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Turkey reins in social media — one platform at a time

another knock against democracy…

Compliance to the new social media law ‘sets a bad precedent’

An Alstom tram set on Istanbul line T1 crossing the Galata Bridge, northbound, December 5, 2013, Istanbul, Turkey. Photo by Mark Ahsmann via Wikimedia Commons, CC BY-SA 3.0.

When Turkish President Recip Erdoğan became a grandfather for the fourth time last year, his daughter and son-in-law (then-Minister of Finance) announced the birth of their child over Twitter.

In addition to many celebratory tweets from Erdoğan’s ruling Justice and Development (AKP) followers, the couple received insults, too.

The tweets were eventually taken down and the account was deleted. But these insults led to Erdoğan’s renewed interest in finalizing legislation in the country to centralize control over social media platforms in Turkey.

“Do you understand why we are against social media such as YouTube, Twitter and Netflix? To eradicate such immorality,” President Erdoğan told AKP members during a televised address, referring to the allegedly insulting tweets.

“These platforms do not suit this country. We want these platforms to be banned, taken under control,” Erdoğan said.

The law came as swiftly as the detentions of social media users allegedly behind the insults.

Adopted in July 2020, and effective October 1, 2020, the new social media law (Law on the Regulation of Publications on The Internet and Suppression of Crimes Committed By Means of Such Publications) sets up a series of requirements that will have a lasting impact on digital rights and freedom of expression in Turkey.

Social media companies will be obliged to have an office in Turkey; their representatives will be held accountable in legal affairs; the bandwidth of companies that refuse to open an office will be throttled up to 90%; social media companies will be obliged to store users’ data in Turkey; The companies will have to release a report on their activities every six months; failure to do so will result in a fine of up to 10 million lira ($1.3 million USD).

A year after Turkey restored access to Wikipedia, the country is now grappling with these new restrictions.

Although companies did not comply at first, recent fines have forced some social media giants to cave in, with Tik Tok being among the most recent companies to comply.

How it started

In April 2020, Human Rights Watch reported on how the social media law appeared under a draft law on economic measures to address COVID-19:

The draft law, circulated April 9, stipulates that all platforms accessed by over 1 million users daily must appoint a legal representative in Turkey on whom courts can serve orders to take down content or block access to accounts. Any platform that refuses would see its bandwidth reduced by 50 and then 95%, rendering the platform unusable in Turkey.

These proposed amendments were temporarily withdrawn.

But a month later, Turkey’s Presidential Complex published a 161-page social media guidebook, authored by Fahrettin Altun, head of Media and Communications, with direct advice to “to begin centralizing control of the digital domain.”

Altun believes that social media has become a “life risk” to Turkish citizens who are increasingly imperiled by fast-paced digitization and therefore benefit from the government’s centralization of control of digital spaces.

Journalists and internet freedom advocates described the social media guidebook as a tool for censorship.

“The guidebook was a step toward establishing government control over Twitter and other platforms,” said Fatih Polat, editor-in-chief of the opposition newspaper Evrensel, in an interview with Deutsche Welles (DW).

Gulin Cavus, founder of the Turkish fact-checking network Teyit, said the threat of online disinformation does not come from Turkish citizens, as the guidebook claims, but rather from the government agencies that are “knowingly engaging in manipulation,” speaking to DW.

How it’s going

In November 2020, Turkey fined Facebook, Twitter and YouTube a total of $1.18 million USD for not complying with their new social media law.

The following month, Turkey’s Information and Communication Technologies Authority (BTK) slapped platforms with a new penalty of 30 million Turkish liras ($3.8 million USD) each, for their failure to hire local representatives.

The fines worked. YouTube, Instagram, and TikTok were among the first companies to appoint local representatives.

Facebook also announced on January 18, 2021, that it would open a local office. Last January, Facebook also announced its decision to appoint a local representative in Turkey in compliance with the new regulations.

In their statement Facebook said:

We have been closely following developments on Turkey’s recently amended Internet Law No. 5651 which stipulates new requirements for social media platforms. Like other companies, we have decided to begin the process of appointing a legal entity as a local representative in compliance with the law, while also recognizing how important it is for our platform to be a place where users can exercise their freedom of expression.

This decision does not change Facebook’s Community Standards, nor the global process for reviewing government requests, and we will withdraw the representative if we face pressure on either. We will continue to review and evaluate government requests in accordance with these policies, including our commitments as a Global Network Initiative member, and under the UN Guiding Principles on Business and Human Rights. We will continue to report details of the content we restrict, in line with our existing transparency processes.

The TikTok platform said:

TikTok is a powerful platform that gives voice to diverse communities, and we remain focused on providing people in Turkey the opportunity to express themselves creatively through video, from sharing unique cooking skills to easy tutorials on drawing. We’re also committed to respecting local laws in the markets in which we operate, even when we disagree with them. As such, we will comply with the requirements of the law — establishing a local legal entity and providing a local point of contact to the Government in Turkey as a next step to compliance – while we maintain our commitment to the freedom of expression that is fundamental to the creativity that thrives in our community.

In retaliation to companies that refused to comply, the Information and Communication Technologies Authority (BTK) banned online businesses from advertising on Twitter, Periscope and Pinterest, in a decision published in the Official Gazette on January 19.

This move is likely to impact the livelihoods of many in Turkey, at a time when the country is facing economic challenges as a result of an ongoing pandemic.

Meanwhile, the compliance of YouTube, Facebook, TikTok, and other platforms are a “bad precedent that will make it harder for other companies to fight back,” said Electronic Frontier Foundation. EFF was especially critical of YouTube’s decision to comply, given the Turkish government’s history of previous attempts to control the platform.

Turkish officials say the law is similar to Germany’s NetzDG [Network Enforcement Act]. However, experts disagree. Emma Sinclair-Webb, Human Rights Watch Turkey expert, said that unlike in Turkey, Germany has a “clear separation of powers and an independent judiciary.”

According to Engelliweb, a site that documents censored content, as of October 2020, at least 450,000 domains, 140,000 URLs, and 42,000 tweets are currently blocked in Turkey.

On January 21, the International Press Institute (IPI) issued a statement calling on Turkish to withdraw the new law and rescind imposed penalties.

IPI Turkey Program Coordinator Renan Akyavas said:

This law and its penalties threaten the removal of critical voices, including journalists who have been driven from mainstream media, from social media via content removal or self-censorship. Turkey must withdraw this law and all penalties on social media companies issued under it. This law represents a serious expansion of digital censorship and threatens a last bastion for journalists and critical public discussion.

But officials in Ankara are yet to budge.

Written by Arzu Geybullayeva

For Valentine’s Day, Traceable, Transparent Jewelry Supply Chains | Human Rights Watch

Valentines Day Gold Rose “Jewelry companies around the world should ensure that the jewelry they sell is sourced from mines where human rights are respected,” said Juliane Kippenberg, associate children’s rights director at Human Rights Watch. “This Valentine’s Day, consumers buying jewelry for loved ones should send companies a strong message – what symbolizes love and joy should not be made in abusive conditions.”

Labor rights violations, violence, and other abuses have remained a serious problem in gold and diamond mining. Human Rights Watch has documented horrific violence against miners and residents in Venezuela and Zimbabwe, and found hazardous child labor in small-scale mining in Ghanathe PhilippinesMali, and Tanzania. The Covid-19 pandemic, as well as restrictions on movement and blocked trade routes, has created additional human rights risks. Source: For Valentine’s Day, Traceable, Transparent Jewelry Supply Chains | Human Rights Watch

We’re not looking at the most important vaccine statistic

Bronx Medical Clinic Administers COVID-19 Vaccinations
Moderna Covid-19 vaccines in a freezer at a vaccination site in New York City. | Photo by Spencer Platt/Getty Images

Everyone wants to know how well the vaccines work. But a key metric is hardly ever discussed.

The Food and Drug Administration is working through thousands of pages of documentation for an emergency authorization of the Johnson & Johnson vaccine, which could come through this month. Most states are gradually expanding vaccine eligibility, production of the Pfizer and Moderna mRNA vaccines is increasing, and new studies show good results for additional vaccine candidates as well.

The news on the Covid-19 vaccine front of late has been quite good — perhaps so good that our perspective on the fight against the pandemic may be getting a little warped.

Case in point: the media coverage and public reception of the Johnson & Johnson (J&J) vaccine. Results from its trials were released last week. According to the company, it should be able to deliver 100 million doses in the first half of this year. But this good news hasn’t been greeted with the enthusiasm that accompanied announcements about the Pfizer and Moderna vaccines.

Perhaps that’s because in its clinical trial, the J&J vaccine had an efficacy number — the percentage of cases prevented entirely — of 66 percent. Compared against the 95 percent efficacy rate for the Pfizer vaccine and the 94.1 rate for Moderna’s, Johnson & Johnson’s vaccine simply doesn’t look as good.

But in another sense, the Johnson & Johnson vaccine trial results were incredibly encouraging. The same trial showed that J&J’s vaccine makes Covid-19 cases much milder, meaning you might still get sick but you are much less likely to be hospitalized or die. Indeed, on that front, the J&J vaccine performs just as well as Pfizer’s and Moderna’s, a fact that seems to have been undersold in news coverage about it.

To put J&J’s effectiveness in another context, think about the flu. Flu vaccines mostly don’t prevent you from getting sick with the flu but instead make the flu much less awful if you catch it and less fatal for at-risk populations. A Covid-19 vaccine that was similar to that — one that made you much less likely to be hospitalized or die, and made the disease milder — would still be enough to help bring the pandemic to an end and give us back our lives.

That’s exactly what we have with the current crop of vaccines, including the three that haven’t been received as well as Pfizer’s and Moderna’s. No one who got two doses in clinical trials for the Moderna and Pfizer vaccines has been hospitalized or died, and the same holds true for the new vaccines from Johnson & Johnson, Oxford/AstraZeneca, and Novavax (which haven’t yet been approved in the US). Each of the vaccines has demonstrated very high protection against severe Covid-19 in trials.

So why aren’t we talking about that?

How “efficacy” became the measure of vaccine success

The vaccines developed against Covid-19 can protect people in three ways. First, they can make the vaccinated person less likely to catch the disease. That’s called “efficacy.” It’s the number that made the headlines when Pfizer and Moderna results came out this fall — 95 percent and 94.1 percent efficacy, respectively. For every 20 people in the control group to develop symptoms of Covid-19, only one in the vaccinated group did.

That’s an incredible achievement, and it’s what’s gotten most of the attention in the reporting on the vaccines. But it has overshadowed discussion of the other two ways a vaccine against Covid-19 can protect people.

The second is that the vaccines seem to make vaccinated people less likely to transmit the disease; new research suggests the Pfizer and Moderna vaccines do this, too, though imperfectly (so you should still be cautious around unvaccinated people).

And the third way the vaccines can protect people is by ensuring that when a vaccinated person does get the disease, they experience a mild case and are not likely to require hospitalization or be at risk of dying.

This last finding is a big deal. As long as vaccines can make sure that Covid-19, even if you get it, isn’t very bad, we can use them to chart our way out of the pandemic. But this effect of the vaccines has been largely neglected.

Now, there’s a reason headlines have focused on the efficacy of preventing all disease rather than severe disease: It’s what the earliest clinical trials were primarily set up to study.

Every clinical trial defines in advance a primary clinical endpoint: the outcome researchers are primarily focused on studying. The study is designed to have a large enough sample size to detect differences in this primary outcome between the trial group and the placebo group. For the vaccine trials, the primary clinical endpoint has largely been symptomatic Covid-19 infection (however mild or severe), or, in some cases, a positive Covid-19 PCR test.

It makes sense for the studies to set that endpoint. Designing a study to measure rare events like hospitalization or death is much harder than designing a study to measure relatively common events like infection. Covid-19 is a scary disease, but less than 1 percent of people who get sick will die. That means that a study designed with death from Covid-19 as a primary clinical endpoint would need to be enormous, with potentially hundreds of thousands of participants. Pinning down the exact frequency of rare events simply requires a lot of data, and vaccine developers could only include so many people in their first clinical trials because recruiting and coordinating participants is expensive and time-consuming.

So instead, most studies primarily measure how many cases of Covid-19 the vaccines prevent. They do collect data on hospitalizations and deaths, but it’s not the primary outcome their studies are designed to measure, and that has been reflected in press releases, media coverage, and the popular understanding of how well the vaccines work.

As it happens, that data on hospitalizations and deaths looks really good. Indeed, there have been zero cases of hospitalization or death in clinical trials for all of these vaccines. But we hear about that less partly because the studies weren’t designed with that outcome in mind.

This focus on preventing cases, rather than preventing cases and hospitalizations and deaths, may have led to the sentiment that the new, unapproved vaccines are worse, and that it’s okay that the US isn’t expediting their approval and distribution because people would rather get the better vaccines anyway. This line of reasoning would be understandable if some vaccines are 95 percent effective at preventing hospitalization and death and some are only 60 percent effective. But in this instance, it’s a mistake, since all of the vaccines are indistinguishably effective by this metric.

The focus on studying efficacy, instead of studying hospitalization and death, affects major policy calls.

South Africa suspended its rollout of the AstraZeneca vaccine after a new study found that the vaccine had very low — potentially zero — efficacy against the variant strain of the disease that predominates in the country. Obviously, that finding was really bad news for the AstraZeneca vaccine. But less widely broadcast was the fact that no one in the study got seriously ill or was hospitalized from Covid-19 (no one in the placebo group did, either; the study was small and didn’t contain at-risk people).

Now, let’s be clear: While other studies have convincingly demonstrated that the AstraZeneca vaccine protects against hospitalization and death, it seems to work less well against the South African virus variant, and that might well mean it works less well to prevent hospitalization and death as well. One crucial caveat here is that the study population was young; we would not have expected many hospitalizations or any deaths within that age group. So it could be that the AstraZeneca vaccine has very limited usefulness against the new strain. Or it could be that the AstraZeneca vaccine offers very strong protection against severe disease from the new strain. The study was not set up to answer that question, so we simply don’t know.

In that regard, South Africa’s decision to suspend the AstraZeneca vaccine rollout based on the discouraging data makes some sense. But countries that have focused on hospitalization and death statistics, rather than efficacy statistics, have made the opposite call.

“I think it’s important for people to bear in mind that all of them, we think, are effective in delivering a high degree of protection against serious illness and death, which is the most important thing,” UK Prime Minister Boris Johnson said, defending Britain’s continued rollout of the AstraZeneca vaccine.

Countries face tough choices here, and their leaders would be able to make a vastly more informed decision if there had been a study with sufficient statistical power — a lot more participants to detect whether the vaccine is protecting against hospitalization and death. As it is, the understandable focus on efficacy simply doesn’t give us much information on this essential question.

The communications challenge of vaccine statistics

In the past few weeks, some public health experts have started working to change the conversation on vaccines to focus on the key hospitalization and death numbers. One person leading this effort is Ashish Jha, dean of the Brown University School of Public Health, who tweeted on January 31:

Am often asked about different vaccines and their efficacy

Each trials tracks, reports efficacy differently

Currently, we have preliminary results for Novavax and J&J

But what numbers matter? What should you look for?

Here’s one set of data to track. In a simple table pic.twitter.com/9m2OBgqcla

— Ashish K. Jha, MD, MPH (@ashishkjha) February 1, 2021

One note about this data: It refers only to the clinical trials. Now that the vaccine is out in the world, we’re getting real-world data. The news is still good: 700,000 people in Israel have been vaccinated with the Pfizer and Moderna vaccines, and there have in fact been a few hospitalizations — 16, to be precise, for a rate of 0.002 percent — and no deaths.

Jha’s message was widely shared, but efficacy still continues to be the statistic that people fixate on.

Communications about severe disease and hospitalization face an uphill battle. Efficacy is much easier to explain — do you get sick or not? For severe disease, on the other hand, many studies have slightly different benchmarks for severity. And while right now there have been zero hospitalizations and zero deaths by anyone vaccinated in the clinical trials for any of the Pfizer, Moderna, Novavax, AstraZeneca, and Johnson & Johnson vaccines, it doesn’t mean those outcomes are guaranteed. (Again, in Israel, 0.002 percent have been hospitalized so far that’s very, very low, but it’s not zero.)

Furthermore, as the pandemic stretches into its second year, we’re all desperate for certainty. “This study simply didn’t collect enough data to tell us what we hoped to learn” is not the answer any of us are looking for. The efficacy of the vaccines is known; their effectiveness against hospitalization and death is known to be very high but not pinned down for certain, especially not against the South African variant. All of those pose extraordinary challenges for public health officials and the media to communicate.

But a shift from a focus on efficacy to a focus on improved outcomes is essential for good vaccine decision-making. Moderna and Pfizer can’t produce enough mRNA vaccines to end the pandemic alone, so the public embrace of the Johnson & Johnson vaccine — and potentially the AstraZeneca and Novavax vaccines, which we’re waiting to learn more on — might make a huge difference for whether things start to get back to normal in the US in April or in August. That’s a difference of potentially hundreds of thousands of lives lost.