Highlighting Heroes and Ignoring Villains: Visual Framing of Polio and Polio Vaccine in Newspapers

"The findings of this study have practical implications for those involved in designing persuasive visual messages aimed at improving the acceptance of polio vaccine, especially in the hard-to-reach areas of Pakistan."



Polio vaccine hesitancy remains high in Pakistan, one of the two remaining polio-endemic countries worldwide, due to various socio-political, religious, and economic factors. In response, the government of Pakistan and its international partners such as the United Nations Children's Fund (UNICEF) have devised a multipronged communication strategy to counter resistance to polio vaccine in the high-risk and hard-to-reach Pakhtun community. In this strategy, mainstream news media has been identified as a key stakeholder, as they have the potential to reach a wide range of population and disseminate easy-to-understand messages, including both visuals and text. This study investigates how leading Pakistani English newspapers visually portrayed polio and polio vaccine from 2010 to 2022, a time period featuring significant fluctuations in polio cases in Pakistan.



As outlined here, visual framing refers to the process of choosing events to cover, capturing images, and determining how they are presented. Communicators create or present particular images to make a certain aspect of an issue more salient and thus to affect how the receiver of the visual information understands the issue presented. Specifically, journalists' selection of visuals can have a significant impact on audience attention, provoke emotional responses, and influence their memory, attitudes, and behaviours. Thus, visual framing has the ability to convey unspoken meanings, raising awareness of these meanings even when the accompanying story is not read.



Although in March 2022, Pakistan did not report any wild poliovirus cases for 14 consecutive months, between April and December 2022, Pakistan experienced a major resurgence, with 20 new cases. These cases were clustered among unvaccinated children in the southern parts of Khyber Pakhtunkhwa (KP) province, which is a home to the Pakhtun community. Polio vaccine hesitancy among the Pakhtun community is due in part to the United States (US) operation in Abbottabad, where Osama Bin Laden was killed. News media reports claimed that US intelligence agencies had used a fake hepatitis vaccination campaign to track Bin Laden, which led to the perception that polio vaccination campaigns were a conspiracy against Muslims. Consequently, polio vaccination teams have been facing physical attacks, threats, abductions, and even deaths at the hands of militants.



Thus, part of the strategy of the government of Pakistan, in collaboration with international partners like UNICEF, has been to generate positive perceptions of healthcare workers (HCWs) and to present them as heroes in the mainstream news and social media. To support this positioning, efforts have been made to train journalists in the coverage of polio-related stories, engage with media owners and senior editors to shape news media policies regarding polio coverage, and provide effective information subsidies to news media outlets through trained public relations officers.



Using visual framing as a theoretical framework, the researchers analysed 115 images from three selected newspapers published from 2010 to 2022. The final sample included 44 images from Dawn, 49 images from The Nation, and 22 images from The News.



Key results include:

• Selected characteristics of visuals:
  • The visual analysis of images from selected newspapers revealed that 41.50% (n = 44) images featured males, 19.81% (n = 21) featured females, 29.24% (n = 31) featured mixed, and 8.49% (n = 9) were unidentified. The males depicted in the images represented various roles, including security officials, HCWs, parents, religious scholars, government officials, and foreign donors. On the other hand, the females in the images were predominantly portrayed as mothers of polio-afflicted children, HCWs fulfilling their duties, government officials inaugurating polio campaigns, and participants in protests against attacks on HCWs. The underrepresentation of women in the images can be attributed to two major factors. First, socio-culturally speaking, Pakhtun community upholds strict religious traditions and values which limits and restricts photographers in general and male journalists in particular to capture images of Pakhtun females and female HCWs. Second, Pakhtun women have limited direct interaction with men outside their immediate families.
  • Regarding the identities of the individuals in the images, 78.30% (n = 83) were identified as Pakhtuns, 10.37% (n = 11) were non-Pakhtuns, and 11.32% (n = 12) were unidentified.
  • Children were the most frequently featured in the images analysed, appearing in 37.73% (n = 40) of the sample. The second most frequently featured community was HCWs, who appeared in 22.64% (n = 24) of the images. The majority of these HCWs are female, covering their entire body with wearing burqas and veils.
• Frames:
  • About 18.26% (n = 21) of the sample images included the vaccine diplomacy frame. In this frame, collaboration between different national and international stakeholders against polio was most prominently featured.
  • The education and awareness frame constituted 42.60% (n = 49) of the overall sample. Within this frame, 12.24% (n = 6) of the included images accounted for sub-frame that depicted polio-related brochures and infographics with numbers and statistics inscribed on them. The sub-frame focusing on polio campaign messages comprised 87.76% (n = 43) of the selected images, aiming to raise awareness about prevention through vaccination. The campaign materials covered by newspapers were in both English and Urdu languages; however, considering that polio is prevalent within the Pakhtun community, it is worth noting that Pashto language was absent from these materials.
  • About 13.04% (n = 15) of the sampled images represented the criminality and security frame, which focused on issues related to polio and polio vaccine security.
  • The heroism of HCWs and affected children frame constituted 21.73% (n = 25) of the sample. Within this frame, 68% (n = 17) of the images portrayed the challenges encountered by polio teams as they strive to eliminate the disease. For example, images of female HCWs who travel to remote areas of the country show compassionate HCWs. These images can evoke a sense of heroism toward HCWs.
  • The medical resource frame accounted for 4.34% (n = 5) of the overall sample. These visuals feature various elements, such as shirts worn by polio HCWs, serving as powerful reminders of the campaign's mission and motivating parents to prioritise polio vaccination for their children.

Thus, the results show that the selected newspapers used images to frame polio as an issue that requires significant international collaboration and has benefitted from heroism of HCWs. In particular, the findings suggest that the images are well aligned with the policies of UNICEF and the government of Pakistan, which aim to portray HCWs, particularly female polio workers, as heroic figures while emphasising the grave threat of polio to children in underprivileged areas of the country. HCWs are playing crucial roles in polio vaccination campaigns, and the analysis indicates that newspapers visually present them positively. Further, the authors argue, "these visuals portraying HCWs as heroes possess significant potential to boost community acceptance of the polio vaccine."



"However, while these newspaper visuals underline the commitment of the international community to eradicating polio from Pakistan, there is a risk for these efforts to be perceived negatively by local communities, potentially hampering the success of polio vaccination campaigns. Some studies suggest that local communities tend to view the involvement of the international community, particularly from Western countries, in polio vaccination campaigns with suspicion....In addition, the focus on government officials, politicians, and international partners may inadvertently convey that polio is solely a concern of the government and its global allies, rather than an issue necessitating active engagement at the grassroots community level..."



Exploring practical implications of the findings, the researchers suggest that UNICEF and its partners, particularly those working in high-risk polio areas, should focus on enhancing the technical capacity of local journalists. Furthermore, these organisations should design specialised training programmes for photo and multimedia health journalists that emphasise the crucial role of visual storytelling in news stories. They could also provide specialised training for photojournalists, guiding them on the appropriate visual frames to focus on. For instance:

• Because women HCWs can persuade mothers to vaccinate their children and build trust among Pakhtun communities, it is necessary to address the marginalised visual representation of female HCWs in news media because it could potentially hinder the success of these campaigns.
• Visuals should vividly portray the potential consequences of polio on children's lives, highlighting its debilitating effects, and the highly contagious nature of the disease.
• Shifting the focus from official meetings, government officials, and international organisations to community-level framing has proven to be more effective in engaging local communities. Photojournalists need to emphasise the communal aspect of polio, framing it as a collective problem rather than solely attributing it to the government or international organisations.
• It is imperative to ensure that visuals featuring written messages are presented in the Pashto language.

In conclusion, "this study contributes to the fields of visual communication, health communication, and international communication, particularly related to the Global South."