Most people in western countries would recognise the archetypal cranky uncle – the cantankerous older relative who lays claim to “common sense” as they dismiss climate change as a socialist plot or vaccines as a conspiracy perpetuated by big pharma.
It’s a character that John Cook knew well because, like a lot 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 how to spot climate misinformation, the part-time cartoonist drew a cranky uncle as the central character.
Since the Cranky Uncle game was launched in late 2020, it has been used by tens of thousands of people around the world.
But when Unicef asked Cook if he could adapt his game to combat misinformation about vaccinations in the developing world, he hesitated.
“Everyone has a variation of that cranky uncle,” Cook says. “But climate misinformation is a very western construct and now we are going into countries that are culturally quite different.
“But we’re finding that the cranky uncle is a universal human experience.”
The new Cranky Uncle vaccine game has already been launched in Tanzania, and trials have been completed in Kenya, Uganda and Ghana, with rollouts planned in more countries, including Pakistan.
In 2019, the World Health Organization named vaccine hesitancy – “the reluctance or refusal to vaccinate despite the availability of vaccines” – which was often underpinned by misinformation, as one of the 10 biggest threats to global health.
Unicef says some 20 million children missed one or more routine vaccines in 2022. Vaccination numbers are improving in some areas, but have mostly not caught up with pre-pandemic figures. 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 misinformation.
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 having a jab”, and then explain the facts.
But Cook and others have developed an approach which – perhaps ironically – is known as the “inoculation technique”, where people are taught common modes of arguing used by “cranky uncles” before they are exposed to the myths they spread.
“We’ve found through a number of studies that inoculation has some powerful benefits, such as it converts immunity across topics,” says Cook.
The original Cranky Uncle climate game has been downloaded more than 55,000 times from the Apple app store, but data isn’t available for Android downloads. The game is available in 12 languages as well as a teachers’ guide.
Before launching the vaccine version of the game, Cook says, a review of studies into vaccine misinformation found the two most pervasive arguments were that natural remedies were always the best approach to fighting disease and a fallacy known as “false cause”.
The “false cause” fallacy comes usually in the form of an anecdote that a person fell ill after having a vaccination, with a spurious link made back to the vaccine.
In the game, players are presented with a healthcare worker and the Cranky Uncle character.
Players learn 10 “tricks” or fallacies that the Cranky Uncle will use to misinform them. The job of the player is to take a quiz and spot the fallacies.
The more often players spot the right fallacy – such as when the uncle is using the “false cause” trick or claiming a conspiracy – the angrier the uncle becomes.
Cook and his wife Wendy, a graphic designer, worked on the game with Unicef, the not-for-profit Sabin Vaccine Institute and the public health consultancy Irimi.
Kate Hopkins directs research on vaccine acceptance at Sabin and ran workshops with locals and healthcare workers to co-design the game in west Africa.
Hopkins says results from trials of the game in Kenya, Uganda and Ghana have delivered “statistically significant shifts in vaccine attitudes”.
“We’ve seen a positive increase in attitudes to vaccinations and a positive increase in people’s discernment between facts and fallacies.
“The characters are recognisable to the players and the scripts are changed across countries and they’re specific to the local communities.”
Chelsey Lepage, at Irimi, ran workshops developing the game in east Africa. She says there are many people who are reluctant to be vaccinated because they think vaccines are part of a conspiracy.
“A lot of people feel vaccines are a way to reduce African populations, so you can understand why these things take root,” she says.
Cook had to redraw the Cranky Uncle character several times to reflect local populations. One version with the character in a suit for the Ugandan game had to be redrawn “because in Uganda a blazer confers authority”, Lepage says.
Lepage says they also added the character of a health worker, whose job in the game is to deliver factual information.
“This is in part behaviour change messaging. We want people to change their behaviours and we also need trusted messengers.”
Cook says he hopes the game will help people to become better critical thinkers – whether that is around vaccinations, climate change or any other public debate.
“I had 15 years immersed in climate misinformation and so this was a whole new realm.
“I was getting outside of my lane. But it’s vindication that this approach works across topics.”
• This article was amended on 8 January 2024 to correct the number of languages in which the Cranky Uncle game is available.
