Tackling misinformation is key to COVID-19 vaccination drive « Back to Blogs

As COVID-19 immunisation programmes start to get underway in the Asia Pacific region, governments are having to grapple with the spread of rumours and misinformation as well as the myriad logistical challenges involved with distributing and administering vaccines.

Building trust and confidence in the COVID-19 vaccine is vital and countries can learn a lot from previous mass vaccination campaigns; something that was discussed during a recent webinar organised by BMJ, Asian Development Bank and UNICEF.

There are multiple issues that need to be addressed — these range from religious, cultural, historical and political ones.

One issue is that gelatine derived from pigs is used as a stabiliser in some vaccines, but the consumption of pork is forbidden to Muslims. As the world’s largest Muslim majority country, one of the challenges Indonesia faces is concern that the COVID-19 vaccine is not halal and permissible under Islam. However, the country learned lessons from their measles-rubella vaccine programme in 2017 and 2018.

Indonesia faced widespread vaccine refusal when they started the phase 2 measles-rubella childhood vaccine campaign in 2018. Although the Indonesian Ulema Council stated that the vaccine is permissible for the greater public health good, the fact that it was haram still impacted the campaign. This resulted in a coverage of 72% instead of the minimum 95% target.

For the COVID pandemic, authorities moved much more swiftly to get the Council to certify that the Sinovac coronavirus vaccine is halal — following an audit of the manufacturing process in China and in-depth review of relevant documents. The health sector has also worked with religious and community leaders to respond to vaccine hesitancy and dispel negative messages.

Indonesia started its mass free vaccination programme against COVID in mid-January and according to Our World in Data had administered 795,058 doses for first dose and 151,573 doses for second dose by 8 February (10.20 AM). The country is taking a different approach to others by targeting younger working people aged 18 to 59 with their “youth first” vaccine strategy. This is in addition to targeting healthcare workers and those in public service.

With its population of 270 million, Indonesia has the highest cumulative number of Covid-19 patients in Southeast Asia and according to government data, about 80% of infections are among the working population. However, its ambitious rollout isn’t going to be easy with the world’s fourth-biggest population which is spread over a vast archipelago, bringing numerous logistical challenges.

In order to build confidence in the vaccine, President Joko Widodo, aged 59, was the first person in the country to get the jab. The head of the police, head of the military and other local leaders were also vaccinated early in order to instil confidence in the vaccine.

The Philippines is due to start COVID-19 immunisations next month despite suffering Southeast Asia’s second-worst outbreak of the coronavirus with more than half a million infections and more than 10 000 deaths. However, the country faces an uphill battle overcoming rumours and disinformation. There are long-standing low immunisation rates in the Philippines and the percentage of fully immunised children has been steadily declining.

This is partly due to a controversy surrounding the dengue vaccine, Dengvaxia, which was approved in early 2016 at the height of the election season. It was then banned after its maker Sanofi said it could put people who had not previously been exposed to the infection at higher risk of a severe case. This episode led to congressional enquiries and increased mistrust of government officials and healthcare workers.

“Vaccine mistrust is not irreversible, but trust has to be earned,” said Dr Gideon Lasco, senior lecturer at the University of the Philippines Diliman’s department of anthropology and research fellow at the Ateneo de Manila University’s development studies program, during the webinar. He emphasized the importance of bringing in experts from a trusted institution, such as the Philippine General Hospital, to take the lead in communicating the case for vaccines rather than politicians. Consistent, clear and transparent communication from government bodies and healthcare workers is imperative to win the trust of the public and to help deal with rumours and disinformation.

Misinformation about the COVID-19 vaccine spreads rapidly through social media and word of mouth. So it is crucial to get religious groups and community organisations onside to help dispel peoples’ concerns. It is also vital to get accurate, factual messaging into households and communities. As Dr Patrick Osewe, Chief of the Asian Development Bank’s Health Sector group told the webinar: “If we do not educate households and communities and they have the wrong information then we can have the best vaccines in the world but people will not take them.”

Perhaps most importantly, frontline healthcare workers need to have the tools to counter the spread of negative messages through high-quality information and training. The right information, messaging and partnerships and of course vaccines are the only effective way to ensure that mass vaccination campaigns are taken up.


As part of the BMJ and ADB partnership, more webinars will take place and cover the critical issues faced by frontline healthcare workers in the pandemic.

ADB Coronovirus Information Centre

In response to these many challenges, BMJ in partnership with the Asian Development Bank (ADB) launched this new Coronavirus Information Centre for all healthcare workers in ADB’s 49 member countries in the Asia Pacific region. The Centre offers free access to BMJ’s clinical decision support via BMJ Best Practice, e-learning modules via BMJ Learning, as well as patient information leaflets and procedural videos. Information on vaccines can also be found through the extra resources menu.

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