Controversial Ebola vaccine trials in Ghana: a thematic analysis of critiques and rebuttals in digital news

Abstract

Background: Communication is of paramount importance in responding to health crises. We studied the media messages put forth by different stakeholders in two Ebola vaccine trials that became controversial in Ghana. These interactions between health authorities, political actors, and public citizens can offer key lessons for future research. Through an analysis of online media, we analyse stakeholder concerns and incentives, and the phases of the dispute, to understand how the dispute evolved to the point of the trials being suspended, and analyse what steps might have been taken to avert this outcome.

Methods: A web-based system was developed to download and analyse news reports relevant to Ebola vaccine trials. This included monitoring major online newspapers in each country with planned clinical trials, including Ghana. All news articles were downloaded, selecting out those containing variants of the words "Ebola," and "vaccine," which were analysed thematically by a team of three coders. Two types of themes were defined: critiques of the trials and rebuttals in favour of the trials. After reconciling differences between coders' results, the data were visualised and reviewed to describe and interpret the debate.

Results: A total of 27,460 articles, published between 1 May and 30 July 2015, were collected from nine different newspapers in Ghana, of which 139 articles contained the keywords and met the inclusion criteria. The final codebook included 27 themes, comprising 16 critiques and 11 rebuttals. After coding and reconciliation, the main critiques (and their associated rebuttals) were selected for in-depth analysis, including statements about the trials being secret (mentioned in 21% of articles), claims that the vaccine trials would cause an Ebola outbreak in Ghana (33%), and the alleged impropriety of the incentives offered to participants (35%).

Discussion: Perceptions that the trials were "secret" arose from a combination of premature news reporting and the fact that the trials were prohibited from conducting any publicity before being approved at the time that the story came out, which created an impression of secrecy. Fears about Ebola being spread in Ghana appeared in two forms, the first alleging that scientists would intentionally infect Ghanaians with Ebola in order to test the vaccine, and the second suggesting that the vaccine might give trial participants Ebola as a side-effect - over the course of the debate, the latter became the more prominent of the two variants. The incentives were sometimes criticised for being coercively large, but were much more often criticised for being too small, which may have been related to a misperception that the incentives were meant as compensation for the trials' risks, which were themselves exaggerated.

Conclusion: The rumours captured through this research indicate the variety of strong emotions drawn out by the trials, highlighting the importance of understanding the emotional and social context of such research. The uncertainty, fear, and distrust associated with the trials draw from the contemporary context of the Ebola outbreak, as well as longstanding historical issues in Ghana. By analysing the debate from its inception, we can see how the controversy unfolded, and identify points of concern that can inform health communication, suggesting that this tool may be valuable in future epidemics and crises.

Fig. 1

Study design flow chart. Flow chart shows data sources and exclusion by keyword search and thematic analysis

Fig. 2

Overall count of articles included from each publisher, with theme proportions. Diagrams show the proportion of negative and positive themes (critiques and rebuttals) in articles from each publisher, with size scaled to represent the number of articles included from each news outlet (shown also in tabular form beneath)

Fig. 3

Daily count of stakeholder mentions. Number of articles mentioning institutional stakeholders daily (blue bars), compared to total relevant articles daily (grey bars). Quantified by keyword search, conducted after completion of thematic analysis

Fig. 4

Daily combined count of critiques and rebuttals, exact and moving average. Legend: Circles indicate exact count of critiques (red) and rebuttals (green) appearing daily. Line plots show a 7-day moving average, calculated to show overall trend in critiques and rebuttals per day

Fig. 5

Overall count of theme mentions. Number of articles mentioning each theme, colour-coded to distinguish critiques (red) and rebuttals (green)

Fig. 6

Daily count of individual themes, shaded by number of articles per day mentioning a given theme. Themes were conceived as “statements about the trials,” and divided into two categories: critiques of the trials (red) and rebuttals on behalf of the trials (green). a Themes discussed in section "Secret trial and insufficient public information": Descriptions of the trials as “secret” or “clandestine” were most prevalent in the first half of the controversy, but following Parliamentary discussions, this theme was superseded by the more restrained judgements that the trials had provided “insufficient information” to politicians and had failed to “sensitise” the general public. Trial representatives began responding in mid-June that information had been provided and public sensitisation would be done. b Themes discussed in section "The fear that vaccine trials will bring Ebola": Early concerns about the trials’ safety included two related but distinct fears – first, that trial participants might contract Ebola from the vaccine, and second, that because Ghana had no Ebola cases, the researchers must have intended to introduce Ebola into the population for the purpose of testing the vaccines. Rebuttals included repeated explanations of why the trial vaccines could not infect participants, as well as several assurances that Ebola was not being introduced to the country, however most rebuttals focused more on the idea that the trials were “following all protocols” and safe in a general sense. c Themes discussed in section "Incentives": Incentives – 200 Ghanaian Cedis (GH₵) and a mobile phone – were a target for extensive criticism, both from those who felt these were valuable enough to be coercive, and also from those who perceived the trials to be very risky and consequently viewed the incentives as insultingly small. Rebuttals included the clarification that phones were intended to facilitate communication between researchers and participants, and the money was to compensate participants for their time. d Uncategorised themes