Countering hesitancy and misinformation to build vaccine confidence

To develop a data-driven global solution for mitigating vaccine hesitancy with AI-enhanced social listening, personalized vaccine information and fact-checking against misinformation.

Joseph Wu

Professor, School of Public Health, The University of Hong Kong (HKU-Med)

Lead Scientist, Laboratory of Data Discovery for Health (D24H)

Vaccine hesitancy refers to the reluctance or refusal to vaccinate despite the effectiveness and availability of vaccines. The global epidemic of vaccine hesitancy threatens to reverse the worldwide progress made over the past few decades in tackling vaccine-preventable diseases (VPDs). Recognising that the herd immunity that has been built up over the past few decades to keep VPDs at bay is now becoming increasingly vulnerable to waning trust and growing impact of vaccine misinformation and anti-vaccination movements, the World Health Organization (WHO) listed vaccine hesitancy as one of the top threats to global health in 2019. Recent global surge of measles outbreaks in both developed and developing countries (which typically occurred in locales with suboptimal immunisation coverage as a consequence of vaccine hesitancy or refusal) are sirens for the imminent need to mitigate the global epidemic of vaccine hesitancy. The current suboptimal uptake of COVID-19 vaccines across North America, Europe and many other parts of the world (e.g. Hong Kong and Singapore) further highlights the tremendous challenges in overcoming vaccine hesitancy and refusal even in the context of a world-devastating pandemic that has killed more than 3 million people and caused more than US$16 trillions of economic damage worldwide.

Our goal is to serve the global community, particularly populations in which: (i) vaccine hesitancy and/or misinformation is prevalent; or (ii) people have limited access to timely and affordable access to veracious vaccine information or effective responses to their questions about vaccines. Our target populations include both high-income areas (e.g. Hong Kong where vaccine hesitancy is high despite low prevalence of vaccine misinformation) and low-income areas (e.g. many parts of Africa and Southeast Asia with weak public health and healthcare systems).

Our research over the past decade has shown that vaccine hesitancy emerges and spreads in many populations for a myriad of complex social, political and cultural reasons, which include complacency against the threat of VPDs, lack of confidence in vaccine safety and effectiveness, inconvenient access to vaccine information and vaccines, and exposure to vaccine misinformation aimed at generating confusions and conflicts. The specific root causes of vaccine hesitancy are highly diverse among different individuals and vary across time, locations and demographics. As such, we aim to develop data-driven strategies, knowledge bases, analytics and goodwill that will help us better understand each person’s reasons for vaccine hesitancy and concoct personalised solutions to overcome these barriers and build vaccination resilience.

By design, the digital dashboard, chatbots, fact-checking database, and repository of countermeasures and pre-emptive measures in our proposed global framework will all be public goods. Furthermore, as we develop and implement the proposed framework, we will publish the methodology and findings of our research in peer-reviewed scientific journals.

We expect our solution will create tangible impact for the global community by: (i) providing free online access to veracious vaccine information; and (ii) allowing anyone to ask questions about vaccines in a virtual setting free of stigmatisation, judgements and discrimination. Successful implementation of our platform will be particularly helpful for people who have limited access to timely and affordable access to reliable vaccine information or effective responses to their questions about vaccines (e.g. many parts in Africa and Southeast Asia). In addition to the advantage of scalability and automation, our AI chatbots can help users more effectively navigate through our knowledge base according to their particular questions and hesitancy about vaccines. We posit that chatbots may be particularly appealing for those who are uncomfortable disclosing their histories, doubts and inquiries (about vaccines) to a human agent. This premise is supported by the scientific literature, e.g. Lucas et al reported that patients were more likely to disclose history and emotions when informed that they were interacting with a chatbot vs a human clinician. The real-world success of ROO (a sexual health chatbot designed for teenagers) and Woebot (a mental health chatbot designed for the global community) also support our premise.

Over the next year, we will focus on developing and implementing our solution for locations where our teams are based, i.e. Hong Kong, Singapore and the UK. Afterwards, we will then iteratively refine our framework and expand our reach through our networks (e.g. by collaborating with the WHO to kickstart our expansion to serve other locations such as the US).  

We will evaluate the performance of our platform online by continuously monitoring and analysing user volumes and feedbacks. Indicators for successful impact would include: (i) sustained growth of our user base across time and geographies; (ii) adoption of our dashboard and chatbots by health authorities such as the WHO and CDC; (iii) presence and endorsement of our chatbots on major social media platforms; (iv) top ranking of our website among organic links returned by major search engines when users search for vaccine related information; (v) evidence of reduction in vaccine hesitancy and/or misinformation or increase in vaccine uptake in populations served by our platform.

Our biggest barrier is talent recruitment because we are competing for the same pool of technical talents (most notably, in data science and software engineering) that are highly sought after by enterprises and startups in technology, finance and other industries that can support much more generous remunerative packages. In the longer term, victories against vaccine hesitancy and misinformation could become victims of their own success as ephemeral triumphs over past epidemics have demonstrated (e.g. influenza, yellow fever, Ebola, etc). We posit that vaccine hesitancy will persist as long as VPDs remain global health threats, which implies that our fight against vaccine hesitancy will be never-ending (pathogens that are highly adaptive and/or have non-human reservoirs cannot be eradicated). As such, just like conventional pillars of public health protection such as clinical and microbial surveillance, our proposed solution will require continual financial and human capital investments in order to sustain its operations and impact. We will seek collaboration and endorsement from global health institutions, research funding agencies as well as technology companies (e.g. Facebook and Tencent) to support our fight against vaccine hesitancy and misinformation. Being selected as a Challenge Team by The Trinity Challenge will substantially boost our reputation and credibility.

LSHTM

Laboratory of Data Discovery for Heath (D24H)

WHO Collaborating Center for Infectious Disease and Control, HKU

Imperial College London

City University of London

Cambridge University  

University of Twente

University of Udine

Nanyang Technological University

Chinese University of Hong Kong

World Health Organization

University of Washington

University of Antwerp

As highlighted in a political declaration launched at the United Nations General Assembly in April 2021, effective mitigation of the global epidemic of vaccine hesitancy and misinformation requires a global, multidisciplinary and sustainable effort. As such, The Trinity Challenge (TTC) provides a unique and accessible opportunity for us to pitch our Solution to world-leading institutions in health, technology and education to attract their support in the form of access to data, tools, expertise and endorsement for our fight against vaccine hesitancy and misinformation. As indicated earlier, talent acquisition will be a major challenge for us because we are competing for the same pool of technical talents that are highly sought after by enterprises and startups in technology, finance and other industries. By publicising our Solution via the TTC network, we hope to attract and recruit talents in data science, software engineering and communication to join our mission. Finally, given the critical role of the digital world in our Solution, we hope that TTC will facilitate our liaison with technology giants including Google, Facebook, Tencent and Microsoft (which are founding members of TTC) regarding implementation/adoption of our Solution on their platforms and their professional suggestions on how to improve our Solution.

We would like to expand and solidify our partnerships with social media companies in order to maximise our reach, visibility, and impact. We would also like to develop new partnerships with health care facilities and technology companies (e.g. to connect the Chatbots with vaccination programs and medical records or to generate tracking apps) so as to improve the utility of our findings to better serve the decision-makers and the general public. We will further strengthen and leverage our relationships with governmental agencies and local communities. These partnerships will allow us to monitor the links among information environment (e.g. fake news, misinformation, counter-narratives), public attitudes and sentiment, and vaccination behaviours.

Further, our social media listening, dashboard, and other intervention components will enable real-time monitoring and evaluation (M&E) of emergency risk communication in the preparation for, response to, and recovery from COVID-19 and future epidemics. Partnering with social media companies, health care facilities, technology companies as well as governmental agencies and local community organisations will strengthen our capacity to better prepare for, respond to, mitigate and recover from large-scale public health emergencies.