On June 28, senior advocate Prashant Bhushan posted a series of tweets about how Covid-19 vaccines are unsafe. His comments were soon flagged as misleading by Twitter.
In response to the backlash, he put out a detailed clarification on Twitter titled ‘Why I Am Vaccine Skeptic’, where he claimed that while he is not anti-vaccine or anti-science, he is aware of scientific views on several subjects being driven by “political, commercial and media-vested interests”, and serious adverse effects of vaccines being underreported.
Experts and fact-checkers, however, even flagged as misleading some of the reports Bhushan, 64, cited to make his case. For instance, the advocate quoted a report that uses data from a June 18 technical briefing by Public Health England (PHE) to claim that those who have received a Covid-19 vaccine are six times more likely to die from being infected by coronavirus variants than those who have not taken the shots. The PHE data in the report, experts have pointed out, has been taken out of context, as it incorrectly gives the number of deaths among vaccinated and non-vaccinated people without taking into consideration other factors like age group, comorbidities etc.
“Why can’t those in the establishment take opposing views like mine?” Bhushan asks Forbes India. “There’s enough research to show that the disadvantages of taking the vaccine far outweigh the advantages,” he says, adding that he believes Indians have developed robust immunity against the coronavirus because “50 percent of the population has been infected by the virus”.
He says, “Just like we do not know how long the natural immunity will last after the disease, we do not know how efficient the vaccine will be. There is no point in injecting a vaccine that has not passed proper testing phases and was rushed.”
Doctors and scientists, however, say Covid-19 vaccines currently administered are safe and efficacious (see Myths vs Facts). “Vaccine development has gone through rigorous safety and testing. The process has been expedited at various steps, but the steps have not been ignored,” says Dr Akhil Singh, assistant professor, anaesthesiology, pain medicine and critical care, All India Institute of Medical Sciences. He explains that the literature around antibodies produced by Covid-19 vaccines is evolving and there is no conclusive evidence yet on how long natural immunity lasts. “It is important to be sceptical of everything, even science,” he says. “But public personalities should be aware of the weight of their words and choose them wisely. Especially in the middle of a pandemic that has claimed so many lives... and when we know that mass vaccination is the only way to end it.”
The problem, however, is not just limited to Bhushan. Many Indians are wary about getting inoculated for multiple reasons, including lack of trust in the government, misleading reports, lack of data in the public domain, and fear-inducing misinformation through social media.
Vaccine-related misinformation fuels hesitancy, which is a huge challenge, says Shankar Kaul, managing director of information and analytics company Elsevier India, which is helping institutions and health care workers with Covid-19 research. This fear has a direct impact on India’s vaccination numbers, which are dismal due to factors ranging from vaccine supply constraints to rural-urban access divide.
India has set an ambitious target of vaccinating its entire adult population by year-end, for which it will have to administer close to 188 crore doses. With less than six months to go, the country’s vaccination numbers stand at 37 crore as of July 9, with close to 30 crore people receiving the first dose and seven crore individuals receiving both doses. Kaul points out that the total number of fully-vaccinated people represents just about 5 percent of India’s population.
Low vaccination numbers, when combined with misconceptions and fear, are risky, he says. “For instance, there is a common misconception that after taking the vaccine, a person does not have to wear a mask. Vaccinated people can still infect other people, which is a high risk given that only 5 percent of the population has been fully vaccinated so far.”
According to Kaul, this calls for the government at both the Centre and state-level to collaborate with health care providers, non-profit organisations, and public health experts to amplify the reach of verified information. “Regular communication through mass media channels can also help to a certain extent,” he says. Infodemic in India An August 2020 report by the American Journal of Tropical Medicine and Hygiene highlights that in the first three months of 2020, nearly 6,000 people were hospitalised globally because of coronavirus misinformation. During this period, the report says, at least 800 people may have died due to misinformation related to Covid-19. Injury or death was a result of following unscientific advice, such as eating large amounts of garlic, taking vitamins to treat infections, or self-diagnosis such as holding their breath for a certain period of time.
The dangerous implications of misinformation led the World Health Organization (WHO) to coin the term ‘infodemic’, which is “an overabundance of information and the rapid spread of misleading or fabricated news, images, and videos”.
“Infodemics and rumours create mistrust and undermine public health responses at the national and community levels by confusing people and nudging them to adopt risk-taking behaviours, such as refusing vaccination,” Dr Roderico H Ofrin, WHO representative to India, tells Forbes India. “Infodemics surge during health emergencies, when evidence-based information about a disease is still evolving, which leads to uncertainty that both confuses and scares people and prompts them to seek information from every possible source, some of which may be unreliable.”
In India, misinformation has been propagated even by political leaders, public figures, and celebrities. For instance, yoga guru and businessman Baba Ramdev, Niti Aayog’s VK Paul and Madhya Pradesh Chief Minister Shivraj Singh Chouhan have claimed that immunity boasters can be used for treating Covid-19. Doctors and experts have said that such claims encourage people to try untested therapies and wait too long to seek medical help.
Ayush 64, for instance, is a polyherbal concoction that the Ministry of Ayush said has been “found to be useful in treating mild to moderate cases of Covid in clinical trials”. No clinical data has been released to verify the claim. Ramdev falsely claimed that Patanjali’s Coronil tablet was certified by the WHO and can be used as a “cure for Covid-19”, which was later endorsed by former Union Health Minister Harsh Vardhan.
There is a need to make accurate information available to people in a timely manner, says Syed Nazakat, founder of DataLEADS, a digital media and information initiative that conducts data analysis, fact-checking, media research and development initiatives. “Data deficiency and information vacuum allow misinformation to flourish.”
Spreading Fear The WHO has declared vaccine hesitancy as one of the top 10 threats to global health, says Anand K, CEO, SRL Diagnostics. “Lack of trust in the newly developed vaccines, fear of side effects and even unfounded fear of death, inconvenience of booking slots on a web platform have all led to vaccine hesitancy,” he adds.
Dr Niranjan Patil, microbiologist and scientific business head of Metropolis Healthcare, says people in India are not as vaccine-resistant (objecting to vaccines) as they are vaccine-hesitant (being unsure about getting the vaccine). “Risk perceptions and demographic characteristics, socioeconomic status and political ideology have all led to a decline in India’s vaccine uptake,” he says.
This hesitancy stems from various dubious, uncorroborated claims being circulated online, such as videos claiming that vaccines contain tracking devices, or can alter our DNA, says Nazakat. Other recent fear-provoking claims, he explains, have been that of the Bharat Biotech’s Covaxin containing calf-serum and few videos claiming that the vaccine has dangerous amounts of potassium chloride, which is used in lethal injections. “The most dangerous has also been the false claims that people aged below 50 who took the vaccine are expected to die within five to 10 years. Vaccine hesitancy grows largely from this kind of misinformation,” explains Nazakat.
Ripple Effect in Rural India Rural India is home to 65 percent of India’s population, amounting to nearly 90 crore people. As per a Reuters analysis, published on June 7, titled ‘India’s Vaccine Inequity Worsens as Countryside Languishes’, 114 of India’s least-developed districts, home to about 18 crore people, had administered only 2.3 crore doses of Covid-19 vaccines. Almost the same number of vaccines had been administered across nine cities—Mumbai, Delhi, Kolkata, Chennai, Bengaluru, Hyderabad, Pune, Thane and Nagpur—“which combined have half the population of the least developed districts”, the report states.
Adding to this is unflinching fear. “People think they are test subjects for the government, and that if something happens to them post-vaccination, no one will help them. It is hard to explain to them that vaccines are for their benefit,” says Anuradha Jakhoda, an ASHA worker in Bichpuri village of Uttar Pradesh. “For the past few months, getting them to believe in us has been difficult.”
A case in point is Beena, a domestic worker in Jalandhar, Punjab, who does not want to get vaccinated. “I won’t be able to bear the expenses of hospitalisation if anyone in my family gets sick after vaccination,” she says, adding that she has heard that people in the village died after taking the shots. “Vaccination is not for us, it is for those who can afford treatment,” says Beena, a single mother of four children.
“The biggest challenge with misinformation in rural and urban India is not just that false information makes people believe unscientific and harmful claims, but it is also making them less likely to accept truthful information,” explains Nazakat.
Some villages are using language and culturally-relatable messages in awareness campaigns that are proving to be effective. Examples include messages in the local dialect in rural Nashik, Maharashtra; songs and memes in the Wagdi dialect in Banswara and Dungarpur in southern Rajasthan; videos in Kurku, the indigenous language of tribals in the Amravati city of eastern Maharashtra.
WHO is working closely with the central and state governments to identify and correct rumours. “We do this by actively listening to people’s concerns and addressing them by sharing verified information. This creates information literacy that builds resilience to misinformation and fake news, and empowers communities to identify genuine sources to make evidence-based choices,” says Ofrin.
“Health care workers, ASHAs in particular, are the first point of information source for the community and WHO supports the provision of latest, accurate and simplified information for them to deliver.”
WHO’s field workforce in India constitutes 2,600 people in 23 states, who act as amplifiers and listeners. They have become the voices for credible information. Perils of Social Media A January 2021 study by doctors from Rochester, US, and Pune, published in the Journal of Medical Internet Research, points out that 30 percent Indians use WhatsApp for Covid-19 information, and just about as many fact-check less than 50 percent of messages before forwarding them. About 13 percent of respondents say they never fact-check messages before forwarding. “Rumours on WhatsApp have resulted in chaos, panic, and mob lynching in many parts of the country. People are led to believe anything,” says Nazakat, adding there have also been cases of doctors and health care workers falling for misinformation.
To aid medical experts and curb the spread of misinformation, Elsevier has launched the Covid-19 Healthcare Hub, a platform for evidence-based information and tools. “We aligned localised resources with global care standards to provide frontline workers with a single source of credible data to help with prevention and management of the disease,” says Sonika Mathur, global chief content officer, Elsevier.
Over the past year, Elsevier has researched the Alpha, Gama, Zeta, Beta and Delta variants, and has partnered with experts to provide vaccine administration resources and clinical guidance on vaccines available for use and in development. “The judiciary and the government have also had a role to play in combating misinformation and vaccine hesitancy,” says Biranchi Narayan P Panda, assistant professor (law), Xavier Law School. Some of the initiatives taken by the government, he explains, include setting up a 24-hour portal to curb the spread of fake news on the direction of the Supreme Court, invoking Section 54 of the Disaster Management Act, 2005, to punish persons indulging in spreading fake news, and directing social media companies to remove posts spreading misleading information around Covid-19.
Nazakat says the dangers of misinformation are worse than most people realise. It needs a multifaceted, multi-disciplinary and long-term approach. “There is no magic bullet,” he says. “Combating misinformation should be the topmost priority.”