Constructing (Mis)trust: A Critical Discourse Analysis of Vaccine-Hesitancy Narratives Among Low-Literacy Populations in Pakistan

Abstract

Despite the success of vaccination programs in Pakistan, vaccine hesitancy remains a major challenge, particularly in communities with low literacy, where health messages are conveyed primarily through speech. This research adopts a critical discourse analysis approach to examine, line by line, how trust and mistrust in vaccines are constructed in the discourse of low-literacy communities in Khyber Pakhtunkhwa. The study treats hesitation not as a mere lack of knowledge but as something “constructed” through language, including the stories people tell, the words they borrow from religion and politics, and the silence they observe regarding health workers. Data were collected through thirty-two in-depth interviews, non-participant observation of vaccine visits, and a community talk via mosque announcements and WhatsApp voice notes. The text was analyzed using Fairclough's three-dimensional model of discourse, which examines text production and consumption as well as the social forces operating behind the text. Results demonstrate the nonrandom nature of mistrust. It is created through repeated assertions about foreigners' intentions, metaphors that pit vaccines against poison and testing against death, and a palpable and justifiable rage against government neglect, which was never about the vaccine. The study suggests that health communication in Pakistan should shift away from the mere task of correcting messages and toward the discourse of neglect that health communication surrounding vaccine talk in these communities has drawn its focus from.

Keywords

Vaccine hesitancy, critical discourse analysis, low literacy, health communication, trust, Khyber Pakhtunkhwa, polio vaccination.