Editor’s Note: This week’s piece comes from researchers Dr. Chizoba Wonodi, Chisom Obi-Jeff, Dr Carleigh Krubiner, Elana Felice Jaffe, Dr. Ruth Karron, and Dr. Ruth Faden. They analyze the rise of conspiracy theories during public health crises like the current coronavirus pandemic and explore who is most vulnerable to conspiracy theories about COVID-19 vaccines and why people display vaccine hesitancy. The research is part of COVER, a six-month Wellcome-funded project led by researchers from Johns Hopkins School of Public Health and implemented in Nigeria by Direct Consulting and Logistics.
Less than 12 months after the World Health Organization (WHO) declared that the COVID-19 outbreak constituted a Public Health Emergency of International Concern, 11 COVID-19 vaccines have been approved and administered in 75 countries, with Nigeria planning to introduce in March 2021. Against the backdrop of the 108 million cases, 2 million deaths and 76.69 billion USD in economic loss globally, the COVID-19 vaccine is the world’s best shot at combating COVID-19 and returning lives and livelihood to normal. Yet, conspiracy theories (CTs) and a raging infodemic on COVID-19 and the vaccines threatens the vaccines’ promise.
What are conspiracy theories and why should they matter?
Conspiracy theories reject standard explanation for events and describe them as a secret plot perpetrated by influential people or organizations. These theories increase during social crises or health emergencies, due to uncertainties, contradictions, and psychological distress associated with the event.
When the COVID-19 quickly spread globally, leaving mass disruption and death in its wake, people were left with many questions and few answers. Conspiracy theories emerged to fill the gaps. Fueled by the internet and social media, CTs have travelled and thrived. There are different theories about the origin of COVID-19 and speculation about the motives behind COVID-19 vaccines in Nigeria. Nearly everyone has heard one CT or another, and many people continue to be bombarded with them daily. Belief in these CTs is concerning because it threatens the adoption of COVID-19 preventive behaviours, including potential vaccine hesitancy as an obstacle to achieving adequate coverage and immunity.
Conspiracy theories, fake news, and rumours about vaccines are not new in Nigeria. Their disruptive effects have previously exerted heavy financial and programmatic burden on the country. Widespread rejection of polio vaccination in Northern Nigeria in 2004 following false rumours that the vaccine sterilizes Muslim girls is still fresh in people’s memories. It took Nigeria more than a decade of concerted effort and significant funding to overcome the vaccine hesitancy and interrupt wild polio transmission. In 2017, a false rumour about the Nigerian army injecting children with ‘vaccines’ to cause monkeypox erupted in South East Nigeria. This rumour disrupted immunization activities in South East Nigeria, previously known for high immunization coverage and strong vaccine demand in both the public and private sectors. Given lessons from the polio vaccine experience, government officials, religious leaders and respected public figures quickly restored order and trust with targeted communication and public persuasion. The contrast between the long-running polio rejection and short-lived monkeypox disruption highlights the notion that vaccine hesitancy can vary by source and course. It also illustrates that no program or region is immune to direct or collateral damage from CTs and rumours.
Who will be most vulnerable to conspiracy theories about COVID-19 vaccines?
COVID-19 vaccines will be administered to a new cohort (adults) for whom there is limited experience on how they will accept the vaccine. Unlike the previous experience with polio and monkeypox rumours, where a single malicious plot was linked to one vaccine or event, with COVID-19, the CTs are numerous and wide-ranging. A recent analysis by the National Primary Health Care Development Agency (NPHCDA) and Nigeria Centre for Disease Control showed CTs circulating in Nigeria about COVID-19 vaccine safety, efficacy, allocation equity, and low confidence in the healthcare system. This begs the question, how different will COVID-19 vaccine hesitancy be compared to experiences with other vaccines; and what new approaches are needed to tackle the problem? While exposure to these COVID-19 CTs is almost universal, we do not know yet what proportion of the population believes them or a common profile/characteristics of a COVID-19 CT believer. Historically, vaccine hesitancy in Nigeria has been more common among populations with low literacy and poor health outcomes. Given the role social media plays in fueling COVID-19 misinformation, there is not enough evidence yet to fully understand the hesitancy pattern and whether the educated population is more or less skeptical than the less-educated population.
Why do people believe in conspiracy theories about COVID-19 vaccines or display hesitancy toward them?
The NPHCDA has commenced periodic surveys to track trends in attitudes to COVID-19 vaccines. They have also instituted rumour surveillance to identify circulating rumours and respond with the facts. These are laudable efforts that must be supported by all. However, more exploration is needed to understand why people believe in CTs and what pathways lead to vaccine hesitancy. Although this is a new research area, there is emerging evidence to show that intrinsic and extrinsic factors may explain why some people will believe in CTs about COVID-19 vaccines rather than credible information to the contrary. Recent studies have linked vaccine hesitancy to moral foundations — universal instincts that determine how people make decisions. It may be worthwhile to explore if certain moral concerns predispose people to believe in CTs. This will complement information gleaned from standard knowledge, attitude, and practice studies and throw light on possible pathways to influencing attitudinal change even among CT believers.
Trust in government is another crucial factor. Distrust in the government and vaccinations has been linked to belief in CTs and vaccine hesitancy. A global survey found that respondents who trusted their government were more likely to accept a vaccine. Those who distrusted their governments were more likely to believe in alternative explanations for things happening. With the country’s challenging economic situation and hardship exacerbated by lockdowns, there is already significant public discontent with the government, particularly handling the relief materials meant to cushion the pandemic effects. Some believe COVID-19 response is another conspiracy by politicians to loot the treasury. This level of distrust is likely to fuel belief in CTs about the vaccine.
With the COVID-19 vaccine rollout on the horizon, there is an urgent need to understand what factors may contribute to vaccine hesitancy, including moral foundations, government distrust and CT beliefs. More research is needed to identify these factors and target them with appropriate public health messaging interventions.
Current study to better understand COVID-19 vaccine conspiracy theories in Nigeria
The COVID-19 Vaccine Ethics Research (COVER) in Nigeria aims to examine these issues in detail to inform communication strategies and messages that will contribute to a successful COVID-19 vaccine introduction in the country. COVER is a mixed-methods study using qualitative and quantitative approaches to better understand Nigeria’s CT phenomena and its link to COVID-19 vaccine acceptance. Vaccines are our best bet out of the COVID-19 outbreak. The hope is that with equitable access to vaccines and the needed supply reaching Nigeria in short to medium term, the spread of COVID-19 can be mitigated so that we all can return to some semblance of normality in our lives.
Government institutions such as National Orientation Agency has role to play in the desemination of fact and correct fake news and rumour.
They have branches nation wide and at the grassroots where poor and indigent people would he reached with ease.
The time to start is now.
Well done Dr Wonodi. We are proud of you.
Trust in government and the health system is actually a crucial factor and a determinant of belief in CT. People who believe in these CTs may have been failed by the health system and may thus not believe that anything good can come out of it.
That being said, this research is very timely as the results can contribute to effective message development around the vaccine.
Hope the results from this research will be made available to the public in some way.