Fighting Misinformation, Building Trust: Lessons from Dr Ifeanyi Nsofor

In this episode of LSTM In Conversation, Dr Laura Dean speaks with alumnus Dr Ifeanyi Nsofor, public health physician, behavioral science researcher, and global health equity advocate. Together, they explore Dr Nsofor’s journey from aspiring surgeon to championing preventive health, his experiences tackling misinformation during the Ebola response, and the power of technology and social media in shaping health narratives today.

The discussion highlights the importance of breaking down scientific evidence for communities, amplifying voices from the Global South, and rethinking global health leadership to ensure equity and accountability. Dr Nsofor also reflects on his time at LSTM, the lessons that shaped his career, and the pressing steps needed to achieve health equity in the next decade.

Transcript

 I'm delighted to be here with today's guest. Ifeanyi Nsofor, a public health physician, behavioural science researcher and Global Health Equity advocate. He has over 130 published articles and has led over 30 research projects across West Africa. He's recognized as one of the top 100 most influential Africans in 2020 and played a key role in evaluating the African Union's response to the Ebola outbreak. He's a member of the global fellow’s advisory board at the Atlantic institution, roads trust, Oxford. Ifeanyi is currently the director of a project that uses social media and community pharmacists to increase HPV vaccine uptake in Nigeria. I'm delighted to be your host for today. My name is Laura Dean. I'm a reader in social science and global health at LSTM and hopefully will guide us through an exciting conversation with Ifeanyi. So Ifeanyi, perhaps we could start with asking you, what inspired you to pursue a career in global health and public health advocacy, and how did LSTM shape your journey?

All right, thanks, Laura. It's really a pleasure to be part of this. LSTM holds a very important place in my in my life, because I think a lot of what I do today was shaped by LSTM in 2007 as a long time ago. So interestingly, I left medical school in 1998 when I left medical school, I wanted to be a plastic and reconstructive surgeon, right? And in Nigeria, when you leave medical school, you have one year of internship within the hospital, so they are trained further before your final license. And then you now do your National Youth Service one another year where you serve the government, usually in in you know, different locations across the country. So, I did my national youth service with the Nigerian army in Abuja, the National, the nation's capital, and I remember that, you know, that was really a turning point for me as a young doctor, because I saw lots of the cases I saw in the clinics were really preventable. You know, you would see a mother will rush her child febrile. You know, in shock, anemic and all. And most times you would save the child, you know, transfuse the child and ensure that the child survives. But even a few times you lost them. And for me, it got me thinking then that maybe I'm really not suited for this clinical work, I'd rather work more in preventing people from falling ill, because in my mind, I then it made more sense. It was more cost effective. And that was when I decided, well, I abandoned my plastic contractive surgery and for me, then it was community health, public health, global health, whatever you choose to call it. And I was lucky to have gotten a Ford Foundation International fellowship that paid for my master’s at the Liverpool School of Tropical Medicine. So that was, that's how, that was how I segued into, you know, public health, you know, public health advocacy, research and all because I really felt, and I still feel, that we need to prevent people from falling sick. Because, apart from the cost, the finances of taking care of illnesses, you also cost a lot in terms of morbidity and illness and ill health, you know, to people essentially, yeah, so that's, that's how I found myself inthis truck. Thank you. It's really nice to hear about your passion for the for the social drivers of health and why it's important that we address those in preventing people from falling ill. And I know that's the heart of much of the community health systems work we do here at LSTM, and part of the master’s program that that you under talk linked to the social drivers of health, you've been really vocal in your career about combating health misinformation, and could you share with us a little bit more about the strategies that you've seen to be most effective when tackling misinformation in public and globalhealth in 2019 This was after several years of working in global health, I became a fellow, an Atlantic fellow for health equity. And part of the fellowship here was, you know, an executive course on health equity at the University of global health equity in Rwanda. And I'm telling this story because when I walked into the class, when we got to the botaro campus in Rwanda, I saw a mural on the wall. It was a writing, and it says, to achieve equity in healthcare, we have to achieve equity in health education. So So for me, when I saw that particular quote, It was like a reaffirmation of everything I had done before to improve knowledge of. You know, health, education, you know, improving people's knowledge about what to do, what not to do to improve health. Because ultimately, the first step in changing people's behaviours for Good is for them to know. For them to know, know the get the right information. Get the right information through different channels. Ultimately, you know, and also get that information in such an empathetic way that they would see, you know, the value in it for them, and be able to, you know, prioritize health for themselves and for their families. And for me, this was really something that has shaped, you know, the way that I do the work that I do, because it's all about information, and when you think about it, the people who are putting out the wrong information also know the importance of of what they do. But if I may speak briefly to public health advocates like myself, through all these years, I've also partnered a way of framing my public health advocacy in such a way that it's easy for for me to articulate my thoughts. So, for instance, I say, what's the problem? You define what the problem is. What are the solutions to that problem? Then, then, what are the calls to action? You know, and the calls to action is what you want people to do, and it will depend on who it is you're talking to. If you're addressing a particular health issue and you're talking to, say, program managers, the calls to action would differ from, you know, if you're talking to a woman in the village or the traditional leadership and all. But to me, everything really boils down on what you know, getting the right information, getting those information the right channels and at the right time, and also consistently, you know, at the long run, it helps you change behaviours.

Thank you. I think that's important in terms of information being powerful, but also the right information for the right people at the right times. And perhaps you could talk a little bit more about how you think technology and digital platforms can be useful in further driving kind of the sharing of public health information and countering misinformation?

Well, I mean, we live in a technology in the technology age, I think any public health advocacy campaign that does not embrace the power of technology is really, in a way, in today's world, it doesn't matter where the people are located. It's really doomed to fail, to be honest. So, the question is, What? What? What technological platforms exist, or, you know, have the most usage where it is that you're located. And, you know, we can't talk about technology for public health advocacy without mentioning social media. And I know that for people like us who work in the public health space, some people, you know, people are like divided. You know, I don't want to get engaged with social media, while others say we should engage with social media. But I like what an American tech entrepreneur said, Eric Coleman, he said, it is no longer whether we should do social media, but how well we do it, you know. So, it's understanding that, you know, you have more than 3 billion people across different social media platforms, and so that is where people live, even in places like Nigeria, for instance, probably close to 50 million Nigerians, about 25% of our population, on Facebook and Instagram. So, you cannot, you cannot ignore it, because this is where people, you know, live, interact, you know, trade and all. But also, let's not forget other, other technologies. So, for instance, TV, radio, podcasts like this. I mean, there are different ways. So, for me, in summary, in today's world, we really need to tap into technology. But ultimately, to me, the most influential technology as of today is social media. And I want to see more people like myself use social media for good, putting out the right information and as much as possible, countering those wrong information that you know people who the Mischief Makers put out on a regular basis.

Thank you. I agree with you. I guess I wondered if you could talk a bit more about your experiences of the use of information and science communication and tackling misinformation when you were involved in the Ebola response in West Africa, because obviously that was a huge challenge and something that had to be overcome. And populations where access to technology and digital platforms is quite inequitable in itself. And so, I just wondered what your experience has been in those types of contexts, or in public health crises where a response and information is needed, but obviously there's a lot of misinformation circulating at the same time. Years ago, I was I was the director of policy and advocacy with Nigeria Healthwatch, which is really Nigerian. Just leading public health nonprofit, you know, that puts out information to the public. One thing that we did was we, we tried to put out information in different ways. So, for instance, radio was a very important way that we put out information, because in Nigeria, especially in northern Nigeria, who are based in Abuja, but most, most radio stations now can transmit across, you know, different regions. So, radio was very important. Sometimes we'll create different radio shows. You know, go to different radio stations. Talk about the people have calling pro we have calling programs. People can call and ask questions. But we also did, you know, Vox pops, we will send some of our colleagues to the street and ask people questions about health. The idea is to just unpack what we think about different health issues, then come back, edit it, you know, in our studio, and now put out that, you know, small snippets of what people said, whether it was right or wrong, and put and now, you know, help people understand, understand the best way to address those health issues. One other thing that we did then was, you know, we had this project we did at every election in Nigeria, we could, we called it vote for health Naija, because for us, we had, we had consistently advocated that for healthcare to change in Nigeria, we need active citizenship for health. So, people need to understand that health matters, and if it matters to them, then they can begin to hold elected representatives, even before they are elected accountable, you know, to say, what are you going to do about our health care? So, we had, you know, vote for health Naija, but also for me as a thought leader, having written all these articles, for me, it has become a very important way of putting out information, especially opinion articles. Yeah, of course, I also publish in peer reviewed journals, but I've, over the years, I've come to realize that open when you publish opinion articles, for instance, it's easier for people to understand what it is you're talking about, because you write in such a way that you break down very complex health issues for people to understand. And I remember even Liverpool LSTM used to have, I don't know if you see in existence. This evidence update where some of the, you know, you summarize for creating, you know, publications that are usually 50 pages, summarize them into two pages, you know, in formats that policy makers program managers can understand. So, so for me, you know, I've really approached this, you know, through different ways. And the beauty of it is that what works in one place may not work in in the other place, but it is really looking at the population that you're primarily interested in and saying, what is like, what's the low hanging fruit here? You know, what will work the most if you're if you're addressing issues that affect young people, surely, social media, you know, if you know, sometimes even when I work with Nigeria Health Watch, we would go to communities and really go around, you know, and talk to people face to face, have small rallies where people can come together and even help moderate some community conversations. You know, because in those communities, those were the things that worked best for them. And for me, I think it's very important tapping into those things that work best in different communities.

I suppose it would be really nice, I guess, to hear your reflections around lessons you have for academics, researchers, scientists, who are working at that kind of interface where they're working a lot with communities and then trying to support that accountability within the health system, so that decision makers or program managers, as you're as you're saying, kind of act on the findings or the information or things that are being produced within Research, or the kind of everyday realities of communities. And I guess, from your experience, it would be really nice to hear about what you think some of the challenges are for researchers and scientists when they're communicating that their work. And how do we ensure that we don't unintentionally feed into some of these kind of misinformation, debates or things that are happening.

Okay, so, I mean, I think for you know, researchers, academics, you know, really interested in producing strong evidence, you know, publishing, you know, articles to help advance their careers and all. But to me, it is also understanding that when an evidence is generated in a particular place, we also need to break it down for the local people to understand what it is we're talking about. You know, because I think, or I think most times, you know, when, when scientists talk about different issues, they really use very, you know, be. Highfalutin words, you know, you know, for lack of a better expression, they use a lot of jargon that people don't understand. And even if people don't understand what it is you're talking about, it's almost as if you've not spoken to them, right? So, and if I go back to what I said initially about problem, you know, what I consider as a formula for health advocacy, what is the problem? What are the solutions and what are the calls to action? So even when you have generated evidence in a particular location, you know so, so these are the different problems. So, for this particular community, these are the these are the solutions, you know, to addressing your issues. But for the different demographics in those communities. These are the different ways you can be part of those solutions, which for me, is what the calls to action really mean. If I go back to the work, we did evaluating the African Union's support to end Ebola in West Africa, we travelled across Guinea Liberia and Sierra Leone across in a within a two week period, you know, interviewing African Union volunteers, international partners, community members, you know, ministries of health, different stakeholders, interviewing them. And at the end of the day, we produce a report for the African Union to say, you know, these are these are these are these are the these are the ways that the African Union volunteers were game changers for this. And going forward, if we're going to stop such epidemics from happening and overwhelming our health system, these are the things we ought to do. And interestingly, when we did that, when we did that, when we did that research, the Africa CDC was not in existence. So, one of our recommendations was actually establishing an Africa CDC under the African Union to take charge of infectious disease prevention, detection and response across the continent. So to me, in some ways, really, we need to break down to people, and I feel that scientists, academics should also not just focus only publishing in peer reviewed articles, because you see, you are the experts. People you already have a lot of respect. You know, across the board, people respect you. People want to listen to you. And when you publish in only peer reviewed journals, it's almost like we're just talking to ourselves, you know, because how many people outside the academic community you get to read those articles, you know? So, I would like to see scientists write more of opinion articles, commentaries, you know. Go on radio shows, go on TV, be active on social media. And I'm happy to see that more scientists are beginning to really do that, but we really need to do more of that so that, ultimately, beyond generating evidence and promoting our careers, but really helping our communities understand in very simple forms, what the issues are, and you know how they can address them. And one of the things that I think we're really passionate about in LSTM at the moment is around how we can support, I guess, African scientists and African voices, or other voices from within our LMIC partners to have equal weighting, I suppose, on the kind of world stage in terms of priorities and and knowledge sharing and tackling misinformation. And obviously you were part of recommending the establishment of the Africa CDC, which has been a great step towards that. And so I guess I just wanted to understand more about your opinions and how, how we can be allies in LSTM and supporting the kind of dominance of information, generation and sharing to from the to shift from the global north to the global South, or to countries that historically have had less of a prominence on that kind of stage in terms of what's listened to, I suppose I also speak and write a lot on decolonizing global health. Yeah, you know, I'm happy that the movement is picking up, but I think that we should use knowledge, whatever it is is generated, you know. So, I like to see more of, you know, knowledge transfer from the global south to the global north. And that can happen in different ways. Of course, you know LSTM. LSTM, on its own, is also a leader in this space, because over the years, LSTM has really had very great partnerships with different countries, Ministries of Health in the global south. But get more people who are on the ground. I mean, from the work that I've done traveling across different African countries, you know, you get to communities, and you see, you know, they don't have very fancy, fancy titles. You know, they've not travelled to very fancy places. But these are the people who are the game changers, who are making, who are doing all the work, you know, to really change. You. Ah, you know health systems where they are located. So, for instance, I think you know what happens in Rwanda, the community health worker system in Rwanda that is really the bedrock of the Rwandan health system. It's something that I think the global community needs to know, get to know more about. So, for instance, when LSTM holds meetings, for instance, it's not just the very big professors that should be invited, people who are on the ground, people are who are applying very basic solutions that save lives. You know, is the day-to-day thing that they do in their in their communities. I think that's really that's really important. And again, I keep going back to social media, because it's such a very powerful space. So, it will also be good for LSTM to tap into the alumni network and get to, you know, profile more alumni on social media. It may be having, you know, tweet chats, you may be having Instagram Live, it may just be, you know, getting information from people about the work that they are doing and how they are saving lives, especially people from the Global South, and help and help profile that. Because the more that happens, the more those individuals are established as thought leaders in their own right, and the more they gain prominence and probably also get other recognitions to come and share the work that they do. You know what? I don't know if it still happens in LSTM but when I, when I was there, the I had to go to Zambia for my research. You know, I went to Zambia. A number of my classmates went to different places, and it was a life it was a life changer for me, because, although I do, I'm Africa. But I hadn't been to Zambia, in fact, then I hadn't been to Southern Africa at all, but I was there for eight weeks, did my research in HIV, you know. And by the time I got back to LSTM, I decided to also be a research client to the school. When I went back to Nigeria for a period of three years, students from LSTM, three different students, came to do their own research in Nigeria, in different, you know, areas of health. So even the existing student community within LSTM, I think there is a very important resource, because a number of people who leave the global south for Masters or PhD really have huge experiences doing this work, you know. So, it'll also be good to get some of those, you know, students who are already in campus, you know, to really get to hear about the work that they do and profile that work. But ultimately, LSTM has to be a leader, you know, in decolonizing global health. LSTM itself acknowledges that, you know, it's history. Really is, really, is really, you know, dipped in, you know, you know, slavery and colonialism, and that's fine. But in trying to address that, I think, you know, LSTM, should, you know, continue to engage with people from the global south and profiling them, and when LSTM leadership are at different tables, where people are required for leadership, also try to recommend leaders from the Global South, because, you know, people have great experiences. Thank you. I completely agree with you, and I think we do recognize our kind of colonial history and LSTM, and we are really trying to address that, but it has to be addressed in collaboration with people like yourself and the game changers at the grassroots level that you know you've reminded us about and how we support to amplify those voices and change those power hierarchies is really important. You've talked a lot about your time at LSTM and shared some memories, and I know certainly from my time as a student at LSTM, the kind of collegial relationships and the learning from each other as students is really important. But I wondered if you could just reflect for us a little bit about your fondest memories of your time LSTM, and how the education and network that you gained through LSTM has impacted your professional work so far.

So, I mean, coming to LSTM was really when I look back, very important decision as a Ford Foundation fellow. I had the options to go to the London School of Hygiene and Tropical Medicine, Queen Margaret University, Edinburgh or LSTM. These were my three choices I was supposed to choose, because the British Council had done the placement on my behalf, and I remember asking the British Council officer, which one would you recommend? Of course, I was gravitating towards London school, because most of my seniors in medical school went to London School. I can't remember the lady's name here, but she said, Go to Liverpool. And I asked why, and she said, Liverpool has a great research experience that that was how I made my decision to go to Liverpool. And I did not have not regretted that. I. Because, first of all, it was also my first time of being in an international space with people from different countries working together in Nigeria. We being part of the polio campaign. Of course, I had people coming, you know, international workers coming, and all but just being an academic, academic environment with people from different countries, fellow Nigerians, Africans, people from other parts of the world, it was really it was really fun. And for me, you know, some of my fondest memories in Liverpool was really the openness of the faculty, and coming from a place where, you know, there was a hierarchy between you and your lecturers. You couldn't even call them by their first names and things like that. I remember when, when Professor Ghana, who was my academic advisor, my first academic advisor, asked me to call him Paul. I just looked at if I had three of us, two of us from Nigeria, one guy from Sierra Leone. We told him, it's not possible. We cannot call him Paul. And he was like, why? I said, Professor Ghana, I come I'm Nigerian. I come from Igbo tribe in my in my tribe, you're like a big Masquerade. And when a big masquerade comes out, other smaller masquerades run out, you know, because that's how important, yeah. But he insisted, so for me, that informal environment being able to engage with your lecturers, your advisors. Eventually, Doctor Sally Field board became my academic advisor until I until I left. But just that familiarity to me was really something that shaped, you know, what I did. I came to Liverpool as a very important doctor. I left as somebody who, who you know, who had all those, you know, all those airs of importance, really, you know, removed from me. But Liverpool, for me then, was really fun, because it's a multicultural city. It was easy to move around and see people like yourself. So it was almost like the difference between Liverpool and Abuja, where I live, was, it was the weather, you know, because it was easy for me to really integrate. I really loved going to the city centre. It was almost like a daily occurrence, even if I wasn't buying anything, just going around, walking around. And with time, when I started traveling around the UK, when I had the time, you know, it was, it was, it was great going to the dogs, learning about, you know, the colonial history of, you know, Liverpool and all, and just generally, exploring the city. And, of course, you know, one fun challenge I had in Liverpool was struggling to understand when people speak, when the Liverpool indigenous speak. It was a lot of battle trying to understand what they were saying, you know. But with time, you know, I was easy to comprehend that. Yeah. So, to be honest, Liverpool was the first place where that shaped my understanding of equity. I didn't know the word then for equity, but just seeing how things were done, relationship with students, when you were going for your research, the way, the way that you were counselled on how to behave, what to do, how to respect people, the communities, you know, they really shaped what I did. And seemed very, very, very influential faculty come, you know, really come down to, to my level as a student. Then to me, was, what is something that I can't forget in the history I keep telling the stories of Professor Ghana. You know, it's, it's, well, I'm still calling Professor Ghana. That's how that's, that's how much is ingrained in my mind.

That's really lovely to hear. And I think, as you say, that almost humility and being humble and stripping of titles is really central, certainly in my experience, as well to really supporting us, to address health equity issues and to support kind of decolonization processes. And I think, as a kind of resident of Liverpool, I think it speaks to the values of the city, as well as LSTM as an institution, and it's really nice to hear you, hear you reflect on that you have been a real champion of global health equity and had many achievements that have promoted better health and well being for many people around the world, and particularly in in Western and Central Africa. And I suppose I wanted to ask you a final question, really, as if you could talk to us about what you think are the most pressing steps needed to achieve health equity globally, and how do you see that changing over the next decade?

So I think for me, I'm going to quote the Gates Foundation, all lives are created equal. I think we need to, we need to really bear that in mind and practice it. Saying that is also speaking to the international global health community, that the way that Africa, for instance, is perceived is totally wrong. You know, for some people, they look at it once you talk about infection. Short diseases. What comes to mind is Africa, you know, forgetting the great work that people do across the continent. You know, to, you know, to to stop those infectious diseases from happening and all so. So, for me, you know, I think so for one is all eyes are created equal to we need to use knowledge, no matter where that knowledge is generated from. We need to have equal representation of leadership at the global level. Because if you look at covid, I've written and spoken a lot about, you know, covid vaccine, inequity and the fact that global bodies came together to make a decision for Africa without Africa being at the table. It doesn't make sense, but it's 21st Century, and that is still happening, so that has to change to get you know, Africans and people from other low- and middle-income countries to part of the decision making process. But having said all this, I think we are one hand, I need to see African leaders be more responsible. Be more accountable to our people. Governance improved corruption, you know, eliminated. But in doing this, we need, we need the global north to hold African leaders accountable. Because, you know, almost every year, every two years in Nigeria, you hear that certain amount that was stolen by a politician that was held in the Global North after several decades, is being returned to the country. And what I ask myself is, why is that money allowed to be stolen first to the global north? So the Global North has an important responsibility to hold African leaders accountable, so that when those funds are coming, you have to stop, or you have to stop those funds from moving, you know, out of Africa. The estimated, you know, illicit, illicit financial outflows out of Africa is almost 80 something billion dollars a year that leaves the continent. What Africa get as foreign aid is about 60 something billion dollars. And what that tells you is that if the global north is more involved in blocking those illicit financial outflows, probably will not be needing any aid from anywhere at all, because those funds will have to be used for our people, you know. So, I think that's very important African leaders stepping up then the global north leaders also, you know, being part of that so that, you know, funds are not leaving the continent and other parts, other parts of the of low- and middle-income countries. Because if we believe that all lives are created equal, then you have a situation where the UK, Canada were holding covid 19 vaccines when Africa didn't have any, you know, three to five times their population size, you know, holding those vaccines because, you know, they felt that their own people mattered the most. But I think the last thing I'm going to say about this is also for the global community to realize that when it comes to infectious diseases, there are no borders. It doesn't matter how much you police your borders, infectious diseases would always find a way to cross over, and that is why, you know, we need to really look at this and as a global community, you know we are strong as our weakest link, and bearing that in mind, I think is really going to help us advance health equity for everyone, ultimately.

Thank you. Ifeanyi, it's been really lovely to talk to you, and thank you for reminding us really clearly that to achieve health, to achieve equity in healthcare, we have to achieve equity in health, education and reminding us of the role that everyone has to play in that whether they're in the global north or the global South, in terms of holding each other to account and amplifying the voices of the of those change makers at the local level. And I think you've highlighted the really useful tools that we have available to us in tackling misinformation, particularly social media, but also using more kind of historical technologies like the radio and community meetings and things that really can drive change and shape trust within health systems. So, thank you very much, and you've been a great guest, and I've really learned a lot from talking to you. And please do continue to share your experiences that that you've had at LSTM and keep doing the great work that you're doing. Thank you. Thank you so much for having me.