic symptoms of the hemorrhagic fever could transmit the virus [6,7]. Most recently, the novel coronavirus outbreak, triggering the specter of SARS, has thrown public health officials and the popular press into overdrive. The unrealistic demands placed on officials to provide up-to-the-minute updates on any and all expedited research have led to the wide circulation of inaccurate claims. These have included a high-profile report that the coronavirus can be transmitted by asymptomatic individuals , and a more contentious study arguing that snakes are the virus’ natural host . While the former may occur from time to time, the latter is almost certainly false.
When these examples are considered together, a pattern emerges. In the midst of a public health crisis, the complexities of human disease are watered down into digestible headlines, creating a media narrative that downplays the ambiguity surrounding the epidemic. The trade-off is a loss of precision and accuracy in the interpretation of biomedical literature.
Why is this a recurring problem?
Scientific research is driven by the discovery of natural laws and objective facts, and journals such as Science seemingly uphold the highest standards of research integrity. That is, the data are not misleading, and the conclusions are consistent with the data. However, it is the manner in which the uncertainty within and limitations of the data are expressed that leads to miscommunication. In an era when researchers are under excessive pressure to churn out high-impact publications, they are not trained to communicate their findings to a non-academic audience who should be the constituents and direct beneficiaries of public health research. Instead, journalists and special interest groups are free to translate research from academic jargon into clickbait, thereby circulating inaccurate information, whether intentionally or not.
In each case, there is a shared path to the miscommunication of research. First, flashy titles meant to grab the reader’s attention oversimplify or overstate the research findings, which are often so nuanced that they cannot be accurately summarized in a single sentence. In the case of India’s Zika outbreak, the phrase “a single mutation” adopted by the editors of Science invokes an unambiguous one-to-one relationship between one nucleic acid change and the spectrum of neurological outcomes encapsulated within a diagnosis of congenital Zika syndrome. Second, the abstract, the most read section after the title, may include a sweeping and unfounded conclusion statement. In this case, the claim that the mutation “makes [Zika virus] more virulent to human [neural progenitor cells], thus contributing to the increased incidence of microcephaly in recent [Zika virus] epidemics,” simply does not follow from experiments conducted in tissue culture and mouse models. Even more problematic was the outward-facing press release, written by communications specialists rather than the scientists who did the research and is primarily used by journalists to craft stories for the general public. These documents can be especially damaging when they drive a false media narrative, such as the one put forth by India’s Ministry of Health, because they are fodder for spin-off stories and even policy decisions.
How can we, as young scientists, address this problem?
Fortunately, because we attend a university that has the resources, infrastructure, and responsibility to train us as communicators, we as Yale students can take concrete steps to prevent our own research from being misconstrued. On campus, we have faculty and lecturers in our science departments who have been employed by major media outlets including The New York Times (Carl Zimmer), NBC (Dr. Robert Bazell, PhD), and The Atlantic (Dr. James Hamblin, M.D.). In partnership with these talented individuals, graduate programs should develop curriculums that promote written composition and public speaking geared for non-academic audiences on prescient scientific topics. Given that the Yale Poorvu Center for Teaching and Learning already hosts communication workshops and offers certificates in teaching, using this pre-existing infrastructure to offer a certificate in science communication is a viable option to address the challenges of science misrepresentation and skepticism.
Finally, we as students have the responsibility to seek out existing opportunities to bridge communication gaps and prevent future epidemics of fear or ignorance. Yale is home to the Global Health Justice Partnership, a collaboration between the public health and law schools, that publishes a number of outward-facing reports written by students. It is on us to step outside of our academic institutions and embody a new model of science communication as Yale students and as leaders.
As students, we have the responsibility to… bridge communication gaps and prevent future epidemics of fear or ignorance.
This paradigm shift has already begun. In response to the Indian Ministry of Health press release, Dr. Nathan Grubaugh, PhD, an Assistant Professor of Epidemiology at the Yale School of Public Health, penned “Cause to remain alert: on Zika virus”  for The Hindu, an Englishlanguage newspaper headquartered in India. In this op-ed, Dr. Grubaugh, who is an expert in mosquito-borne viruses, cogently discussed current knowledge gaps in CZS research and advocated for continued vigilance among pregnant women, their families, and women planning on becoming pregnant while Zika circulates in the country. These concerns were later echoed in academic literature , and the Indian government walked back their claims that the circulating Zika lineage did not pose a risk for CZS.
Despite these efforts, confusion surrounding the U.S. travel advisory to India has persisted in the popular press [12,13]. Clearly, there is an urgent need to improve the way in which we communicate evidence, uncertainty, and the nuanced facets of scientific research to the general public. At Yale, we can lead the way in accomplishing these goals if we accept our responsibility to become both academics and communicators.
Yuan, L., Huang, X.-Y., Liu, Z.-Y., Zhang, F., Zhu, X.-L., Yu, J.-Y., … Qin, C.-F. (2017). A single mutation in the prM protein of Zika virus contributes to fetal microcephaly. Science, 358(6365), 933. https://doi.org/10.1126/science.aam7120
Zika Virus strain that causes microcephaly not found in Rajasthan. (2018, November 3). Retrieved April 9, 2020, from https://pib.gov.in/PressReleseDetail.aspx?PRID=1551803.
Saxena, S. K., Kumar, S., Sharma, R., Maurya, V. K., Dandu, H. R., & Bhatt, M. L. B. (2019). Zika virus disease in India. Update October 2018. Travel Medicine and Infectious Disease, 27, 121–122. https://doi.org/10.1016/j.tmaid.2018.10.022
Wheeler, A. C. (2018). Development of Infants With Congenital Zika Syndrome: What Do We Know and What Can We Expect? Pediatrics, 141(Supplement 2), S154. https://doi.org/10.1542/peds.2017-2038D.
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Gatter, R. (2016). Quarantine Controversy: Kaci Hickox v. Governor Chris Christie. Hastings Center Report, 46(3), 7–8. https://doi.org/10.1002/hast.584
Challenging the US Response to the West African Ebola Outbreak. (n.d.). Retrieved April 9, 2020, from https://law.yale.edu/ghjp/projects/infectious-disease-and-justice/challe…
Rothe, C., Schunk, M., Sothmann, P., Bretzel, G., Froeschl, G., Wallrauch, C., Zimmer, T., Thiel, V., Janke, C., Guggemos, W., Seilmaier, M., Drosten, C., Vollmar, P., Zwirglmaier, K., Zange, S., Wölfel, R., & Hoelscher, M. (2020). Transmission of 2019-nCoV Infection from an Asymptomatic Contact in Germany. New England Journal of Medicine. https://doi.org/10.1056/NEJMc2001468.
Ji, W., Wang, W., Zhao, X., Zai, J., & Li, X. (2020). Homologous recombination within the spike glycoprotein of the newly identified coronavirus may boost cross-species transmission from snake to human. Journal of Medical Virology, n/a(n/a). https://doi.org/10.1002/jmv.25682
Grubaugh, N. (2018, November 9). Cause to remain alert: on Zika virus. Retrieved April 9, 2020, from https://www.thehindu.com/opinion/op-ed/cause-to-remain-alert/article2545…
Rolph, M. S., & Mahalingam, S. (2019). Zika’s passage to India. The Lancet Infectious Diseases, 19(5), 469–470. https://doi.org/10.1016/S1473-3099(19)30169-0
Rossi, A., & Rossi, A. (2020, January 8). Do Travelers Still Need to Worry About the Zika Virus in 2020? Retrieved April 9, 2020, from https://www.smartertravel.com/traveler-information-zika-virus/
Belluz, J. (2019, March 22). The new, confusing Zika travel advice, explained. Retrieved April 9, 2020, from https://www.vox.com/2019/3/22/18275679/zika-travel-advice-explained.
Coming soon. Please see the print issue PDF at http://tinyurl.com/distilled2020 for headshot, affiliation, and email address.
Coming soon. Please see the print issue PDF at http://tinyurl.com/distilled2020 for headshots, affiliations, and email addresses.