In 2020, the WHO acknowledged it was not only fighting a pandemic caused by the SARS CoV-2 virus but was also engaged in an “infodemic”. An infodemic occurs when an abundance of information, both accurate and misleading, spreads rapidly alongside an epidemic (World Health Organization 2020a). This type of information ecosystem makes it difficult for people to locate trustworthy information and reliable guidance. Infodemics have occurred before the COVID-19 pandemic; however, its scale has required public health agents to develop new strategies for managing them (World Health Organization 2020b). Chou et al. (2020) argue that in this type of information ecosystem, a traditional approach to misinformation centered on debunking would likely prove insufficient. These authors called for interdisciplinary research to develop new health strategies that identify the most effective timing, manner, and forums for responding to misinformation. They suggest that one such strategy could rely on getting ahead of misinformation, by developing proactive responses or inoculations against misinformation (Chou et al. 2020). Making health information easier to locate and understand is an initial and necessary step in science translation, so that evidence-based public health practices can be put into use (Elliott and Resnik 2019).

A July 2020 roundtable on health literacy convened by the National Academies of Sciences, Engineering, and Medicine explored an additional challenge resulting from the proliferation of health and medical misinformation and disinformation during the COVID-19 pandemic. The roundtable identified “midinformation” as a category distinct from misinformation and disinformation, being an information crisis where the public experiences a state of “informational ambiguity based on scant knowledge or emerging scientific evidence” (National Academies of Sciences, Engineering, and Medicine 2020). Combatting “midinformation” requires making sure that the information users see first is the information you want them to see (National Academies of Sciences, Engineering, and Medicine 2020. A possible strategy to reach audiences who rely on internet searches is to identify the information pathways used by them (National Academies of Sciences, Engineering, and Medicine 2020).

Wikipedia is recognized for advancing public health (Heilman et al. 2011, Mathew et al. 2013, Cohen 2014, Masukume et al. 2016, Morata and Chadha 2019, Smith 2020, Wikimedia Foundation 2020, McNeil 2020) and is one of the most accessed health information sources (Heilman and West 2015, Smith 2020), with over 30,000 medical articles on the English Wikipedia alone receiving over 5 million pageviews a day in April-May 2019 on average (Maggio et al. 2020). Wikipedia ranks highly in Google search, and users often select it (Calabrese et al. 2019). It can be used to deliver information quickly and effectively to large, established, relevant audiences. While commercial media platforms such as Twitter or Facebook make it easy to post messages and measure impact, Wikipedia is a volunteer nonprofit with strict and unique content guidelines that can be more challenging for expert use. However, science-based information on health conditions, therapies, and events (including epidemics or disasters) can be missing or underdeveloped on Wikipedia. Some health agencies developed strategies to integrate content in Wikipedia and evaluate readership and community response (Lum et al. 2018, Morata and Lum 2018, Murphy et al. 2019). No one has yet produced generalized instructions specifically for health organizations on how to engage quickly, easily and effectively with Wikipedia’s content and community.

Consequently, there is an as yet unmet need to develop a general-interest interactive guide on the Wikipedia and Wikidata platforms to support health professionals/communicators in quickly distributing key messages during crisis situations. Wikipedia has guides for publishing content such as biographies and specialized health information, but no guide for organizations to share updated population-level health messages. We propose creating this general-interest interactive guide using the Wikipedia platform’s plentiful, developed native tools. The proposed infrastructure would be used to publish health information in Wikipedia to create a case study/demonstration and report pageviews. We aim to lower Wikipedia's barrier of accessibility to health communicators who wish to use Wikipedia for instant publication of institutionally backed messages. The proposed guide would cover basic features of Wikipedia: key messages, citations, and collecting readership metrics.

More advanced features might include

• using multiple language versions of Wikipedia via translation;
• setting up automated metrics reporting;
• sharing non-text media;
• anticipating off-Wikipedia or offline reuse of Wikipedia content in apps or virtual assistants such as Apple's Siri or Google Assistant;
• using Wikidata to collect, curate and share data; and
• describing other flagship projects which major health organizations designed and incorporated into Wikipedia engagement processes.

Our proposed guide should be tested on selected focused health-related topics as case studies of what Wikipedia communication and impact can offer.

Whatever the selected topic of interest, common elements are

• collecting key health messages from reputable agencies,
• empowering organizational representatives to get those messages into Wikipedia’s ecosystem and
• accessing reports of the size of the audience which reached information through the relevant Wikipedia pages.

To increase and expedite health institutions’ global reach to the general public, we propose the development of a general-interest interactive guide on Wikipedia to support health professionals/communication capacities to disseminate health-related information via the Wikipedia ecosystem.

The proposed plan would improve the timeliness and accuracy of communications and situational awareness regarding threats to the public’s health and at-risk populations by expanding the delivery of health information to not only public health professionals, but also to large global audiences through Wikipedia. We expect it to achieve high communication impact, which we will evaluate through metrics reports. These reports can include a list of articles edited, photos and datasets shared, language communities served, publications cited, and pages viewed. Based on the precedent of classroom projects (e.g. Azzam et al. 2017, Weiner et al. 2019) and our review of traffic reports, we conservatively estimate the content would receive more than 10 million views in one year. Additionally, the guide and case studies developed under this project can make publishing to Wikipedia a more accessible option for health organizations globally. The guide would provide peer-to-peer advice for professionals to orient themselves and consider options and opportunities for reaching an expansive audience.

Finally, the impact of this project is likely to extend beyond science communication to the general public. Newer systems that evaluate scholarly impact today recognize the importance of a publication appearing in Wikipedia. For example, Altmetric measures the influence and online reach of scholarly output through readership counts, mentions in news sites, blog posts, citation manager bookmarks, social media, and Wikipedia citations. Contributing peer-reviewed scientific information into Wikipedia boosts not only the diffusion of an agency's knowledge, but also its scholarly recognition.

Wikipedia serves a large number of readers who expect and need high quality information on specific topics, complete with bona-fide citations and links to reliable sources. Health organizations, on the other hand, have high quality content but difficulty delivering it to readers at scale. Participant agencies and Wikipedia can provide each other mutual support by expediting and expanding access to selected content to Wikipedia's established large audience. In coordination with established Wikipedia community projects such as WikiProject Medicine, WikiProject Disaster Management, or Wikimedians for Disaster Response, this proposed idea aims to develop processes to help ensure that health information in Wikipedia is current, high quality, accurate, and translated in multiple languages.

Our main goal is to develop a model which expert health organizations can use to implement a health communication campaign in the Wikipedia ecosystem. This model includes presenting a case study of Wikipedia publishing, demonstrating how to collect communication impact metrics, presenting examples and an explanation of how the publishing and audience metrics are evidence of reaching new audiences, and finally packaging all of these outputs into a guide which can support any health organization's engagement in Wikipedia. Specific activities include the following (cf. Fig. 1):

Figure 1.  

Schematic overview of the steps involved in developing a public health agency model for Wikipedia

Develop a Wikipedia case study for a specific situation or condition

Collect communication impact metrics

Reach new audiences

Create a guide which presents training materials

Our proposal can only fully achieve success if carried out in coordination with support from Wikipedia community projects such as the ones mentioned here established Wikipedia community projects and staff from the participant organizations. A kick-off planning meeting with representatives of Wikimedia entities would be organized at the onset of the project to facilitate detailed conceptual and strategic planning. Recruiting public health informatics and data science expertise would be key in the first two phases of the project. Instructional design expertise should be considered for the third phase. Finally, minor purchases of supplies would be dedicated to customization of the offline Wikipedia through the Internet-in-a-box platform.

At the moment of submission of this manuscript, our proposal is unfunded, but several of its elements are being executed by the agencies mentioned in the abstract and the WikiProjects aforementioned under Approach. The authors welcome the adoption of the proposed strategy or any of its elements by groups who share this project’s goals.

The authors thank Tim Moody, Internet-in-a-box; Alexandre A.P. Montilha, Universidade de São Paulo; and CAPT David Byrne, National Institute for Occupational Safety and Health; who read and commented on earlier versions of this article. We also thank Amin Azzam at the University of California, San Francisco, for the constructive review.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention CDC. Mention of any company or product does not constitute endorsement by NIOSH or the CDC.

In addition, citations to websites external to NIOSH do not constitute NIOSH endorsement of the sponsoring organizations or their programs or products. The description of the project idea is not associated with any specific funding opportunity, nor will it have any bearing in funding decisions. Furthermore, NIOSH is not responsible for the content of cited websites. All web addresses referenced in this document were accessible as of the publication date.