Global pandemics, conflict and networks - the dynamics of international instability, infodemics and health care in the 21st century.

Background: The COVID-19 global pandemic is a harbinger of a future destabilised world driven by climate change, rapid mass migration, food insecurity, state failures and epidemics. A significant feature fuelling this destabilised world is networked misinformation and disinformation (referred to as an infodemic), particularly in the area of health.

Aims: To describe the interactive dynamic of climate change; mass population movement; famine; state failure and epidemic disease, analyse developments over the year 2020-2021 and discuss their relationship to an infodemic about disease and public health responses and how this should be addressed in the future.

Methods: Using the concept of 'the Five Horsemen' of epochal change and network theory to guide a narrative review.

Results: Concepts of epidemiology are reflected in how misinformation is spread around the world. Health care services and personnel face threats as a result that make it more difficult to manage pan global health risks effectively.

Conclusions: Heath care professionals at an individual and organisational level need to counter infodemic networks. Health care professionals who consistently spread misinformation should have their licence to practice withdrawn.