Mmadu-Okoli C, Nsofor Ifeanyi. WhatsApp, COVID-19 related misinformation in Africa and the need for continuous infoveillance. HPHR. 2021;39. 10.54111/0001/MM8
WhatsApp is a social media application preferred for its ease-of-use in sharing real-time information during COVID-19 and public health emergencies in Africa. Yet, like a double-edged sword, the absence of fact-checking avenues within the app allow for the spread of health misinformation, hindering prevention and control efforts. In this commentary, we help readers understand the patterns of use and factors that influence the sharing of COVID-19-related misinformation among WhatsApp users in Africa, based on already available literature, and to make recommendations on how to reduce the public health implications through a multi-stakeholder approach.
In the past decade, fake health claims have done great harm during epidemics in Africa. As Cunliffe-Jones et al 1 highlights, cases of deaths recorded in Nigeria through the use of false medications to treat Ebola Virus Disease 2, untrue stories about healthcare workers in Liberia3, overwhelming ratio of unverified online information, during the Zika virus outbreak in Cape Verde4, viral claims of cure for malaria 5, mental health distress from a viral fake story in Zambia6, HIV treatment in Tanzania7, fake anti-vaccination narratives8 and chloroquine poisoning from attempts to treat COVID-19 via self-medication9 all point to social media being used for health misinformation.
Social media are network technology tools used for finding information, connecting with loved ones, sourcing news and following events10. Compared to traditional media, social media is preferred for its accessibility, low data costs, virality, reach; ability to spark conversations, allow users make changes after publishing, with little room for bureaucracy, delays and fact-checks required before sharing news11.
WhatsApp, the #1 messaging and #3 most used social media app in Africa12,13, is a major platform for sharing COVID-19-related information14, as it maintains user-anonymity and inability to verify messages exchanged therein. These messages, often shared with good intentions, and not rooted in scientific evidence, could lead to physical, social, economic, or psychological harm15, worsening public health efforts.
Africa needs a multi-stakeholder-driven, sustained infoveillance: using data from epidemic-related information, for surveillance and decision-making16. A review of over 31 existing sanctions against false information in Africa17, strengthening the media to prebunk and debunk misinformation, and teaching health-news literacy skills, are proactive approaches to take.
The Health Internetwork Access to Research Initiative (HINARI) of the World Health Organization (WHO), was a database of choice: a vital resource, housing journals that cater to the research, practice and teaching needs, for low-priced settings in Africa18. The search criteria involved combination and modification of search terms/keywords related to the title of the paper. Database search from November 1, 2019 to August 7, 2021, using search terms, i.e., some related keywords in this article such as “(WhatsApp) AND (COVID19) AND (Misinformation)”, “(WhatsApp) AND (COVID19) AND (Misinformation) AND (Africa)”, “(WhatsApp) AND (Health Misinformation) AND (Africa)”, and “(WhatsApp) AND (Health) AND (Fake News) AND (Africa)” yielded 51, 16, 101, and 60 respectively. These yielded a total of 228 results from these 4 different searches, within the time frame selected to cover from the period when COVID-19 began to make the news before it was officially declared an outbreak in December of 2019, to the day of the database search on the HINARI.
Using a scoping review, 162 titles were removed from the list because they had related keywords but did not provide information or narratives relevant to the subject matter; while the abstract of 49 results did not meet the objectives or answer the key questions of the paper. In Five (5) of these results were narratives from studies or observations done outside of Africa as a location, while 12 of the search results reviewed, provided or pointed to relevant insights on the subject matter. Informed by the final selection of these papers alongside existing news stories and reports related to this topic, we applied a thematic approach to answer three key questions in this piece:
“Fast, simple, secure messaging available on phones all over the world”. This is WhatsApp’s unique selling value, highlighted on its website’s home page. Security, privacy and deliverability in low-bandwidth areas are benefits which over two billion users from 180 countries enjoy, for personal, business and payment purposes. In Africa, three countries record the highest percentages of monthly users, aged 16-64: Kenya (97%), South Africa (96%) and Nigeria (96%)19. The end-to-end encryption feature within this Facebook-owned messaging app, allows users to share messages without monitoring from the WhatsApp team, thus providing an unsupervised journalistic platform for virality.
Patterns of public health misinformation during infectious disease outbreaks are observed according to different stages of response to outbreaks. An approach grouped epidemic-related misinformation into 4 categories: transmission, prevention, treatment, and vaccination20. Also are conspiracy theories, risk-factor-, disease-causation-, and complication-related misinformation21.
When Africa recorded the first few COVID-19 cases, panic messages were shared using WhatsApp. A major fake claim was that warm temperatures of the African region and the strong immune systems of Africans were responsible for the low cases22. Conversely, 8,167,083 COVID-19 positive cases have been recorded on the Africa CDC dashboard, as of September 20, 2021. Countries like Nigeria, Niger, DR Congo and Sudan where respondents felt the news about the virus was exaggerated, also showed the lowest observation of protective measures23.
Other unverified messages were that the disease was not in existence and only concocted by African or foreign governments to take over power and shrink the African population, COVID-19 was created in China by the United States, the vaccine contains traceable microchips, Africans are being used as lab rats for vaccine trials.23,24. Some myths, busted by the WHO25, include false prevention and control claims like 5G networks, steam inhalation, hot baths, intake of garlic, hydroxychloroquine, or gargling warm water with salt or vinegar.
These messages have one thing in common: the nudge for users to “forward as received” to their loved ones. Good intention is often the driving force for sharing information about COVID-19. Information and knowledge sharing constantly shapes our knowledge and behaviour. Influenced by trust, ease of use, and information quality, community identification, and commitment, altruism, reputation, or enjoyment in helping, desire to raise awareness, users found the app as a valuable alternative source of information, and felt confident in the message itself 26,15. Altruism is the strongest predictor of fake news sharing on COVID-19, while entertainment is not associated with it. Additionally, news-find-me perception (exposure to news, without consciously sourcing for it and information overload affect the sharing of COVID-19 related fake news more than other factors like trust in online information, and seeking status, self-expression27.
In Zimbabwe, efforts at countering COVID-19 misinformation via WhatsApp, show that social media messaging from trusted sources leads to a 30% decrease in potentially harmful behaviour: not abiding by the lockdown rules28. Furthermore, users most likely trust international organizations and agencies, followed by the NGOs and CSO, the government and family and friends. In Niger Republic, friends, family and WhatsApp are the most trusted sources, as almost half (46%) of respondents trust their friends or family, while 1-in-5 (22%) consider WhatsApp as their source of COVID-related information23. In Nigeria, 98.2% of Nigerian youths who identified that their reasons for using social media were to build relationships with online communities, used WhatsApp to share information on COVID-19 pandemic disease in Nigeria while 5 (1.8%) did not. These respondents had shared untrue information about COVID which they later realized were untrue. 53% of them are students29.
Government policies also influence misinformation sharing. On one hand, the South African Government, placed strict measures against sharing fake COVID-19 claims, via her Disaster Management Act, such that anyone who creates, sends or shares such narratives is liable for prosecution. This is in addition to a digital platform, called Real 411, where digital offences such as disinformation, hate speech, incitement to violence, can be reported30. On another hand, countries like Nigeria, have WhatsApp-only, affordable data bundles from network service providers, which allow the ease of sharing information via the app. The laws against spreading false information have doubled since 2016 across at least 11 countries from 17-31, yet there is little or no effect, since these rules are merely against “false information” against public officials and institutions; and are poor staffing and budget for fact-checks and implementing these laws.
Generally users are more likely to trust messages if it came from a legitimate news source or government sources and least likely to trust those from someone they respect. Their response to these messages are shaped by the reliability of the message, the possibility of independent verification, the type and source of message, and how much it helps others get informed, amongst other reasons
Demographic groups also share and receive misinformation differently. In a survey on COVID-19 vaccine perceptions done in 15 countries across 5 regions covered by the Africa CDC23, a significant proportion of the respondents across the continent express concerns about vaccine safety, 41% had online sources as their trusted source of information (second to TV at 61%) compared to health bodies (23%) and government agencies (18%). The radio (51%) is the most popular source in the Western region. This observation is closely similar to another study in Nigeria31, where the top sources of COVID-19 information were television (28.1%), WhatsApp (16.5%) and health care providers (14.3%). However, in the Northern regions, countries like Morocco and Tunisia were more likely to trust information from healthcare bodies and government sources, with Morocco being the country in the region to most likely trust online information, and Tunisia, the least.
More so, older people are most likely to trust information from healthcare organizations, while 55% of young people under-25 are more likely to trust information from online/social media sources. Those who show signs of vaccine hesitancy (44%) are more likely to believe disinformation (44%) and conspiracy theories (43%). In Nigeria, older people preferred WhatsApp, while younger people defer to international bodies for accurate information32. Another observation by Africa CDC shows that those who are most likely to believe rumours are those from Northern region, male, younger respondents, those generally sceptical about vaccines or those who have social media as their top trusted sources. Men and younger respondents tend to cite WhatsApp, while women and older respondents are more likely to mention family and friends.
Researchers need access to relevant data to provide scientifically-evident information to all stakeholders —governments, ministries, policymakers, co-researchers, communicators, influencers, media, health and educational institutions, and the public—to bridge imbalance in the demand and supply metrics of published research done on COVID-19, when compared to the published news, opinions and fact-check articles online. Researchers need opportunities to partner with or leverage WhatsApp to educate and monitor information trends. Insights generated can provide better avenues for addressing user-behaviours, which a one-time survey may not reflect.
Building influencers and circles of trust within WhatsApp communities of common interest is important, to help counter fake claims, which often stay undetected before they go viral. The curricula at all educational levels should include critical thinking and health news literacy skills. In Uganda, teaching critical reasoning to primary school students, with few resources and teachers show a consequent high level of ability in identifying health misinformation33.
Alongside the WHO Health Alert on WhatsApp, a well-funded multistakeholder, multimedia, multilingual fact-checking approach, especially for those in disproportionately-affected communities who may suffer more harm from the spread of fake news. These include people living with disabilities, in hard-to-reach areas, with language or cultural barriers, immigrants, children, etc. Risk communication campaigns during epidemics, should factor proper audience segmentation (age, sex, education), language, tone, and imagery, since misinformation patterns vary across demographics and are associated with the difference in the psychological and behavoural responses to information shared via WhatsApp.
WhatsApp requires social listening tools that allow users to track it as it quickly goes viral. Stakeholders need to work together to ensure that Africans do not just spot misinformation but to reduce the supply at source using strong updated policies that impact positive behavioural change amongst WhatsApp users.
The authors have no relevant financial disclosures or conflicts of interest.
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Chidindu C. Mmadu-Okoli is a graduate of Medical Laboratory Science from the University of Nigeria Nsukka and a Post-Baccalaureate Intern at the Nigeria Centre for Disease Control, Abuja. She is a 2021 Mentee at Solutions Journalism Network, USA, a 2019 #PreventEpidemicsNaija Health Journalism Fellow at Nigeria Health Watch Foundation, and a 2019 Science Communications Fellow at the Africa Science Literacy Network. She is passionate about communicating for health science, and development; with research interests in health literacy, epidemic preparedness and health security, women’s health, and non-communicable diseases. Her TEDx speech on Patient-Centred Storytelling and the Future of Healthcare advocates for narratives that foster healthy patient-provider interactions for effective healthcare delivery. Chidindu is on Twitter, @iamchidindu
Ifeanyi M. Nsofor, is a public health physician, a graduate of the Liverpool School of Tropical Medicine and the CEO of EpiAFRIC. He is a Senior New Voices Fellow at the Aspen Institute, Senior Atlantic Fellow for Health Equity at the George Washington University and an Innovation Fellow at PandemicTech. Ifeanyi spoke at the 2nd Exploring Media Ecosystems Conference at the Samberg Centre, MIT. The title of his talk was “forward this to 10 people, the epidemic of health misinformation in Nigeria”. You can follow Nsofor on Twitter @ekemma