Shortly after the launch of a nationwide polio eradication campaign in Pakistan in April 2019, a series of anti-vaccination propaganda videos went viral on social media.
The mass panic triggered by the spread of the propaganda culminated in a record number of locals refusing the vaccine alongside an increase in attacks on health workers and security personnel. An investigation by the authorities found that the campaign had been coordinated by a local resident who was later arrested, alongside 12 accomplices, for spreading the false information.
With growing public skepticism toward the vaccine, and violent incidents targeting health workers on the rise, the Pakistani government canceled its annual nationwide anti-polio drive. The dire consequences of the anti-polio disinformation campaign in Pakistan provide a prescient reminder that the spread of false and misleading content online can cost lives, especially when deployed against public health campaigns in countries with prior histories of religious and cultural opposition toward inoculation.
On April 22, several students in Masokhel, a village on the outskirts of the northwestern city of Peshawar, were admitted to a hospital after complaining of an adverse reaction to a polio vaccine. Shortly after, social media users on Facebook and Twitter began sharing videos that allegedly depicted children fainting and vomiting after vaccination. Other users posted misleading messages, reporting that hundreds of children had died after receiving their polio drops.
The Express Tribune, a local media outlet, reported that over 25,000 children were admitted to hospitals in the locality by parents who had viewed the misleading content online. Incensed by the alleged death of local children caused by the vaccine, a large crowd ransacked the village health center.
The false reports continued to spread to other parts of the country, with local and international outlets reporting an increase in attacks by unidentified gunmen on health workers. The New York Times reported that unidentified gunmen had killed a health worker and two security personnel accompanying a team of health workers in Chaman. After another health worker was killed by gunmen in the neighboring province of Balochistan on April 25, the Pakistani government was forced to curtail the campaign to ensure the safety of the 270,000 workers administering the vaccine.
Rumors spread like wildfire
The anti-polio disinformation campaign began with the emergence of two videos depicting the same individual, later identified as local resident Nazar Muhammad. The first video shows Muhammad in a hospital room flanked by children who allegedly had an adverse reaction to the polio vaccine. Muhammad addresses the camera, complaining that locals faced an impossible choice: risk the health of their children by giving them the vaccine or risk a confrontation with law enforcement, whom he claimed were arresting locals who refused the vaccine. In a second video, Muhammad addresses local media outside the hospital, claiming that the children featured in the previous video had died after their condition worsened.
The ruling Pakistan Tehreek-e-Insaf (PTI) party’s regional division uploaded both videos online alongside a message debunking the false claims.
A number of users shared videos of parents rushing their children to nearby hospitals in addition to claims of children from the village falling ill after receiving the vaccine. Regional local media outlets on both platforms also shared those videos.
@khaberwalay0, a “24-hour news service” based out of Karachi, posted a number of tweets on April 22 amplifying the unverified videos of children falling ill after receiving the polio vaccine in Peshawar. A government inquiry did not find evidence to support the claims that children had fallen ill.
“Da Olas Ghag” (“The voice of the people”), a Facebook page belonging to a regional media outlet, uploaded a series of videos on April 22 and 23 making similar unverified claims. The misleading content amplified by the page gained significant traction, with videos titled, “3 children die of Polio in Peshawar,” “Four children from the same house were killed due to polio drops,” and “Who is responsible for Polio vaccine infected children?” all garnering tens of thousands — if not hundreds of thousands — of views.
Another popular video uploaded on the page allegedly depicted a local father who had lost four children after allegedly allowing them to be vaccinated. The video received over 856,000 views, 4,500 likes, and 29,859 shares at the time of analysis. The DFRLab was not able to confirm the identity of the individual and location of the video; a number of media outlets, however, including The Washington Post, reported that all children admitted to the hospital were found to be healthy and released shortly after.
This campaign mobilized health disinformation in an attempt to exploit fear and anxiety over vaccination amongst the local populace, ultimately contributing to a depressed vaccination rate for the month of April: The Express Tribune reported that the mass hysteria created by the campaign led to over 908,381 families refusing to vaccinate against polio.
The Los Angeles Times, meanwhile, published a piece highlighting how the disinformation campaign had undermined Pakistan’s ongoing $1 billion dollar immunization campaign. According to data compiled by the Pakistan Polio Eradication Programme, a local NGO, Pakistan has recently seen a sharp increase in reported cases of polio, from eight in 2017 to 77 in 2019. The World Health Organization’s (WHO) latest report listed Pakistan as one of only three countries in the world, alongside Afghanistan and Nigeria, where polio is yet to be eradicated.
A war on polio
In Pakistan’s war against polio, immunization workers have become soldiers on the frontlines of the conflict. Vaccinators frequently face beatings, harassment, and gunfire from anti-vaccine advocates as well as militant groups operating in the loosely governed bad lands of the northwestern Khyber-Pakhtunkhwa region. The New York Times reported that the three deaths in April represented the latest in a series of attacks against health workers by militant groups, with an independent media tally estimating that 95 polio workers had been killed in the line of duty since 2012.
Much of the health disinformation on the prevalence of enduring prejudices held by the locals towards vaccination campaigns that conflate religious convictions with preexisting cultural biases towards the West. These recurring narratives characterize foreign-sponsored vaccination drives as a Western conspiracy aimed at sterilizing the Muslim population, claim the ingredients in vaccines contain pork derivatives, and accuse health workers of conducting espionage on behalf of the West. The latter representing a cultural idiosyncrasy, stemming from Pakistan’s geographic and ideological proximity to the Global War on Terror.
This popular distrust towards health workers conducting immunization drives in the region was exacerbated after the arrest of Shakil Afridi, a local doctor running door-to-door vaccination campaigns for Hepatitis-B in the Pakistani city of Abbottabad. Afridi was arrested in 2011 and sentenced to 33 years in prison for his role in aiding U.S. intelligence agencies as a local asset. As part of his work, the doctor ran vaccination campaigns in the city as a pretext to collect DNA samples. The information he provided directly contributed toward the successful U.S. raid on Osama Bin Laden’s fortified compound in the area.
In the midst of a public health crisis, media outlets and social media platforms have a critical role to play in countering misinformation. The case of this anti-polio disinformation campaign, however, demonstrates how malicious actors can hijack these same channels to spread false and misleading information, hindering the government and civil society’s ability to de-escalate the crisis.
As this crisis evolved, Twitter, Facebook, and Youtube worked with the Pakistani government to remove over 174 anti-vaccination links across their platforms. Additionally, Facebook launched an in-product education tool available in Urdu that provides accredited information on vaccines. In spite of these efforts, the modest resources with which this anti-vaccination campaign was carried out highlighted the vulnerability of countries facing economic deprivation, unequal access to education, and societal opposition to immunization drives on the basis of cultural and religious conviction to similar tactics.