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Contextualizing COVID-19 risk communication and community engagement in sub-Saharan Africa for effective epidemic control: Fighting the “Infodemic”

By Ibiloye Olujuwon
on March 30, 2020

WHO Director-General Tedros Adhanom Ghebreyesus: “We’re not just fighting an epidemic; we’re fighting an infodemic. Fake news spreads faster and more easily than this virus, and is just as dangerous. ” (Munich Security Conference on Feb 15, 2020).

End of January, the COVID-19 outbreak was declared a Public Health Emergency of International Concern (PHEIC) by the Director-General of the World Health Organization (WHO), and well before the declaration on March 11, 2020 of a “pandemic”, WHO has been working together in collaboration with countries and the global community to stop the spread of the disease. On February 28, 2020 Nigeria reported the first case of COVID-19 in sub-Saharan Africa. As of March 30, 3,217 people had been infected and 60 had died in the WHO African region. With the now rapidly increasing numbers, there are huge concerns on how African countries will fare.

In the face of limited resources and weak health systems, the COVID-19 pandemic presented sub-Saharan Africa with new challenges: the urgent need for diagnostics, care and treatment for SARS-CoV-2 infected patients, the increased burden on health systems and collapsing economies. People are afraid for their lives and loved ones and means of livelihood have come under threat. I foresee panic buying of household and medical commodities, a rise in price of common goods, stigma and discrimination of suspected COVID-19 infected patients and false cases of COVID-19 reporting to health facilities for care and treatment. To win this virus war and impending social disruption, there is a need for effective risk communication and community engagement  (RCCE) – an essential component of health emergency and response activities.

The World Health Organization (WHO) provided guidance on RCCE for countries to help protect the public’s health in response to the COVID-19 pandemic. Practical actions were recommended on how to implement effective RCCE strategies in preparation for an outbreak and in an epidemic situation. Kudos to African leaders and the Africa Centres for Disease Control and Prevention (Africa CDC), they swept in and put in place systems to strengthen risk communication, internal and partner coordination, public communication engagement, capacity building, addressing uncertainty and managing misinformation in an effort to control the spread of disease. However, ineffective risk communication and community engagement (RCCE) in sub-Saharan Africa still jeopardizes  effective control of the COVID-19 pandemic.  

The  “infodemic” has been identified as a major barrier to COVID-19 control by the WHO-Director General, Tedros Adhanom. The term “infodemic” was coined by WHO to refer to the excessive amount of information (mostly false) about the COVID-19 outbreak that makes it difficult to identify or discern essential information. Sub-Saharan Africa might be worst hit with a truck-load of unverified SARS-CoV 2 information in the media, particularly on social media. Mis-information originates from various sources, from pulpits to the ordinary man on the street selling his wares, from twitter handles and short video clips on social media platforms such as Facebook, Instagram to online community users and from emergency call centres to the public. In Nigeria, Ghana and some other African countries, there were claims that COVID-19 is “a disease of the rich” and “God’s punishment for sinners”.

One of the negative effects of the infodemic is that it influences health seeking behaviour. Exposure to information and messages that downplay the magnitude of the disease and attribute the cause of disease to God’s vengeance lower perceived disease severity and susceptibility and thus, increase risky behaviour in the community. On the other hand, fear laden reports and news may also lead to anxiety and increase demand for health care services, further overburdening the health system in this way. Another negative effect is compulsive panic buying creating artificial scarcity of essential commodities as being witnessed in developed countries.

For an effective emergency response to the current pandemic, there is a need to contextualise RCCE strategies for optimal impact. This requires stakeholders’ involvement in decision making to ensure effective use of social structures, social mobilisation and preferred communication methods.

First and foremost, there is a need to popularise official sources of COVID-19 health information on the continent,  where the latest news, guidelines and evidence on the pandemic are shared and frequently updated. Nigeria Centre for Disease Control (NCDC) has done well in this regard with a daily update on its social media platforms and official website. Partnerships with mobile network providers to disseminate COVID-19 information and the creation of hashtags on social media are low hanging fruits.

For the largely illiterate community and non-medically inclined in African states, there is a need for simple and easy to understand information sharing. Information on COVID-19 should be made available in local languages and pictorials that people can relate with for wider coverage and better understanding of the disease. Focussing on simple preventive measures like hand washing and social distancing would go a long way in achieving short term goals of infection control. The lower class living in rural areas and urban slums (in populous cities like Lagos, Nigeria and other metropolitan areas in sub-Saharan Africa) are most at risk and at the receiving end of fake news. This category of people can easily be reached with COVID-19 preventive messages on the need for hand hygiene and social distancing through radio programmes and communication through their traditional rulers and religious leaders.

Most Africans are religious and hold their religious and traditional leaders in high esteem. Therefore, meaningful engagement with these leaders is key to raising awareness and ensuring that primary preventive messages are well received and acted on by the people. We can learn from the success story of the NINERELA+ project that aimed at improving access to HIV prevention and treatment services through mobilization of faith leaders for HIV stigma reduction in northern Nigeria.Designated epidemic control centres can provide the latest information on the state of COVID-19 epidemic control to these leaders in order to avoid conflicting messages.

Government and development partners including implementing partners of donor-funded programs should promote information sharing to alleviate concerns relating to vulnerable populations’ health – the elderly, chronically ill patients, people living with HIV and/or Tuberculosis patients and internally displaced persons’ camps (iDP). Webinars and seminars on the management of co-morbidities such as HIV and COVID-19 can be organised for health program managers, health workers and patients.

The Information need of refugees and internally displaced persons varies in fragile and conflict areas, in Boko Haram/crisis affected areas in northern Nigeria and southern Cameroun for example. Dissemination of COVID-19 prevention messages through NGOs, refugee and community volunteers and respective communities remain effective channels of communication. These messages must be translated into preferred languages of IDPs and refugees.

The African CDC, Ministries of Health and states governments should consider working with celebrities and social media influencers to spread COVID-19 prevention messages. This approach will effectively tackle misinformation and rumours on social media. We can learn from the example of Vietnam’s National Institute of Occupational and Environmental Health that partnered with lyricist Khac Hun who wrote a song to teach handwashing. The song soon became a UNICEF favourite and sparked the “Ghen Cô Vy Challenge” on TikTok. Furthermore, it is high time media regulatory agencies ensured implementation of media policy and regulations in-country to stem the tide of false reporting and fake news.

In line with RCCE recommendations, COVID-19 helplines were set up to provide information and offer assistance to individuals who may have symptoms or have had contact with a COVID case in affected countries. However, in Nigeria, a disproportionate demand for helpline centres has been reported. Perhaps, NCDC can leverage on medical students and volunteers to meet this demand and provide guidance on care-seeking. Medically oriented volunteers are likely to provide evidence-based information and advice compare to randomly trained communication officers.

Furthermore, leveraging on WHO resources like the RCCE Action Plan Guidance and the COVID-19 risk communication package for healthcare facilities, among other resources for frontline health workers and COVID-19 response managers will help to optimize risk communication in affected countries. These documents are poorly disseminated and used by first line emergency response officers.

Without gainsaying, the infodemic is a wicked problem that requires a mix of strategies that are adapted to local needs. Therefore, contextualizing COVID-19 RCCE as opposed to top-down approaches is key to effective health response and epidemic control.

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