Polio Vaccine Misinformation on Social Media: Challenges, Efforts, and Recommendations

"Given the growing trend toward online health-seeking behaviour and online health communication initiatives targeted at eradicating polio in Pakistan, it is important to recognize the roles that online mis/disinformation efforts play in vaccine communication."

In regions of Pakistan like the Federally Administered Tribal Areas (FATA) and Khyber Pakhtunkhwa (KP) province, resistance and hesitancy toward polio vaccines are driven by socio-cultural, political, and religious factors. On April 22 2019, false rumours regarding the side effects of the polio vaccine quickly spread across various social media platforms, including Facebook, X (formerly known as Twitter), WhatsApp, and YouTube. This rapid spread of misinformation had a detrimental impact on Pakistan's efforts to eradicate polio. This essay focuses on two key dimensions of polio-related misinformation on social media in Pakistan: the current landscape of polio misinformation and the governmental efforts aimed at mitigating its effects.

As a foundation for the analysis to follow, the article explores health information seeking on social media, particularly in Pakistan, where limited access to health information remains a significant barrier to achieving knowledge-based healthcare. But Pakistan's significant surge in internet access and usage in recent years has enabled anti-vaccination campaigners to compete for online attention with government-funded efforts by strategically timing the release of videos and messages to dissuade people from receiving the vaccine alongside the launch of polio vaccination campaigns. Certain campaigners draw inspiration from Western anti-vaccination movements, translating the misinformation from English to Urdu so as to make these inaccuracies more accessible to the broader population in Pakistan. This practice is not limited to anti-vaccination propagandists; it extends to Pakistani journalists, who, during the COVID-19 pandemic, translated news stories about vaccine dangers from the West into Urdu, contributing to vaccine hesitancy among local newspaper readers.

As outlined here, in 2011, the polio eradication programme in Pakistan encountered particular challenges associated with the spread of online vaccine-related misinformation after online rumours circulated that a local provider was involved in a house-to-house hepatitis B vaccine campaign that reportedly aided the Central Intelligence Agency (CIA) in locating Osama bin Laden. This rumour had severe consequences for the polio eradication campaign, especially in northern regions of Pakistan, where militants and extremist Islamic clerics have propagated the false belief that vaccinators are foreign spies.

Then, on April 22 2019, a fake X account, falsely presenting itself as a "24-hour news service" based in Karachi, disseminated a video containing unsubstantiated claims of children falling ill after receiving the polio vaccine. During the same timeframe, a Facebook page affiliated with a regional news media outlet uploaded a series of videos presenting similar unverified assertions. All the claims on these videos were refuted by government authorities, yet the situation quickly escalated into violent protests, culminating in an incident in Peshawar, a high-risk district for polio transmission, where a hospital was set ablaze. In the aftermath of these events, a lingering hesitancy among parents to vaccinate their children persisted. Consequently, over two million children remained unvaccinated against polio after an 8-month suspension of the polio vaccination campaign. This incident also triggered a notable surge in cases of vaccine refusal.

Based on these examples, the researchers find polio-related misinformation on social media to be a significant threat to public health, resulting in vaccine refusals, erosion of trust in public health institutions, and distrust in science, and providing opportunities for anti-vaccination groups and individual advocates to target healthcare workers involved in polio eradication efforts nationwide.

Next, the article examines collaborative initiatives undertaken by relevant government institutions and social media companies in response to the growing prevalence of polio-related misinformation. For example, the Emergency Operations Center KP launched a targeted campaign that enlisted the expertise of medical professionals, parents, and polio health workers. This campaign aimed to confront and dispel the pervasive rumours linking the vaccine to children falling ill. The Pakistani government has collaborated with Meta to block or manage the dissemination of anti-vaccination propaganda on their platforms within Pakistan. The government has also taken steps to counter polio-related misinformation through its Perception Management Initiative (PMI). Furthermore, official polio Facebook pages like End Polio Now have played a significant role in addressing vaccine-related misinformation on Facebook.

Several barriers exist to tackling the proliferation of misinformation on social media, as it presents a multifaceted challenge for these reasons:

• A significant portion of the information circulating on social media is not explicitly labeled as misinformation; instead, it is characterised by misleading language choices or exaggerations.
• Misinformation often relies on anecdotal evidence or personal narratives, making it challenging to refute.
• The use of automated bots to spread misinformation presents a formidable obstacle in countries like Pakistan with low levels of education, internet, and health literacy.
• False content is the predominantly in Urdu (i.e., national language of Pakistan) and Pashto (i.e., regional language widen spoken in KP province) languages. These languages carry a strong connection with the local populations, making content presented in them more relatable and trustworthy.
• Maintaining a balance between content removal and the freedom of expression is challenging. The move on the part of the Ministry of Law and Justice in Pakistan to criminalise the dissemination of fake news by introducing amendments to the Prevention of Electronic Crimes Act of 2016 has sparked intense criticism from proponents of free speech. There is ongoing debate and observation regarding the impact of this potential legislation on mis/disinformation regulation and its implications for freedom of expression.
• Collaborative initiatives between the government and social media companies have focused on simplistic strategies of merely deleting content and accounts linked to misinformation. This approach overlooks the potential benefits that can be gained from engaging diverse stakeholders in a more comprehensive way to effectively combat online misinformation regarding the polio vaccine.

The article proposes four approaches as a pathway forward:

1. Pakistani authorities need to consider embracing a more inclusive approach by engaging multiple stakeholders, including academics, scientists, researchers, educators, political parties, government entities, digital rights groups, civil society activists, Pashtun community leaders, religious scholars, journalists, fact-checkers, and media advocacy groups, to devise comprehensive strategies for combating misinformation. To achieve this, the Pakistan Polio Eradication Programme (PPEM) needs to strengthen the capacity of the PMI.
2. PPEM needs to conduct a thorough analysis of the intended population to identify potential interventions and subsequently communicate the recommendations to PMI so that it might more effectively boost awareness and improve health literacy regarding anti-vaccination propaganda associated with polio in Pakistan.
3. Educational materials need to be designed through a collaborative effort among the aforementioned stakeholders and presented in multiple languages, including Pashto. Children, especially those from working-class and lower-middle-class backgrounds, often act as facilitators for their parents' access to technology due to their potential tech literacy limitations, so educational interventions are particularly needed to protect them from the harmful impacts of misinformation. By incorporating best practices in media information literacy and health literacy, the PMI could create understandable flyers, infographics, and brochures to increase awareness about the risks and benefits associated with the polio vaccine.
4. The PMI could actively promote independent fact-checking initiatives to join government efforts in combatting misinformation.

In short, this analysis has found that prevalent online mis/disinformation has significantly contributed to the increase in polio vaccine refusal in the Pakhtun community since the 2019 incident. The online mis/disinformation campaign not only mirrors but also reinforces public distrust in government-led public health initiatives. This skepticism is rooted in various factors, such as Pakistan's historical experiences with colonialism and its rigid government structures, widespread perceptions of United States government interference in public health campaigns, and the influence of religious groups. "In a broader context, this essay sheds light on the major challenge of public distrust in science in the digital media landscape in a country in the Global South."

The researchers conclude by underscoring the importance of addressing language-specific misinformation and tailoring communication strategies to effectively counteract false narratives in the local community. "Successful initiatives demand the active involvement of all stakeholders."