COVID-19 and vaccines in Africa: a descriptive and thematic analysis of Twitter content

Study design

This study used a qualitative descriptive design by collecting and analysing content on Twitter. Twitter is a micro-blogging site that enables users to post short messages (tweets) up to 280 characters -in the form of facts, opinions, events, personal stories- reply to tweets, share tweets from others’, retweet or simply like tweets. Twitter users can also engage with others through hashtags (#) specific to certain topics, e.g. #COVID19.

Ethics

This paper used publicly available data from Twitter and hence did not require ethical approval.

Data collection and cleaning

Data were collected from Twitter using the search terms ‘coronavirus’, ‘COVID-19 vaccine’ and ‘Africa’ between the 11^th and the 16^th of December 2020. The search occurred through the Twitter search bar on three random days; the 11^th, the 13^th and the 16^th December and the search resulted in three datasets. The authors chose this time to capture data shared during the first few days following the approval and subsequent administration of the Pfizer and BioNTech vaccine in the UK. Only original tweets (not retweets) were eligible for inclusion.

Data were collected using the tool NCapture offered by the software NVivo 12. NCapture is a free web-browser extension that facilitates data collection from the Internet to import into NVivo, a software used for organising and managing qualitative data¹⁹. Once captured, results were imported into NVivo for Mac (Version 12) as a dataset. Data cleaning entailed identifying and eliminating duplicates and retweets. All authors then reviewed data to identify potentially relevant tweets in line with the study aim. Tweets had to fulfil the following inclusion criteria to be included in the final dataset; first, the Twitter account had to originate from an African country as classified by the WHO²⁰, (location was identified in the Twitter profiles) and second, the tweet had to mention ‘coronavirus vaccine’ or ‘COVID-19 vaccine’ and Africa had to be mentioned in the tweet as well. Twitter accounts without a stated location and those relating to coronavirus or COVID-19 vaccines in contexts other than Africa were excluded from the final dataset. Only tweets written in the English-language were included in the study.

Data analysis and interpretation

We used descriptive statistics to describe our sample (Twitter accounts, hashtags) and thematic analysis to make sense of tweet contents. We were interested in identifying the characteristics of those sending tweets, for example if these were individuals or organizations, their occupation or type of business, and Twitter accounts by country. Thematic analysis (TA) is a method used within qualitative data to help determine, analyse, and clarify patterns of meaning ('themes') emerging in qualitative data²¹. We used an inductive analysis approach and hence our analysis was guided by the data. The analysis entailed i) familiarising with the data, ii) initial generation of interpretative codes, iii) identifying relationships between the codes to generate themes and iv) reviewing and redefining themes²². To ensure our findings' credibility, all co-authors were involved in data cleaning, analysis, and interpretation of findings.

Research question 1

Who is involved in sharing tweets about COVID-19 vaccines or vaccinations in the WHO African region?

The study comprised n=208 Twitter accounts. The majority were from South Africa (n=69; 33%). About 43% (n=90) of the accounts were from individuals, while about 42% (n=87) were from news agencies. Table 1 presents characteristics of the Twitter accounts.

Research question 2

What hashtags (#) are being used to engage Twitter users on the topic?

The most commonly used hashtag was #Covid19vaccine (s), n=20 (10%) (Figure 1). Others included the combination of #Covid19 and #vaccine (s) (5%), #Covidvaccine (2%), #coronavirus #vaccine (1%) #CoronavirusVaccine (<1%), #covid19vaccines (<1%), #Coronavaccine (<1%), and #C19vaccines (<1%).

Figure 1. Hashtags identified in our study sample.

Research question 3

What is the thematic content of tweets?

Thematic analysis resulted in four themes and nine sub-themes. The main themes were i) the capacity for vaccine production, ii) vaccine procurement, iii) vaccine logistics and iv) the perceived safety and efficacy of vaccines. Tweets are denoted by the letters TW followed by a number.

Theme 1: The capacity for vaccine production in Africa

This theme related mainly to the perceived capacity of countries in Africa to manufacture a COVID-19 vaccine. Vaccine development efforts were seen as absent within the region (TW 201). However, a few tweets (TW114; TW199) highlighted South Africa's capacity to manufacture vaccines, although others were less optimistic (TW212), with some (TW 209) purporting that the country had not produced vaccines locally in 25 years. Some hoped that the pandemic had served as a lesson for Africa to ramp up its vaccine production capacity (TW162). One tweet (TW82) highlighted current ongoing efforts to ensure Africa's participation in global vaccine efforts. One main challenge to vaccine production by African countries was the high production costs due to patent protections (TW78; TW152; TW 200).

Theme 2: C0VID-19 vaccine procurement

Most tweets centred around vaccine procurement, and the sub-themes identified included the availability and accessibility of vaccines for African countries and the cost of vaccines. Some tweets raised questions concerning Africa’s ability to procure COVID-19 vaccines (T90), when vaccines would be available (TW74; TW115), which vaccines African countries would get (TW74) and who would pay for them (TW74; TW115). The expectation was that African countries would get vaccine deliveries in mid-2021 (TW47; TW61; TW62; TW63; TW67; TW68; TW71). There was much less of a focus on what vaccines would be availed to African countries. However, it was suggested that the continent would likely rely on vaccines produced in China and /or Russia in the immediate future (TW107). Overall, most tweets related to this theme suggest that Africa would be last in securing vaccines (TW127; TW182; TW184; TW185).

The cost of vaccines was seen as a potential hindrance to securing vaccines for Africa. The WHO estimates that the continent would require $9bn to fund 1.4 billion doses (TW40; TW 202; TW 206; TW 208; TW 210; TW 211). The question around ‘Who will pay?’ was posed (TW74; TW115), with some claiming that vaccines would be sold to the continent at exorbitant prices (TW70). Others called on pharmaceutical companies to reduce the cost for African countries (TW26; TW27). Tweets highlighted the WHO's central role in enabling vaccine access in Africa through the COVAX programme (TW36; TW110). Vaccines expected through this programme were deemed inadequate to meet demand (TW33; TW168; TW 200). Notable was potential funding from the international community, for example, the Bill and Melinda Gates Foundation (TW54), the World Bank and the Afreximbank (TW46). And while this support was lauded and encouraged in some tweets (TW68; TW103), some decried the continent's over-reliance on donors (TW70; TW73; TW185).

Theme 3: COVID-19 vaccine logistics

This theme centred on the distribution of vaccines, storage and roll-out. Questions surrounding who would handle the distribution of vaccines were raised (TW74; TW90; TW138). Besides, Africa's ability to store the vaccines at extremely low temperatures (minus 70°C/ 94°F) or lower, as would be the case for the Pfizer and BioNTech vaccine, were put into question (TW90). National airlines were said to be ramping up capacity and improving cold chain air freight for distribution (TW15; TW16; TW81; TW83; TW84; TW86; TW89; TW109). The need to leverage existing solar-powered technologies to enhance the cold supply chain in Africa's remote locations was reiterated (TW175). The prospects of other potentially efficient and easier to store vaccines coming into the market were viewed as good news for the continent (TW135).

The vaccine roll-out issue was a notable sub-theme (TW5; TW21; TW52; TW98; TW181). There were questions around 'Who would get vaccinated first?' The remarks made by Director-General Tedros Adhanom on the importance of countries to vaccinate priority groups, including health workers, older people, marginalised groups at higher risk as well as people with underlying medical conditions was shared in a number of tweets (TW98; TW181). Yet, given the continent's expected limited supply, it was believed that deciding on priority groups would be difficult and would require making some tough decisions (TW167). The need to develop a vaccine allocation system based on human rights and African values was highlighted in one tweet (TW166).

Theme 4: The perceived safety and efficacy of COVID-19 vaccines

This theme highlighted the misinformation about vaccines' perceived safety and efficacy, including fake vaccines on the market (TW2; TW3; TW158; TW99). Some questioned the safety and efficacy of vaccines developed in less than one year, citing the complexity and time needed to develop most vaccines (TW106). Some countries, like South Africa, were said to be making concerted efforts to assure people that vaccines approved and deployed would fulfil all safety requirements (TW2; TW3). There was a call on African governments to beware and vigilant of potential fake vaccines during procurement (TW189) and for policymakers to ensure that full consideration had been given to the vaccines before approval and roll out (TW99).