Alongside Covid-19 pandemic, India is fighting vaccine hesitancy and an infodemic too
Much like we cannot let the pandemic get the better of us, we also cannot let an infodemic continue to spread and impact precious lives.
I have been practising medicine for two decades. During this time, many of my colleagues and I have experienced, spoken about, and tried to mitigate the dangers associated with self-medication. This means that people treat an illness or a health problem without consulting a doctor or adequate medical supervision. I have also dealt with the impact of superstition on taking medications.
But even for me, it was difficult to imagine what I witnessed during the height of the Covid-19 pandemic last year. While it had been repeatedly communicated that the infectious and unpredictable nature of the zoonotic virus meant that one should go to the doctor even if they were experiencing mild symptoms, many people did not feel the need to. Guidance and advisories were both followed and violated in equal measure. Further, many were either self-medicating or referring to borrowed prescriptions. To add to this, social media was flooded with ‘genuine-looking’ fake prescriptions and a list of options that could presumably prevent, cure, mitigate virus-related symptoms.
Nearly a year into the pandemic, my patients are again inquiring about whether they should wait before taking the government-approved vaccines, and alarmingly, if they should take them at all. And once again, social media has been flooded with (mis)information on the potential side-effects of these vaccines and other opinions on why one should not take the vaccine. This misinformation and disinformation on social media, called out by the WHO as an ‘infodemic’, is also akin to a second pandemic, because like Covid-19 it spreads fast and has a dangerous impact on people’s ability to make sound health decisions. And while it is understandable that in the case of a new disease like Covid-19, there may be panic and anxiety in people, it is very important to recognise that this outright rejection and suspicion of scientific information and data is dangerous to both individual and public health.
Further, these phenomena of science denialism and vaccine hesitancy that we are witnessing is not India-specific, nor is it new. But it can definitely undermine individual health and the collective health of any country. Over the years, there has been a lot of research on the complex roots of these phenomena and associated anti-health public behaviour. Reasons are diverse, and causes vary from country to country. Low levels of education and literacy, sticky intergenerational social norms and a host of prevailing superstitions have played a huge role. Views of political and religious leaders have also influenced the masses. Media’s illiteracy on health and science-related subjects, as well as the industry and marketers' denial of toxic ingredients in their products and their impact on health, have also contributed to the mix. For example, for a very long time, there were many who, in the face of overwhelming scientific evidence, denied that smoking and lung diseases were connected or that nicotine addiction was real.
We have also seen that science denialism has real costs in infectious-disease management. Take the measles virus, for instance. It is a highly infectious disease that was eliminated in the United States in 2000. Despite the availability of a safe and effective vaccine, in 2018, the Centre for Disease Control and Prevention (CDC) reported 214 measles cases in the country. This was partly a result of vaccine denial. In Europe, the number of infected patients has quadrupled in the past couple of years and now amounts to nearly 41,000, a record high.
In India, at the height of the pandemic, people were still talking about how the Covid-19 virus would not spread in a warmer climate. There were several semi-scientific therapies and alternative medical treatment being suggested and circulated on social media. And even now, there is a view that alternative medicines are 'at the very least not harmful' so it is ok to take them. Such non-harmful aspects of some traditional medicinal products may indeed be the case, but this does take away from the need of the hour to follow scientifically-validated mechanisms for prevention and treatment.
In the long-term, for better national health outcomes, this structural scientific denialism, combined with the ongoing technology-driven infodemic, will have to be actively countered with a comprehensive strategy that responds to the complex socio-political-economic reasons behind them. Additional investments in overall education and literacy level would matter but might not offer a complete solution. There is also a need to focus on constant monitoring of the population’s existing knowledge, opinion and behaviours on any given health issue. As reasons for anti-health behaviour or anti-vaccine sentiment are better understood, real-time targeted communication, based on scientific evidence, can be crafted to counter rumours, false beliefs, and fake news. Calling out influential people on their unscientific views will also be needed.
Finally, experts continue to point out that strengthening STEM (Science, Technology, Engineering and Mathematics) curriculum in K-12 schools and teaching vaccinology in the degree and in CME (Continuing Medical Education) courses, will be key to bringing about positive health-related behaviours in the general public, while also building India’s healthcare understanding and capacity.
In the short-term, however, doctors and health workers must realise that their science-based advice isn’t received without doubt or scepticism. Simply telling the patient to take medicines won’t always work. Rather, advising patients will now become a complex trust-building, educational and persuasion exercise, which has to be backed by handy bite-sized science-based evidence and information. In the case of the Covid-19 vaccines, this means explicitly telling patients and the community that the vaccine is needed, asking why a patient is hesitant in the first place, countering any misinformation they may come upon in their social circles and media, addressing patient’s concerns about side-effects, and assuring patients about the safety and efficacy of vaccines.
Much like we cannot let the pandemic get the better of us, we also cannot let an infodemic continue to spread and impact precious lives. Your health and mine are at stake.