Introduction

The negative influence of rumours on health-seeking behaviours is not new. Historic records document rumours and their detrimental effects during the early days of smallpox inoculation in the eighteenth century and the global influenza and HIV epidemics in the twentieth century (Canada and Chauret 2021; Cohut 2020; Heller 2015). The COVID-19 pandemic is no different, with misinformation undermining public trust and the public health response from the very beginning. Rumours about the origin or existence of the virus, who was susceptible to it, and how it could be prevented or cured surfaced immediately, sometimes with devastating outcomes for individuals who believed harmful misinformation (Bursztyn et al. 2020; Kebede et al. 2020; Wonodi et al. 2022). Rumours circulated about COVID-19 vaccination before public officials authorised any vaccines for use, and misinformation intensified as vaccines were rolled out across the world. The over-abundance of information—of which some is misinformation and disinformation—during a health emergency is called an ‘infodemic’ (Tangcharoensathien et al. 2020). Johns Hopkins Center for Communication Programs (CCP) is a global health-oriented academic centre affiliated with the Johns Hopkins Bloomberg School of Public Health. With funding from the US Agency for International Development (USAID) through the Breakthrough ACTION project, CCP has engaged in identifying and addressing misinformation through strategic communication for many years and across various health areas. Before the COVID-19 pandemic began, CCP in specific countries began developing an approach to collecting and analysing health rumours in central databases to inform a coordinated response to emerging disease threats. This effort was part of the response to recommendations emerging from countries’ joint external evaluations (JEE),Footnote 1 which use standard criteria to assess various health-security-related capacities and gaps. Building on prior work done by UNICEF, Internews, CCP and other organisations working in humanitarian aid and global health, CCP rapidly adapted existing approaches to infodemic management for COVID-19 and now uses it in partnership with the Ministries of Health in several countries (Bugge 2017; Earle-Richardson et al. 2021; Fluck 2019; Spadacini 2016).

While infodemic management involves a multi-level suite of tools and practices, the aim of this chapter is to describe CCP’s approach to identifying and responding to COVID-19 rumours through case studies in Mozambique and Côte d’Ivoire. We first discuss the definition of a rumour and the overarching process of systematising rumour management, focusing on rumour identification and analysis. We then tell the story of developing rumour management systems in two settings, describing dominant rumours and how we worked collaboratively with government and community stakeholders to develop and disseminate communication materials informed by rumour data. Finally, we discuss some cross-cutting insights from CCP’s experiences with rumour management over the course of the COVID-19 pandemic.

What Is a Rumour?

The first challenge in developing a systematic approach to identifying and managing rumours is simply defining the term ‘rumour’. In our usage, ‘rumour’ has a functional definition—what a rumour is—and a meaning definition—why rumours emerge and spread. Put simply, a rumour is a piece of information containing unverified or false content communicated from person to person. A rumour may contain information where the veracity is not yet known, and thus we use the determination at the time of its emergence, even if later experts confirm that the information is true. Still, rumours may remain unverified or eventually be verified as false.

Rumours may fall into several categories. ‘Misinformation’ is false or inaccurate information that individuals spread in good faith in order to help others or make sense of a situation. This scenario suggests a second definition of ‘rumour’: a collective hypothesis about reality or a way to make sense of uncertainty or suffering (DiFonzo et al. 2012). Communities undergoing some sort of trauma may share what we would call rumours to try to account collectively for what is happening. By contrast, ‘disinformation’ is false or inaccurate information spread intentionally by people to deceive individuals or disrupt institutions (Bugge 2017). Public health professionals may also describe reports of disease cases or outbreaks as rumours. Event surveillance is the rapid detection and verification of potential cases or outbreaks of new or rare diseases by investigating reports of such cases (Toyama et al. 2015). CCP, however, tended to focus on belief-based rumours (misinformation and disinformation), referring reports of potential cases or outbreaks to the relevant epidemiology or surveillance team.

While some people may use the term ‘conspiracy theory’ interchangeably with ‘rumour’, a conspiracy theory is a specific type of rumour that claims to explain a phenomenon in a way that differs from the official account, usually involving a secret plot or nefarious motives (Pierre 2020). Conspiracy theories can be a very resonant form of rumour for communities with low trust in institutions, and result from a variety of motivations, including sense-making, emotional regulation and image curation (Douglas et al. 2017). Similar motivations prompt people to share misinformation online, including creating a sense of belonging, amplifying a certain self-perception or hoping to verify the rumour (Oh and Lee 2019). Experts trying to address rumours through risk communication and community engagement (RCCE)—particularly within communities that mistrust, and may in the past have been exploited by, health authorities—must acknowledge that sometimes past rumours first dismissed as conspiracy theories later proved to be true—for example, acts of forced sterilisation or clinical trials without consent (Lowes and Montero 2021).

Challenges in Rapidly Identifying and Addressing Emerging Rumours

COVID-19 is in some ways the ‘perfect storm’ for rumours. SARS-CoV-2 is a novel virus and COVID-19 vaccines are newly developed; rumours tend to emerge when uncertainty and anxiety exist (Wood 2018). On top of this uncertain environment, there is a well-organised anti-vaccination movement, already prepared to speak into the information gaps with counter-narratives that resonate with people who lack trust in health authorities or science. African countries have been viewed as a laboratory for untested vaccines, producing an environment of distrust for new, high-profile vaccines (Coronavirus: France racism row 2020). The proliferation of user-generated content online has created an information overload, and into this perfect storm of uncertainty, distrust and overwhelm, public health professionals must speak. Yet correcting misinformation once it has already taken root often occurs too late. Research has shown that people feel challenged to integrate new information that corrects or refutes misinformation to which they have already been exposed, even if they understand and believe the correct information (Gordon et al. 2019). Recently, researchers have analysed the spread of misinformation using a contagion analogy, emphasising the need to ‘nip in the bud’ newly emerging rumours before they can spread widely and wreak havoc (Ligot et al. 2021). Preventing widespread exposure to rumours by rapidly identifying and robustly refuting them is critical for limiting the influence of rumours and misinformation.

Thus, RCCE practitioners need to build in a systematic approach for rumour detection that stays active during non-epidemic times and scales immediately in an emergency. However, identifying rumours and addressing them pose several challenges. One is finding the right sources: how does an organisation or government ‘hear’ what people are saying before rumours become prevalent? Even with growing social media penetration across the world, the volume of social media data and the inaccessibility of private, person-to-person conversations has necessitated creative approaches to rumour collection. These nevertheless tend to focus on single points in time (like surveys) or are only activated during emergencies. The second problem is rapidly processing large volumes of unstructured data. Already identified rumours can be tracked over time using pre-coded survey responses. But the challenge in identifying novel rumours is finding them without knowing what one is looking for. Likewise, responding to rumours is a complex and fraught endeavour, as RCCE activities must address rumours without either spreading them further or reinforcing them among those who believe them by repeating them (Pennycook et al. 2018). Public health communication activities have used a variety of approaches to address health misinformation in different settings, such as pre-bunking, refuting, factual elaboration, myth-busting or testimonials, with varying effectiveness (Caulfield 2020; van der Meer and Jin 2020; Wang et al. 2021).

Methodology

In order to meet these challenges, CCP in Côte d’Ivoire and Mozambique (as well as several other countries not discussed in this chapter) implemented specific approaches from real-time monitoring and qualitative data analysis (which we call community listening) as well as web and social media analysis (social listening).

Community listening is the act of routinely gathering unstructured comments, feedback and questions from local liaisons who have been trained to recognise and submit rumours through a mobile application. These ‘key informants’ may, for example, be agents working at health hotlines, community health workers, hosts of local radio shows or religious leaders. They participate in training to understand the nature and importance of rumours, how to identify reportable rumours and how to submit them to the database. Community listening also includes more traditional research methods, such as surveys that elicit misinformation or questions that people have. Rumours are entered into a structured form and then coded, using a standard codebook, by data managers.

In our case studies in Mozambique and Côte d’Ivoire, CCP complemented community listening with social listening. Social listening is the act of mining web or social media data to understand online conversations about a topic. While rumour submissions from community listening may have included social media rumours (for example, if a local key informant saw a rumour on social media and submitted it to the database), we also employed standard social listening techniques such as tracking sentiment towards relevant health behaviours (i.e. COVID-19 vaccination) and conducting topic modelling to identify new ‘conversations’ in the social media environment. Latent Dirichlet Allocation is an approach to topic modelling that is appropriate for rumour identification because it does not require training data or a priori topics, but rather groups the data naively, producing a set of topics that can then be evaluated for misinformation (Jang et al. 2021).

In Mozambique and Côte d’Ivoire, CCP leveraged existing and new relationships to build a layered network of rumour sources that fed unstructured data to a central database for analysis and action. These ‘rumour trackers’, as part of a larger infodemic management system, are cloud-based databases that aggregate rumour submissions for thematic analysis. Thematic analysis is a simple but rigorous approach to qualitative data, normally performed over several rounds during a discrete time period (Nowell et al. 2017). CCP adapted thematic analysis for ongoing data analysis that is iterative and inductive (Tibbels et al. 2021). In the two implementations discussed in this chapter, the rumour tracker is built using the District Health Information System 2 (DHIS2) open-source software (University of Oslo, Norway). DHIS2 is used in over 70 countries as the national health-management information system, as well as by local and international non-government organisations for case management or monitoring and evaluation. In the case of rumour management, each rumour gets its own form submission, and the same rumour may be submitted multiple times if key informants hear it in multiple places. The form requests the source of the rumour, the date it was heard and where it was heard. Key informants enter no individual information about who supplied the rumour, as the purpose of the system is not to identify individual rumour-mongers but rather to offer a snapshot of circulating beliefs and concerns. Data managers perform a preliminary topical coding, assigning deductive codes (a priori topics already in the form), such as prevention, transmission, symptoms, origin, vaccination, government response, treatment or stigma. These categories allow data managers to identify spikes in certain topics that require investigation.

General topics, though, are not actionable. Coding by topic allows the team to rapidly organise rumour submissions, but they may struggle to develop messages on ‘government response’ or even confirm all submissions fit our definition of a rumour. This necessitates a second level of analysis: synthesising submissions into belief statements. Belief statements are unique (duplicates are removed) and succinctly summarise the rumour that is circulating. See Fig. 18.1 for an example of the synthesis process.

Fig. 18.1
A flow diagram. Submissions lead to topical code which further leads to a synthesized belief statement that reads, COVID-19 vaccines cause infertility or other reproductive health effects. Submissions include infertility after getting the vaccine, and COVID-19 affects the performance of men in bed.

Example of raw rumour submissions grouped by topic and assigned a unique belief statement

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Belief statements, whether identified through community or social listening, are classified according to a standard set of questions (Bugge 2017; Fluck 2019). These questions (Fig. 18.2) allow responders to ascertain the overall threat of the rumour to public health, which allows CCP teams to prioritise responses.

Fig. 18.2
A set of questions. If believed, could this rumor, cause physical harm to people? create an obstacle to positive behaviors? create barriers to accessing other health services? stigmatize people perceived to be risk, infected, vaccinated, or recovered? and undermine trust in health authorities?

Rumour prioritisation questions

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Data managers assign belief statements a unique identifier and add those deemed to be sufficiently prevalent or threatening to the DHIS2 submission form. They code subsequent submissions with the unique identifier to track the ebb and flow of belief statements over time. Through this type of analysis, CCP produces dashboards that summarise themes over time and display raw rumour submissions organised by topic. The rumours are shared with the relevant government-led technical working groups (TWG) or emergency response coordination mechanisms and are also used by CCP teams to inform strategic communication interventions.

In the following case studies, we give a brief overview of the context for rumour management in Mozambique and Côte d’Ivoire, along with any specific nuances of how rumours were identified, and then describe efforts to address rumours through communication interventions.

Case Study 1: Mozambique

In Mozambique, CCP started working with the Ministry of Health’s (MOH) national health hotline AlôVida in the first months of the pandemic. AlôVida was tasked with responding to concerns from callers and identifying rumours. CCP collaborated with the MOH, the Foundation for the Development of the Community (FDC, Fundação para o Desenvolvimento da Comunidade) and VillageReach in this initial phase. Through monthly meetings, this collaboration aimed to strengthen AlôVida by ensuring the hotline operated 24 hours a day and could expand data analysis and visualisation in order to inform the national response to the pandemic. CCP staff in Mozambique prepared and shared a technical brief on how to track and address rumours around COVID-19 and synthesised guidance for COVID-19 message development, which included an index of accurate, standardised COVID-19 information from trustworthy sources. These resources and partnerships equipped CCP to become a key partner of MOH in rumour management. When the COVID-19 vaccine rollout began in March 2021, the MOH in Mozambique strengthened the coordination and collaboration of the RCCE implementing partners and invited CCP to co-chair a technical working group (TWG) on rumour management on COVID-19 and vaccination against COVID-19. This TWG started meeting with nine member organisations to review the data and discuss strategic rumour management. The group expanded to 13 members, all part of the wider RCCE working group, which creates synergies and avoids duplications.

Rumour Identification

The CCP team built on existing efforts by identifying additional rumour sources and creating a DHIS2 database to log, rapidly code, analyse and visualise rumours. Data were collected from AlôVida; from vaccine acceptance surveys by UNICEF (one-time online survey) and by Plataforma Educativa de Informação sobre a Saúde (PENSA, ‘Health Information Education Platform’) (routine ongoing SMS surveys through the text messaging platform from the MOH); from community feedback collected by the Mozambican Red Cross; from social listening conducted by UNICEF; and from input from TWG members who also acted as key informants. A total of 2851 rumour submissions were analysed between January 2021 and April 2022.

Based on the initial analysis of topics, the TWG agreed on 25 belief statements grouped under eight main themes, including vaccine deployment, barriers, safety, efficacy, testing and authorisation process, conspiracy theories, prevention measures and modes of transmission. Gradually, the TWG had identified additional belief statements; by April 2022, it had collected a total of 41 unique belief statements. CCP continued to develop digital graphics and audio-visual materials to respond to specific rumours and also presented insights from the rumour analysis to the TWG every two weeks. For each belief statement, official sources of information were identified and members of the TWG agreed on which statements they would address in communication materials.

Rumour-Informed Communication Materials

Between June 2021 and April 2022, CCP and members of the TWG coordinated their production and dissemination of communication materials, including 8 materials by CCP, 20 by the Programa Inter-Religioso de Comunicação para Saúde (PIRCOM; ‘Interfaith Platform for Communication for Health’), 9 by UNICEF, 5 by the World Health Organization and 2 by the John Snow Inc. MOMENTUM Routine Immunization Transformation and Equity programme. CCP brought to the TWG its experience in providing technical assistance to the MOH from July 2020 to April 2021. During that period, CCP had developed 12 digital graphics addressing specific rumours on COVID-19 prevention and care, which were published on the MOH website and Facebook page. CCP had also created 14 audio and 9 audio-visual materials broadcast on TV and radio stations at national and community levels. One example was a testimonial from a journalist who recovered from COVID-19 and appealed to people to call the MOH COVID-19 emergency line. Furthermore, one of the first rumours that CCP addressed in August 2020 was that COVID-19 was the end of the world, a punishment from God. To respond, communication materials promoted ‘seeking correct information from trusted sources’ and then listing in bullets the correct information: ‘COVID-19 is a disease caused by coronavirus, is highly contagious, and is difficult to control.’ The materials acknowledged the emotions and uncertainty linked to the outbreak and its evolution: ‘There have been many deaths and people sick because of COVID-19, therefore many people feel afraid and uncertain, but COVID-19 is not a punishment from God.’ This digital graphic ended with a description of official sources of information and MOH hotline numbers (Fig. 18.3).

Fig. 18.3
A communication material addressing COVID-19 includes the graphics of coronavirus. Below, there are logos of U S A I D, breakthrough action, and others. The text is in a foreign language.

Digital graphic addressing COVID-19 as a punishment from God

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Once the vaccine rollout began in early 2021, in line with the initial approach adopted by CCP, TWG members agreed to focus on sharing credible, emotionally resonant information and joined efforts to provide testimonials by people recovered from COVID-19 or vaccinated against COVID-19. For example, materials indicated that COVID-19 has no cure; vaccination is important even for those who have had COVID-19; the vaccine prevents severe cases and deaths, but people must continue preventive practices to avoid new variants; COVID-19 is not over; it is important to prevent other endemic diseases such as malaria and cholera, which may leave people more vulnerable to COVID-19; people who do not have IDs can use alternative documents to register for vaccination; and it is important to keep one’s vaccination card to track dosage. All these testimonials and other materials reinforced the benefits of the vaccine and the need to continue with prevention measures without referring to the rumours directly. CCP worked closely with PIRCOM, a USAID-funded Mozambican faith-based non-profit organisation composed of leaders from different religions, to assist in the development of 20 materials showing the support of religious leaders for the COVID-19 vaccine and clarifying rumours, with pictures of male and female leaders from different provinces and different faiths getting vaccinated (Fig. 18.4). This collaboration with all faiths possibly contributed to reducing rumours that COVID-19 was the ‘Mark of the Beast’ and that the vaccine killed—beliefs that contributed to vaccine hesitancy in Mozambique, consistent with other research suggesting the importance of religious leaders in promoting vaccination (Kulkarni et al. 2022).

Fig. 18.4
An advertisement promoting the vaccination of Carona. A nurse is injecting the vaccine into another person, and both are wearing masks. The text is in a foreign language.

Christian leader Evelina Muaculher on digital graphic

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Despite all the efforts made, rumours that COVID-19 does not exist or that COVID-19 is over continued to circulate in Mozambique, while rumours related to the safety or trustworthiness of the COVID-19 vaccines continued to dominate in terms of topics (62 per cent of all rumours are about vaccines). To address this, CCP produced a digital graphic (Fig. 18.5) and audio-visual materials with the same character, explaining that COVID-19 is not over, starting with highlighting desired prevention behaviours such as wearing a mask correctly, frequently washing hands with water and soap and maintaining a distance of 2 metres from other people to avoid increasing cases of COVID-19.

Fig. 18.5
An advertisement about COVID-19 includes the logos of U S A I D, breakthrough action, and others. The text is in a foreign language.

COVID-19 is not over graphic

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The CCP team produced another set of digital graphic and audio-visual materials using the inoculation approach to foster resistance against fake news about vaccines. These communication materials acknowledged that false information was circulating about COVID-19 vaccines and reinforced the importance of seeking correct information and reducing uncertainty in the community. These messages helped to redirect people to MOH hotlines at a time when eligibility for the vaccine was expanded to pregnant and lactating women, and rumours started spreading that vaccination caused sexual and reproductive health problems (e.g. interfering with contraceptive methods, causing infertility, mothers having to stop breastfeeding), and also that it caused problems in the blood (e.g. blood clots; making people urinate blood).Footnote 2 CCP also collaborated with the MOH to plan the calendar of publications on its Facebook page to avoid audience fatigue and assisted in the preparation of introduction texts that provided key information to those who did not see the graphics or audio-visual materials accompanying the post. These efforts were important in the Mozambican context, as people sometimes cannot see images and videos due to slow data or use of Facebook in free mode.

Case Study 2: Côte d’Ivoire

In Côte d’Ivoire, CCP through its Breakthrough ACTION project is involved in addressing HIV, malaria, COVID-19, Ebola and diseases with epidemic potential as well as promoting family planning. Through this project, CCP supports the government of Côte d’Ivoire (GoCI) in encouraging the population to adopt appropriate behaviours across the relevant health areas. At the end of 2019, the Breakthrough ACTION project proposed to the GoCI a design for a rumour management platform with real-time visualisation capabilities, which would allow for rapid and concerted decision-making. The implementation began in March 2020, coinciding with the first cases of COVID-19 in the country. In February 2021, with the deployment of the COVID-19 vaccine in Côte d’Ivoire, rumours around COVID-19 vaccination surged. Consequently, risk communication stakeholders met to discuss and address these rumours, and the Risk Communication TWG was identified as the coordination space for sharing insights from the rumour management system to refine the vaccine communication strategy. During the early stages of the vaccine rollout, these coordination meetings occurred twice a week.

Rumour Identification

The data in the rumour management system came from multiple sources:

  • Community liaisons. Community members responsible for reporting rumours to the system, typically through WhatsApp. They include health workers, locally based NGO staff, community leaders, community members and health district communication focal points.

  • Hotline operators from health-related hotlines. These operators are responsible for reporting rumours reported by callers who are seeking health information.

  • Radio personalities. These radio hosts work at partner radio stations and are in charge of reporting rumours shared by the listeners during the radio programmes.

These individuals acted as key informants who understood their communities and were trained to recognise reportable rumours. Figure 18.6 shows the information-collection system and the approach to analysis.

Fig. 18.6
A graphic addressing COVID-19. The information collection via 1 4 3 hotline and WhatsApp, leading to coding and analysis with topical coding, data export, and synthesis, followed by a presentation with R C T W G, and action by mass media development or adaptation, community engagement, and job aids.

Overview of the rumour management system

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Overall, from March 2020 to April 2022, the CCP team, in partnership with the Risk Communication TWG, analysed 6303 rumour submissions and synthesised them into 83 actionable belief statements. CCP analysts complemented the community listening analysis with social listening approaches as described above, investigating spikes in negative sentiment on Facebook or Twitter, tracking news articles and applying topic modelling analyses to monthly extractions of social media data and summarising insights in ‘rumour briefs’. Vaccination-related rumours were the largest single category. Perceptions of who was at risk, how severe COVID-19 was, discussions about the ebb and flow of cases and the emergence of variants, and reactions to the government response also topped the list, as shown in Fig. 18.7.

Fig. 18.7
A horizontal bar graph presents the number of submissions. Vaccination has the longest bar of 1920, followed by variants with 595, and progress or end of the epidemic with 594, while stigma has the shortest bar of 50. Values are estimated.

Major themes, March 2020–April 2022

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The main vaccine-related rumours were about the safety and side effects of the vaccines, followed by perceived efficacy. Figure 18.8 provides a breakdown by topic. Vaccine-related

Fig. 18.8
A horizontal bar graph plots the bars for the number of submissions, COVID-19 vaccine-related. The bar of vaccine side effects and adverse outcomes has a maximum value of 795, and the bar of vaccine origin, testing, and authorization has a minimum value of 240. Values are estimated.

Thematic distribution of COVID-19 vaccine-related rumours

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misinformation concerned beliefs that the vaccine was dangerous, that the vaccine infected people with COVID-19 and that the vaccine was intended to kill or sterilise Africans and reduce the African population. Other rumours involved suspicions about the speed with which the vaccines were developed.

Rumour-Informed Communication Materials

The Ministry of Health has used this rumour management platform to inform messages addressing the public’s fears, beliefs and information needs. At the beginning of the COVID-19 crisis, most rumours were linked to stigma or risk perception, such as the belief that COVID-19 only affected white people, that COVID-19 did not exist in Africa, and a lack of concern about the barrier measures, particularly mask-wearing and physical distancing. These rumours identified through the continual community listening methodology were consistent with misinformation identified through more traditional research channels (as discussed in Chap. 13 of this volume). The CCP team developed several materials, including 15 posters, 6 video vignettes and 5 audio vignettes, each developed in six local languages. Each material was focused on a well-defined theme; the selection of themes was oriented by the prevalent concerns found in the rumour data, such as signs and symptoms, barriers and where to go for testing, with information on official sources of information and contacts for MOH’s helplines. These materials were disseminated using a range of strategies, including distribution of posters to community sites and in health facilities, posting and sharing of video vignettes on Facebook and WhatsApp and broadcasting via traditional mass media channels (radio and television). For example, CCP staff and the Risk Communication TWG worked with religious associations to produce communication materials involving religious leaders who modelled the recommended measures (Fig. 18.9).

Fig. 18.9
A communication material provides guidelines to prevent the spread of COVID-19, which include washing hands frequently, sanitizing hands, using face masks, social distancing, and avoiding handshakes. There are logos of U S A I D, breakthrough action, and others. The text is in a foreign language.

Poster promoting COVID-19 prevention measures in religious settings

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CCP’s team produced several ‘good to know’ messages on prevention against COVID-19, which deconstructed misinformation stemming from rumours, such as the belief in a new plant-based cure that undermined people following other prevention measures (Fig. 18.10).

Fig. 18.10
A poster promoting the prevention measures of COVID-19 includes the graphics of Coronavirus. There are logos of U S A I D, breakthrough action, and unicef. The text is in a foreign language.

Brochure with COVID-19 topics addressing misinformation collected through rumour tracking activities

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As the COVID-19 vaccines rolled out in Côte d’Ivoire, rumours emerged that the vaccines did not work or were dangerous for certain groups, or that COVID-19 only affected certain types of people. During the coordination meetings of the CCP-supported Risk Communication TWG, stakeholders discussed actions to address this misinformation through the development of communication materials to show the benefits of vaccination, as well as visuals designed to reach people over 50 years old, teachers, health workers, travellers and the general population. Figures 18.11 and 18.12 illustrate materials that were developed to provide a counter-narrative to low-risk perception of COVID-19 or fears about the safety of the vaccines. These materials offered a story of positive reasons to get vaccinated that leveraged a sense of collective responsibility and in which priority populations could see themselves.

Fig. 18.11
A brochure addressing misinformation collected about COVID-19 includes a photo of a community leader holding a verified document and giving a thumbs up. There are logos of UNICEF, Gavi, and others. The text is in a foreign language.

Graphic promoting COVID-19 vaccination among people with chronic illnesses

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Fig. 18.12
An advertisement promoting the vaccination of COVID-19 includes a photo of a community leader getting vaccinated. There are logos of U N I C E F, Gavi, and others. The text is in a foreign language.

Graphic promoting COVID-19 vaccination among people aged 50 and over

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Discussion

Thematically, COVID-19-related rumours in the two case studies fell into several categories: denial of the existence of the virus and distrust of the case and death counts, conspiracy theories about the origin of the virus, issues with prevention measures (such as the belief that masks are deliberately infused with the virus), beliefs about who is at risk or most affected, and alternative prevention and treatment methods (some harmless, such as drinking specific teas; others harmful, such as injecting bleach). Vaccine-related rumours emerged even before the vaccines were authorised, but typically related to questions about whether the vaccines worked, conspiracy theories about why the vaccines were promoted or who benefited, issues with vaccine deployment and access, side effects and negative outcomes on health, and religious or cultural factors. Certain rumours required an immediate and specific response, such as debunking the idea that consuming copious amounts of alcohol or drinking or injecting bleach would cure COVID-19. Standard public health communication approaches were not able to address certain other rumours; rather, stakeholders had to build trust over the long term by improving transparency and engaging trusted messengers.

Communication interventions in these two settings typically relied on the ‘factual elaboration’ approach, wherein teams offer concise, true statements that respond to—without overly focusing on—the rumours and include a clear call to action (van der Meer and Jin 2020). In Côte d’Ivoire, for example, the ‘good to know’ brochure indirectly addressed the emerging belief in a miracle cureFootnote 3 by explicitly saying there was no cure and calling people to follow the barrier measures. In Mozambique, the graphic responding to COVID-19 as a punishment from God expressed empathy, clearly rejected the rumour, but focused the majority of the content on what people could do to protect themselves. Materials in both settings leveraged testimonials and modelling, engaging trusted influencers to deliver the messages.

Identifying rumours through community and social listening, as CCP has done in Côte d’Ivoire and Mozambique, has several limitations. One, it means data managers must collect unstructured data to identify novel rumours rapidly. Analysts use the coding process to organise unstructured data into categories, but this potentially tempts them to overly quantify qualitative data. Treating rumour submissions, even when coded and organised, as though they were survey results is misguided, so implementers need to manage expectations and advocate for triangulating data through other research methods. Another limitation relates to evaluation. How do we know rumour tracking works? Does it accurately reflect reality? What populations does it overlook? Does it influence the trajectory of the pandemic? These are hard questions to answer because pandemic response has so many different players and interrelated factors. Evaluators are hard-pressed to develop a valid counterfactual analysis or tease out what happens with or without a rumour-tracking system in place. CCP has performed assessments to assess some of these questions, but much remains to be done. In Côte d’Ivoire, we conducted a household-based survey for a time period concurrent with the rumour-tracking implementation. We compared misinformation cited by survey respondents with rumours identified through our rumour-tracking approach and found remarkable consistency between the two approaches in terms of themes and beliefs that emerged, which offers some reassurance that the rumour-tracking approach is identifying novel rumours in real-time and incurring fewer expenses than frequent household surveys. Our teams collected user feedback to understand how people who play a role in the system—such as key informants, hotline workers or members of TWGs—perceived and used the system. By and large, they felt it was useful, easy to use and relevant to their work. The key informants particularly felt they were playing an important role in the pandemic response. Likewise in Mozambique, while we were unable to estimate the impact of communication materials from rumour-tracking efforts, we could observe trends in rumour submissions related to the local context; as rollout expanded to additional groups in phases, rumour submissions on side effects or negative outcomes of the vaccine peaked and then reduced. Similarly, rumours related to religious barriers or other cultural barriers declined over time as communication interventions intensely engaged religious leaders in promoting vaccines and addressing misinformation.

Tracking and managing rumours systematically as a component of infodemic management allowed public health authorities to hear concerns from communities in their own words. Trust—both institutional and interpersonal—has emerged as a huge issue during the COVID-19 pandemic in promoting protective behaviours and addressing misinformation (Bollyky et al. 2022). Tracking rumours is a way to centre communities and encourage a connection between the public health responders and the people they are tasked with serving.