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Introduction

Although anti-vaccination sentiments existed in the Maldives prior to the COVID19 pandemic, support for these ideas have increased since it broke out in 2019. Anti-vaccination cases that have come to the forefront prior to the COVID19 pandemic point to religious beliefs influencing the decision to not vaccinate. In December 2019 Colonel Naeem of the Maldives National Defence Force (MNDF) stated that the statistics from the Ministry of Gender, Family and Social Services (MoGFSS) show that non-vaccination of children is increasing and that this is due to extreme religious beliefs such as believing that protecting from diseases beforehand is refusing to trust in god. MoGFSS, MPS and MNDF have conducted joint operations where parents who refuse to vaccinate children are counselled on agreeing to vaccinate and refusals have resulted in children being taken into state custody. The Child Rights Act of the Maldives which came into effect in February 2020 mandates that parents must complete the vaccinations necessary for their children. 

The theft of a vaccine stamp, an administrative stamp and a CPU storing vaccine copies and official documents in 2020 from an island health centre point to attempts to circumvent government mandated vaccination. The theft occurred shortly after a paediatrician raising vaccine awareness on his twitter account alleged that children were secretly being enrolled in schools without having completed the required vaccination against government regulations.

Like the rest of the world, the Maldives has not been exempt from the CoronaVirus (COVID19) which has caused a worldwide pandemic. The first case of the COVID19 in Maldives was reported on 07 March 2020 and the government declared the Maldives first public health emergency on 12 March 2020 under Section 33 of the 7/2012 Public Health Act (implemented in 2012) that accords the power to declare a state of public health emergency to the Director General of Public Health. The restrictions related to Covid19 under the state of emergency was dissolved on 13 March 2022.

Covid19 vaccine was made freely available to both locals and foreigners in the Maldives including tourists. Vaccination rates in the country are high with 945,036 vaccine doses having been administered as of 12 June 2022. According to the Health Protection Agency 398,197 people have completed the first dose of the vaccination and 371,051 people completed 2 to 3 doses of the vaccination.

However COVID19 pandemic denial and anti-vaccination sentiments (COVID19 and in general) have seen an increase in the Maldives since the pandemic began as has support for and visibility of individuals and groups espousing these views. It is possible that the high vaccination rates are the result of government measures to encourage vaccination such as parents and staff not being allowed in schools without vaccination, restrictions on receiving certain services and more rather than belief in vaccination or the pandemic. 

A CSO called Health Defence Maldives  “advocating for the protection & promotion of the right to health in the Maldives” was established in October of 2020 but it was dissolved by the Ministry of Youth, Sports and Community Empowerment (MoYSCE) in April 2021. The reasons stated included: spreading anti-vaccination views which according to the Ministry goes against the constitution and international conventions Maldives is party to and failure to appoint a steering committee as per laws and regulations pertaining to NGOs.

In February 2022 a case was lodged in the Civil Court of Maldives against the Health Protection Agency (HPA) for ‘forcing’ vaccination upon citizens for instance through circulars mandating civil service employees must be vaccinated or submit Covid19 tests regularly.

COVID denial and anti-vaccination sentiments have contributed to lax adherence to mandated precautionary measures, especially the masking mandate and vaccination requirements which received much opposition from some groups.

Actors

Primary actors are individual and non-state actors while secondary actors are political actors and media platforms.

Individual actors:

  • Are the primary actors in this case and include: anonymous social media accounts as well as public accounts; and telegram and viber communities, a few of which were under investigation by the police for the promotion of anti-vaccination.
  • Most of the individual actors appear to be acting in their personal and private capacity.
  • Examples:
    • @vaccinenurakka (Translation: “vaccine danger”) is an actor that was active before the CoronaVirus pandemic. Their social media accounts have since been deleted including the viber community. It cannot be discerned whether these accounts were a single individual or a group. 
    • @HealthlawMV is a twitter account that was created in February 2022 and likely linked to Health Defence Maldives. Their twitter bio states as follows: Leading Health Related Legal Case in Maldives to uphold the fundamental freedoms & constitutional rights. 
    • @VaccineAniyaa (‘Aniyaa’ is a Dhivehi word that means injury/harm/torture) is a twitter account that appeared around 2020 that was publishing anti-vaccination content. The account was anonymous and has been suspended.

Non-state actors: 

  • The main non-state actor is Health Defence Maldives which continues to operate unofficially although its status as a CSO was revoked after six months in 2021 due to its anti-vaccination stance. According to Health Defence Maldives they are a group “advocating for the protection & promotion of the right to health in the Maldives” Their website is still no longer online although their telegram group and social media is still active with their twitter bio stating that they are a “People’s movement against Medical Mafia, Medical Negligence, Forced Medical Interventions. We stand for the protection of bodily integrity & informed consent.” 

Media platforms:

  • Media platforms in Maldives are not independent although news coverage has largely been positive towards vaccination, with some media articles even encouraging the population to get vaccinated.
  • This can be seen from the coverage by the state owned Public Service Media (PSM) as all their news on this issue appear biassed in favour of the government such as repeatedly giving credit to the President and government for doing a “good job” with the handling of the pandemic including vaccination efforts. 
  • News articles are not entirely impartial and reflect the stances of their owners of the particular media.
  • Media also published stories from international news. For example news claiming negative effects of vaccines and deaths suspected to be vaccine related.

Political actors: 

  • Political parties:
    • The opposition coalition of Progrssive Party of Maldives (PPM) and Peoples National Congress (PNC)
  • Politicians:
    • Eg: Former President Yaameen Abdul Gayyoom

Behaviour

Transparency:

  • The identity cannot be verified for anonymous individual accounts that are/were vocal proponents of anti-vaccination and COVID19 denial.
  • Non-state actors, media platforms and political actors are transparent in their identity.

Intent:

  • The intent of anonymous individual accounts cannot be verified but the public individual accounts do not seem to have aspersive intent.
  • The behaviour of political actors suggests aspersive intent fuelled by political motivations as the opposition parties PPM and PNC initially opposed the vaccines, especially questioning the vaccines sourced from India and spreading misinformation regarding vaccinations.

Authenticity:

  • None of the actors identified were found to be using unlawful means of communication.

Dependency:

  • No evidence was found of ​​dependency.

Infrastructure:

  • No evidence was found of linkages or back-end communication.

Content

Harm:

  • The content does not contain threats and is not directly harmful. 
  • However the spreading of false information affects the ability of others to form their own ideas.
  • Spreading of anti-vaccination sentiments can result in possibly fatal health consequences.

Language:

  • The main language used is Dhivehi (written in Thaana or latin alphabets), sometimes with a mix of English words.
  • English content was also spread including local as well as resharing of content from anti-vaccination sources from across the world.
  • Dhivehi translations of international content in English were also shared.

Expression:

  • The content is based on self-expression (especially content by individual actors who are public) and/or can be protected under freedom of expression, freedom of speech and other fundamental freedoms.

Truthfulness:

  • A lot of the content was found to be deceptive.

Synthetic:

  • Some of the content is manipulated such as videos in English being shared with Dhivehi translation that twists the words spoken in the video to contribute to the misinformation narrative.

Example: A video by the account @VaccineAniyaa has a short clip of Paul Offit where he says: “What’s the best way to convince a parent to get a vaccine, is just to have an outbreak. So that’s it. Fear cells. Sadly people are compelled much more by fear than reason.” The first line of Dhivehi text at the top of the video reads: “The easiest way to force [someone] to get a vaccine.” The second line reads: “Vaccine advertiser Paul Offit.” The text at the bottom reads: “What is the easiest way to make a parent accept vaccinating their child? The second line reads: “The way is to continue spreading an outbreak (disease).”

Narratives: 

Below are some of the narratives encompassing the wider anti-vaccination narrative:

  • COVISHIELD vaccine is only produced in India and not safe.
  • Vaccines were developed too quickly to be safe.
  • The vaccine given to the public is different from the better separate vaccine given to the ruling government members and their families.

Other narratives which have been prevalent before COVID19 include:

  • Vaccines cause mental illnesses and disabilities in children.
  • Vaccines cause Autism.
  • Vaccination is unislamic as it is refusing to trust in god.
  • Vaccines are made from foetuses.

Translation of the text in the image:

Friday Sermon from 24 January 2020. [Text in white box reads] Beloved muslim siblings! Islam mandates that we must care for children from the point they have been conceived. And it is haram to cause any kind of harm to those children –

Text in yellow reads: What kind of a thing is it to take a living child from the uterus and create vaccines using their limbs? And will that have any benefits? At Least 80 children have been murdered to make MR and MMR vaccines!

Degree

Audience:

  • The general adult population of Maldives.
  • Parents are an important target population.
  • Those who are undecided regarding vaccination, especially COVID19 vaccination.
  • Those who are anti-vaccination.

Targeting:

  • No evidence was found of micro-targeting.

Platform:

  • Social media platforms: Facebook (including pages, groups and communities), Twitter and Instagram.
  • Messaging apps: Viber, Whatsapp, Telegram (mainly through groups on these apps).
  • Although the accounts such as @vaccinenurakka have been banned/deleted, their viber group is said to have had over 1000 followers in 2020 and anti-vaccination groups and accounts spring up as soon as any of those accounts are banned from platforms with members in the thousands.
  • Websites: Eg; Health Defence Maldives website.
  • Clubhouse is also a popular platform.

Virility:

  • Although evidence of inauthentic boost to engagement was not found, it cannot be ruled out. 
  • Fake accounts are a popular method used by actors in the Maldives to boost engagements for their continent to promote their narratives.

Scale:

  • There is no evidence of a coordinated campaign, either one-off or ongoing.

Effect

The campaign threatens society and individuals’ health and medical safety.

  • According to the latest statistics from HPA, COVID19 vaccination rates have declined drastically. Amongst the population eligible for the COVID19 vaccine, 88.03% have completed the first dose and 84.80% have completed the second dose of the vaccination. However only 35.12% have completed the booster (third) dose of the vaccine.
  • Completing government mandated vaccination is a prerequisite for enrollment in schools in the Maldives and anti-vaccination sentiments could lead to possible barriers to the fundamental rights of children such as access to education.
  • Paediatric doctor Ahmed Faisal tweeted in 2020 that there was a school in Addu where unvaccinated children were being admitted against government policy and that children who have not completed their vaccination are being enrolled in schools across the country.
  • In January 2020 government officials expressed concern over forgery of documents indicating the completion of vaccine requirements after the theft of items including as a vaccine stamp, official stamp of a government office, a CPU storing official documents from a government office on the island of Maradhoo-Feydhoo of Seenu Atoll.
  • In 2020 measles was detected in the Maldives for the first time after the disease was declared eradicated from the country in 2017. The second patient identified was a three year old child that had not completed the required vaccination doses for measles. Following the new measles cases an initiative by the Health Ministry identified 48 islands where minors had not completed vaccination.

Diagnosis

This case has been identified as misinformation. 

  • Actors: Primary actors – Individual actors and non-state actors.
  • Behaviour: does not indicate intent to deceive.
  • Content: majority seems to be legitimate expressions of opinion regarding vaccination and COVID19 pandemic that is verifiably deceptive/untrue.
  • Degree: there is no real evidence of coordination.
  • Effect: drastic drop in those getting the COVID19 vaccine booster shots as well as an increasing level of anti-vaccination sentiments in general than the pre-pandemic levels.

Conclusion:

Prior to COVID19 the main reasons for anti-vaccination identified by authorities have been religious reasons while post-pandemic anti-vaccination sentiments are mainly regarding the safety of vaccines including the belief that vaccines cause disabilities, chronic health issues and even death.

Although the main primary actors involved in the case are individuals expressing their opinions and views regarding vaccination and the pandemic, the government and other political actors such as the opposition have also used the pandemic and misinformation for their political agendas as well including the current government lifting pandemic related restrictions against the advice of health professionals in the country.

Such misinformation has also resulted in diseases that have been eradicated from the Maldives making a resurgence in the country as well as lax adherence to public health safety measures such as physical distancing, masking and sanitising.

Although the content does not contain threats and is not directly harmful, the spreading of false information affects the ability of others to form their own ideas.

There is a possibility that the high literacy rate; high usage of the internet and smartphones could have negative impacts such as the fast and easy proliferation of misinformation. There is a need to increase information and digital literacy skills amongst the population of the Maldives in order to counter misinformation cases such as this.

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