Dear Dr. Nunes,

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Ivan Filipe de Almeida Lopes Fernandes, Ph.D.

Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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2. Has the statistical analysis been performed appropriately and rigorously? -->?>

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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Reviewer #1: Reviewer's report

Thank you for the opportunity to review the manuscript titled “Social inequalities in the misbelief of chloroquine’s protective effect against COVID-19: results from the EPICOVID-19 study in Brazil”. This manuscript presents original research examining the socioeconomic inequalities in beliefs regarding chloroquine’s protective effect against COVID-19 in Brazil, using nationally representative data. The topic is timely and relevant, especially in the context of health misinformation, political influence, and public trust during health crises. The study addresses important public health and equity concerns and employs appropriate methodological approaches, including the use of the Slope Index of Inequality (SII) and Concentration Index (CIX).

However, there are several areas that could benefit from further clarification and refinement:

The abstract and introduction are clearly written and provide a coherent overview of the research problem, objectives, and context. The background is well-situated in relevant literature, and the rationale for the study is well-articulated. The authors successfully convey the public health relevance of the research question, and the writing is concise and accessible.

Methodology

1. The manuscript introduces a Jeopardy Index based on the aggregation of four sociodemographic variables reflecting social privilege. While the operationalization appears reasonable, the authors should briefly explain why this specific index was used along with relevant references supporting its use.

2. This section should clearly state which statistical software was used for data analysis (e.g., Stata, R, SPSS), including the version.

Results

1. In the sentence summarizing participant’s demographic characteristics, report the exact percentages for race and education as well.

2. Line 156 can be rephrased like this for clarity: “Approximately 47.9% either lacked knowledge about or did not believe that chloroquine has a protective effect against COVID-19.”

3. In Table 1, I recommend including the counts (n) alongside the percentages (%) for each category of the variables.

4. In Table 2, the sample size is reported as (n = 88,772) in the heading, but this should be written as (N = 88,772) to reflect that it refers to the total sample. Please ensure that the notation for sample size (i.e., N for total sample, n for subsamples) is used consistently throughout the manuscript, including tables, figures, and text.

5. In the tables even though confidence intervals for inequality measures and other estimates are provided, it does not clearly indicate which variables or associations are statistically significant. Although readers can infer significance from whether the CIs include zero, it would improve clarity if statistically significant results were explicitly indicated, either in the text or in table footnotes.

6. The interpretation of SII and CIX results in the text could be expanded. Also, consider including key effect estimates (e.g., percentages, odds ratios, and confidence intervals) in the main text where relevant, so readers don’t have to rely only on the tables.

Discussion

1. The discussion is bold and well-supported with relevant references. The integration of political context and its influence on public beliefs is especially commendable. However, this section could be strengthened further by expanding the discussion on how socially disadvantaged groups are disproportionately affected in such scenarios. While this is touched upon, giving it more emphasis would enhance the depth and equity focus of the discussion.

Reviewer #2: Dear authors,

Congratulations on this manuscript. I believe it has merit for publication after revisions.

Title

• Short title appears truncated (“protective in Brazil”); suggest “protective effect in Brazil.”

Abstract

• Major: Abstract states “Lack of knowledge was 2.49 times greater among women than among men.” That appears inconsistent with the adjusted models (female vs male OR≈1.06 for “don’t know”). The 2.49 figure corresponds to Jeopardy Index 8 vs 0, not to sex alone; please correct.

• Clarify whether “yes” and “don’t know” are both treated as “denialism” in the abstract; the main text provides the rationale, but readers won’t see it here (See Discussion for justification).

Introduction

• Although I find it important in a personal way for the Brazilian context, several sentences speculate on political alignment and behavior. PLOS ONE prioritizes testable, neutral claims; please tone down speculative language or back it with citations framed cautiously.

• Where you assert widespread emphasis on chloroquine/policy decisions, ensure each claim has a source in text (some are cited later in Discussion). Consider moving part of the policy chronology to the Discussion or Supplement.

Methods

• The sampling is three stage (cities, census tracts, households), but it’s unclear whether analyses accounted for weights, clustering, and stratification (e.g., survey adjusted multinomial models; robust SEs). Please specify and, if not used, justify and consider re estimating with survey design corrections.

• You pool three rounds (May–June 2020). Indicate whether survey round was included (e.g., fixed effects) to address temporal shifts in beliefs, and report any round specific sensitivity analyses.

• Treating “don’t know” as “denialism” is conceptually debatable. You provide a rationale later; please pre specify this classification here and add a sensitivity analysis modeling “don’t know” separately (or as uncertainty), and another collapsing “yes vs not yes.”

About Joepardy index:

• • Clarify the distribution (mean, SD, histogram) and percent in each score (0–8).

• • Justify the coding choices (e.g., women=1 vs men=0; non white=1 vs white=0; ordinal steps for education/wealth). Consider a robustness check using an alternative weighting or PCA based index.

• Explain how you handled race/skin color (grouping “non white” merges Black, mixed, Asian, Indigenous). Consider disaggregated models by group to check for heterogeneity (if possible).

• Report full model terms for the multinomial regressions; confirm absence/presence of multicollinearity among index components when they are also modeled individually.

• Clarify whether city (or region) was included to capture contextual differences.

Results

• Reconcile the sex effect language with the models. The tables show only modest female vs male differences for “don’t know” (OR≈1.06).

• When stating that belief is “~20% across the index,” consider presenting 95% CIs for Figure 1 predictions and/or a test for trend/flatness.

Discussion

• Date inconsistency: You attribute high misbelief partly to data collected “between May and August 2020,” but Methods indicate May 14–21, June 4–7, and June 21–24 (no August). Please correct.

• Normative/political passages read strongly opinionated. Reframe in neutral, evidence based terms and minimize conjecture; ensure all assertions are cited and kept proportional to your data (e.g., claims about governmental strategy and herd immunity).

• Since “don’t know” drives the strongest inequalities, emphasize implications for risk communication and health literacy (who, where, how to target), and consider whether media exposure or regional context could mediate associations.

• Where you mention mask/stay at home results, add a brief Supplementary Table rather than “data not shown.”

Limitations

• Explicitly discuss design effects and any post stratification weighting (if used).

• Clarify misclassification risks in self reported beliefs and in grouping heterogeneous racial categories as “non white.”

Conclusions

Avoid causal language; emphasize that findings are associational given cross sectional design.

Reviewer #3: The manuscript addresses a topic of clear relevance to public health, as it discusses a form of social vulnerability across multiple contexts. The study demonstrates methodological rigor and adheres to established ethical standards. I consider it suitable for publication.

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what does this mean? ). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy

Reviewer #1: No

Reviewer #2: Yes: JOSE FIRMINO DE SOUSA FILHO

Reviewer #3: No

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Attachments

Attachment

Submitted filename: Reviewer file.pdf

Social inequalities in the misbelief of chloroquine’s protective effect against COVID-19: results from the EPICOVID-19 study in Brazil

PONE-D-25-30857R1

Dear Dr. Nunes Pereira,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Ivan Filipe de Almeida Lopes Fernandes, Ph.D.

Academic Editor

PLOS One

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions??>

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously? -->?>

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #1: Yes

Reviewer #2: No

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

Reviewer #2: Yes

**********

Reviewer #1: I have reviewed the revised manuscript and find that the authors have addressed the reviewer comments adequately. The revisions have strengthened the manuscript, particularly in terms of methodological clarity and interpretation of results. I do not have any further concerns and recommend the manuscript for publication.

Reviewer #2: Dear authors, congratulations on your work; I believe it is acceptable for publication in its current format.

**********

what does this mean? ). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy

Reviewer #1: No

Reviewer #2: Yes: José Firmino de Sousa Filho

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Attachments

Attachment

Submitted filename: Reviewer file_10.01.26.pdf