As everyone reading this knows, the Covid-19 pandemic is raging around the world, with South Africa in the grip of a second wave worse than the first. At least 32,000 people in SA have died directly from Covid-19, and we have had over 71,000 “excess deaths” that can be attributed to the pandemic. 

Vaccines save lives. They are one of the most successful public health interventions ever – the World Health Organisation (WHO) estimates that immunisation saves over two million lives every year (four per minute). 

New vaccines for Covid-19 have been developed very quickly (in under a year – faster than the four years of development for the mumps vaccine, the previous recordholder). 

Some of these vaccines have now been approved for widespread use by regulators following rigorous testing for safety and efficacy. While non-pharmaceutical interventions such as staying at home, mask wearing and physical distancing remain vital, the greatest weapon against the pandemic is mass immunisation (some have called it the only silver bullet). 

This virus is catchy — we need vaccines urgently

As a result, South Africa’s government has ordered more than a million doses in the short term, with plans for millions more to arrive later this year. Over 66% of the population needs to be immunised to achieve herd immunity.

Yet, there’s a big problem. 

As President Cyril Ramaphosa said in his January 11 address to the nation, “There is much disinformation and conspiracy theories that are being spread around Covid-19 vaccines. Yet vaccines have been used to eradicate diseases such as smallpox and polio.”

Doubts and fears about vaccinations mean that many South Africans could reject immunisations when they are available (here, here and here). In a survey conducted by Ipsos in mid-December, 47% of South Africans said they would refuse innoculation against the coronavirus. 

Much of the vaccine hesitancy comes, understandably, from genuine questions or misunderstandings. Many rumours have power because they contain a grain of truth. These can be resolved through mutual respect and frank, open communication – building trust, answering questions, clearing up misunderstandings and raising public awareness. 

But vaccine resistance is also being fuelled by false rumours, lies and conspiracy theories. Some people in powerful positions who command respect, such as our Chief Justice and several senior ANC officials, have strongly rejected Covid-19 vaccines. Also, due to unfounded fears, 5G telecommunication towers were destroyed in KwaZulu-Natal.  

I am lurking in a South African WhatsApp group of vaccine denialists that has hundreds of messages a day condemning Covid vaccines, including videos suggesting Covid-19 = 666 (number of the beast) = AI = Antichrist (literally) = Gates branding everyone = Rapture which is predicted in Biblical Revelations (I won’t give a link as I don’t spread this junk). 

There is a long history of vaccine resistance (anti-vaxx), and it is crucial to address this now as thousands of lives are at stake. This has been studied extensively by Heidi Larson of the Vaccine Confidence Project.

In workshops run by the People’s Health Movement of SA (PHM-SA) in communities around Cape Town, all the following rumours were heard: 

“Covid-19 is not real; Physical distancing is neo-colonialism anti-Ubuntu; Covid is same as HIV; Covid comes from refugees & immigrants; Covid comes from 5G mobile phone networks; Covid is a conspiracy of government to control people; Covid is Chinese bio-terrorism against the world; Pharma companies caused Covid to make profit; Many scams to steal money – for food parcels, SASSA grants; Bill Gates is manipulating Covid & vaccines for global control; SA Covid rules are just an excuse for repression against the poor; Hydroxychloroquine is a cure or treatment for Covid; Tests for Covid actually spread Covid; Prayer and church pastors can cure Covid; SA government is lying about Covid.”

They are all false.

Infodemiology

Infodemiology is the WHO term for the science of managing infodemics, the overabundance of information – some accurate and some not – that occurs during an epidemic. 

The WHO makes a distinction between misinformation (unfortunate honest misunderstandings and rumours) and disinformation (the intentional spreading of confusion and lies for motives such as profit, subversion or ideology). 

As the director general of the WHO, Tedros Ghebreyesus, says, “We’re not just fighting an epidemic; we’re fighting an infodemic. Fake news spreads faster and more easily than this virus, and is just as dangerous.”

Strategies for dealing with this infodemic are provided in the newly released Vaccine misinformation management field guide released by UNICEF and partners. It provides guidance on how to respond to the infodemic, going through the stages of:

• Listen: Social listening of electronic media (websites, Twitter, Facebook, WhatsApp and more), broadcast media (TV, radio, newspapers) as well as reports of direct communications (e.g. rumours heard by community health workers) are brought together to a national repository.
• Understand: assess the misinformation, determining which are low risk and high risk of leading to vaccine resistance, as well as determining the most influential communication channels and the sources of dangerous disinformation. 
• Engage: in the longer term, provide tools and training for people to critically assess misinformation (pre-bunking). More immediately, debunk high risk misinformation in a particular format (present the correct facts; mention the misinformation with a warning; explain the fallacy; repeat the correct information). There are tools for making the information ‘sticky’ so people will remember and share.

Unicef supports systems like this in many countries.

Trust is more important than detailed knowledge (people believe a simple message from their pastor more than a lecture from an unknown professor). 

“Public health moves at the speed of trust,” as Rishi Manchanda says. We must use all the ways of communicating we can: broadcast media, celebrities, electronic media, local channels, especially through frontline health workers who tend to be highly trusted and are vital for a successful vaccination programme.

The WHO also advises all of us to assess the source of information we receive – go beyond the headline, identify the author, check the date, examine supporting evidence, check your biases and turn to fact-checkers. 

A number of strategies have been suggested for speaking to different people on various issues (here). Useful suggestions on talking to someone who is misinformed about the coronavirus are given here. 

Don’t simply contradict a deep-held belief: instead, come with empathy – useful suggestions are given here. Particularly effective is talking about your own experience, e.g. “Why I immunised my own children.”

It is important that all communications are respectful and kind, as Brendon Bosworth says. Most people passing on misinformation do so through genuine concern and uncertainty. Covid-19 science and vaccinology is confusing and there is much fear. 

We need communication grounded in empathy and facts to counter Covid vaccine resistance

What do we need in South Africa to manage this?

Luckily, there are already several great initiatives in South Africa. The Covid-19 People’s Coalition Health team, including PHM-SA, MSF and SECTION27, have developed very useful explanatory leaflets on vaccines. 

PHM-SA is running the community Covid-19 training sessions mentioned above. Pontsho Pilane of Motsweding FM radio provides an excellent service explaining health issues in Setswana. What’s Crap on WhatsApp fact-checks and debunks fake news and disinformation.

As the Unicef guide suggests, we need a partnership led by government to listen to what mis- and disinformation is being spread in South Africa, to assess the risks and plan a response, and then to carry out effective communications. 

This should include broadcast media, electronic and social media, and communications networks with frontline health workers, faith-based organisations, trade unions and other civil society partners. 

We need to do the basic work to allow correct information to be spread in South Africa – why, for example, is there not a simple list in all 11 South African languages of the confusing terms like epidemiology, virus, immune system, exponential, population immunity and many more?

We need a central repository organised by the presidency or the department of health that provides clear information and accurate refutations of all rumours identified, available in all SA languages. 

We need a call centre that anyone can call for free to check any rumour. 

We need a cadre of spokespeople to be available to respond immediately to any media request and to give interviews in all SA languages. 

We need a training course that is offered free to all journalists in the country on how to responsibly report on the pandemic and vaccine programme. 

We must involve traditional leaders and healers in this effort. We must support nurses, community health workers and other frontline health professionals to be knowledgeable advocates, who can report back on concerns, rumours, misinformation and lies. 

To be effective, we have to use all the channels we can to get accurate information accessible to all. In particular, we should work with people who are known and trusted. 

We need well-known people to promote the vaccine on live TV: Janine van Wyk, Thulani Hlatshwayo, Babalwa Latsha, Siya Kolisi, Dane van Niekerk, Quinton de Kock (the captains of the women’s and men’s football, rugby and cricket teams respectively), Caster Semenya, Chad le Clos, President Ramaphosa, all cabinet ministers, premiers and mayors, chief justice Mogoeng Mogoeng; heads of Christian, Muslim, Jewish, Hindu and other faith organisations, Trevor Noah, Charlize Theron, Miss South Africa Shudufhadzo Musida, Sho Madjozi, Benjamin Dube, Zolani Mahola, AKA, Cassper Nyovest, Zola, other great artists, bands and choirs, influencers like Tumi Sole and TV celebrities, as well as presenters on all TV and radio stations. 

We could generate FOMO (Fear Of Missing Out) among celebrities – everyone would like to be invited to be on the national “A list”, using their influence to save lives. 

This will be more effective than leaflets and (with the greatest respect) Daily Maverick articles. The Ministerial Advisory Committee on Social Change should organise this now, so these high-profile immunisations can happen in the first week the vaccine arrives in SA.

Also, everyone reading this article can do something to help. 

Many of us feel disempowered as the pandemic rages, locked down in our homes, doomscrolling through social media. However, we all have a crucial role to play: calling out misinformation wherever we see it. 

As we learnt from the HIV treatment movement, “Silence = Death.” 

It might be embarrassing to correct someone you know, but it could literally be life-saving. In the first Harry Potter book, Dumbledore tells us, “It takes a great deal of bravery to stand up to our enemies, but just as much to stand up to our friends.” 

Go on, be a hero of the infodemic! DM/MC

Peter Benjamin is an activist with the People’s Health Movement of SA, Muizenberg Community Action Network and HealthEnabled.