A coherent and innovative bottom-up action plan is the way forward to combat the infodemic
Amidst the ongoing, prolonged Covid-19 outbreak with recurring questions on re-opening schools, colleges and workplaces, the only solution at hand is the rapid vaccination of the country’s mammoth population, coupled with social distancing and other measures. Given that just under 10% of the population is fully vaccinated, the next big challenge, once the vaccine shortage is taken care of, is to address the vaccine hesitancy. Fuelled by misinformation and declining public trust, the path to vaccination coverage is strewn with challenges that require immediate attention.
Recently, a video from Uttar Pradesh’s Etawah district surfaced where an old woman was seen hiding behind a drum fearing Covid vaccination, showing how real vaccine hesitancy is in the rural belts of the country. Not just the rural areas, an anxious 45-year-old domestic worker and her family in Hyderabad were quite hesitant to take the vaccine owing to the fear that it might kill them. This is a classic instance of how fears, myths and rumours have translated into real-time and large-scale hesitancy and a dip in the vaccination uptake.
Like the virus mutations, misinformation has also manifested over time since the beginning of the vaccine rollout. While in the beginning, people, including the frontline workers, were sceptical of the vaccine timelines and its efficacy, several States in India struggled with low turnouts. Even the healthcare workers were not immune to the misinformation infodemic. Despite the steady pace of vaccination over time, the misinformation infodemic continues to thrive.
Over the last few months, owing to the misinformation circulating on social media, people have either moved to a ‘wait and watch’ approach or reject the vaccine. The reasons for hesitancy/refusal include social media content (unscientific cures, conspiracy theories, rumours, fake news), anecdotal (word-of-mouth, past experiences), hyperlocal rumours in the case of rural India, sense of invincibility, lack of safety around vaccination centres, serious consequences post inoculation, including impotence & death, religious reasons, choice of vaccines, changing guidelines of the gap between the doses and contraindication that women should not get Covid-19 vaccines during their menstrual cycle.
The same is reflected in the cases of larger States including districts of Uttar Pradesh and Rajasthan, which have slipped into the chasm of anxiety and mistrust. Owing to poor and unclear communication, ripple effects of vaccine hesitancy are especially seen in the rural and tribal-dominant regions and among the minority communities. In fact, according to a Local Circles survey, 33 crore Indian adults may currently be hesitant to take the vaccine. With the recent inclusion of pregnant women for inoculation, significant hesitancy has been observed among this group. A 16-country survey on Covid-19 vaccine acceptance among pregnant women has revealed that potential harmful side-effects to the foetus have been noted as the primary reason for vaccine hesitancy.
Another added layer to this is the fear spread through vernacular media reports with captivating headlines written and reported without scientific understanding. For instance, the results of a preliminary study conducted by ICMR scientists on 274 samples of breakthrough infections (testing positive after the two doses) in Odisha were misrepresented by projecting the vaccines to be ineffective against the variants. Instead, what should have been reported is that 99.6% of people who had breakthrough infections survived. The preprint study also highlighted the need to monitor the emergence of any vaccine-escaping variants and accordingly plan the next steps of the vaccine development.
Having gone through the lethal second wave and bracing ourselves for the third wave, tackling misinformation is an important and urgent challenge to address. Ignoring vaccine hesitancy only implies more scope for misinformation and the vicious cycle continues.
However, there are also success stories, including how local governments are taking the lead in addressing the hesitancy. A case in point being all the panchayat members of Melghat village in Maharashtra have set an example by taking the vaccine and overcoming the hesitancy in their region. While Bikaner in Rajasthan is set for a door-to-door vaccination drive, teachers in Tamil Nadu have been performing skits to ward off hesitancy in the rural areas.
A three-pronged strategy is suggested to combat vaccine-related misinformation. First, given the diversity and distinct topography of the country and the varied reasons behind vaccine hesitancy, there is no ‘one-size-fits-all’ solution. It is imperative to curate and adopt local solutions through the concerted efforts of community stakeholders, including the local government — from District Collector to the panchayats, civil society organisations, teachers, healthcare workers (doctors, nurses, ASHA workers), local influencers, among others.
However, one must be careful in devising local strategies especially in the case of vaccine hesitancy, which has behavioural and psychological aspects to it. For instance, while incentivisation or compulsion appears to be feasible, it will only further erode the trust in the efficacy of the vaccines and in the institutions.
Similarly, at the national level, an effective, targeted, and rigorous communication plan must be undertaken by the State and national governments to campaign for the vaccination uptake. Neither vaccines nor vaccine hesitancy is a new challenge for India. In fact, there is a lot to learn from India’s successful polio immunisation campaign, which ensured last mile coverage of the polio vaccine. The government’s Universal Immunization Program included a holistic approach by partnering with community mobilisers, religious leaders, celebrity ambassadors and endorsements, advertisement campaigns across the nation through radio, print and television, among others. India’s turnaround response in its battle against polio is an important milestone and a reminder that through strategic planning and communication, logistical and hesitancy hurdles can be surmounted for the last mile vaccination coverage.
The second measure is to ensure better science communication, ie, to bring scientists and vernacular media journalists together so that the media professionals can be trained and guided with factual, sensitive, and real-time developments of the Covid-19 vaccines. This, in turn, will help educate the public and build trust in vaccine efficacy.
The third is to focus on transparency in sharing vaccine-related data. This includes publishing the findings of Adverse Events Following Immunization reports, efficacy studies of the respective vaccines and the phase III trials in the public domain to build trust and boost vaccine acceptance. This, in turn, must be clearly and easily communicated to the public. It is, therefore, pertinent to address the root cause of the problem of vaccine hesitancy, combating misinformation. A coherent and innovative bottom-up action plan is the way forward to combat the infodemic.
(The author is Health Fellow (Misinformation) at Factly, a program in partnership with Facebook)