For almost as long as humanity has had vaccines, it has also had propagandists who try to scare people out of using them. Among the many medical questions contemplated in the journal The Lancet in the late 1890s and early 1900s—“Grey Hair and Emotional States,” “In Praise of Rum and Milk,” “On the Value of Cheese as a Dietetic Resource in Diabetes Mellitus”—are letters debating the efficacy of the smallpox vaccine, the age at which children should get it, the risk of the vaccine relative to the disease, and the extent to which local authorities should enforce compulsory vaccination in case of outbreaks.
The misleading claims Americans will soon hear about the newly released COVID-19 vaccines are nearly identical to claims made about smallpox immunizations 120 years ago: The ingredients are toxic and unnatural; the vaccines are insufficiently tested; the scientists who produce them are quacks and profiteers; the cell cultures involved in some shots are an affront to the religious; the authorities working to protect public health are guilty of tyrannical overreach. In the British Medical Journal in that period, a Dr. Francis T. Bond frets about what to do about his era’s anti-vaxxers and their arguments, which have since become well-trod canards because they are effective in frightening people.
Today’s anti-vaccine activists, however, enjoy a speed, scale, and reach far greater than those of Dr. Bond’s day. Bottom-up networked activism is driving the spread of anti-vaccine COVID-19 propaganda. Americans are about to see a deluge of tweets, posts, and snarky memes that will attempt to erode trust in the vaccine rollouts. Society’s ability to return to a semblance of normalcy depends on how effectively public-health authorities counter this misinformation and how assiduously media outlets and internet platforms refrain from amplifying it—but also on whether average Americans recognize that the material they click on and share has real-world consequences.
The deliberate campaign against the vaccine has already begun. Within 48 hours of the first people in the U.S. receiving the Pfizer vaccine, anti-vaccine activists were amplifying stories of allergic reactions and sharing claims about friends of friends whom the vaccine had supposedly injured or killed.
Public-opinion polling indicates that tens of millions of Americans are what physicians call “vaccine hesitant,” and stories of people who experience harsh side effects from the injection, or die for entirely unrelated reasons after receiving it, will inevitably find an audience. But many vaccine horror stories will originate in the well-established echo chambers of anti-vaccine true believers, including many of the same people who actively reject the scientific evidence that consistently affirms the safety of childhood immunizations against measles and other diseases. Some, such as Robert F. Kennedy Jr., leverage pseudoscience and attempt to drive public focus to outlier adverse events. Others bypass even the attempt at creating a veneer of scientific legitimacy and straightforwardly embrace conspiracy theories instead. Since 2018, anti-vaccine communities have cross-pollinated extensively with QAnon and other paranoid fantasies. Participants in anti-vaccine groups online frequently see posts claiming that the government is using COVID-19 vaccines to secretly implant microchip identifiers in people, or that ingredients in vaccines will turn people into 5G antennas.
In today’s networked form of activism, determined groups—as varied as Beyoncé’s Beyhive, QAnon adherents, or the K-pop stans who commandeered pro–Donald Trump Twitter hashtags during the 2020 campaign—leverage the entirety of the social-media ecosystem to promote the things they believe in. If they succeed in getting a meme or a hashtag to trend online, they’ll often get some news coverage in broadcast or print media, elevating the message to a far larger audience. This is how bottom-up narratives spread.
By 2010, the majority of broadcast and print media had stopped covering discredited claims that vaccines caused autism. However, social media offered an opportunity to evade the media gatekeepers and take ideas directly to the public, so anti-vaccine organizations such as the National Vaccine Information Center prioritized establishing a strong social presence on the most important platforms. They grew audiences on their own Facebook pages, and cross-promoted their content within wellness communities, natural-parenting circles, and groups opposed to genetically modified food ingredients. In 2015, as declining childhood-immunization rates prompted states to limit exemptions from required shots, anti-vaccine groups began to evangelize more aggressively. They coordinated to dominate public-health hashtags originally intended to promote flu shots. They actively courted celebrity influencers with large Instagram and YouTube followings. They probed for fence-sitters.
These strategies have served them well. In 2015, as a new mom, I helped start a pro-vaccine group called Vaccinate California, which sought state-level legislation to improve school-immunization rates after a measles outbreak at Disneyland. A data-scientist colleague and I documented how anti-vaccine activists deliberately shifted their messaging strategy from a falsifiable and discredited canard (“Vaccines cause autism”) to a political statement (“Vaccination requirements are government overreach”). During the debate over the bill, they posted anti-vaccine memes using Tea Party hashtags such as #TCOT (“Top Conservatives on Twitter”) and #2A (for the Second Amendment), attracting new evangelists from those communities—and setting up connections that they leveraged during other local legislative fights, and again recently during the protests against business closures and stay-at-home orders.
This change in messaging focus from health misinformation to political statements would come to pose a challenge for tech platforms when they began to debate what to do about the growing movement; in 2019, after more measles outbreaks and some congressional inquiries, the policy teams at Facebook, Twitter, and YouTube began to take action. They tried a variety of approaches: decreasing the reach of user posts making false vaccine claims; banning ads making those claims; and removing anti-vaccine groups from recommendation engines. But the tech companies allowed ostensibly political content to continue as free expression. “Vaccines cause autism” violated the policy; “School vaccines are government tyranny” did not.
Anti-vaccine movement building extended offline as well. Recognizing that the public stereotype of anti-vaxxers was that they were extremely white and affluent—bourgeois bohemians who named their kids after California plant life—anti-vaccine leaders began to pursue minority adherents. They targeted the Somali community in Minnesota and the Orthodox Jewish community in Brooklyn. (A few years later, both groups experienced large measles outbreaks.) Kennedy reached out to Louis Farrakhan, leader of the Nation of Islam, with claims that the government was covering up how the measles shot was causing autism in Black boys. Nation of Islam community members became a visible presence at California anti-vaccine rallies; Farrakhan regularly speaks out against vaccines today.
These battles over the narrative surrounding childhood immunizations were somewhat confined to parenting communities; most adults aren’t regularly searching for information about childhood shots. Now, however, America is about to embark on a battle to immunize the entire country against COVID-19. This time, everyone is paying attention to the topic of vaccines. Everyone is searching for information. And the online, networked factions that have long fought to erode confidence in vaccines recognize that this is their moment.
Anti-vaccine activism around COVID-19 is more than just misinformation. This word doesn’t adequately convey the deliberateness of the messaging strategies that movement leaders consciously began to adopt in January 2020. The leaders of the anti-vaccine movement are not accidentally spreading this material. It’s intentional. Indeed, many are trying to profit from the sale of “detoxes” and vitamins they claim will prevent COVID-19, or they have books or e-courses to promote. Even the coordinated protest signs appearing at rallies and on highway overpasses are sold to the activists who put them up. It’s propaganda—a marketing campaign for an idea. The movement’s most active followers, the people spreading the anti-vaccine message across all social platforms, are true believers. The fight is for the attention of the fence-sitters, the curious, the questioning.
Countering bottom-up, grassroots-driven propaganda is a significant challenge for anyone who wants the vaccination effort to succeed and the pandemic to end. Since much of it plays out on social media, it’s often seen as a social-media problem. This is partially true: Laissez-faire attitudes in Silicon Valley enabled these factions to grow for years. Platforms only began to take significant action to minimize the impact of anti-vaccine pages in 2019, after major measles outbreaks in Brooklyn and Samoa. As old diseases gained new footholds, Congress began to ask questions about the amplification and recommendation of health misinformation.
Tech platforms continued their newfound commitment to countering health misinformation this year, as COVID-19 spread around the world. However, the results have been mixed: Anti-vaccine activists reacted early to the new pathogen. As the news out of China was just beginning to indicate that something was terribly wrong, anti-vaxxers were already making claims that the disease was a vast plot to force mandatory adult vaccination. Despite concerted efforts to crack down on health misinformation following the measles outbreaks, some of the old-guard anti-vaccine influencers—including Kennedy—who pivoted to coronavirus-related scaremongering saw huge audience growth.
Social-media takedowns are not the right approach to addressing this content because they turn the propaganda into forbidden knowledge, often increasing the demand. Down-ranking and deprecating anti-vaccine content can minimize some of its reach, but it doesn’t address the underlying lack of trust in institutions, pharmaceutical products, or government. Restoring that trust requires far more work, but time has run out. The coronavirus vaccines are new, without years of data about efficacy or long-term effects. They have also been politicized, and not just by QAnon enthusiasts; during the 2020 campaign, many on the left, including the Democratic nominees Joe Biden and Kamala Harris, expressed concern about receiving a vaccine that the Trump administration had rushed to approve.
“Prebunking”—preemptively addressing misinformation that people are likely to see—may be the way forward. All vaccines and medicines carry some risk, and a small percentage of people will have adverse reactions. These stories will be amplified on social media, and broadcast media will have to decide how to put them in context. According to the CDC, 655,000 people die from heart disease in the United States in a typical year. At least a few of the hundreds of millions of Americans who are to be vaccinated in 2021 will inevitably suffer a heart attack shortly thereafter. Anti-vaccine activists are likely to blame Pfizer or Moderna for those deaths. This strategy—stringing disparate incidents together into an overarching narrative of danger and harm—has been effective for the movement to date.
In addition to the health claims, some activists, particularly conservative influencers, will darkly warn of impending government mandates and “forced vaccines” absent any evidence that such a program would be put into practice. They will appeal to individual rights and disparage the idea that immunization benefits a broader community.
Fighting back against bottom-up propaganda requires an understanding of the pathways by which the information spreads. False narratives will move from anti-vaccine echo chambers to mass audiences via social-media sharing, as well as coverage in local and mainstream media. Countering this misinformation requires a whole-of-society effort.
Detecting emerging narratives is no longer the challenge it once was; good data about social-media trends are easier and easier to obtain. While visibility into some platforms, such as WhatsApp, remains a challenge, most propaganda campaigns quickly appear in mainstream social spaces, where researchers can understand what is spreading and which communities are seeing it.
The real challenge lies in countering anti-vaccine narratives with accurate information that can help instill confidence. Health agencies and tech platforms must partner with religious and civil-society groups that are trusted by targeted communities, giving them resources and funding and helping them reach their audience. Conspiracies thrive in low-trust environments. If certain communities don’t generally trust the government on matters of health, the people they do trust must be part of the conversation. When, for example, the ultra-Orthodox Jewish community in Brooklyn experienced a measles outbreak because of internalized vaccine misinformation, an ultra-Orthodox nurse who understood the community’s fears led the effort to fight back with empathy.
Health authorities and government officials must communicate transparently with the public. Does the vaccine have side effects? Discuss them. Do some indications suggest that it isn’t as effective as predicted? Tell the public that, because some armchair expert on social media certainly will. Media outlets have a role to play here, too, both in how they report on incidents related to vaccination and in how they contextualize the information coming from authorities. The muddled early messaging about masks—which health agencies initially discouraged the public from using—has given encouragement to opponents of masks ever since. Avoiding confusion and misimpressions about vaccines from the beginning is of the greatest importance.
And finally: All Americans have to be cognizant of what we share. Each of us has remarkable power to amplify content. That comes with a commensurate responsibility that most users haven’t yet fully internalized.
This is the whole-of-society approach that we need. Allowing confidence in vaccines to be undermined has real-world impact. Neither social-media companies nor health institutions acted decisively to contain or counter the anti-vaccine movement during its rapid growth from 2015 to the present. In response, anti-vaxxers grew a digital army by preying on the fears of parents with the same stories that Dr. Bond bemoaned in his letters at the turn of the last century. He asked readers of The Lancet to notify him about Anti-Vaccination League speeches in his community. “I shall be glad if any of your readers who may be aware of the proposal to give such lectures in their own immediate neighbourhood will kindly communicate with me as soon as possible,” he wrote, “in order that efforts may be made to place the lecturer and his misrepresentations in their proper light before the public.” Similar vigilance is essential now.