Introduction
Since May 6, 2022, a monkeypox outbreak has spread to or been detected in more than 100 countries. Shortly after media coverage of the outbreak, misinformation about monkeypox was reported.1 The World Health Organization advised “detecting public sentiment…[to] address possible rumours and misinformation.”2 This qualitative study used real-time data from TikTok, a social media app allowing users to create and share short videos, to proactively identify monkeypox conspiracy theories for public health to debunk before their potential viral spread.
Methods
To identify emergent conspiracy theories about monkeypox, content and metadata under #monkeypox (864 videos) on the app’s desktop version were collected using the DataMiner website scraper tool and manual retrieval of videos on May 21, 2022. We chose the app owing to its high monthly use (>1 billion users). We reviewed each English-language video for the presence of a conspiracy theory or theme related to the emerging monkeypox outbreak. We classified theories into a typology and reported their viewership and engagement metrics. M.Z. coded the videos; T.C. audited coding decisions. Ethical approval and informed consent were not needed because videos were publicly available and posted without expectation of privacy. Data were analyzed using Microsoft Excel, version 2208.
Results
We identified 153 videos with a monkeypox conspiracy theory or theme. The estimated mean time since posting was 30.2 hours. In total, videos received 1 485 911 views (median, 2872; IQR, 1691-6697), 74 328 likes (median, 192; IQR, 93-386), 7890 comments (median, 26; IQR, 12-53), and 13 783 shares (median, 21; IQR, 8-58).
Our analysis sorted conspiracy theories into 11 types (Table). The most prominent were assertions that monkeypox was a planned pandemic introduced for power, control, or money or to instill fear (71 videos [46.4%]); content alleged that monkeypox was a purposeful repeating of COVID-19, intentionally released, or associated with COVID-19 and conspiracy theories such as “the great reset” and “one world order.”
Fifty-one videos (33.3%) were related to vaccines and asserted monkeypox was an excuse to administer or mandate vaccines worldwide. Vaccine manufacturers and governments were accused of knowing of an upcoming outbreak or having a role in creating the outbreak. Content alleged that government approval or orders of smallpox vaccines were proof of involvement. Five videos (3.3%) alleged that COVID-19 vaccines were the reason for or contributed to the outbreak. The World Health Organization was accused of involvement in the outbreak as an excuse to pass the May 2022 global pandemic treaty (27 [17.6%]) and erode the sovereignty of countries, override national laws, and seek broader power.
The commentary of Bill Gates predicting or addressing the need to prepare for the next pandemic was taken as evidence of his involvement (28 videos [18.3%]). Specifically, Gates’ comments about a possible bioterror attack or laboratory-created pandemic were cited, with some allegations of Russian government involvement (22 [14.4%]). Simulated pandemic preparation exercises were also taken as evidence of a preplanned pandemic (16 [10.5%]).
Several conspiracy theories tied unrelated news events to the cause and/or cover-up of the monkeypox outbreak. An escape of monkeys in the US, as covered in a news story, was cited as potentially leading to the monkeypox outbreak (22 videos [14.4%]). Lost and found vials of smallpox had similar allegations (6 [3.9%]). Other videos suggested monkeypox was a symptom of an upcoming religious rapture (7 [4.6%]) or was introduced for political purposes (5 [3.3%]).
Discussion
Our results demonstrated the potential use of real-time social media data to identify and understand conspiracy theories before their viral spread. This is particularly important during the information-gathering phase of infectious outbreaks.3 The COVID-19 pandemic has shown the challenges of viral misinformation4,5 and the need to proactively deter it.6 A limitation was that we included only videos in English under 1 hashtag; there are likely videos with conspiracy theories in other languages or different hashtags. Public health experts may consider greater attention to and investment in monitoring the online environment.
