When the credibility of good information is undermined, we can't just rely on strategies we believe should work. We need to be one step ahead, writes Jess Berentson-Shaw.
Vaccinating most people against Covid-19 is a significant stepping stone in managing the virus and its huge social, health and economic impacts.
Vaccination, like managing Covid-19 more generally, can be approached in different ways, depending on what matters most to us in New Zealand (and to some extent, who matters most).
Dr Nikki Turner, the head of the Immunisation Advisory Centre, points out that if we aim for high vaccination rates we will do better for those who are more vulnerable to the impacts of Covid-19 - it is an approach that takes care of those who need it most. Higher vaccination rates also give us the best opportunity to manage any cases we do get without people in the medical system becoming overwhelmed. So it is better for our healthcare workers and others who need the healthcare system. As Turner says:
“I recommend we put all our efforts into vaccinating everyone we possibly can, particularly more vulnerable individuals and communities. Then, when we do open the borders and the disease comes into New Zealand, we will see predominantly mild and asymptomatic disease. This will be manageable.”
Compassion and pragmatism have been at the heart of our Covid-19 response
A strategy in which we put all our efforts into vaccinating as many people as possible is in line with how we have approached Covid-19 in New Zealand to date - with care and concern for our most vulnerable community members and with a clear eye on what people working within our healthcare systems can actually manage. What then do we need to ensure that most people will take the option to get vaccinated?
There are many approaches to ensure people are both inclined towards vaccination and can actually get vaccinated. The critical importance of access shouldn't be overlooked in all our discussion and concern about vaccination. The easier and more straightforward it is for people to get vaccinated, the more likely they are to get one. It's why seasonal flu shots get offered all over the show: workplaces, pharmacies, GPs, etc. It's how we improved our childhood vaccination rates in the 1990s and 2000s, by actually reaching out and going into those communities who experienced barriers to getting their children vaccinated. It is also partly why our HPV vaccination rates are lower than we need to get rid of cervical cancer entirely in the next generation – because only some schools currently offer the vaccine as standard.
The information environment is a challenge to a compassionate and pragmatic vaccination strategy
Alongside easy access to vaccinations is a supportive information environment. Understanding the importance of vaccination to managing Covid-19 and how it works is key to opting to get one. We have done well in New Zealand with vaccinations more generally. Hesitation about any health intervention is normal. There are always risks and benefits to weigh up, whether personally, for our families, or our wider community. Hesitation doesn’t make declining a vaccination inevitable and in fact very few people do actively decline childhood vaccinations for example (3-5 percent). When false information about vaccinations like the MMR comes around, as it inevitably does, people in New Zealand show a strong resilience to it.
However, Covid-19 is a bit different. We have never faced a global pandemic in the age of social media. Right now we are focused entirely on Covid-19 and getting rid of it in a way that we have not been on other illnesses. Information about it is everywhere which is overwhelming. Everyone has an opinion to share about it. Our information-processing systems have to work particularly hard. Although false information is nothing new, social media means false and alarming information is spread more easily, faster and deeper than before so false information about Covid-19 vaccination is also everywhere. And exposure to this type of information is a problem.
Inoculation against false information will help with our vaccine strategy
Recent research done by Dr JT Thaker and colleagues in New Zealand shows that when people are exposed to a piece of good information about the Covid-19 vaccination on social media they are much more inclined to say they will get vaccinated than when they are exposed to a piece of false information about it. This means people who spread false information could undermine a really effective and equitable vaccination strategy.
So should we stop false information being spread on social media? Yes, absolutely we should. That is a political project that gets to the heart of a modern democracy. It requires a lot of leadership from people in government and action at multiple levels as I have written about before. While social media companies have started some of this work in patchy ways, it won’t deal to our current challenges around Covid-19. So what will? People often jump from this political work to individual behaviour change recommending that people “turn off social media”.
Speaking personally, there are real mental health benefits to this strategy, but it is not going to deal with false information at the source. Likewise, fact-checking false information – another common strategy – is fairly ineffective and spreads false information to people who have not yet seen it. The problem is that the more people see false information (even from a credible source attempting to mythbust it), the more it becomes established in people’s thinking and our wider discourse. Consider how familiar people are with the MMR vaccination false information story, compared to people's knowledge about how the MMR vaccine actually works. There is one measure that people in government and media can take – to inoculate people against false information.
What does inoculation involve?
Just like an actual vaccination doesn't use the live virus to activate your immune system, inoculation about false information does not use the actual false information to draw people’s awareness to it. Rather, it is a strategy to activate people’s critical thinking. It has to specifically alert people to the motivations and strategies used by those people who create and spread false information. Generally, we value our freedom to receive good information and we feel justifiably upset if people with less than altruistic motives prevent us from getting it.
There are five key principles to a good inoculation strategy:
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It has to happen prior to exposure to false information - there is a good argument for targeting older people who may be less social media savvy, come to false information later and be more inclined to believe that false information. Children are also a good audience to work with.
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It needs to warn people about potential exposure to false information.
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It needs to especially describe strategies and tactics used to undermine truth. For example, explaining the use of fake experts, or how astroturfing is used by PR companies paid by people running big industries, like tobacco and fossil fuel, to replicate grassroots movements.
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You need to provide the accurate information - it is important to spread good information widely (it's the positive aspect of fact checking, without the false information attached to it).
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Avoid being specific about the false information (this is how it can spread).
It is simply not enough to ask people to look to good information sources and be aware that false information is being spread. This doesn’t actually give people a good explanation for why and how people may be creating or spreading false information and what the accurate information is.
Cognitive researchers have found that people tend to process, think about, and recall information in what we call causal chains - like a little story where a+b=c. It is important to give people a whole new chain of information if you want them to understand the issue more deeply and act on it in evidence-based ways, rather than replacing a single part of that chain. This is the difference between providing a small bit of information or single fact, eg, “You may be exposed to false information, go to xyz for good information” and a completely new story, eg, “You will be exposed to false information, from these types of sources, using these types of strategies, and it will look like this, and they do it for these reasons. The good information is xyz and can be found here”.
Where people are overwhelmed by information and where strategies are used by powerful figures (including former president of the US Donald Trump) to undermine the very idea of what credible information is and who produces it, inoculating means moving past relying on strategies we believe should work - like just giving people facts - to strategies the research shows us do work. Such evidence-based approaches are going to be critical, not just for an effective Covid-19 vaccination strategy, but for many significant public health issues we are facing and will continue to face into the future in our information environment.
