By Aastha Kant, Ria Golecha, K Viswanath
The government of India has recently approved two vaccines to prevent Covid-19 and, based on the number of candidate vaccines in clinical trials, more vaccines are on their way. The development of efficacious and safe vaccines in such a short span of time is a scientific feat that has few historical parallels and a signal demonstration of what decades of investment in scientific enterprise can do.
Equally important, if not more critical, is the daunting task of administering the vaccine to hundreds of millions of people into the farthest reaches of India. While development and deployment of safe vaccines is a matter of basic science and logistics, building trust and confidence in vaccines requires a different science – understanding human behaviour.
Anti-vaccine forces are already at work globally to engender mistrust threatening the vaccination programme. It is essential that we address early any signs of public distrust by engaging with the public and pre-empt the potential Covid-19 vaccine programme disruptions. When people see the risk of Covid-19 as a serious threat, and have a high degree of trust in science, vaccine acceptance grows. Transparency and trust are foundational to vaccine confidence and acceptance.
Viral misinformation has historically travelled faster than vaccines in India. The history of vaccination in India offers some important lessons. While immunisation is a success story in India, it has not been without challenges. India has witnessed serious resistance to several vaccines.
Owing to viral misinformation, certain communities believed that polio vaccination was a Western ploy adopted to sterilise their population and reduce their numbers. Lack of proper communication and transparency in the HPV vaccine demonstration study in Andhra Pradesh and Gujarat in 2008 led to erosion of trust in people with regard to the vaccine.
Kerala has been in the grip of viral WhatsApp hoaxes about how vaccines were causing more harm to their children than doing any good. As a result, parents of more than 2,40,000 children refused to immunise their offspring with the MMR vaccine, thereby stalling the immunisation drive for two months in 2017.
The old bromides against vaccination are rearing their ugly heads with the introduction of new vaccines. The bases of sowing seeds of mistrust are varied: false listing of ingredients in the vaccines, religious sentiments, political or party identification, fear of adverse effects though unfounded by science or evidence. Although India is a leading producer and exporter of vaccines, vaccine resistance continues in India.
Why is vaccine related misinformation breeding in India? The massive flood of information, rather misinformation and disinformation, is a major though not the sole contributor to vaccine resistance. Nationwide publicity campaigns raise vaccine uptake, but there are doubts about whether they really reach those who are most vaccine resistant.
Certain sections of the society are altogether doubting the seriousness of Covid-19 and questioning the need for vaccination against it. To make matters worse, misinformation on Covid-19 vaccine continues to spread through digital media such as WhatsApp, Twitter, Facebook and Instagram. These platforms have actively begun to counter misinformation and they could be even more aggressive.
Scientific literacy too matters. People, and often the media, confuse correlation with causation leading to connecting unrelated events and making causal misattributions. For example, vaccination is incorrectly and falsely attributed to cause autism among children just because the general diagnosis of symptoms of autism and immunisation occur in the same age period. Parents often latch onto the explanation available to them, hence misinformation on vaccines causing autism deters them from seeking life-saving immunisation for their children.
So what can be done? While various stakeholders are undertaking initiatives to curb misinformation at different levels, there is an urgent need to work proactively, address vaccine hesitancy and build vaccine confidence. Leaving it to frontline staff to address vaccines hesitancy places unreasonable burden on them. Other stakeholders such as media have an important role in reporting based on evidence and science rather than just quoting anti-vaccine actors.
Government has an enormously important role to play in two ways. First, to be transparent about its decision-making including providing information on clinical trials, and all safety related information. Evidence counts! Any perception that information is incomplete or being held back will only foster mistrust and provide grounds for spreading anti-vaccine sentiments.
Second, public health communication campaigns must try to build confidence in vaccines not just by proselytising about facts but addressing related side effects and fears. Engaging policy makers and advocates on evidence based issues as they develop vaccine related policy strategies is critical to ensure mass adoption of pro-vaccine policies.
Social media platforms have an important obligation to intervene more actively to deter rumours and conspiracies instead of putting the onus on individuals to sift information from mis- or disinformation. If each Indian citizen who administers a WhatsApp group ensures that no misinformation is forwarded and limits the number of forwards, then we can escape an impending public health emergency of misinformation overload concerning Covid-19 vaccine.
India’s story on vaccination is a success story. There is no reason that the same success cannot be replicated if Covid-19 vaccine communications are transparent and open and each stakeholder plays their part.
Aastha Kant is Project Manager, Ria Golecha is Project Coordinator, K Viswanath is Director at the Harvard TH Chan School of Public Health – India Research Center. Views are personal
Views expressed above are the author’s own.
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