Polio, formally known as poliomyelitis, remains a dire threat to public health in Pakistan, capable of causing nerve damage and paralysis among human beings. Since the inception of the Global Polio Eradication Initiative (GPEI) in 1988, significant progress has been made in eliminating this disease worldwide. However, Afghanistan and Pakistan persist as the last frontiers in the fight against polio, presenting unique challenges for eradication efforts.
In Pakistan, regions like the Khyber Pakhtunkhwa (KP) province exhibit resistance to polio vaccines due to socio-cultural, political, and religious factors. Multidisciplinary research efforts have been deployed so far as to understand the complexity of this public health challenge, leading to a remarkable 95% reduction in polio cases compared to the pre-vaccination era.
However, challenges persist, especially in addressing misinformation on social media platforms related to polio vaccination. While research on countering misinformation on social media has largely concentrated on developed Western nations, there exists a notable gap regarding Global South countries such as Pakistan, particularly concerning countering misinformation about polio vaccines. Although studies have emphasised the considerable potential harm caused by the dissemination of vaccine misinformation on social media, a lack of comprehensive understanding regarding the prevalence of polio-related misinformation in regions where polio is prevalent highlights the necessity for additional investigation and intervention.
The rise of information and communication technologies (ICTs) has reshaped how individuals access health information, with a significant shift toward utilising social media platforms. Beyond mere consumption, social media has evolved into a space where users actively create, consume, and share health-related content, facilitating peer-to-peer discussions and support networks.
The significance of this shift goes beyond information consumption; it directly impacts mental and physical well-being. Individuals increasingly rely on social media not only to access health information but also to critically evaluate it.
However, alongside credible sources, online platforms are rife with misinformation, posing risks to public health. Recognising this, health organisations globally, including those in Pakistan, have embraced social media as a tool for disseminating accurate health information.
The rise of online misinformation, particularly regarding vaccines, presents a formidable challenge. Drawing from strategies observed in Western countries, anti-vaccine campaigners in Pakistan disseminate misleading information, often translating it into local languages (Urdu and Pashto languages) for wider reach and impact. This phenomenon extends beyond dedicated activists to include entrepreneurs and conspiracists who exploit social media platforms to promote their agendas.
A significant move involved urging Meta, the parent company of Facebook, to eliminate harmful content related to polio from its platform
In 2011, Pakistan's polio eradication programme faced a significant setback fueled by online rumours linking a local healthcare worker, Shakeel Afridi, to a supposed CIA-led Hepatitis B vaccination campaign aimed at locating Al Qaeda supremo Osama bin Laden in Pakistan. This false narrative, compounded by distrust towards vaccinators fueled by militants and extremist clerics, tragically led to the deaths of numerous polio health workers across the country.
On April 22, 2019, a fake news account in Karachi circulated a video falsely claiming children fell ill after receiving the polio vaccine. This video, featuring staged scenes of children fainting, attracted significant attention on social media, sparking widespread panic. Similarly, a regional news outlet's Facebook page shared videos alleging harm from the polio vaccine, including one featuring a father claiming to have lost four children after vaccination. Despite refutations from authorities, these false claims led to violent protests, culminating in a hospital being set ablaze in Peshawar, resulting in loss of life and suspension of the vaccination campaign.
The aftermath of these incidents saw a lingering hesitancy among parents, leaving over two million children unvaccinated against polio after an eight-month hiatus. Vaccine refusal cases surged, with the Nowshera district of KP province witnessing an alarming increase from 256 to 88,000 cases within a month. This decline in vaccination rates necessitated a robust response from health authorities to address the polio misinformation crisis. In this context, the Emergency Operations Center KP initiated a targeted campaign, drawing on the expertise of medical professionals, parents, and polio health workers. This concerted effort aimed to combat and debunk widespread rumours linking the polio vaccine to adverse health effects. As Pakistan recommenced its mission to eradicate polio, a formidable force of over 250,000 vaccinators, predominantly women, had been deployed. These dedicated individuals braved adverse conditions, from covering impoverished urban areas to remote rural regions and everything in between, navigating monsoon floods and scaling treacherous mountainous terrain through waist-high snow, all to ensure the vaccination of the nation's 40 million children under five years old.
Over the past four years, Pakistan's Polio Eradication Initiative has launched various endeavours to address the issue of polio misinformation. A significant move involved urging Meta, the parent company of Facebook, to eliminate harmful content related to polio from its platform. This action became imperative due to the severe threat posed by the spread of misinformation to polio eradication efforts, particularly endangering the lives of frontline health workers, many of whom are women engaged in the Lady Health Workers Programme (LHWP). Meta responded by committing to eradicate specific false claims regarding vaccines from Facebook, including posts perpetuating the notion of vaccine inefficacy or danger.
Moreover, Meta had already been proactive in removing content from Facebook that could incite real-world harm, such as posts falsely implicating polio healthcare workers as CIA agents. Since 2021, Meta has expanded its social media portfolio to include platforms like WhatsApp, Instagram, Threads, and the Horizon metaverse. However, merely removing or concealing false vaccine-related content may not suffice. Meta and other social media giants should adopt more comprehensive strategies, for instance, engaging credible sources, forging partnerships with journalists, civil society organisations, and academic institutions to devise robust approaches for disseminating accurate health information, and implementing stringent policies to curb the circulation of online misinformation.
Despite collaborative efforts between government bodies and social media platforms to curb misinformation, a harsh reality persists: false information about the polio vaccine continues to proliferate, notably on platforms like Facebook
The government has been actively backing the vaccination campaign and has recently joined forces with Meta to curtail the spread of anti-vaccination propaganda on its platforms within Pakistan. Additionally, the government has undertaken measures to counter polio-related misinformation through its Perception Management Initiative (PMI). Furthermore, official polio-focused Facebook pages such as End Polio Now have played a pivotal role in combating vaccine-related misinformation. They also underscore the ongoing efforts of Rotary International and its partners to ensure universal access to the polio vaccine. The page stresses the importance of bridging the gap between established vaccine science and the activities of anti-vaccination groups and individuals, recognising the role of misinformation in fueling vaccine hesitancy. It reiterates that the polio vaccine is safe, effective, and indispensable for eradicating polio in Pakistan. These endeavours, coupled with videos and messages disseminated by the regional division of the Pakistan Tehreek-e-Insaf (PTI) party in KP, as documented by the Atlantic Council Digital Forensic Lab in 2019, signify significant strides in addressing polio-related misinformation on Facebook.
In conclusion, this essay has meticulously dissected the pervasive issue of polio vaccine misinformation rampant on social media platforms in Pakistan. This trend has undeniably fueled a surge in vaccine hesitancy cases. While acknowledging that resistance to the polio vaccine cannot be solely pinned on online misinformation, our analysis highlights its significant role in fostering scepticism, particularly within the Pakhtun community since the 2019 incident.
The online misinformation campaign not only reflects, but also amplifies public distrust in government-led health initiatives. This scepticism is deeply ingrained, stemming from Pakistan's historical encounters with colonialism, its bureaucratic structures, and prevalent suspicions of the US government's involvement in health campaigns. Parental anxieties about their children's well-being and the sway of religious factions further compound this issue.
The dissemination of misinformation in Urdu, a language with stronger local resonance, exacerbates its impact on audiences compared to English-language misinformation. Hence, there's a pressing need to combat language-specific falsehoods and tailor communication strategies accordingly to debunk false narratives within the local community effectively.
Despite collaborative efforts between government bodies and social media platforms to curb misinformation, a harsh reality persists: false information about the polio vaccine continues to proliferate, notably on platforms like Facebook. This persistent spread of misinformation isn't merely a digital nuisance; it poses a grave threat to public health, undermining trust in health institutions and fostering vaccine hesitancy. Moreover, it creates a hostile environment for polio healthcare workers nationwide, exposing them to heightened risks.
From a broader perspective, this essay underscores the profound challenge of public distrust in scientific information amidst the digital media landscape, particularly in countries of the Global South. It's imperative to recognise that solely relying on governmental partnerships with online platforms for content removal falls short of addressing the multifaceted issue of misinformation. Comprehensive solutions demand the active engagement of all stakeholders, including robust involvement from fact-checkers. Furthermore, there's a crucial need for scholars to conduct extensive research on polio misinformation, acknowledging its potential to transcend borders and escalate into a global health crisis, given the persistent presence of the polio virus in Pakistan and Afghanistan. Such collaboration and research are essential to fortify global health systems against looming threats.
This article condenses and adapts the key points from an essay written by Dr Muhammad Ittefaq (James Madison University, USA), Dr Shafiq Ahmad Kamboh (University of the Punjab, Pakistan), Dr Carina M. Zelaya (University of Maryland, USA), and Dr Rauf Arif (Towson University, USA) published in the Journal of Science Communication, focusing on the urgency of addressing polio misinformation in Pakistan and proposing actionable steps toward increasing vaccine uptake.