Sunday Oko and Abara Erim (Lead Writers) — In a context where people's perceptions and reactions to public health interventions significantly influence their effectiveness, social listening has become an important tool for catalysing efforts to better understand attitudes and perceptions of public health interventions. Social listening involves actively identifying and analysing conversations of public health importance to gain valuable insights into the concerns, questions and sentiments of the public. It can be applied to address rumours, misinformation and vaccine hesitancy, as well as promote vaccine introduction and acceptance.
As Nigeria plans to incorporate the Human Papillomavirus (HPV) vaccine into the national immunisation schedule by September 2023, it is critical to utilise tools like social listening to generate evidence and foster demand to ensure the successful integration of the vaccine.
The burden of cervical cancer
Cervical cancer is a silent epidemic that continues to claim the lives of thousands of women across the globe, with a particularly devastating impact on low- and middle-income countries. The statistics surrounding cervical cancer are concerning. In 2020 alone, an estimated 342,000 women lost their lives to cervical cancer, globally. About 90% of these fatalities, occurred in countries with limited resources. In Nigeria, 70,327 women died from cancer in 2018 and cervical cancer was responsible for 14.8% of these deaths, ranking as the second most common after breast cancer. Most cervical cancer cases are caused by the human papillomavirus, making prevention of HPV infection paramount in reducing the burden of the disease.
The HPV vaccine is an integral part of the World Health Organization's (WHO) strategy to eliminate cervical cancer as a public health issue by 2030. The aim is to ensure that 90% of girls receive the complete HPV vaccines before they turn 15. Nigeria's plan to integrate the HPV vaccine into the country's routine immunisation schedule will serve to target the underlying cause of cervical cancer. However, a successful integration hinges on overcoming vaccine hesitancy and fostering communal trust.
As a lead up to the rollout of the HPV vaccine, it is critical to harness the power of social listening to address vaccine hesitancy and misinformation. This involves actively monitoring and analysing conversations and discussions taking place online and offline to gain invaluable insight into public perception, concerns, questions, and sentiments about the vaccine. These insights will be very useful for designing effective communication and demand creation strategies and interventions that respond to the needs and preferences of the communities.
Social listening insights on HPV vaccine in Nigeria
As a part of the Nigeria Health Watch Misinformation Management Project, social listening analysis was conducted online from January to July 2023 to better understand the emerging sentiments surrounding the introduction of the HPV vaccine in Nigeria, by analysing social media interactions and media publications. The findings revealed themes such as mistrust in responding authorities, misinformation, conspiracy theories, and the possibility of outright resistance to the HPV vaccine among members of the general public. The findings also revealed a lack of media coverage of the HPV-vaccine discussions, as seen by the amount of media publications devoted to this critical topic and intervention.
Other key findings from the analysis include:
(Social) Media Engagement: The insights reveal fluctuating levels of engagement over the months. January 2023, which was cervical cancer awareness month recorded the highest Facebook engagement with 8 posts and about 295 interactions. There were also 4 media publications on the HPV vaccine that yielded around 171 interactions. Across the three channels assessed - published articles, Facebook and Instagram - there were about 52 posts and 3,395 interactions on HPV vaccine conversations from January to July 2023 in Nigeria.
- Knowledge Gap: The social listening insights revealed varying levels of knowledge among the public regarding HPV and the vaccine. While some comments demonstrated a basic understanding of HPV's association with cervical cancer and the importance of vaccination in cervical cancer, there were also instances of misinformation, where individuals questioned the vaccine's safety and effectiveness, and associated it with conspiracy theories. There were also other comments indicating beliefs that cancer prevention can solely be achieved through lifestyle choices.
- HPV Vaccine hesitancy and resistance: Attitudes towards the HPV vaccine introduction were also varied with a significant portion of the comments indicating vaccine hesitancy. Many comments linked the vaccine to Bill Gates, voicing suspicions of hidden motives and intentions behind its introduction in Nigeria. Vaccine resistance was evident in some comments with the authors expressing outright refusal to take any vaccine, including the HPV vaccine.
Shaping strategies for HPV vaccine introduction and acceptance in Nigeria through social listening
The insights garnered from the HPV vaccine listening findings are useful to inform and shape the ongoing HPV vaccine demand-generation strategies and interventions by the National and State Primary Healthcare agencies as well as implementing partners. It is important to initiate nationwide comprehensive media orientations and training programmes to fill the current information and knowledge gaps identified. This will equip media professionals with accurate and up-to-date information about the HPV vaccine, empowering them to disseminate accurate and reliable messages to the public. This will ensure more evidence-based information is disseminated and reporting contributes to shaping the HPV vaccine introduction programme, as it will lead to an increase in HPV-vaccine discussions in the country.
Collaborating with trusted community influencers presents an impactful opportunity to promote HPV vaccine acceptance in Nigeria. Leveraging the credibility and influence of respected stakeholders within communities, including community leaders and healthcare professionals, will help in dispelling myths and misinformation associated with the. This will build trust and confidence in communities. Furthermore, leveraging social media influencers will effectively boost the discourse surrounding the HPV vaccine in the country.
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It is crucial to develop robust campaigns designed to counter misinformation about the HPV vaccine. Current insights indicate a concerning level of preconceived biases and misinformation about HPV vaccine in the public. Implementing evidence-based campaigns that directly address these misconceptions will play a vital role in mitigating the spread of misinformation, replacing it with reliable and accurate information.
Finally, continuous monitoring of discussions around the HPV vaccine in both online and offline platforms will enable stakeholders and those responsible for implementation to stay connected with shifting sentiments and emerging concerns. This real-time feedback loop will simplify the process of adjusting and honing demand generation strategies as circumstances require, thereby guaranteeing an ongoing effectiveness.
The road to successful HPV vaccine introduction and acceptance in Nigeria requires collaboration among stakeholders, including government bodies, health professionals, media, community stakeholders, and the public. Social listening serves as a bridge that will provide data-driven insights that unite these stakeholders toward the shared objective of seamless HPV vaccine integration and acceptance in the country.
As Nigeria takes deliberate steps towards a healthier and more promising future for its women and girls, it is important to gather insights into people's attitudes and perceptions and to leverage tools such as social listening to guide communications and other public health initiatives.
