Where is the accountability for those who produce health misinformation that harms the health of children, asked Benjamin Schreiber, a senior adviser to the United Nations Children’s Fund (UNICEF), at the World Health Summit in Berlin on Tuesday.

“We are now living in a situation where the information environment in which we live has become a determinant of health,” said Schreiber, adding that misinformation is a “key risk to achieving global vaccination goals”.

The United States has become a global focal point for vaccine scepticism since Robert F Kennedy Jr was appointed Health Secretary. He has defunded mRNA vaccine research, dismissed members of the national vaccine advisory body and appointed several vaccine sceptics in their place, and revived the discredited notion that high autism rates are linked to vaccines.

The US state of Florida is also removing vaccine mandates for children.

Social listening

Through digital community engagement in 40 countries, using AI-enabled social listening that identifies high-risk messages, UNICEF has identified 229 such messages that have reached 111 million people this year alone.

These messages usually resonate with underserved and excluded communities who have low trust in government, “and this is where the zero-dose children are sitting”, Schreiber added, referring to children who have not had any vaccinations.

Professor Heidi Larsen founded the Vaccine Confidence Project 15 years ago, and said that the biggest thing the project has learnt is that “60 to 70% of the time, the issue was not about the vaccine. It was about distrust of the government, distrust of the producers of vaccines, a bad experience in the clinic… It was a whole mix of things that we needed to understand.”

During COVID-19, the project conducted a study on people’s attitudes to vaccines in 70 countries, and the biggest thing we came away with was that actually there is trust in science… but people trust other sources more.”

Larsen, who is based at the London School of Hygiene and Tropical Medicine, said that it emerged from their study that people in African countries trusted their family doctor, family members and religious and community leaders more than science.

Religious leaders more trusted than scientists

“Religious leaders, aside from in one country, far outweighed the influence of scientists. In other places, it was family members. We need to look at the ecosystem of influences.”

Larsen’s project launched a global vaccine confidence index in 2015, which “identified Europe as being the most sceptical region about vaccines, with France being the single most sceptical country in the world, as 42% of the population said they did not believe the statement that vaccines are safe”, she said. 

At that stage, most African countries believed that vaccines were safe, but three years later, in 2018 when the same survey was conducted, vaccine scepticism had grown in Francophone Africa – influenced by “the sceptical French media”.

During COVID-19, viral social media posts – many originating from the US – promoted conspiracy theories that eroded trust and reduced demand for COVID-19 and childhood vaccines.

“Misinformation and conspiracy theories have become a growing challenge to public perceptions of vaccines,” according to UNICEF’s 2023 report, State of the World’s Children.

‘Falsehoods travel fast’

Dr Mohamed Janabi, the World Health Organization Africa regional director, warned that “falsehoods travel very, very fast through social media, radio shows, talks, community gossip and even pulpits”.

“Spiritual cures have led families to hesitate or refuse completely vaccines that protect the children from polio, measles and other preventable diseases. And the unfortunate thing about the misinformation don’t need visas. They just travel,” said Janabi.

“A recent survey found fewer than four in every 10 Africans trust governments. Where mistrust is high, children are 10% more likely to miss vaccines,” he added, quoting a 2021 study.

“When people feel respected and heard, they begin to trust the nurse, the clinic, the local authorities and the institution that saved them. So, combating misinformation, to me, is not only about saving lives today. It’s about rebuilding the social contract that sustains public health.”

Karla Soares-Weiser, the newly appointed CEO of Cochrane, a global independent network of researchers and health professionals.

“For more than 30 years, Cochrane has been dedicated to a single purpose: producing and sharing trusted evidence to inform health decisions,” Soares-Weiser explained.

“Founded in 1993, our movement began with a very simple but radical idea that health decisions should be guided by the best available evidence, not by opinion, ideology or commercial interests.”

Pre-bunking vaccine myths

She said that three steps are necessary to rebuild people’s trust in science: “First, we must invest in trusted evidence as a global public good. Second, we need to strengthen intermediaries and local voices, because trust is built locally. And third, we must embed equity, transparency and inclusion, ensuring that leadership from the Global South is not the exception, but the norm.”

Schreiber said that UNICEF, which runs the biggest vaccination programme in the world, is building the capacity of health workers from Ministries of Health to proactively address misinformation.

“Of the lessons learned, number one is that speed matters. It’s really important, once you see these high-risk messages coming out, that you react quickly.

“We can ‘pre-bunk’ certain myths. We know already the myths are coming. So when we introduce a new vaccine, we can already spread messages that are pre-bunking these myths upfront and like vaccination causes sterilisation.”

The Vaccine Confidence Project has also founded Iris, a consortium of universities, working on “ways that we can pre-bunk with positive information and different strategies to encourage and basically nudge people towards the more credible information,” added Larsen.