Communicating public health during COVID-19,implications for vaccine rollout

Abstract

A large body of information and opinion related to COVID-19 is being shared via social media platforms. Recent reports have raised concerns about the reliability and verifiability of said information being disseminated and the way systems, processes and design of the platforms facilitates such spread. This, alongside other areas of concern, has resulted in several social media platforms taking steps towards tackling the spread of mis- and dis-information. Here we discuss approaches to online public health messaging from a range of sources during COVID-19, with a focus on official and non-official sources in the United Kingdom (UK). We highlight issues for ongoing public health decisions, and the potential impact for the future course of the pandemic.

This article is a part of special theme on Studying the COVID-19 Infodemic at Scale. To see a full list of all articles in this special theme, please click here: https://journals.sagepub.com/page/bds/collections/studyinginfodemicatscale

Introduction

In recent years, the use of social media platforms and the consumption of online media have enabled individuals and groups to access, share and comment on information with great ease. There have been multiple calls for large social media organisations, such as Facebook and Twitter, to better address the spread of misinformation and ‘fake news’, with specific concerns being raised in relation to the manipulation of elections (Guglielmi, 2020). This commentary contributes to the special issue of Big Data & Society that explores the infodemic associated with COVID-19 – namely, the overabundance of information online and offline, with a specific focus on mis- and dis-information, where individuals or groups spread wrong information and undermine the public health response (Cinelli et al., 2020). This spread of false information can either be done mistakenly or with malicious intent (Jamison et al., 2019).

Growing concerns over the past decade about vaccine hesitancy may have a large impact on the ongoing COVID-19 health emergency and vaccine rollout (The COCONEL Group, 2020). Bonnevie et al. (2021) recently explored social media posts on Twitter opposing COVID-19 vaccination, demonstrating a 79.9% increase in the volume of posts mentioning opposition to vaccinations. This was quantified over the first six months of the pandemic, and compared to a baseline of the previous four months. Vaccine misinformation is, in part, spread through malicious actors who congregate online through social media platforms (Ruiz et al., 2021). In an attempt to explicitly address COVID-19 misinformation spreading through social media, the UK Government recently agreed on a package of measures with some of the largest social media platform operators (i.e. Facebook, Twitter and Google) (UK Government Departments, 2020). Platform operators have agreed:

‘To commit to the principle that no user or company should directly profit from COVID-19 vaccine mis/disinformation. This removes an incentive for this type of content to be promoted, produced and be circulated.

To ensure a timely response to mis/disinformation content flagged to them by the government.

To continue to work with public health bodies to ensure that authoritative messages about vaccine safety reach as many people as possible.

To join new policy forums over the coming months to improve responses to mis/disinformation and to prepare for future threats.’

The UK Department for Digital, Culture, Media and Sport also recently released the ‘Check Before You Share Toolkit’ to help tackle the spread of false information about the COVID-19 vaccine (Department for Culture Digital Media and Sport, 2021). These measures demonstrate a positive commitment from both the UK Government and platform operators. However, this needs to be expanded in legislation beyond the context of COVID-19 to be more widely beneficial.

In this commentary, we examine the role of official UK Government messaging and the influence of public figures in the spread of online information during the public health emergency. Here we consider public figures to be politicians, celebrities, social media personalities or business leaders, with a certain social position and level of influence. We discuss the roll-out of COVID-19 vaccines and the effective engagement required in a complex global context of varying trust in vaccines. We urge governments to work with public figures to promote high-quality information sources to counter vaccine hesitancy in specific groups. Although it is worth highlighting that certain outreach initiatives have avoided association with government messaging efforts, as was the case with a recent video outreach campaign to encourage BAME individuals to engage with vaccination programs (The Telegraph, 2021).

Lessons learned from the ‘first wave’ of the COVID-19 pandemic

Slogans, such as ‘Stay Home. Protect the NHS. Save Lives.’ have been a major part of the UK Government’s approach to communicating COVID-19-related public health messaging. However, concerns have been raised about the effectiveness of slogan-based messages in relation to the health literacy of a nation (Spring, 2020), and there is also evidence to suggest that government-generated messages may be less effective than those of other actors. In a recent investigation of online COVID-19 messaging, Kamiński et al. (2021) analysed a three-day period of tweets from public figures in April 2020, showing that ‘likes’ and ‘retweets’ by the general public of accounts belonging to celebrities greatly outnumbered ‘likes’ and ‘retweets’ for accounts by politicians and health authorities. Brennen et al. (2020) demonstrated that high-profile, prominent public figures play an outsized role in the spread of COVID-19 misinformation, when compared to the general public. Prominent public figures were responsible for 20% of the posts shared that included misinformation. This portion of posts accounted for 69% of overall engagement in the sample (Brennen et al., 2020).

However, while high-profile public figures may generate a high level of engagement with the content that they post, the collective impact of lower profile ‘micro influencers’ is also worth noting. This has been explored with regards to how companies use influencers and celebrities in marketing campaigns. Multiple ‘micro influencers’ with a smaller audience can prove to be more effective than a single celebrity with access to many more people than the aggregate of the ‘micro audience’ (Carter, 2016). Kostygina et al. (2020) have discussed how similar uses of influencer reach can be applied to the effectiveness of public health messaging through social media. There is also a growing body of literature exploring the involvement of social media influencers and prominent public figures in disseminating both trusted information and misinformation in domains ranging from cancer awareness (Kaleem et al., 2019) to communication of health messages and solutions via digital platforms (Lutkenhaus et al., 2019).

COVID-19 vaccine rollout

November 2020 saw the announcement of vaccine efficacy results from different clinical trials, including mRNA (BioNTech/Pfizer and Moderna) and Adenovirus (Oxford/AstraZeneca) based vaccines (Mahase, 2020). As vaccines have gradually been approved for and rolled out into national vaccination programmes, political relationships between nations have played a large role in access to vaccines. We are now seeing the global effects of both vaccine nationalism and vaccine diplomacy to support developing nations through efforts such as COVAX (Hassoun, 2021). Questions about risks related to vaccines have needed to be rapidly addressed by health regulators to ensure vaccination coverage is sufficient. Concerns have also been raised by health practitioners and commentators related to miscommunication of risk and subsequent spread of misinformation (Wise, 2021), which is contributing to the rise of anti-vax movements. Research suggests that once people start engaging with anti-vax content, they are likely to be directed towards more of the same, which propagates the spread of misinformation and anti-vax sentiment within such communities (Abul-Fottouh et al., 2020).

It is beyond the scope of this commentary to review the full context and history of the various anti-vax movements globally. Analysis by de Figueiredo et al. (2020) demonstrates the size and potential consequences of the issue; for example, a reduced confidence in the importance of vaccines has a strong negative association with vaccine uptake. The study also highlights the example of the recent spread of polio vaccine misinformation in Pakistan and Nigeria, leading to subsequent increases in poliovirus cases in both countries. Johnson et al. (2020) recently conducted a network analysis of connected social media users and their online interactions to understand the proportion of pro-vaccination, anti-vaccination and undecided individuals on Facebook. This study also explored the global distribution of users and the strength of interaction between users. Of the 100 million users analysed, 4.2 million were considered to be anti-vaccination, 6.9 million were pro-vaccination and 74.1 million were ‘undecided’. This study illustrates the scale of the challenge facing governments and health authorities to ensure the necessary level of COVID-19 vaccine uptake to achieve herd immunity among their population. The roll-out of national COVID-19 vaccination campaigns and a coordinated global effort is key to the next phases of the public health response and our collective recovery. Online messaging is significant in relation to the success of a public health message, as well as in preventing or slowing down the spread of misinformation. That is not to say that a good social media strategy will, in isolation, lead to a successful vaccination programme as not all people use social media. Public health officials and policymakers would benefit from regular access to macro-analysis of changing sentiment and information spread related to COVID-19 vaccination programmes. Globally, governments appear to be using sentiment analysis to inform policymaking (Singh et al., 2020). However, at the time of writing, the scope and impact of its use is not currently known. The virus will not disappear imminently, and vaccines take time to become effective, particularly where many of the vaccines currently approved require multiple doses to achieve efficacy (Mahase, 2020). Consistent messaging about ongoing public health measures (including, but not limited to, mask wearing and social distancing) alongside pro-vaccination messaging is crucial if we are to prevent unnecessary peaks in spiking infection rates.

It is essential to proactively engage with different groups and communities, with an appreciation for cultural differences apt to impact receptiveness to specific messages. Indeed, cultural differences are becoming apparent through the COVID-19 vaccine roll-out. For example, studies conducted in the UK (Murphy et al., 2021) and globally (Sallam, 2021) have demonstrated that greater rates of vaccine hesitancy are exhibited in association with certain psychological characteristics, race and ethnicity. Intergroup differences in attitudes towards vaccine uptake have been identified (Robertson et al., 2021) and it is clear that different age brackets and demographics have different susceptibilities to vaccine misinformation, which in turn influences hesitancy (Loomba et al., 2021). A range of trusted professionals, celebrities and public figures may be useful in widely engaging groups for uptake of vaccines in hesitant groups (Bonnevie et al., 2020; Fisk, 2021).

Conclusion

We have covered a range of topics related to the online spread of information during the COVID-19 pandemic. The nature of messaging, as well as the source of the messages, are of importance. Looking ahead, online messaging in response to the COVID-19 vaccine roll-out needs to be carefully monitored. Policymakers and public health authorities need to act flexibly and swiftly, using a range of information sources, to combat vaccine hesitancy. If governments are deploying online sentiment analysis to inform their approach to vaccine rollout, then, we urge policymakers to be cognizant of the limitations of the technique which is not always accurate, especially as humans annotating text for analysis often disagree on the sentiment of posts (Mozetič et al., 2016). Any decisions should be appropriately validated especially where the demographics of social media users do not reflect the wider population, particularly digitally excluded vulnerable members of society.

Finally, in analysing and using insights derived from publicly available discourse on social media, researchers and governments need to be respectful of individuals’ privacy and ensure that they are not subjecting individuals or groups of people to invasive or harmful profiling techniques whilst taking effective steps to support health and wellbeing in the wider public interest.