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Polio eradication action with informed and engaged societies
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Social Media - Building Positive Narratives by Social Listening: Learning Brief 4

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Summary

"Understanding how rumours spread and become amplified is a critical element."

These Learning Briefs (see Related Summaries, below) have been developed to capture priority communication challenges facing Pakistan's polio eradication programme. Each looks at a different topic and provides context (why the challenge is important), a description of the bottlenecks and gaps that need to be overcome, lessons from other relevant experiences, and an outline of programme plans to resolve each challenge. This Learning Brief focuses on social media.

Context
Pakistan is rapidly going online. As of early 2020, 75% of people have mobile phones, 35% use the internet, and 17% are active social media users, with growth rates between 2019 and 2020 of 9.6 million (+6.2%), 11 million (+17%), and 2.4 million (+7.0%), respectively. As use grows, so does impact on public discussion and access to information. Social media has become a centre for public discourse, profoundly influencing social ideas and attitudes in almost all spheres of life, including polio vaccination. It is an increasingly powerful communication space that cannot be ignored.

Just a few years ago, the polio programme's online presence was little more than a website, with a few passive feeds to channels like Twitter and Facebook. Over the past few years, this situation has changed, as the programme has taken significant steps to catch up to Pakistan society by building a carefully managed internet presence that includes websites and popular social media channels. It regularly produces and disseminates engaging, accurate content, ensures wide distribution of this content through influential social media partners, and continuously tracks and responds to comments and posts. It also tracks circulating rumours and misinformation and counters them by blocking sources, developing content that repudiates high-impact rumours without amplifying them, and contributing to discussions in the digital social spaces people use to seek and share information about vaccines and the health of their children.

Use of social media will continue to grow, as will its influence on public discourse in Pakistan. Caregivers will increasingly look to social media for answers to questions related to child health, vaccine safety, and the polio programme. Rumours and misinformation will continue to circulate, and, as social media use grows, so will their audience. The polio programme has established a presence, learned how to create engaging digital content, built relationships with significant digital influencers, and started responding to rumours and misinformation, but it is early days, and these capacities and tools need to continue to evolve in line with the development of social media as a force in Pakistan society.

Bottlenecks and Gaps
Key drivers of refusal and vaccine hesitancy and therefore bottlenecks for eradication are the rumours and disinformation circulating on social media about the polio vaccine, the Polio Eradication Initiative (PEI)’s staff, and its agenda. Whether the beliefs are that the vaccine is haram, that polio’s frontline workers (FLWs) are pawns in an international conspiracy, or that the PEI itself represents a foreign agenda, rumours have the corrosive power to undermine trust over time. One way of addressing this problem is by building partnerships with channels like Facebook to block sources of misinformation. However, partnerships with social media companies will not be enough to stop the circulation of misinformation and need to be viewed as one part of a larger strategy.

Understanding how rumours spread and become amplified is a critical element of this larger strategy. While each rumour has its particular path, a common one is to begin on anonymous sites, move to closed communities, and then shift to conspiracy groups, from which messages get shared to popular social media platforms and eventually end up in professional media outlets. This progression amplifies spread and influence, as the horn-shaped figure demonstrates. Analysis of the April 2019 "Peshawar incident" demonstrates how social media was used to create and spread a video lie that captured enough attention to have it move through a number of social media channels, with influencers gathering views and likes as it went. In the Peshawar case, social media was used for initial posting and dissemination, which was picked up quickly and uncritically by news media outlets, resulting in rapid spread. While this piece of fabricated "news" did not begin in the world of anonymous sites and closed conspiracy groups, it built on rumours that had begun that way.

Ironically, some of PEI's own attempts to discredit the original Peshawar posts added to their amplification. This outcome shows the dangers of directly countering anti-polio vaccination rumours. Attempts to discredit a rumour directly or even share it with colleagues can increase its spread, and, while direct rebuttal can be used, it must be done carefully.

Reducing the impact of anti-polio-vaccination content on social media requires building a trusted brand, developing strong relations with social media influencers who share polio content with audiences who trust them, creating engaging content that responds to and captures local concerns and perceptions, strengthening the ability of other media outlets to use social media sources responsibly, and training polio staff to ensure they do not engage with social media in ways that amplify the wrong messages.

Finally, plans to deepen engagement with Pashtun communities and leadership structures will require a much greater focus on creating content in Pashtun and ensuring that it is shared through channels in Pashtun, as well as English and Urdu, through Pashtun-speaking digital influencers.

While work is being done on all the areas discussed above, there are still gaps in knowledge and capacity related to tracking the sources and paths of misinformation, breaking chains that lead to amplification, training polio staff and supporters, building networks of digital influencers, and engaging high-priority populations.



Lessons: Ukraine - Natural Social Spaces
In 2015, Ukraine had a vaccine-derived poliovirus (VDPV) outbreak that was the result of a 10-year decline in immunisation rates from 90% to some of the lowest in the world. Ukraine also had very high levels of social media use. This study looked at how to research the impact of social media on development issues using attitudes towards polio vaccination as the case study. It concluded that research and evaluation initiatives related to social media will only be effective and useful if they focus on natural communication spaces – the online spaces and connections that communities create for their own purposes.

These natural spaces are much more important than the comparatively tiny social media footprint of development organisations. Content in these natural spaces tends to have much greater credibility and standing with the people who use them, provided it is posted by one of their own or an influential figure they trust. Each country will, of course, have its own social media structure. But natural, public social media spaces, in whatever form they take, dominate.

Key Lessons: Creating institutional websites and media channels is only one aspect of a social media strategy and perhaps not the most important one. More important for both research and reach is understanding the natural spaces people are using to share and access information on vaccination and identifying ways to engage with those spaces through content sharing and dialogue. This lesson implies that local content creation combined with a wide range of partnerships with trusted digital influencers to share that content should be a critical element of successful strategies.



Lessons: Responding to Misinformation on Social Media
Social-media-based misinformation about vaccines is a growing global issue with serious public health consequences. This research looks at how Australian organisations promoting vaccination developed a range of strategies in response to multiple social media challenges, including misinformation, anti-science sentiment, a complex vaccination narrative, and anti-vaccine activists. Responses included communicating with openness in an evidence-informed way, creating safe spaces to encourage audience dialogue, fostering community partnerships,
and countering misinformation with care. It concludes that:

  • Directly countering misinformation can be useful for influencing silent audiences (i.e., those observing but not openly commenting, liking, or sharing posts), provided messages are straightforward and succinct and that they avoid emphasising misinformation.
  • Scientific evidence should be paired with stories that speak to audience beliefs and values.
  • Organisations can enhance vaccine promotion and their own credibility on social media by forming strong links with organisations sharing similar values and goals.

Key Lessons: Many anti-vaccination rumours are global or share similar attributes, meaning that successful responses can also be transferable. Directly confronting misinformation can be a useful tactic, but it needs to be done with care to avoid amplifying misinformation. An understanding of local experience and perception is essential to creating content that resonates, and partnerships with influential people and organisations are important elements for building credibility.

Ways Forward
Pakistan's polio programme recognises that building a social media presence and brand is a long-term endeavour that will need to be carefully developed in line with Pakistan's evolving social media landscape. Its 2019 objective to make PEI the top-rated and most trusted source of information on polio in Pakistan is gaining traction. Web use analytics demonstrate slow but continued growth, and channels on Facebook, Twitter, and Instagram show significant influence, with more than 100 million people reached with messages in 2020. Provincial and national production of accurate and engaging curated content to share through those channels has helped push positive polio messages beyond the audience that directly visits the official PEI website. 2020 saw the engagement of 709 additional digital influencers, including Pashtun speakers, providing a base for extending reach and facilitating the sharing of more positive polio content in a wider range of natural social media spaces by people trusted by the users of those spaces. Partnerships with social media channels such as Facebook coupled with Pakistan government legislation have allowed 336 links to negative polio rumours to be identified, 283 of them blocked or deleted, and another 53 flagged to limit their reach.

Building on this progress, 2021 will focus on supporting key elements of programme transformation, such as repositioning polio eradication as a national public cause for the protection of children, mobilising public figures, and expanding partnerships with influencers and their social networks.

Social media by its nature is fast-moving and fluid, and Pakistan's social media landscape is in a period of rapid growth and evolution. The programme will need to reflect this speed and agility and respond to changes in Pakistan's social media environment. It needs to do so with careful attention paid to its listening networks and rumour tracking and with the support of a growing group of digital influencers willing to share positive content with communities who trust them. Each of these elements contributes to building trust, reducing misinformation, and reaching high-risk communities.

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Click here for the 4-page Learning Brief in PDF format.
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Image credit: Pakistan Polio Programme