Social Listening to Strengthen Vaccine Programmes through Chipatala cha pa Foni (CCPF) in Malawi

This initiative involves systematically monitoring and responding to vaccine questions and misinformation in public discourse through a process called social listening. The approach identifies the critical barriers to vaccine demand, including access and availability. The social listening analysis helps health systems prioritise responses to address information needs, gaps, and emerging misinformation and rumours.

VillageReach and the MoH partnered to enable CCPF operators to label incoming calls relevant to COVID-19 vaccination and catalogue whether the caller was asking about vaccine access and eligibility, effectiveness, misinformation, or safety concerns. This allows VillageReach to filter calls about COVID-19 vaccination for further quantitative and qualitative analysis. A significant majority of calls about COVID-19 vaccines are from men (79% in the last two weeks of May 2022), and more than 80% of callers were 45 years old or younger, suggesting the hotline is particularly useful to adult men and that women or people over 45 years old may have barriers to reliable health information via mobile phone.

All CCPF calls are recorded but stripped of any and all personally identifiable information. A VillageReach Malawi researcher then listens to an anonymous sample of 20-25 of the filtered calls per analysis period to log any questions or concerns expressed by the caller. The calls are tracked across the identified topic categories and monitored for the frequency of concerns over time. This analysis helps officials identify new themes as they emerge, and then pivot public communication and messaging to address those concerns. When rumours are identified, their potential impact is assessed as either low, medium, or high impact based on guidance in the United Nations Children's Fund (UNICEF)'s "Vaccine Misinformation Management Field Guide" (at Related Summaries, below). The MoH then prioritises its messaging to address rumours with the highest potential impact on COVID-19 vaccination demand.

In response to the common questions, VillageReach supported the MoH to develop interactive voice response (IVR) messages so that CCPF callers can access information without having to wait to speak with a hotline worker. Updated guidance was also developed for CCPF operators to help them address emerging questions and rumours in real time and in a consistent manner. The bi-weekly analysis report is shared with the MoH through its national COVID-19 task force and risk communication and community engagement (RCCE) group. The report helps inform an RCCE subcommittee on how to manage and respond to emerging rumours and misinformation.

One response that included the development of COVID-19 vaccine programmes aired on a national radio station and several local radio stations. The programmes answered frequently asked questions the CCPF received and aimed to dispel misinformation identified in the social listening reports. Additional efforts included the development of flyers, posters, brochures, radio advertisements, and jingles to amplify accurate COVID-19 vaccine information. For instance, in the first half of 2022, callers expressed concerns that the COVID-19 vaccine would adversely impact family planning. Those concerns were addressed in radio and print advertisements. By May 2022, there were no more calls sampled for the data set expressing family planning concerns. The same was true for rumours that linked the vaccine to fatal side effects.

The VillageReach team that produces the analysis also made recommendations for the MoH that would show its responsiveness to its citizens' concerns. The recommendations included working with religious leaders to dispel religious misinformation, bolstering messaging around vaccines preventing death and serious illness, clarifying where vaccines are available, laying out steps for receiving proof of vaccination, and clearly articulating common side effects from the vaccines.

Immunisation and Vaccines

While the COVID-19 vaccines have been proven to protect against severe infection and death from the SARS-CoV-2 virus, many people around the world have been unaware of how, where, and why to receive the vaccine, or they have expressed misgivings due to misinformation and rumours associated with the vaccine. Efforts to boost vaccination rates in countries and communities where rates remain stubbornly low require an understanding of people's perceptions and concerns. A responsive strategy can then be developed to build trust in vaccine safety, efficacy, and delivery.

CCPF is operated by the Malawi MoH and serves 9,500 callers per month. On average, 100,000 interactive voice recorded (IVR) messages are accessed each month. At the onset of the COVID-19 pandemic, demand for CCPF spiked after it was declared a trusted source of information on COVID-19 during a presidential address. The number of calls attempted to CCPF increased five times, and the number of IVR messages heard increased four times in comparison to before the pandemic. These data illustrate how, as a solution like a health centre by phone proves to be responsive, informative, and trusted, it generates its own feedback loop. That is, as it responds to its citizens, the more it is utilised, and the stronger its data becomes, the quicker a messaging strategy pivots to address the concerns of a broader swath of the population.

According to VillageReach, the following are key to implementing an effective social listening system:

• Mitigation strategies to address misinformation and rumours should leverage existing channels. The cost of introducing social listening within an existing national health hotline, which already collects data on each call, is minimal in comparison to initiating a new, separate data collection process.
• To ensure that multiple types of data sources are included in social listening, it is necessary to conduct a landscape analysis to identify all partners whose existing data sources can be leveraged to address emerging misinformation and rumours. Partners should standardise the coding and interpretation process and work together to jointly present results on a regular basis to decision makers and implementers.
• To create an agile, dedicated, and responsive team, partners should come together to review the data and to make timely decisions that efficiently disseminates accurate information and stymies misinformation.