Documentation:Community perspectives on drug promotion on social media during the COVID-19 pandemic in KwaZulu-Natal, South Africa 2022-2023 DDI.AHRI.Drug.advertising.workshop.coding.matrix.Nov.2023 Nompumelelo Mkwanazi Sweetness H Dube Africa Health Research Institute Nesstar Publisher AHRI.Community perspectives on drug promotion on social media during the COVID-19 pandemic in KwaZulu-Natal, South Africa 2022-2023 AHRI.Drug.advertising.workshop.coding.matrix.Nov.2023 Rujeko Samanthia Chidawanyika Janet Seeley Julia Ndlazi Africa Health Research Institute Nesstar Publisher Global Health Research Institute Africa Health Research Institute South African Population Research Infrastructure Network v1.0.0 Drug promotion; drug advertising; social media; ethics and COVID-19; traditional medicine Drug promotion; drug advertising; social media; ethics and COVID-19; traditional medicine South Africa Data was collected in the eThekwini district. Participants were from the community youth centers, clinics, pharmacies and areas in the surrounding CBD Durban. Workshop discussion responses Young adults ages (18-24), health personnel participating in prescribing, medicines during COVID-19, and a traditional healer Analysed narrative data The participants in the workshops were purposively selected and recruited from local community youth groups and healthcare facilities All the data collected was transcribed and translated. Analysis was done by an experienced social scientist. Notable codes were deduced from the transcribed data. Later, thematic analysis was conducted where common themes raised in the workshops were summarised in a Microsoft Excel work sheet. Access to the data requires accurate completion of the online data access application form accessible on the AHRI Data repository(<https://data.ahri.org/>). Data users are required to abide by the data use conditions stipulated on the application for access to the data. Failure to do so may result in their data access privileges being revoked by the Data Custodian. In order to recognise the effort and intellectual contributions of AHRI investigators in producing and curating the data, users of AHRI data must acknowledge the source of the data and abide by the terms and conditions under which the data is accessed and must cite the dataset in publication using the citation provided as part of this documentation. All analytical datasets published on the AHRI Data Repository are assigned digital object identifier (DOIs) and the DOIs can be found on the Data Repository under Study Description tab - Access policy. AHRI data users are required to always cite the dataset using the relevant DOI. Drug advertising workshop coding matrix Nov 2023.NSDstat 40 18 Nesstar 200801 40 ,P3: There is medication called Corozen 1 ,P6: Let me begin with vaccines 1 1 1 2 1 3 1 NT: Can you explain on that schedule 1..? 1 P1: And again even if your were to purchase it 1 P1: And with regards to the adverse and side effects and the terminology being used 1 P1: Astrazeneca 1 P1: I have seen my mother drink multivitamin. 1 P1: I mean that I use the internet to do school work and sometimes adverts pop up on the internet and that is how I end up seeing Covid updates. 1 P1: I think apart also from lack of information 1 P1: I think the target was more on the elderly aaah maybe because in the first cases were of people of age 35 and above. Aaah I think even the approach when they enrolled the vaccine for the first time o-Sisonke 1 P1: Now again the pharmas were too smart because there was not an ad coming from the company to say 1 P1: Oh yes… That I it was adequate for the targeted group because it was on radio even though I did not know if it was coming from the pharmaceutical company or department of health 1 P1: So what happen is a in a pharmaceutical field when they register medication with SAHPRA 1 P1: That came late…that really came late 1 P1: Through these interviews and free advertisement. Talk about this 1 P1: With advertisement 1 P1: You know there is some discoveries that are being made by accident. There is one Minoxidil …( interruption: we have a meeting here at 14:00. Note taker stepped out to deal with the situation). So we have drugs that are called Minoxidil which was actually discovered to control hypertension but one of the adverse effects was the growth of hair which later on was then stopped as hypertension was to hair growth. Second one is Celdonefille to treat heart but later on adverse effect was erectile disfunction cure. So here with Ivermectin its Antiprotozoal to treat the bacteria and everything and not really the virus. So 1 P1: aaaah ( cough) the traditional medicine as well will pop in and say that this drug does help this 1 P2: And I think maybe to add on that 1 P2: And I think that one was their eye opener. 1 P2: No 1 P2: Yes and I think its it (stutter on the word its) brought confusion to people out of i-health profession because they were not sure which one was good and which one was not good. Cause even the ones that were advertising they were not…I mean they didn’t have that confidence it was like someone was saying what he or she feels like is the truth or this was going to help 1 P3: I am of a different opinion 1 P3: I really don’t think so because aaah its Covid 19 and aaaah everything seemed as if it just started in the year 2019 when I think the…those that were involved were 1 1 P3: To contribute to what has been said 1 P3: We also drank vitamins when we had flu to help our immune system fight the flu 1 P3: We obtain information from listening to people speak. 1 P3: Yes 1 P4: Radio station 1 1 P5: On social media 1 P5: We get this information through the elderly people in our family 1 P6: The truth of the matter is that Facebook is currently the most powerful source of information. On Facebook news feed you will always find Covid related updates 1 P6: Vitamin c 1 P7: Whats app has also become a contributor to obtaining information because there are now hotlines instructing you to send Hi on whats app and then they will update you about everything Covid related for the past 24 hours. It will update you on death cases and so on. That is how I obtain information. 1 When I’m doing school research I use google for doing assignments. That is where I get information. 1 Gender 28 3 Males 1 female 1 4 males 6 females 2 I don’t think it was well managed cause even the signs and symptoms they were talking about from the media and stuff 1 I have just forgotten what its called. That’s where you get updates on the daily cases 1 I think last year the elderly people were incentivized/got paid to vaccinate. How does it happen that you get paid to take treatment that should help you. Maybe this is a plot to kill us 1 I think there was some herbs. I don’t remember the name that if you steam using that nerve 1 SAHPRA will then do a research look in interms of the toxicity level 1 aaam Covid wasn’t first reported globally 1 each and every house hold had a different way to manage this. If at you house you use the oximeter and use…mix certain drugs 1 if they were doctors reporting to have used it and the patient cured out of it 1 in such a way that hospitals that were at privilege to get that are hospitals like King Edward because they have specialists on board 1 it is what they used in the past to heal sicknesses. Sometimes the elderly are unable to take themselves to the clinic so they end up mixing what they already have at their disposal. 1 its found in pharmacies and then there is the house remedies where you mix lemon 1 not that I am against them but we should not be bombarded with them. The fact that companies 1 online advertisement 1 so that was not really clear. You have to say ‘ come vaccinate 1 that’s where we find information especially young South African who are very active on Facebook. 1 the doctors were prescribing different cocktails for different patients cause they were not presenting the same symptoms. Yes we all had Covid but the symptoms we were presenting were not the same so obviously the cocktails that you are going to get maybe are not going to be the same . 1 the remedies you find at the chemist also help. It's not that I have a problem with traditional remedies 1 they knew about this 1 they targeted if I’m excluding the healthcare professionals was the seniors so I don’t think the teenagers or the young youth were targeted at all. 1 this was not going to help so there was a lot of confusion and the videos that were circulating on social media and everywhere that this is wrong this is not right so maybe.. 1 usually other companies as well 1 vaccines helped because I did not get sick. I was also aware that the vaccine has a small trace of the virus 1 we are advertising this first of all its still under section 21 but I feel like they paid people to do it on their behalf because on interviews was like all over…everywhere ( group speaks together) we even now knew which website to check if they have stock. We were informed that it is on Takealot 1 we started hearing about new company names now Astrazeneca. I work in the Pharmacy but I have never heard of Astrazeneca. So ja I think they were opportunistic shame 1 you would get an information leaflet 1 NO. of participants 23 10 2 4 1 I’m assuming. Which would have side effects but those side effects do not really apply on our population here. Maybe it is side effects for a study being done in Brazil 1 You will find that people 1 but I am simply scared of taking them. 1 1 how dangerous would that drug be. Is it fine to be freely available to everyone in the country to have or must be access controlled. Make an example of items that can you can be easily hooked up on 1 maybe a year or two years ago. (group giggles) My worry was why? You remind me of my father (group speaking at the same time). Why leaving it for so many years and then now when the devil is there everybody is running. It was so poorly communicated and from the traditional head office perspective 1 mint herbs and honey and then drink it. 1 on my side its really difficult to comment on because I don’t know if someone is looking at my whats app what so ever since I’m not a TV person. Once you speak about Covid 1 1 recoveries and so forth. 1 schools and certain government institutions have said that you will not have access to them unless you vaccinate 1 so when you get infected with covid 1 1 there are other countries who already had management tools in terms of how they managed 1 there is professors and research institutes close to them who would give them advice. For a clinic that is down in Somkhele that is relying on the information from the district hospital 1 they did the right thing not to exclude the results and say we welcome you to do the research but if you have burning issues to use it before the research is done apply it via section 21. So what they did I this was that they opened up section 21 to say who ever wants to use it is more than welcome to use it at their own risk. So have your own consent to say 1 they were. 1 those herbs you will be fine. So all those things now started putting pressure and redirected our focus even with the buying power from patient. As someone who is at the pharmacy and also retail pharmacy you will start seeing patients coming to ask 1 what they do is they have what we call patient leaflets with the language targeted to patients and then package leaflets which is targeted to the healthcare provider. In most cases you only find the package leaflets which talks about the drug even the package being used that you can never. But in this particular situation it was vaccines 1 you buy those ones. So it was no longer about clinical and scientific based 1 Age bracket 19 18-24 years 2 33-64 1 I want Ivermectin. Do you stock Ivermectin? Because now they are all over the social media and again also the free advertisement where which I don’t think it should have been given so much platform. Free advertisement is us having more debate about one thing that is not yet approved keep on saying its not an advertisement but let us talk about Ivermectin 1 I will start seeing a lot of things about Covid so the binary issue 1 but I would say it’s the fear to take a stand 1 especially elderly people they were experiencing something different from what was said you will experience so I doubt. And I think aaah some people don’t have radios don’t have TVs 1 if you are experiencing side effects apart from mentioned there you are not going to sue anyone. So they followed the right procedures. 1 is a problem. Even university students can no longer write their exams unless they vaccinate. There are certain places that will not hire you if you are not vaccinated. But initially the president had said no one will be forced to take the vaccine but now they are negotiating to make it mandatory. 1 1 patient did not even have a single thing to read about. Beside you get your dose of injection and then you leave the site. So I don’t think they did justice for me. Nothing! 1 such as maybe the use of Cannabis or maybe the Morphine. Then if those ones on patients are likely to cause harm in a population then it is restricted to a higher schedule. For if strepsols are schedule 0 they are less likely to cause harm so make it available. So now with the regulation it says once it goes to schedule 3 get a doctors prescription 1 then who will raise us because we are dependent on the elderly. 1 they tried. 1 they were doing things differently. You find that even prescriptions coming from the same hospital 1 we were not involved in this…(taxi hooting in the background) We never formed part of it 1 1 you don’t’ say I treat Covid better than who. That is why we don’t advertise hypertension medication and say this one treats BP 1 your immune system will be able to fight because it has received a trace of Covid before. 1 Understanding 11 I think they should have done better or more 1 P1: I think because of the pandemic it really forced people to learn new terms. The first one was the quarantine, a lot of people were not even aware of the quarantine, the second one was the isolation so I don’t think there was softer English for someone who is not in the medical field to understand what we are talking about when it comes to that. Even though I am not a person who watches TV a lot (clears throat) but I would come across these on social media popping up or BBC news popping up aaaaah one drug being recorded as a super drug compared to the vaccine was Ivermectin if I’m not mistaken. There was no research done on it, the only thing we knew about it was this is a drug, this drug helps. Again, with the division amongst the healthcare providers some say no, some say yes. (ja, yes the group responds) I think the companies took that opportunity to actually smash it on to say yes this does treat that. 1 do get it over the counter to take it and go. So those ones you are not allowed to advertise. Come back to Ivermectin 1 doctors would be using different approach and that is when we started seeing medication that are not country being prescribed and then you can see that they using google to search these drugs. So the information became available late when there is a national circular coming to say Azithromicin is not related to Covid please do not use it its irrational. But that came late like 3 1 in South Africa we have Medicine Controlled Act working in hand with the u-Pharmacy Pharmas act as well. So these ones control what is being advertised and one of the requirements from there is 1 it was like a top down kind of an approach. Do this 1 radio Ivermectin 1 so I don’t know. However 1 so we are waiting for other countries to actually come in and say in our country we are using chloroquine and it seems to be working well with our population and then us not really ( clear throat) joining up with SAHPRA and doing literature review and see if does it work with our population? We are already adopting guidelines from there. I think that is where the problem started happening 1 the youth was still aaaah spreaders of i-Covid if I’m not mistaken there was some ballroom that took place in is it in Durban North Balito which cause so much havoc and those were only kids and that time we were still talking about vaccinating over 60 you see. 1 you understand? So they were aware of that they just being smart about it. You watch a podcast about Covid and in the middle of the podcast you get an ad about Corenza 1 Views 9 4 months and already cocktails were being issued all over and with regards to private as well 1 I think even pharmars there 1 Ivermectin was a antimicrobial which fell on schedule 4 which means there is some toxicity there but it was all over. 1 TV Ivermectin 1 like going to their pension sites and doing aaaah maybe road shows. So that people will have information so that whatever this information…those misinformation that were trending were not going to disturb people. I don’t think it was well managed on my side. And I thought that maybe it was the pharmaceutical who gave the department of health the information and then the department of health…but I don’t think it was well managed. 1 schedule drugs from schedule 3 upwards shouldn’t be advertised. You can inform the public that it is available but you shouldn’t advertise it. Hence you have never seen Aphexine and all these other high schedule level being advertised. 1 wear the mask and the…it was so poorly organized. 1 with the advertisement that I’ve came across 1 you think Corenza came at the right time. ( the group laughter collectively). And if the person is not aware of the technology they would think oh its part of it 1 Sources of information 7 I think the doctors if they don’t have their own whats app group where they discuss 1 P2: I get my information from the clinic. 1 P4: Google , there isn’t a website that google is unable to access. The moment you type on google, the sites will pop up. 1 social media Ivermectin or Johnson and Johnson vaccine 1 they are sponsored by them 1 they changed also with the procurement as well 1 they were not straight forward to say we are treating Covid. We talking about flu season and we started seeing more adverts about ACC 200 and tell you that if you have the mucus 1 Types of Drugs used 5 so it all appeared online. 1 they started looking at how many Chloroquine do we have. If you look at the doses that were submitted during Covid 1 they will just put it online ‘ hey Covid you have mucus ACC 200 is right here. So I don’t know I felt like maybe it was during their prime time to advertise and they decided to invest more on it. Cause if I recall correctly I don’t see one registered pharmaceutical company saying we treat Covid 1 two doses or one dose is better than the two doses all those then the pharmas utilized that. 1 you will find one doctor from Durban North prescription is managing differently 1 Concerns 3 1 for the vaccines were being forced up 1 1 later on you will see the same hand writing of that doctor but the name of the patient is different and it’s a different prescription and a different practice but you see actually this is the same thing I came across when I was in Durban North and now I am in Umhlanga and I am seeing the same thing. I don’t know maybe someone said lets paste this and everyone is copying it. 1 2 aaam Covid wasn’t first reported globally 1 you hear SAHPRA is looking at those one that was rejected by minister of health Zweli Mkhize after being bought…what was it again? 1 1 0 there are other countries who already had management tools in terms of how they managed 1 1 0 but I would say it’s the fear to take a stand 1 1 so we are waiting for other countries to actually come in and say in our country we are using chloroquine and it seems to be working well with our population and then us not really ( clear throat) joining up with SAHPRA and doing literature review and see if does it work with our population? We are already adopting guidelines from there. I think that is where the problem started happening 1 1 0 I think even pharmars there 1 1 0 they changed also with the procurement as well 1 1 they started looking at how many Chloroquine do we have. If you look at the doses that were submitted during Covid 1 1 0 1 for the vaccines were being forced up 1 1 you hear SAHPRA is looking at those one that was rejected by minister of health Zweli Mkhize after being bought…what was it again? 1