In India, vaccine hesitancy poses a risk to ending the COVID-19 pandemic. According to latest figures shared by the Ministry of Health and Family Welfare, 342 million people have received the first dose of the vaccine and 93 million have been fully vaccinated until July 26, 2021. That’s about 25% and 6% of the population in India, respectively. Wide variations in the vaccination strategy across states are keeping India from achieving a desirable vaccination rate. Supply shortages in many states have left millions of people vulnerable to the virus. In addition to vaccines running out, fears and rumours about the vaccine have resulted in delay in acceptance or refusal of vaccination. Misinformation on social media and messaging platforms about the vaccine causing infertility, serious side effects or even death has been circulating widely even before the vaccination programme rolled out in the country. Other reasons for refusal of vaccines include disbeliefs among people that coronavirus is spreading in their area and that they can be infected by the virus.

The Covid Symptom Survey (CSS) reveals that the proportion of the population hesitant to Covid vaccines is highest in Tamil Nadu (40 per cent), Punjab (33 per cent), Haryana (30 per cent), Gujarat (29 per cent), and Andhra Pradesh (29 per cent). The digital divide that exists in the country has also exacerbated the problem. The vaccine registration process involves the use of smartphones and the internet, and a lot of people across the country do not have access.

This blogpost captures the views of editors of Ekta consortium about the reasons for vaccine hesitancy in India and their response to the challenge. The Ekta consortium has been formed by six independent fact-checking groups in India: AFP Fact Check, BOOM Live, Factly, India Today Fact Check, Vishvas News and WebQoof. All the groups are part of Facebook’s third-party fact-checking program, and Meedan has provided access to its fact-checking platform Check and strategic support for this project.

1. Where are you seeing vaccine hesitancy and misinformation related to the COVID-19 vaccine?

Social media platforms and messaging apps contribute to the spread of misinformation but so do influencers and self-proclaimed doctors.

Rakesh Dubbudu, Editor, Factly: Social media content including unscientific/magical cures, conspiracy theories, rumours, fake news by so-called experts/cons have been circulating on closed groups like WhatsApp & shared on platforms like Facebook & YouTube. Misinformation in rural areas is spread through word-of-mouth or people’s past experiences of vaccination. Some people also have a sense of invincibility and they believe that Covid won’t affect them.

Shachi Sutaria, Fact-checker, Journalist- Health, BOOM: This can be seen on social media channels such as WhatsApp, Telegram and Facebook. A section of medical practitioners and quacks are perpetuating their videos through Telegram.

Kritika Goel, Associate Editor, WebQoof: Other than WhatsApp, Facebook, Twitter and Telegram, we have seen politicians, self-proclaimed doctors and quacks promoting conspiracy theories related to COVID-19 and vaccines. Some of the groups on these social media platforms use different words or short forms to escape the algorithm. We have seen politicians openly promoting "cures" which are not backed by science or evidence.

2. What kind of misinformation has been circulating around on the COVID-19 vaccine? Can you share some examples?

Serious side effects, death, misinformation related to the vaccine containing items that are prohibited in certain religions and other conspiracy theories have been doing the rounds online and off.

Shachi Sutaria: Death due to vaccination and post COVID-19 vaccination side effects are the biggest drivers of vaccine hesitancy. Reports of the body becoming magnetic post vaccination, or people developing different diseases, the vaccine containing cow serum, aborted fetal cells, aluminium are driving vaccine hesitancy. Misinformation such as the vaccines containing microchips and collecting personal data, vaccines altering human DNA, are also doing the rounds.

Rakesh Dubbudu: The spectrum of misinformation ranges from questioning the vaccine ingredients such as cow serum, pig fat, aluminum, etc., vaccines affecting menstrual cycle/causing infertility, homemade concoctions to either cure or prevent Covid-19 instead of vaccinations, government implanting microchips through the vaccine, magnetic effects at the site of injection to death within 2 years after the vaccine.

Kritika Goel: From vaccines containing chips to control people to vaccines causing death, all these unfounded theories have contributed to vaccine hesitancy in the country. A lot of people have been made to believe that the vaccines will make them "magnetic", will make them infertile, that the vaccine contains cow serum and pig fat. Some posts also claim that the vaccine is the reason behind the new variants and the subsequent waves.

Uzair Rizvi, Fact checker, AFP Fact Check: Misinformation surrounding death, impotence, menstrual issues in women, and other health issues related to vaccines are floating widely on social media. There’s also content like vaccines making the body magnetic, or containing microchips to track people’s movements.

Chayan Kundu, Senior Journalist, India Today Fact Check: The main misinformation is death due to vaccination, then comes misinformation about vaccines having microchips, magnets, vaccines being a strategy for population control and conspiracy theories like connection between the vaccine lobby and the Wuhan lab and misinformation related to pregnancy.

3. In your understanding, what are the main reasons for vaccine hesitancy among people?

Kritika Goel: The Quint conducted a survey in the rural areas of the states of Uttar Pradesh, Madhya Pradesh and Bihar and we found that misinformation was one of the reasons behind vaccine hesitancy. A lot of people are made to believe through WhatsApp forwards that vaccines will actually kill them and that is what is making them hesitant. As per our understanding, it is also because of lack of awareness, communication and information which is given to them. In a few cases, we have found that people in villages don’t even know about the existence of Covid vaccines.

Rakesh Dubbudu: Unverified sources actively spreading Covid-19 misinformation and a huge lack of procedural awareness in terms of registration & administration have been reasons for hesitancy. Given the timelines of vaccine research and how rushed the process was, there is low trust in the safety & efficacy of the vaccine. Finally some people also have choice anxiety in terms of waiting for a specific vaccine & concerns around safety of vaccination centers.

Chayan Kundu: The Covid vaccines have been made within a very short span of time, much less than the usual time it takes to create a vaccine with proper trials, there is hesitancy from the very beginning about its efficacy and its side effects in the long run.

Shachi Sutaria: Health and science are topics which are continuously evolving and the latest updates have to be effectively communicated to the community at large. In reality, there is lack of access to updated health information, spread of misinformation through quacks, anecdotes of pain post vaccination and reports of people still getting infected as well deaths post vaccination; all these are exacerbating the existing vaccine hesitancy.

Uzair Rizvi: Some of the misinformation is being floated by doctors themselves on their YouTube channels or on social media where they talk about unproven side-effects; this discourages people from taking vaccines.

4. Given that there is a digital divide in our country, what steps can be taken to ensure the most marginalised can access information related to vaccines. What out of these is your group focusing on/ plans to focus on?

Chayan Kundu: Door to door campaign by the health workers. Political leaders, councilors, local panchayats should be part of this campaign. Rolling out information on social media particularly on WhatsApp, facebook to counter misinformation.

Kritika Goel: We have been working with three local news organisations in UP, MP, Bihar and Assam to be able to reach out to the rural audience and ensure that they have access to fact-checked and verified information. We try to gather misinformation which is doing the rounds in their circles so that we can debunk it and bring forth the facts. We are also creating awareness videos to tell our audience about the importance of vaccines and debunk the myths around Covid-19. All this content is being produced in local languages to make it more accessible to the reader. We are writing text pieces, producing animated and stand up videos, creating cards (templates that can be shared over WhatsApp). We also aim to produce some jingles and do skits so that we are able to connect with the audience better. Some of this content that we are producing is also being published on local websites and being aired by local channels.

Shachi Sutaria: Along with writing regular stories debunking misinformation as well as explaining different health and scientific terminologies and reports, BOOM has also been conducting workshops with senior citizens in multiple languages to help them discern their way through the information overload during Covid-19 times.

The team collaborated with several foundations and NGOs and provided them with resources to verify and tackle the spread of misinformation. We even trained office bearers of these foundations in ways of sharing correct information to reduce vaccine hesitancy.

While we have regularly been interacting with doctors and shooting videos with them wherein we are breaking down facts and debunking myths, we also initiated a social media campaign called "Sansani nahi sach". Television actor Aasif Sheikh was the face of this campaign.

Rakesh Dubbudu: Local governments must curate and adopt local solutions (communication campaigns) through partnering with community mobilizers, religious leaders, doctors, ASHA workers, among others. Celebrity endorsements on TV also improve vaccine confidence.

There have been multiple success stories where media such as art forms (theatre or skits) and other incentives have improved the vaccine uptake.

Uzair Rizvi: Celebrity endorsements will help in disseminating information. Door to door campaigning by health workers can also spread information about the efficacy and benefits of Covid vaccines.