Using Social Media to Build Confidence in Vaccines: Lessons from Community Engagement and Social Science Research in Africa

"...[A] better understanding of the complex sociopolitical drivers of distrust in vaccination will increase the potential of social media to rebuild vaccine confidence..."



Experts have become increasingly alarmed about the continued waning of public confidence in vaccines. Social media are considered to be major contributors to this decline by facilitating the rapid, widespread sharing of misinformation and enabling vaccine anxieties and rumours to travel rapidly. The dominant narrative assumes that mistrust in vaccines is primarily the result of a lack of information; on this view, if individuals are provided with knowledge about the benefits and value of vaccines, uptake will rise. However, as this article explains, a critical social science perspective highlights the limitations of this view. Informed by social science research in Africa, the article examines how social media could in fact be harnessed to foster vaccine confidence.



As outlined here, vaccine confidence refers to the belief that vaccination, along with the public, private, and political entities implicated with it, serves the public's best interests. The way distrust in these entities manifests and why it occurs varies considerably across place, populations, time, and vaccines. The reasons for distrust are also anchored in social, political, economic, and historical realities, such as social exclusion and marginalisation, geopolitical relations of inequality and oppression, poor relationships and interaction with healthcare professionals, and top-down vaccination initiatives. Building confidence in vaccines therefore necessitates identifying and targeting the complex reasons fuelling distrust so that more trusting relationships between authorities and citizens can be developed.



Specifically, key communication principles, which are elaborated upon in the article, to build trust include:

• Ground communication in context specific reasons for distrust.
• Communicate with honesty and openness.
• Leverage trusted individuals or organisations to convey messages and serve as vaccine endorsers.
• Communicate in engaging, creative, and relatable ways, including using imagery and media touching on positive emotions and storytelling (e.g., personal accounts).
• Encourage and facilitate two-way communication using empathy to allow for feedback and addressing any concerns or questions.

Per the authors, much can also be learned from the history of community engagement initiatives in various African countries - for example, in the context of polio eradication efforts. These experiences underscore the power of engaging deeply with affected communities and their socio-cultural contexts, working together with them to identify and respond to health challenges. Key principles for engaging communities to build trust include, in brief:

• Genuinely listen to community concerns (e.g., in the polio eradication initiatives in Nigeria, extensive, block-by-block research and house visits were conducted to listen to people's views and experiences).
• Facilitate open exchanges and active dialogue that encourage questions, debate, and conversations.
• Foster community-based responses and ownership of initiatives, including empowering affected communities and local leaders as primary partners in defining vaccine research agendas and in co-designing, planning, and implementing vaccination initiatives.
• Recognise that communities are not homogenous, and understand intra-community power dynamics and structures.
• Sustain dynamic and ongoing engagements over time; trust can grow incrementally through ongoing relationships of engagement and reciprocity.
• Incorporate social science research in the development and implementation of community engagement.

Next, the authors ask: What can we learn for using social media to build vaccine confidence? Suggestions include:

• Use social listening to understand and ground communications in reasons for distrust. Social media can be utilised to listen to people's concerns about vaccines and to help gain an ongoing understanding of the context-specific reasons for distrust, through which more tailored and targeted responses could be developed.
• Leverage trusted individuals or organisations. Bloggers and other social media actors are often influential, locally and globally. Collaborating with these influencers to serve as vaccine endorsers could provide a way to reach large audiences by individuals they consider to be trustworthy.
• Facilitate creative, two-way, and open forms of engagement. The diverse capabilities of social media - such as widgets, online video/image sharing, graphic buttons, games, feeds, podcasts, microblogs, chatting, and forums - offer possibilities for communicating in creative ways that resonate with people. Moreover, social media enable open exchange and user-centred interaction, which offers avenues for communicating with, rather than to/at, the public.
• Foster community-based responses and ownership of initiatives. For example, Community Action Networks (CANs) emerged during the COVID-19 pandemic in South Africa to organise community assistance through WhatsApp groups. These groups expanded organically into a collective multimedia platform for community communication and mobilisation, including through Facebook pages and groups, use of videoconferencing platforms, and local TV and radio. These grassroots networks identified pressing problems and used local resources to respond to these matters through self-organising neighbourhood initiatives during the pandemic.

The authors stress that they are not suggesting that social media are the panacea to public distrust in vaccines. They recognise limitations of relying on this one approach, such as its potential to exacerbate the digital divide. That said, they "believe in the transformative potential of harnessing social media as part of a broad public health approach to promote vaccine confidence in all its complexity."



In conclusion: "The prevailing narrative about social media and vaccine confidence arguably depicts an incomplete picture of the problem and minimises potential opportunities. Vaccine confidence is a complex phenomenon that reflects multiple dynamics and webs of influence....[S]ome of the core characteristics of social media hold potential - still largely untapped - for targeting these more complex drivers of distrust in vaccines....Critical social science research and community engagement in various African countries show that listening and dialogue, transparency, relationships, and community ownership and participation can help build public trust in vaccines. These insights could inform interventions using social media as part of a broad public health approach to promote vaccine confidence."