Global research has highlighted the declining public confidence in vaccines, focussing on the important role of social media in contributing to this decline. As such, several public health interventions have used social media to counterbalance its risks and to promote vaccination. Such research and interventions commonly assume that mistrust in vaccines arises from limited or a lack of information, which can be redressed through education and awareness raising.
A new study published in the BMJ explores the limitations of this assumption, and how a better understanding of the more complex socio-political drivers of distrust could increase the potential of social media to rebuild vaccine confidence. The study reviews critical social science research and theory on vaccine confidence, including what it is, what hinders or drives it, and what may help to (re)build it. It explores how insights from this scholarship could inform interventions using social media as part of a broader public health approach to promote vaccine confidence.
The research was conducted by Dr Sara Cooper from the South African Medical Research Council’s Cochrane South Africa, together with colleagues from Bayero University and Aminu Kano Teaching Hospital, Nigeria; Makerere University, Uganda; Catholic University of Bukavu, DRC; Kamuzu University of Health Sciences, Malawi; Africa Centres for Disease Control and Prevention, African Union Commission; and World Health Organization Regional Office for Africa, Congo, respectively, and was funded by Advancing Health Online Initiative (AHO), a consortium of partners including Meta and MSD, and several non-profit collaborators.
Significance of findings
- Using examples across time, place and vaccines, the findings indicate how vaccine confidence is a complex phenomenon that reflects multiple dynamics and webs of influence including - social, material, historical, and political.
- It shows how many of the drivers of vaccine confidence are not about the vaccines themselves, but about the relationships that people have with institutions, systems, and experts—big and small; past and present.
- It also demonstrates how distrust in vaccines and the entities behind them is not always unreasonable or irrational and relates to genuine concerns about the intentions of authorities, to processes whereby people feel disrespected or unheard, or to feelings of betrayal by systems meant to provide protection.
- Further, the findings indicate that (re)building confidence in vaccines requires comprehensive community engagement to develop more trusting relationships between citizens and authorities. It shows how much can be learnt in this regard from the rich history of community engagement and social sciences research in Africa—for example, in the context of polio eradication efforts, HIV/AIDS treatment advocacy, Ebola outbreak responses and vaccine trials, malaria vaccine trials, and most recently covid-19 vaccines. Experiences from these initiatives underscore the power of listening and dialogue, transparency, relationships, and local community ownership and participation.
Dr Sara Cooper said “The drivers of mistrust in vaccines are potentially deeper and more complex than the dominant narratives about social media and vaccine confidence would have us believe. Our review demonstrates how critical social science research and community engagement initiatives in Africa can provide important insights for understanding these factors and for using social media to promote vaccine confidence in all its complexity.”
“Drawing on these insights, our review describes how many of the core characteristics of social media could be utilised to foster in-depth community engagement and trust building. For example, social media provides an ideal mechanism for ‘social listening’ to understand and ground communications in community concerns and sentiments; for leveraging trusted individuals or organisations to work with the public; for facilitating creative, two-way, and open forms of engagement; and for community mobilisation and collective action that is more horizontally networked rather than vertically controlled”, concluded Dr Cooper.
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Contributor: Dr Sara Cooper, Cochrane South Africa