PERSPECTIVE
published: 28 July 2021
doi: 10.3389/fpsyg.2021.682931

Conspiracy Theories: A Public Health
Concern and How to Address It
Marie-Jeanne Leonard* and Frederick L. Philippe
Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada

The SARS-CoV-2 pandemic was characterized by a significant increase in theendorsement of conspiracy theories. Conspiracy theories are narratives that can enable
and accentuate distrust toward health professionals and authorities. As such, they
can lead to violent radicalization and should be considered a public health issue. This
perspective article aims to further the understanding of professionals on conspiracy
theories via the 3N model of radicalization and self-determination theory. Based on
empirical research, theory, and existing interventions, potential initiatives intended totackle the issue of conspiracy theories during pandemics are also presented.
Keywords: conspiracy theories, public health, self-determination theory, needs, radicalization, conspiracy beliefs

INTRODUCTION
Edited by:Manuele Reani,
The Chinese University of Hong Kong,
China
Reviewed by:
Margarida Rangel R. Henriques,
University of Porto, Portugal
Marius Hans Raab,
University of Bamberg, Germany*Correspondence:
Marie-Jeanne Leonard
leonard.mariejeanne@courrier.uqam.ca
Specialty section:
This article was submitted to
Cognitive Science,a section of the journal
Frontiers in Psychology
Received: 19 April 2021
Accepted: 28 June 2021
Published: 28 July 2021
Citation:
Leonard M-J and Philippe FL(2021) Conspiracy Theories: A Public
Health Concern and How to Address
It. Front. Psychol. 12:682931.
doi: 10.3389/fpsyg.2021.682931

Increasingly, people around the globe grow tired and frustrated in response to lockdowns andhealth measures that are meant to counter the ongoing SARS-CoV-2 pandemic. This angst ispartly manifested through the increased popularity of conspiracy theories (European Commission,2020). An international survey carried out in 28 countries revealed that one-third of people
worldwide believe that “a foreign power/other force” consciously caused the current pandemic(e.g., 18, 58, and 26% believe so in the United Kingdom, Bulgaria, and Thailand, respectively; Gallup
International Association, 2020). Such conspiracy beliefs represent public health issues contributing
to the fracture of the trust civilians hold toward government officials and health professionals, aphenomenon that has been observed during other disease outbreaks (Cohn and Kutalek, 2016).
The objective of this perspective article is to improve the understanding of conspiracy theories,
to discuss how they impact the population, and to highlight potential ways to intervene during
pandemics based on theory, empirical research, and existing interventions.
We argue that conspiracy theories should be considered as narratives that can lead toviolent radicalization and, as such, this phenomenon represents an important public healthissue. Conspiracy theories are better understood via the 3N model of radicalization (Kruglanski
et al., 2019) and self-determination theory (Ryan and Deci, 2017). The 3N model specifies threepillars in the radicalization process that align with the understanding of conspiracy theories (i.e.,
Need, Narrative, and Network), while self-determination theory deepens the understanding of the
Need pillar.

CONSPIRACY THEORIES
Need refers to the motivation to recover significance following its loss due to an adverse event(Kruglanski et al., 2019). Specifically, this significance loss can be conceptualized as the thwarting of
three psychological needs that were found to be universal: competence, autonomy, and relatedness(Ryan and Deci, 2017). Indeed, the satisfaction or frustration of these three psychological needs

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Conspiracy Theories and Public Healthpeople, and/or objects (van Prooijen and van Vugt, 2018). Thesenarratives also imply agency, that is, they attribute intentions tomalevolent and malicious groups of people who form a coalition
and who have a deliberate plan that represents a threat to theingroup (van Prooijen and van Vugt, 2018). Above all else, these
theories are characterized by a secrecy element, which makes
them irrefutable.
When one adheres to a narrative, they then seek the presenceof like-minded individuals, forming a Network (Kruglanski et al.,2019). In the past few months, those who endorsed a conspiracy
theory on SARS-CoV-2 connected via social media, creating echochambers. These echo chambers spread the reinforcement ofboth individual and collective actions that exacerbated tensions
between civilians and impeded the initiatives of authorities to halt
the propagation of the virus around the globe, propelling actions
such as civil disobedience, maskless demonstrations, or a refusal
to get tested and vaccinated.
Conspiracy theories and their associated actions are endorsed
to satisfy the thwarted needs and fulfill the lost sense ofsignificance. However, conspiracy theories are not expected totruly satisfy the basic needs, they potentially, only temporarily,
compensate for them. Research has indeed found that whenneeds are experienced as frustrated, they lead the individual torigidly engage in activities that appear to overcome some of theinsecurities and threats stemming from need frustration, but
this engagement falls short of achieving this and often leads
to worst consequences (for a review, refer to Vansteenkiste
et al., 2020). Empirical data suggest that conspiracy theories may
cultivate the thwarting of the basic needs, creating a feedback
loop in which the person is further reinforced to support andexpand their beliefs in conspiracy theories (Douglas et al.,2017; van Prooijen, 2020). For instance, it has been shownthat exposure to conspiracy theories decreases the feelings ofcontrol and autonomy by increasing perceptions of powerlessness(Jolley and Douglas, 2014a,b; Douglas et al., 2017). This is
not surprising given that, although conspiracy theories offer
an alternative explanation to adverse events, they emphasize
how the actions of individuals cannot have an impact on thestatus quo, possibly further thwarting the need for autonomy.
They also highlight how numerous events, people, and objects
are interrelated, as well as how the truth is hidden from thepublic, likely frustrating the sense of competence of individuals.
Eventually, conspiracy theories can increase the feeling of beingsocially alienated, as they underscore how the ingroup is badly
treated by the outgroup and how the ingroup is the target of
threatening plans. In addition, conspiracy theories are often asource of interpersonal conflicts between conspiracy believers
and non-believers, possibly negatively affecting relationships andfriendships and further reinforcing the frustration of the needfor relatedness.

influences how people perceive and react to an event (Ryanand Deci, 2017). The satisfaction of these psychological needs is
considered as a continual quest, and when they are not satisfied
or are frustrated, people naturally seek to fulfill them (Sheldon
and Gunz, 2009; Ryan and Deci, 2017). They are, therefore,
considered as core determinants of motivation that lead one
to act on their environment and to carry certain objectives(Sheldon and Gunz, 2009; Ryan and Deci, 2017). Conspiracy
theories unfold following an important event that hinders theperception of control of an individual (autonomy), the abilityof an individual to make sense of the world (competence), andconnectedness of an individual (relatedness; Ryan and Deci,
2017; van Prooijen, 2020). In 2020, many countries enforced
a lockdown for months, a significant event that precipitatedeconomic uncertainty and restrained individual freedom. Many
have perceived their basic needs as thwarted as they lost control
over their usual occupations, they were cut off from their loved
ones, and authorities disseminated mixed messages because they
did not (and still do not) fully understand the new virus. Suchstressful events are likely to reactivate the recall of past personal
life events that were need thwarting in a similar fashion (e.g.,experiences of ostracism, natural disasters, or other traumas),thus exacerbating the current need thwarting experience of thepandemic (Philippe and Houle, 2020). A vulnerability to thereactivation of such need thwarting memories can motivate one
to retrieve significance by finding compensatory ways to fulfill
those needs, making one cognitively receptive to new narratives.
Conspiracy theories are a form of Narrative, defined asa shared belief system providing an alternative ideologicalframework to explain a situation and offer guidance as to how tobehave to regain significance, control, and affiliations (Kruglanski
et al., 2019). As conspiracy theories are alternative narratives
to the status quo, people turn to them to compensate for
their thwarted needs. Such narratives accentuate the threatening
characteristics of demonized outgroups and praise the people
who endorse the beliefs and behaviors put forward by theideology, hence cognitively and behaviorally polarizing believers(Kruglanski et al., 2019). Of note, some authors have suggested
that believing in conspiracy theories can be adaptive to survival(van Prooijen, 2020); however, one could argue that such beliefs
could be considered adaptive only when they concern realconspiracies and not unjustified conspiracy theories. In the past,some conspiracies were proved to be real, rendering it difficult todistinguish unjustified conspiracy theories from real conspiracies.
Unjustified conspiracy theories are not adaptive for survival, as
they can be detrimental to the health of others and the individual(e.g., SARS-CoV-2 being a hoax, vaccines being dangerous, etc.).
The European Commission (2020) characterizes real conspiracies
as focusing on a specific event or individual, such as anassassination, and based on valid proof and facts brought
forward by “whistle-blowers and the media.” The European
Commission (2020) adds that whistle-blowers recognize theextent and limitations of their knowledge instead of being rigid
and absolute about it. On the other hand, unjustified conspiracy
theories are characterized by five distinctive elements: pattern,
agency, coalition, threat, and secrecy (van Prooijen and vanVugt, 2018). Such narratives are not parsimonious and detail apattern establishing causal relationships between multiple events,
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PAST HEALTH CRISES ANDCONSPIRACY THEORIESPast health crises provide some insights into the development ofconspiracy theories concerning viruses. The element of mistrust
toward mainstream media, influential figures, authorities, and/or
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Conspiracy Theories and Public Health(Abramowitz et al., 2017), as past epidemics were marked by
the dissemination of ambivalent messages on the virus atplay (Kou et al., 2017). However, changing information is notnecessarily synonymous with mixed messages (Carlsen and
Glenton, 2016). To prevent their information and messages
from being considered as mixed, policymakers and authorities
should “acknowledge” the presence of uncertainty and thatthe information disseminated will be adjusted as time goes by(Carlsen and Glenton, 2016). Otherwise, people might consider
and interpret mainstream information as misinformation (Balland Maxmen, 2020). Furthermore, Ball and Maxmen (2020)
emphasized that authorities and policymakers should describe
the reasons and rationale that “guide” the changed decisions
during an epidemic.
We recommend the following societal and individual-level
initiatives to defuse conspiracy beliefs and prevent them from
cognitively crystalizing in the long run. These initiatives areconceived from empirical studies, professional reports, andsuccessful measures involved in the adequate handling of past
epidemics (Niang, 2015; Cohn and Kutalek, 2016; Baggio et al.,2019; Sigfrid et al., 2020). Studies have suggested that increasing
the sense of control, perception of transparency, and selfaffirmation (i.e., asserting the values, meaning, and feelings ofan individual) can decrease the strength of conspiracy beliefs(Whitson and Galinski, 2008; Carlsen and Glenton, 2016;
Douglas et al., 2017; Poon et al., 2020; van Prooijen, 2020). Thereis a consensus among professionals that engaging the populationand genuinely listening to their needs, perceptions, and concerns
greatly helps to ensure the efficacy of sanitary measures during
disease outbreaks (Niang, 2015; Cohn and Kutalek, 2016; Baggio
et al., 2019). Indeed, public health measures to contain past Ebola
epidemics were varied and included community engagement
initiatives (Coltart et al., 2017). Though Coltart et al. (2017)consider it unclear which initiatives worked best, as they wereusually implemented at the same time, the authors highlighted
that community engagement initiatives seem to act as a catalyst
to other initiatives (Coltart et al., 2017). Community engagement
measures potentially work by increasing trust toward authorities,
therefore increasing compliance and adequate function of otherpublic health measures (Coltart et al., 2017).
Therefore, we first strongly advise state and local governments
to invest in the implementation of a “qualitative community
feedback mechanism” as was implemented for instance by the
Democratic Republic of Congo as an additional measure for
Ebola epidemics (Baggio et al., 2019; Nachega et al., 2020). Thismechanism collected perceptions and comments of people about
the epidemic (i.e., Ebola) to (1) improve trust and engagementof communities and (2) help officials with feedback to adapt
their decisions and priorities in terms of the needs of thecommunity (Baggio et al., 2019). The information collectedby the feedback mechanism was afterward coded, analyzed,
and shared with the adequate authorities (Baggio et al., 2019).
Such a mechanism allows each citizen to feel part of thelarger social network and favors community engagement andempowerment, elements identified as key targets during an
epidemic to reduce fears and rumors (Cohn and Kutalek, 2016;
Baggio et al., 2019; Sigfrid et al., 2020). Therefore, state andgovernmental institutions was the most recurring theme reported
to facilitate the endorsement and spread of conspiracy theories
throughout past epidemics as various as the Zika (Kou et al., 2017;
Smallman, 2018), Ebola (Masumbuko Claude et al., 2019; Vinck
et al., 2019), or H1N1 (Smallman, 2015). Many of these virusrelated conspiracies revolved around capitalistic ill-intentions
among powerful individuals (Smallman, 2015, 2018; Masumbuko
Claude et al., 2019).
Trust can be modulated by real conspiracies unveiled in
the past, past persecutions, and disparities perpetrated byauthority figures toward minority groups (Smallman, 2015,2018; Abramowitz et al., 2017; Kou et al., 2017) or by how
authorities and institutions are perceived to competently manage
an epidemic (Masumbuko Claude et al., 2019). In addition,
we argue that mistrust toward institutions and the government
could be a pre-epidemic social symptom engendered by pastexperiences of need frustration (e.g., social ostracism andinjustice), which could be triggered or exacerbated by a healthcrisis and subjectively experienced as mistrust due to the loss ofsignificance. This mistrust could then be further affected by how
authorities and policymakers alienate the psychological needs ofthe population through their management of a health crisis andthe enforcement of sociosanitary measures. This lack of trust is tobe taken seriously, as it has been associated with a higher risk of
not complying with measures and behaviors intended to containthe spread of a virus (e.g., refusing to get vaccinated, avoiding toconsult with a health professional, etc. Vinck et al., 2019).

A PUBLIC HEALTH CONCERN
There is a dire need for official authorities worldwide to tackle thisissue, as conspiracy endorsement feeds at least three clear publichealth concerns. First, the actions perpetrated by conspiracy
believers increase the risk of contracting and propagating
SARS-CoV-2 among the population, which, unsurprisingly, puts
resources and financial pressures on health care systems. In
addition, conspiracy theories can have economic repercussionsat an individual level. Individuals of low socioeconomic status
can see their financial struggles increase due to influential
conspiracy leaders who tend to ask for financial donations to fundtheir organizations and to continue promoting their alternative
narratives. Financial donations are often portrayed by conspiracy
narratives as a way to restore the lost sense of significance. Last,people integrating conspiracy theories as core beliefs should beof high concern for governmental representatives and healthprofessionals. Such core beliefs increase the likelihood of one
endorsing other conspiracy theories and networks in the long run(van Prooijen, 2020), potentially further bolstering their distrust
and rejection of traditional medicine (e.g., vaccines, treatments,
and basic hygienic measures).

POTENTIAL INITIATIVES
Policymakers and authorities should be careful to not
circulate mixed and confusing messages at a given time

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Conspiracy Theories and Public Healththe pandemic1 . Such a detector would have the potential toprovide tailored information based on the misunderstandingsof the population and unfounded rumors not reported via
the qualitative community feedback mechanism. Based on thisdetector, authorities could make a weekly review and disseminate
it to the media (e.g., editorials and radio stations) to inform thegeneral population and disseminate it to elementary, high school,
and college professors to ensure the circulation of adequate andtruthful information among youth.

local governments should ensure their population the universal
access to a feedback mechanism regarding SARS-CoV-2 sothat all can demonstrate self-affirmation by expressing theirthoughts, perceptions, and questions about the current pandemic(Poon et al., 2020; van Prooijen, 2020). Special advisors should
be appointed to oversee the mechanism and the adequate
communication between involved parties (Sigfrid et al., 2020).
State and local governments should also take the time topublicly and transparently respond to questions and comments
raised via the feedback mechanism (including recognizing thelimitations of government in understanding SARS-CoV-2), thus
demonstrating that concerns of civilians are considered in thedecision-making process (Niang, 2015; Baggio et al., 2019). The
aim should not simply be to convince people of the “truth” butrather to create a bidirectional communication system allowing atrue connection of trust between civilians and officials (O’Malley
et al., 2009) and acknowledge the emotional stress induced by
the current situation. This type of mechanism would support
the needs for autonomy, competence, and relatedness and would
therefore potentially reconnect one with truthful information
regarding SARS-CoV-2 (Goldberg and Richley, 2020).
Second, at a micro-level, when health professionals facea person who endorses a conspiracy theory, we strongly
recommend them to open a non-judgmental dialogue and instill a
sense of trust in the relationship. Given the premise that endorsed
conspiracy beliefs are a failed attempt to satisfy thwarted needs,
these dialogues represent an opportunity that must be grasped (1)to let the person express their beliefs in a safe environment, (2) torespectfully offer rational counter-arguments if necessary, (3) torationally explore why the counter-arguments are frustrating andhow the conspiracy beliefs could keep one frustrated in terms of
autonomy, competence, and/or relatedness, and (4) to investigate
healthy ways to fulfill the needs so that the person can reconnect
with others (Niang, 2015; Orosz et al., 2016). Such actions havethe potential to satisfy the initially thwarted needs, therefore
curbing the influence of conspiracy beliefs.
Finally, not all believers in conspiracy theories are on the
track to radicalization. Kou et al. (2017) described how “in theface of crisis, people face enormous uncertainty and have urgent
information needs,” which translates into important needs forautonomy and competence. Some, in a quest for “collective
sensemaking,” (Kou et al., 2017) were only deceived by fakenews advertised on social media or were misinformed by atrusted close other (European Commission, 2020). Around theworld, some countries tried to counter distrust regarding SARSCoV-2 by employing fear campaigns that advertised threatening
health messages, further frustrating the need for competence
and autonomy (Stolow et al., 2020). Research suggests thatthese campaigns are ineffective, as they are experienced ascontrolling and only extrinsically motivate one to comply withthe recommended health measures (Williams et al., 1999). They
often have a short-term modest effect (Tannenbaum et al.,2015), mostly among people who are already in agreementwith the message, but they fail to change the behaviors of
the target group for which they were developed (Ruiter et al.,2014). Instead, authorities should employ rumor detectors(Baggio et al., 2019) specifically targeting fake news regarding

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GETTING POLICYMAKERS TO
IMPLEMENT CHANGESAt the moment, there is a need to raise awareness of policymakers
on the issue of conspiracy endorsement. To do so, we strongly
encourage researchers and other professionals working in thefield of conspiracy to increase their presence in the media (e.g.,
via radio hosts and journalists) to circulate reliable informationand to get the conversation going on the issue of conspiracy
endorsement (Burstein, 2003). By raising the salience of the issue
and by changing the public opinion on this issue, the chancesof getting the attention of policymakers increase (Burstein,2003). In addition, more articles and materials written in lay
language are needed (Economic and Social Research Council,
2021). Such articles and material could be tailored for publishingin daily newspapers known to be read by policymakers (e.g.,
The Hill Times in Ottawa, Canada). The members of the public
who feel concerned by the issue of conspiracy endorsement
should be encouraged to lobby and/or to solicitate their local
or state government representatives via emails, phone calls,
and in-person meetings to encourage the implementation of
preventive initiatives. The civic engagement action of lobbying
could even increase the satisfaction of the three psychologicalneeds by rallying members of the public with an objective,
providing a sense of self-efficacy, and producing a sense of control
within their society.
To increase awareness and highlight the scale of the issue ofconspiracy endorsement in the population, we further proposethat researchers investigate the societal costs generated byconspiracy endorsement and their associated behaviors. Suchsocietal costs would include the direct costs related to mental
health issues and the actions associated with endorsed conspiracy
theories, including health services used due to mental and/or
physical health issues and their indirect impact on loss of
productivity at work and job turnover. The direct costs could
be two-fold; on the one hand, people who endorse conspiracy
theories are at risk of refusing and avoiding traditional healthcare services (including refusing vaccines) in favor of alternative
medicines, which could have long-term impacts on their healthand the spread of viruses in the general population. On theother hand, the development of long-term diseases and/or
the development of mental health issues could have a direct
economic impact on health care services used (e.g., emergency
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Conspiracy Theories and Public Healthreduce the prevalence of endorsement of conspiracy theories;
however, the best approach to regain trust is unknown (Vinck
et al., 2019). The initiatives presented in this article aim toincrease community engagement and trust toward authorities bysatisfying the needs for autonomy, competence, and relatedness;
however, they do require a certain basic level of trust fromthe population, which is a limitation to their potential efficacy.
It is therefore not possible at the moment to determine thelevel of efficacy of the presented initiatives. To try to ensure
their efficacy, governments will have to multiply their voices atvarious places simultaneously and deliver consistent messages
and information. Governments could also collaborate withalternative and local leadership figures present in the population(e.g., athletes, influencers, and religious figures, Coltart et al.,2017; Vinck et al., 2019). We encourage that the implementationof the proposed initiatives is paired up with an assessment of theirusefulness and efficacy.
Some governments have already implemented channels ofcommunication through which people can raise their concerns
and ask questions (e.g., public consultations with the populationand government representative talks including question periods).
However, the effectiveness of these channels of communication
can be hindered, as some governments do not end up
holding their end of the bargain and implement the changes
promised. If governments do not listen to the concerns of
their population, transparently communicate, and support thesatisfaction of the needs of the population for autonomy,competence, and relatedness, one unavoidable consequence isthat the endorsement of conspiracy theories will increase and,
therefore, negatively affect the public health of their population.

room visits, hospitalizations, psychiatric hospitalization, andmedication use).
The understanding of health professionals on conspiracy
theories should also be actualized and updated. Professional
orders (i.e., doctors, psychologists, and socials workers) should
encourage health professionals to attend continuous training
activities demystifying conspiracy theories and how to address
them when confronted with an individual endorsing them.

ACCOUNTABILITY AND
TRANSPARENCY
Given the importance of the issue of mistrust toward authorities,
the handling of actions perpetrated by governments andhealth professionals that can reinforce conspiracy theories
is to be considered. Indeed, past conspiracies that wererevealed as true have served as fuel for the current unjustified
conspiracy theories circulating (e.g., Tuskegee experiment,
Wikileaks, etc.; Smallman, 2018; Pierre, 2020). To facilitate
the implementation of the proposed initiatives and increase
trust, authorities and policymakers should support and value
the concepts of accountability and transparency (Coltart et al.,2017). Accountability is important to value due to thesecrecy element characterizing conspiracy theories. Government
officials, medical professionals, researchers, and any otherauthority figures who perpetrated and/or caused the persecutionof a group, intentionally or not, should be publicly held
accountable. Covering up past and present faults only risks
amplifying the secrecy element of conspiracy theories andreinforcing their endorsement and generalization. The other key
element, transparency, has been pointed by multiple authors
as a critical principle with which to manage public healthconcerns, including epidemics, which are events of tremendous
uncertainty (O’Malley et al., 2009; Carlsen and Glenton, 2016).
Governments holding back information increase the risk thatpeople “collectively generate alternative narratives” (Kou et al.,2017). Carlsen and Glenton (2016) reported similar conclusions
and highlighted the importance of being transparent regarding
the rationale of strategies used and the reasons for the decisions
taken. Based on their systematic review of qualitative studies,
Carlsen and Glenton (2016) believe that “transparency regarding
uncertainty” would lead to “compliance with public healthstrategies.”

DATA AVAILABILITY STATEMENTThe original contributions presented in the study are includedin the article/supplementary material, further inquiries can bedirected to the corresponding author.

AUTHOR CONTRIBUTIONS
M-JL conceptualized the manuscript and conducted the literaturesearch, wrote the original draft, contributed to the critical reviewof the manuscript, and edited the manuscript. FP supervised
the conceptualization of the manuscript and contributed to thecritical review of the manuscript. Both authors contributed to thearticle and approved the submitted version.

DISCUSSION
The present article asserted that conspiracy theories are
narratives that can lead to violent radicalization via the thwartingof the universal needs of autonomy, competence, and relatedness.
There is a consensus among experts that mistrust toward
government representatives and authorities is central to the
spreading of conspiracy theories during epidemics. Such mistrust
toward authorities and influential figures could reflect therepetitive thwarting of needs. Accordingly, initiatives promoting
community engagement are considered essential to ensurecompliance with health measures during epidemics and to
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FUNDING
This work was supported by the Social Sciences and Humanities
Research Council of Canada (Grant number #430-2018-00740).

ACKNOWLEDGMENTS
We thank Nessa Ghassemi-Bakhtiari for her feedback on thisperspective article.
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July 2021 | Volume 12 | Article 682931