Geospatial Mapping of Public Sentiment and Infodemic on Human Papillomavirus Vaccination in India: An Indication to Formulation of Strategies for Effective Implementation

"Identifying and addressing ongoing concerns and misinformation regarding the HPV vaccination will facilitate the development of effective strategies for the successful national implementation of the HPV vaccine and the subsequent reduction of cervical cancer incidence."

India contributes to nearly one-fourth of the global cervical cancer burden, so ensuring uptake of human papillomavirus (HPV) vaccination is crucial. However, misinformation and rumours related to the HPV vaccine have circulated in India, contributing (alongside cultural and societal norms influencing vaccine acceptance and other factors) to an alarming pattern of vaccine hesitancy observed on social media. This study aimed to identify public sentiment towards HPV vaccination in India based on the Behavioral and Social Drivers (BeSD) framework through geospatial, content, and sentiment analysis.

The data collection period spanned from November 1 2007 to May 13 2023. A total of 1,487 tweets originating from India were extracted. Of these, 1,010 tweets were identified for sentiment and content analysis. A total of 683 tweets were selected for the final geo-spatial analysis.

The sentiments expressed towards the HPV vaccine in the 1,010 tweets were mixed. There is a pervasive proliferation of misinformation, primarily focusing on vaccine safety and efficacy, medical controversies associated with the HPV vaccination trials conducted in India, allegations of research fraud and scandals surrounding the HPV vaccine, and a prevalent sense of uncertainty in selecting the appropriate brand of vaccine.

Multiple vaccines are accessible to safeguard individuals against cervical cancer. There exists a demographic actively inquiring about alternatives to the presently accessible vaccine. This group expresses heightened apprehension due to the scarcity of general information dissemination regarding HPV vaccines, resulting in uncertainty regarding selecting an appropriate HPV vaccine. Notably, individuals within this cohort exhibit favourable attitudes towards an Indian vaccine. They seek reliable information about the testing procedures associated with Indian vaccines. Advocates for HPV vaccination in India emphasise the necessity for its incorporation in the national immunisation programme.

However, the public also expressed a positive attitude towards HPV vaccines, promoting their uptake and empowering individuals through education and knowledge dissemination. A portion of the population also tweets out accurate information in an effort to ensure access to increase health literacy. When cervical cancer vaccine awareness campaigns were held worldwide, Indians tweeted to share details and to promote vaccination.

Having documented sentiments around HPV vaccination in India, the paper goes on to highlight the different levels of policy implementation that can be adopted by utilising the BeSD framework, which encompasses four major elements:

• Thinking and feeling:
  • Most individuals' concerns over perceived susceptibility to disease and adverse events following immunisation (AEFIs) pose obstacles to achieving optimal HPV vaccination coverage. In this response, promoting understanding of the risks and benefits related to HPV vaccination is essential to combat misinformation. For that, healthcare experts can play a crucial role in disseminating evidence-based information, explaining the safety measures, and highlighting the importance of vaccination for preventing HPV-related diseases. Clear communication about the potential side effects, frequency, and severity can help individuals make informed decisions. By proactively addressing these concerns, healthcare providers and authorities can establish trust and credibility, providing accurate information and personalised guidance to individuals to promote HPV vaccination.
  • According to this study, mistrust towards vaccine manufacturing companies is another prevalent concern among the public. To address this lack of trust, it is suggested that responsible journalism and a meticulously designed crisis communication plan could be implemented.
• Social processes: For example, HPV vaccination and cervical cancer are linked to sexual health, a topic often stigmatised in India, possibly due to the marginalisation of women's health, which may hinder widespread HPV vaccination efforts. To counter these adverse perceptions concerning the vaccine and the disease, a stigma communication plan could be put in place enhance HPV vaccination acceptance. Risk communication approaches have proven efficacious in mitigating the stigma associated with diseases, resulting in positive outcomes.
• Motivation:
  • Notable efforts by healthcare practitioners have been observed in disseminating accurate information to counter misinformation. These endeavours have effectively boosted confidence in the HPV vaccination process. In parallel, a subset of the population has focused on highlighting the favourable outcomes associated with the HPV vaccine. This effort highlights people supporting vaccination initiatives and increases motivation. As such, including success stories is imperative in the strategic promotion of HPV vaccination within the Indian context.
  • The recent development of an indigenous HPV vaccine within India assumes the capacity to nurture a sense of nationalistic satisfaction and augment societal acceptance, as numerous individuals have highlighted a favourable inclination towards the Indian HPV vaccine. By adopting the slogan "Made in India", health authorities can foster enthusiasm among individuals to actively engage in vaccination initiatives.
• Practical issues: Numerous individuals have voiced apprehensions concerning the restricted availability and accessibility of the HPV vaccine. The primary reason underlying this constraint is the high cost associated with the vaccine. The aforementioned indigenous HPV vaccine in India, priced at a range of 200-400 INR per dose, would resolve issues associated with affordability. Concurrently, the Ministry of Health and Family Welfare of India's expressed a resolute determination to initiate the rollout of the HPV vaccination, marking a strategic milestone to resolve the issue associated with the limited accessibility of the HPV vaccine.

In terms of the significance of social media not just for this study but going forward, medical professionals can utilise various platforms to disseminate accurate information regarding HPV vaccination, emphasising its safety, efficacy, and significance in preventing cervical cancer. Engaging in interactive communication enables direct addressing of apprehensions, while collaborating with influencers extends the reach and effectively counters misinformation. Crafting visually engaging content further enhances engagement, and vigilant monitoring of social media discussions enables timely identification and resolution of emerging issues. These strategies empower medical personnel to play a pivotal role in addressing vaccine hesitancy and fostering HPV vaccination uptake in India.

In conclusion: "The insights gained from these results will guide policymakers, healthcare practitioners, and public health organisations to implement evidence-based interventions, thereby countering vaccine hesitancy and improving public health outcomes."