This story is part of Doubting the Dose, a series that examines anti-vaccine sentiment and the role of misinformation in supercharging it. Read more here.
In an apartment that she shares with her sister in Dhaka, Bangladesh, 24-year-old Sultana Mehjabin Tushi now spends her free time scrolling through social media looking for lies about COVID-19 vaccines.
Like the rest of the world, Bangladesh has been flooded with misinformation about COVID-19 and the new vaccines. Tushi is a volunteer for a program run by UNICEF that trains young people to find and report misleading posts online. “A recent rumor about the COVID-19 vaccine I came across was that it will endanger the lives of people and will be even more dangerous than the COVID-19 virus ‘made by China,'” she says. “‘They want to harm Bangladeshi people, and that’s why we should not take it. I saw it in a random Facebook group and reported it after seeing it.”
It’s one small piece of the work that organizations such as UNICEF and governments are doing to try to increase acceptance of the COVID-19 vaccines in the developing world. In one recent survey in Bangladesh, around a third of respondents said that they were reluctant to take the vaccine. The numbers vary by country, but in much of the world, a significant proportion of the population still isn’t convinced that they want to be vaccinated. The slow rollout of vaccines is another major challenge, but as vaccines become more readily available, the fight against misinformation will only become more pressing.
Heidi Larson, founder of the Vaccine Confidence Project
People seem to really be believing some of these things more than in our historical memory.”
Rumors about the supposed dangers of vaccines have grown more prominent with COVID-19. “People seem to really be believing some of these things more than in our historical memory,” says Heidi Larson, the founder of the Vaccine Confidence Project, a research group that studies vaccine misinformation and hesitancy at the London School of Hygiene and Tropical Medicine. “I think in these times of hyper-uncertainty, people need some story that makes all of this somehow coherent. And some of these conspiracies give a storyline to it that kind of makes sense.”
Many of the ideas are recycled from previous conspiracies: Before some people claimed that 5G caused COVID-19, others claimed that 4G caused H1N1 and 3G caused SARS. The misinformation varies by location, though there are many common threads. In Afghanistan, some people don’t think they need the vaccine because of a persistent rumor that Muslims are immune to the virus. In sub-Saharan Africa, “we’ve seen many people claim that COVID doesn’t affect Africans, and it’s a white-person problem that governments are using to delay elections,” says Mesfin Teklu Tessema, the head of the health unit at the International Rescue Committee, a nonprofit that works with refugees and others displaced by war and natural disasters. Others believe that the vaccine causes infertility.
When people are living in a conflict zone or under a government they don’t trust, they’re even more likely to be susceptible to misinformation. During an Ebola outbreak in the Democratic Republic of Congo, for example, “People saw people dying from Ebola, and they still resisted using the vaccine,” Tessema says. “They saw it as a government tool to intimidate them or to sterilize the population. Because they have decades of hostilities and mistrust with the government, anything that comes from [the capital] Kinshasa is received with suspicion.”
In the case of Ebola, the International Rescue Committee focused on working with people who were trusted in the community—healthcare workers, religious leaders, and other community leaders—to share accurate information about the vaccine. It’s the same basic strategy that it and other organizations are relying on for the COVID-19 vaccines. It’s especially important in areas where internet access still isn’t widespread. “It’s really about interpersonal relationships and that community dialogue that really matters in those places,” he says.
Nicole Grable, public health adviser at Mercy Corps
“We trained ‘truth champions,’ people who were part of community groups, to send back to us the rumors that they were hearing.”
In Liberia and Burkina Faso, UNICEF is using social listening—tracking trends on social media—to find both gaps in information and rumors about the new vaccines. To respond to rumors, one strategy it’s testing is to use “inoculation” messages, with the theory that if you expose someone to a rumor in the right way in advance, they’ll be less susceptible to it later, in the same way that a vaccine made from a weakened virus can help protect someone from the actual virus.
The strategy involves sharing a clear, “sticky” fact that people will remember, then giving a warning with a weakened version of the rumor, flagging reasons why someone might share that rumor for financial or political gain, and then finishing the message with the correct information again. Recent studies suggest that the approach can help. A recent guide for governments and organizations about vaccine misinformation that UNICEF developed with the Yale Institute for Global Health and the nonprofits First Draft and the Public Goods Projects explains the strategy, along with an overall approach to tackling the problem.
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Organizations are testing a variety of other tactics. In South Africa, as part of a national COVID-19 vaccine communications plan that it’s working on with the government, UNICEF filmed short stories about people’s experience with the disease, and it has been playing the videos on LED screens on trucks driving from community to community as a way to increase understanding of the risk, so people are more likely to want the vaccine.
In Haiti, Mercy Corps ran a text and voicemail campaign last year about COVID-19, which it’s now relaunching with a focus on the vaccines. (Since not all Haitians own smartphones or have internet access, texting and calls are the best way to reach the most people.) It’s also hiring digital community organizers to spread accurate information in the country, both through their own networks and through influencers such as DJs and religious leaders. In the program with social media volunteers in Bangladesh, UNICEF is also asking volunteers to help share correct information in their networks.
The most effective strategy may be working directly with community leaders. “I think there’s way too much focus on debunking misinformation,” Larson says. “I think it’s important, but it’s not going to fix the problem. . . . It’s important that people don’t read stuff that says, ‘If you drink a quart of chlorine, it’ll cure you.’ That’s bad, and people should know that that’s wrong. But that’s not going to change the emotions, sentiments, and attitudes behind this. So I think we really need more of a trust-building strategy.”
Tessema, from the International Rescue Committee, believes that working with trusted leaders in communities will help overcome hesitancy to take COVID-19 vaccines, the same way that it helped overcome hesitancy about the Ebola vaccine. The lack of supply of the vaccine in low-income countries is an even bigger challenge, he says, arguing that we need to do much more to help ramp up manufacturing. (Like many other advocates, Tessema believes that pharmaceutical companies that received taxpayer support to develop COVID-19 vaccines have a responsibility to share their intellectual property so other companies can help speed up manufacturing.)
Still, misinformation about vaccines is likely to continue to be a significant challenge in the developing world, just as it is in countries such as the U.S. And what happens with the COVID-19 vaccines will impact how people think about vaccines in general. “I think we should make every effort to get this right,” says Larson. “Not just for COVID, but for after COVID. This is a huge moment in history that we’re creating. If people remember being left out in COVID, that’s what they’re going to remember the next time we have a problem. And they’re going to trust even less.”