The 2019 EVALI ‘Misinfodemic’

The 2019 EVALI ‘Misinfodemic’

Part One (of three):  Searching for ‘patient zero’

The Foundation for a Smoke-Free World recently commissioned an independent analysis of media coverage before, during, and after the 2019 US EVALI (e-cigarette, or vaping, product use-associated lung injury) outbreak. Our analysis covered over 18,000 news stories published by top-tier media outlets in the United States, United Kingdom, India, and South Africa between January 1, 2019 and March 31, 2020.

In August 2019, one month before the outbreak peaked in September, the US Centers for Disease Control and Prevention (CDC) coined the term EVALI. Our goal with this media analysis was to uncover how journalistic coverage of the EVALI outbreak influenced public perceptions surrounding nicotine.

The outbreak in a nutshell

Health officials in the United States noticed a sudden cluster of vaping-related lung injuries in July 2019. Most victims reported using bootleg tetrahydrocannabinol (THC) vaping products. Neither the geographic distribution nor the age distribution of EVALI patients correlated with legal nicotine vaping.  All individuals with EVALI who were tested had vitamin E acetate (VEA) — a thickening agent used to ‘cut’ illegal THC vape oils — in their lungs. In April 2020, the EVALI lung poisonings were shown to be most common in US states where recreational cannabis and THC use are illegal.

“Dates of symptom onset and hospital admission for patients with lung injury-associated with e-cigarette use, or vaping – United States, March 31, 2019 – February 15, 2020” [Source: CDC]

In November 2019, the US CDC publicly confirmed the probable cause of EVALI (in May 2020, the CDC congratulated itself for pinpointing VEA as the culprit). VEA seems to have entered the bootleg THC vape oil supply chain in late 2018. By early 2019, legal THC vape oil producers were proudly proclaiming that their products did not contain VEA.

In September 2019, a prominent member of that community, who had raised alarms linking VEA to lung injuries as early as August, published a comprehensive article that traced the journey tainted bootleg THC cartridges took from China to the United States:

What we know is this: Near the end of 2018, a new additive entered the street THC vape cart supply. And hundreds of serious pulmonary injuries, and possibly as many as nine deaths, followed.  Public health officials and labs have discovered the new additive — a form of vitamin E oil used as a cutting agent — tainting a large amount of the devices that sick people reported using.

Misdiagnosis and misperceptions

THC and nicotine vaping involve different devices, liquids, supply chains, people, and purposes. They should not be confused. But they were. Our analysis shows that evaluated news coverage focused primarily on nicotine vaping, and on nicotine itself. The public confusion that resulted is alarming for three reasons:

  • Between September 2019 and January 2020, US adult misunderstanding increased. Belief that THC vaping was the cause of EVALI dropped from 34% to 28%, while belief that nicotine vaping was the cause increased from 58% to 66%.
  • People who vaped THC during the EVALI outbreak were not alerted to the potentially life-threatening dangers of illicit, poisoned versions of these products.
  • Numerous surveys have shown that public misunderstanding of nicotine itself is widespread, potentially discouraging smokers from using nicotine patches, gum, and other nicotine replacement therapies to quit smoking.

In response to a US EVALI outbreak, caused by illegal unregulated THC vaping products in the US only, many US states and countries around the world moved quickly to ban or restrict access to nicotine vaping products. As Australian researchers who studied this response have noted, “Media reporting in the US, Australia and the UK of the CDC’s analysis of the causes of the EVALI outbreak contributed to regulatory over-reactions to nicotine vaping by the public health community.”

Next:  Part Two – The misinfodemic spreads worldwide

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