This study explores and describes strategies to reduce the negative effects of conspiracy theories about the coronavirus disease 2019 (COVID-19) vaccines and related protocols, in order to increase their acceptability and uptake and so reduce the spread of COVID-19 in South Africa (SA). Beliefs in conspiracy theories and misinformation have existed throughout human history, fuelled by rapid and uncertain societal changes (Douglas et al. 2019:3). They can have serious consequences (Van Mulukom et al. 2022:2). From the beginning of the COVID-19 pandemic, messages circulated on social media stating that the disease was intentionally introduced by the Chinese to start a war on America (or vice versa) (Douglas 2020:270). Some reporters affirmed that some people believe that 5G mobile phone networks were associated with the spread of COVID-19 through the radiation they transmit, leading to attacks on cell towers in some parts of the world, including Europe (De Coninck et al. 2021:2). Hornsey and Fielding (2017:462) asserted that people who believe in conspiracies attest to the existence of groups of powerful people with malicious intent behind particular events and, coincidentally, reject the contradictory scientific evidence. In the context of COVID-19, the effects of conspiracies are reported to have negative outcomes on vaccination against coronavirus and related protocols (Douglas et al. 2019:18; Pummerer et al. 2020:2; Soteri et al. 2021:684).

The African continent has not been spared the destructive effects of COVID-19. The Africa Centre for Disease Control and Prevention (Africa CDC 2020:n.p.) recorded that some countries, such as Burundi, the Democratic Republic of Congo, Sudan, Algeria and Egypt, have reported case fatality rates higher than the global case fatality rate of 6%. As the coronavirus is highly contagious, with deadly health outcomes, governments all over the world have issued safety measures to control the spread of severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2), which is the viral agent responsible (Van Mulukom et al. 2022:3). However, there is widespread lack of adherence to safety protocols (Pummerer et al. 2020:1). Furthermore, trust and confidence in the efficacy of vaccines is compromised by people who refuse to accept their value (Bokemper et al. 2021:825; Douglas 2021:3; Imhoff & Lamberty 2020:1114). For example, in May 2021, the South African Government Communication Department (2021:n.p.) published guidelines to tackle misinformation related to COVID-19 in the hope that two-thirds of the population would get vaccinated to achieve herd immunity. Some of the issues that raise distrust and rejection of vaccines include the belief that COVID-19 vaccines will change a person’s deoxyribonucleic acid (DNA), that they contain some microchip device that will be used to track people’s whereabouts and that they are a way for the oppressors in the past to control people again – all of which are refuted by the facts, as further elaborated on by the SA Communication Department.

Previous studies have focused on understanding beliefs in conspiracies and misinformation (Douglas et al. 2019:3; Van Mulukom et al. 2022:1) and their impact on COVID-19 vaccines and related protocols (Dyrendal & Jolley 2020:2; Heiss, Gell & Rothlingsch 2021:3). However, there is limited information on efforts to manage these beliefs (De Coninck et al. 2021:11; Douglas 2020:274), especially for the purpose of overcoming resistance to vaccination, which has now become an urgent matter.

In South Africa, as of 06 October 2021, out of a total adult population (18 years and older) of nearly 40 million, only 9.53 m individuals were fully vaccinated – that is, they had received one dose of the Johnson & Johnson or two doses of the Pfizer vaccines – representing just 24% of the adult population. The reluctance of so many South Africans to get vaccinated highlights the core of the problem: that more studies need to understand the challenges to achieve general vaccination (De Coninck et al. 2021:1; Douglas 2021:1). Failure to address COVID-19-related conspiracies and misinformation, which can be promoted by high-profile individuals including politicians and scientists (Bierwiaczonek, Kunst & Pich 2020:1271; Bokemper et al. 2021:825; Duplaga 2020:1), will delay eradication of COVID-19 pandemic.

Eysenbach (2020:n.p.) coined the concept of ‘infodemiology’ in the context of health and misinformation. Furthermore, unpacking the destructive nature of ‘infodemics’, the Africa Infodemic Response Alliance (AIRA) (2020:n.p.) averred that they make susceptible individuals confused and lead to mistrust in public interventions, eventually causing death if not properly managed (Mbunge 2020:1810). Given that infodemics tend to spread widely within a short time, the World Health Organization (WHO) attempted to define the term as the outbreak of context-based reliable and unreliable information during epidemics (Tangcharoensathien et al. 2020:n.p.). It is on these grounds that the author, having been exposed to conspiracy theories promoted by people in social networks about COVID-19 vaccines, embarked on this study to seek ways of addressing them in the context of South Africa. It is hoped that the outcomes of this investigation will increase vaccine acceptability and adherence to related protocols, in order to achieve the required herd immunity to eradicate COVID-19 (AIRA 2020; Bertin, Nera & Delouvée 2020:8; Eysenbach 2020:n.p.).

The author has personally experienced both the devastating effects of COVID-19 infection and the corresponding conspiracy theories and misinformation about its source and treatment. In the first week of June 2020, the author experienced flu-like symptoms such as abdominal pains, weakness of joints and loss of taste. By that time the symptoms of COVID-19 were known, and relevant statistics were being received daily via mobile phones, the radio and websites, so she went to get tested. When the results came back within a week, the symptoms had subsided except for persistent headaches. However, checking the facts on COVID-19 from the South African government website to deal with personal sense of shame, self-blame and misinformation to cope with anxiety and fears was of great help in challenging her thinking. Furthermore, recovery from COVID-19 and lessons drawn from exposure to misinformation about the disease has given her an opportunity to be an ambassador of spreading science-based information on COVID-19. But the experience has left an unanswered question. In addressing your concern on the statement below, how about if we add,’ which is expressed by the author as follows:

The author has witnessed with concern her students’ reluctance to accept COVID-19 vaccines during a 3-month community project campaign between July 2021 and September 2021, hosted by the institution where the study was conducted. One of the concerns the students raised is the fear of infertility and death caused by the vaccines.

Noting some challenges, including poor health literacy, that may prevent the African continent from mounting an effective response to misinformation about COVID-19, Lucero-Prisno, Adebisi and Lin (2020:1) advocated for approaches that may counteract the problem. For example, critical thinking skills can be taught to check for facts and logic on sources of information as opposed to passive acceptance of convincing but false news (Dyrendal & Jolley 2020:7), such as ‘the side effects of the vaccine will be worse than having COVID-19’, and the ‘vaccine causes paralysis’. These beliefs impacted the author so negatively that there were notably delays in acceptance of COVID-19 vaccination to the last week of the 3 months of the campaign. Furthermore, there was a sense of curiosity to watch and see what would happen to colleagues who were vaccinated, whether they would experience any untoward symptoms or even deadly outcomes from the vaccines before acceptance of vaccines. Therefore, personal decisions to embark on the following steps in any information that came through from social media or verbal sources were made:

Falade (2019) argued from the African perspective that there is close a relationship between religious and political authorities and the uptake in scientific information. The author of this review is in full agreement with this view as her decision to accept COVID-19 vaccines was motivated by religious authorities in high ranking within the church and the president of SA, Mr Ramaphosa, who led by example and took the first steps to get vaccinated. Consequently, the role-modelling actions displayed by the leaders strengthened the personal choice to let go of conspiracy and misinformation beliefs.

Thus, the author seeks answers to the question: what are the strategies available in literature that could be used to address conspiracy beliefs and misinformation?

This study aimed to explore and describe strategies that can be used to reduce the negative effects of conspiracies and misinformation about COVID-19 in order to increase vaccination intentions.

This study adopted the narrative literature review approach to address the author’s concern about COVID-19- related conspiracy beliefs and misinformation. It involved comprehensive and critical analysis of the literature to locate the study within the body of knowledge in a particular focus on identifying gaps in the general public’s knowledge of the pandemic (LoBiondo-Wood & Haber 2014:21). The literature search was conducted using Google Scholar, the WHO website, the South African Department of Health website, the Africa CDC and North-West University Library through the e-Link Catalogue, seeking journal and conference publications issued between 2019 and 2022. The search terms used are listed in Table 1. Juntunen and Lehenkari (2021:332) proposed three phases for the purpose, including planning, conducting and reporting, as illustrated in Figure 1.

The search strategy results are provided in Figure 2 and accessed studies in Table 2. All articles were evaluated for rigour based on purpose and objectives, design or strategies used, findings and implications or conclusions and quality rank appraisal in terms of A, B and C relating to high-quality grade, good-quality grade and low-quality grade, respectively.

Twenty-seven articles relevant to this review were identified, read and synthesised to draw the conclusions relevant to the research question (Table 2). The results of the review yielded two themes, including reasons underlying conspiracy beliefs and misinformation on COVID-19 and their communication strategies. The latter are discussed here under three subthemes.

Reasons for beliefs in conspiracy theories and misinformation on COVID-19: These beliefs vary in scope and magnitude but at core represent a psychological need for knowledge and clarity (Douglas et al. 2021:1; Dyrendal & Jolley 2020:1). They usually spread faster when there is lack of information in times of uncertainty as a way to satisfy curiosity and clear uncertainties (Douglas 2019:7, 2020:271). A person who holds conspiracy beliefs has an intrinsic desire to make sense of experiences and circumstances to gain control and eliminate the perceived threat (Hawley 2019:977; Heiss et al. 2021) by believing in alternative information to deal with ambiguity (De Coninck et al. 2021:9). A study by Mohammad and Motlaq (2021:68) on Facebook on a COVID-19 post reported that most people with conspiracy beliefs reacted with negative and pessimistic comments compared with those with positive views and belief in scientific information. Thus, increased feelings of anxiety and depression are associated with higher conspiracy beliefs and misinformation on the pandemic (De Coninck et al. 2021:1). Thus, there is a need to address these beliefs in order to escalate public immunisations (Bertin et al. 2020:8) and should include communication on conspiracies (Douglas 2019:22) to enhance the response to this health crisis (Douglas 2021:4).

Three themes emerged from the literature:

The WHO’s Information Network for Epidemics (EPI-WIN) was established in December 2019 following the coronavirus outbreak in Wuhan, China, as a resource to give updates and respond to questions related to the epidemic (WHO 2021:n.p.). It handles information, rejects misinformation and addresses COVID-19 infodemics through networks with organisations around the world to provide scientific information. In the report on the COVID-19 response released in February 2021, the WHO Regional Office for Africa acknowledges the supportive role the organisation played in coordinating the global, African and national responses to the pandemic to mitigate risk communication (WHO Africa Region 2020:5). Consequently, COVID-19 websites that provide accurate, up-to-date information on statistics, vaccines and related protocols exist in most countries. Romer and Jamieson (2020:1) added that it is critical that health authorities provide citizens with specific messages via unbiased media.

The WHO regional office in Africa established risk communication in 47 member states, so that people at risk are able to make informed decisions and alleviate obvious threats, such as COVID-19 infection, to protect themselves (WHO Regional Office for Africa 2020:30). This report explains that it is inadequate simply to provide information on the causes and transmission of coronavirus but that it is imperative to adopt individualised approaches to support families and communities with key messages that encourage the changes we want to see. Supportive strategies, for example, include paying attention to fears and uncertainties, allowing people to express concerns and engaging communities to address risks based on their contexts (Adebisi et al. 2021:139; WHO Regional Office for Africa 2020:30). Furthermore, Hawley (2019:977) warned that whilst it is not easy to change people’s thinking patterns, ensuring dialogue, giving individualised support and dealing with social triggers of conspiracy beliefs and misinformation would go a long way in solving the problem.

Dealing with conspiracy theories and misinformation is difficult; hence, strategies to mitigate their effects need to be sought (Bertin et al. 2020:8; Douglas 2021:4; Douglas et al. 2019:21). Amongst these are the following:

The fundamental reason underlying beliefs in conspiracies is described in this review as a psychological need for knowledge (Dyrendal & Jolley 2020:1). Other explanations used to account for them include an attempt to seek clarity (Douglas 2021:1) and a drive to gain insights into one’s experiences during a crisis (Hawley 2019:977; Heiss et al. 2021). In the absence of accepted information, alternative sources are sought, including conspiracy theories and misinformation (De Coninck et al. 2021:7). Carneh and Schrieder (2021:2) challenged this attitude of passive, uncritical acceptance of knowledge with a scientific attitude that seeks to ask the right questions, motivated by basic research to find the right answers, as an attitude to be adopted. Romer and Jamieson (2020:1) acknowledged that in the context of COVID-19, conflicting messages from public health officials, politicians and the media have made it difficult for the public to reach consensus and adopt effective preventive behaviours, especially during the crisis stage when COVID-19 was a new phenomenon for the entire world. Thus, it is important that governments take initiative and provide leadership to guide citizens with accurate, up-to-date information and ease anxieties and panic amongst its citizens (De Coninck et al. 2021:1). It is also observed that as scientific information during COVID-19 has kept changing remarkably – for example, as new variants of the virus appeared – the efficacy of vaccines also changed; thus, the instability of information may perpetuate distrust of scientific evidence on vaccines. However, the communication strategies proposed in this article could be used to address the need for knowledge with evidence-based information to counteract conspiracy theories and belief in misinformation to reduce the negative effects of these beliefs on the COVID-19 pandemic and escalate vaccine acceptability and compliance with the protocols aimed at eradicating coronavirus.

To the author’s knowledge, this is the first report on strategies to minimise the negative effects of conspiracy theories and misinformation about COVID-19 that undermine vaccine acceptance and protocols. Further research should use multiple approaches to test these communication strategies, specifically in the South African context. The literature shows that conspiracies and misinformation can prevail during pandemics and, although they are hard to control, they can be managed.