Parallel Vaccine Discourses in Guinea: 'Grounding' Social Listening for a Non-hegemonic Global Health

"...advocate for grounding social listening in global health to avoid disconnection from the public. Failure to accomplish this could result in a detached and hegemonic form of 'social hearing', rather than authentic social listening."

Misinformation has been identified as a major threat to public confidence in vaccines, particularly during epidemics. Social listening - defined as a set of methods to collect and analyse discourses - is one heuristic public health tool for detecting misinformation and adapting vaccine communication. In order to overcome the limitations of social listening that solely uses online data and to deepen  understanding of vaccine hesitancy, this study incorporates onsite data collection into social listening and seeks understanding of vaccine sentiments (rather than assessing the accuracy of vaccine claims). Drawing from online COVID-19 vaccines discourses in Guinea and ethnographic fieldwork among Guinean healthcare workers, the paper argues that the current social listening paradigm is grounded in a reductionist approach that can fail to grasp or even misrepresent the complexity of health-related perceptions and knowledge.

This study took place between mid-2020 to mid-2021, encompassing the launch of the COVID-19 vaccination campaign in Guinea in January 2021. The rate of vaccination remained low; at time of writing, only 24% of the population had received complete vaccination. For online social listening, the researchers gathered and anonymised the top 50 vaccine-related public Facebook posts from Guinea-based pages and also accessed their five most "liked" comments. Onsite methods involved ethnographic fieldwork in Mamou, Kindia, Forecariah, and capital Conakry, with 13 in-depth interviews (IDIs) with healthcare workers conducted in January 2021 and casual discussions with health students, social workers, and the general population from the beginning of the pandemic to September 2021.

While the online social listening showcased a predominance of individual and collective safety concerns, distrust towards African elites and Western actors, and, relatedly, belief that the COVID-19 vaccine was a tool for undermining the African population by either sterilising, infecting, or killing recipients, fieldwork revealed that vaccine perceptions were more nuanced and largely shaped by complex kinship relations spanning across online and offline social landscapes. For example, a breastfeeding woman reported that her healthcare worker husband discouraged her from receiving the vaccine due to lack of data on its impact on breastfeeding mothers and infants. Relatives residing in northern countries or in large cities remain the most trusted and influential sources of information for both lay population and healthcare workers in Guinea regarding COVID-19 risk and vaccine usefulness and safety.

The discourses surrounding COVID-19 vaccines also fluctuated: During IDIs, several healthcare workers at first appeared to support the COVID-19 vaccination, only to later confess their unwillingness to get vaccinated due to safety-related concerns. For example, Ms. Gallice, who is a senior nurse, first explained that the African populations were reluctant to vaccinate and she advocated for more awareness campaigns but later confesses that she would herself not take the vaccine because she lacks information on its composition and health effects. Some healthcare workers may share their reluctance to get vaccinated with their acquaintances, including foreign social science researchers, but they would not dare voice it to their hierarchy or openly refuse the vaccination organised on their professional premises. "Rather than viewing this behavior as inconsistent, it can be interpreted as a testament to the multifaceted nature of human conduct. Healthcare professionals often navigate the precarious balance between private vaccine hesitancy and the professional obligation to endorse vaccination..."

Thus, this study "uncovered the relevance and importance of the nature of the interaction (e.g. interpersonal, in public, or within a hierarchical relation), showing that relationships intertwine with multi-layered and co-existing front stage and backstage discourses to shape not only people's perceptions but also their behavior. More specifically, the relationship between interlocutors can determine the ability of vaccine discourses to shape vaccine decisions. Through examining relations, [the study] showed how trust and power are central to the formation of health decisions. Trust is often associated with kinship, a domain that is not captured by solely online social listening. In some cases, power (or hierarchical) relations can lead to more pragmatic action, where either due to government mandate (for health personnel) or more indirect means, individuals are left with little to no option but to vaccinate."

In light of the interconnected discourses revealed in this study, the researchers argue for the advancement of social listening methodologies. They explain: "While online-only methods provide quick, cost-effective access to public discourses on vaccines, they are inherently limited by data representation biases and a proclivity to prioritize information accuracy over understanding people's concerns. Additionally, social media-based narratives are often constrained by factors like text length, user identity, context, and real-life implications of shared opinions."

The transdisciplinary methodology exemplified in this paper represents one possible solution. This approach to social listening involves grounded data collection, such as in-depth, onsite ethnographic research. The researchers argue that this approach provides context, offers insights into real-life decisions, grants access to a wider array of voices, and permits recognition and understanding of individuals' pragmatic negotiations of power relations and hierarchies within their societies - thereby providing a more comprehensive understanding of their responses to health policies.

"In conclusion, if the assemblage of Global Health similarly aims to promote grounded social listening, it must engage the pillars of social sciences for their ability to untangle the threads of complexities and context. Otherwise, the field may struggle to account for and understand lay individuals' perception of diseases and public health intervention underlined in recent epidemic responses....The COVID-19 pandemic has shown us the growing complexities that must be faced and what is at stake. Global Health cannot afford to become increasingly disconnected from those it intends to listen to."