MMost people in Western countries would recognize the archetypal grumpy uncle – the grumpy older relative who claims 'common sense' while dismissing climate change as a socialist plot or vaccines as a conspiracy perpetuated by big pharma .
It's a character John Cook knew well because, like many of us, he had someone like that in his family.
Cook is an academic at the University of Melbourne who researches climate change misinformation and the best ways to combat it.
So when he was building a game that would teach people to spot climate misinformation, the part-time cartoonist drew a grumpy uncle as the central character.
Since the Grumpy Uncle game was launched at the end of 2020 and is used by tens of thousands of people around the world.
But when Unicef asked Cook if he could change his game to counter vaccine misinformation in the developing world, he hesitated.
“Everyone has some version of that grumpy uncle,” Cook says. “But climate misinformation is a very Western construct and now we are going to countries that are culturally very different.
“But we discover that the grumpy uncle is a universal human experience.”
The new Cranky Uncle vaccine game has already launched in Tanzania, and trials have been completed in Kenya, Uganda and Ghana, with rollout planned in more countries, including Pakistan.
In 2019, the World Health Organization cited vaccine hesitancy – “the reluctance or refusal to vaccinate despite the availability of vaccines” – which has often been supported by misinformation, as one of the top ten threats to global health.
Unicef says around 20 million children will have missed one or more routine vaccines by 2022. Vaccination rates are improving in some areas, but have largely not caught up to pre-pandemic numbers. Africa has the highest number of unvaccinated and under-vaccinated children.
The basis for the game is research by Cook and other social science colleagues that tested how best to combat disinformation.
A standard approach to debunking a myth might be to first state the piece of misinformation, such as “climate change is caused by the sun” or “vaccines are dangerous because a child got sick after getting a shot,” and then state the facts. to lay.
But Cook and others have developed an approach known – perhaps ironically – as the “inoculation technique,” in which people learn the common ways of arguing used by “grumpy uncles” before exposing them to the myths they spread.
“Across a number of studies, we have found that vaccination has some powerful benefits, such as converting immunity across subjects,” Cook said.
The original Cranky Uncle climate game has been downloaded over 55,000 times from the Apple App Store, but no data is available for Android downloads. The game is available in seven languages with five more language versions on the way, as well as a teacher's guide.
Before the vaccine version of the game was launched, Cook says, a review of studies on vaccine misinformation found that the two most pervasive arguments were that natural remedies were always the best approach to fighting disease and a misconception known as “false cause'.
The “false cause” fallacy usually comes in the form of an anecdote about someone getting sick after a vaccination, making a false connection with the vaccine.
In the game, players will see a healthcare worker and the Cranky Uncle character.
Players will learn 10 'tricks' or misconceptions that the grumpy uncle will use to misinform them. The player's task is to take a quiz and discover the fallacies.
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The more often players spot the correct fallacy—for example, when the uncle uses the “false cause” trick or alleges a conspiracy—the angrier the uncle becomes.
Cook and his wife Wendy, a graphic designer, worked on the game with Unicef, the nonprofit Sabin Vaccine Institute and the public health consultancy Irimi.
Kate Hopkins leads the vaccine acceptance research at Sabin and held workshops with locals and health workers to co-design the game in West Africa.
Hopkins says results from trials of the game in Kenya, Uganda and Ghana have shown “statistically significant shifts in vaccine attitudes”.
“We have seen a positive increase in attitudes towards vaccinations and a positive increase in people's ability to discern between facts and misconceptions.
“The characters are recognizable to the players and the scripts have changed from country to country and are specific to the local communities.”
Chelsey Lepage from Irimi gave workshops to develop the game in East Africa. She says there are many people who are reluctant to get vaccinated because they think vaccines are part of a conspiracy.
“Many people believe that vaccines are a way to reduce Africa's population, so you understand why these things are taking root,” she says.
Cook had to redraw the Cranky Uncle character several times to reflect the local population. One version with the character in a suit for the Ugandan game had to be redrawn “because in Uganda a blazer confers authority,” says Lepage.
Lepage says they also added the character of a healthcare worker, whose job is to provide factual information.
“This is partly a message about behavior change. We want people to change their behavior and we also need trusted messengers.”
Cook says he hopes the game will help people become better critical thinkers – whether that's about vaccinations, climate change or any other public debate.
“I have been studying climate disinformation for fifteen years, so this was a completely new domain.
“I went out of my lane. But it is proof that this approach works across all issues.”