Life can go back to normal in the United States only if millions more Americans get vaccinated against COVID-19. The problem is that today’s communication environment is perfectly engineered to discourage that. Wild claims go viral, and partisans exploit any scientific uncertainty for political advantage. So when the FDA and the CDC paused the use of the Johnson & Johnson vaccine last week, the problem wasn’t just that a small number of people who had received it had developed a severe type of blood clot, or that experts openly disagreed about whether the move was justified or an overreaction. The April 13 announcement also created yet another opportunity for influencers to undercut public confidence in vaccination.
Never mind that experiencing a blood clot after receiving the J&J vaccine appears more unlikely than being struck by lightning. “There are reasons to believe those in fact aren’t the real numbers,” the Fox News host Tucker Carlson speculated hours after the FDA and CDC announcement. His 15-minute segment treated the government’s abundance of caution as evidence of nefarious intent. Carlson said:
Now [Anthony] Fauci has declared that because the Johnson & Johnson vaccine has injured six people—and if that’s true, by the way, would make that vaccine much safer not just than birth-control pills, but safer than many other vaccines we’ve distributed in the past—because this one vaccine has hurt six people out of 7 million, we need to stop using it immediately. Does that make sense to you? No, it really doesn’t. It seems possible there may be more going on here.
The segment was a master class in spreading conspiracy theories under the guise of merely asking questions. On a typical night, Carlson has a TV audience of a few million people. He got an additional boost on Facebook, where his video was the most popular post about the Johnson & Johnson pause. Forty-five thousand people shared it on the leading social-media platform—which was already awash in friend-of-a-friend stories about supposed side effects from COVID-19 shots, aspersions against vaccines more generally, and portrayals of pandemic-related public-health measures as affronts to personal liberty.
After putting off a decision on the J&J vaccine last week, the CDC’s Advisory Committee on Immunization Practices lifted the pause yesterday. But health agencies’ conclusion that a vaccine is safe is only one factor in individual Americans’ decision about whether to get it. When the pandemic began, Gallup polling indicated that confidence in many institutions was at or near a historic low; though initially high, confidence in the government’s ability to handle the coronavirus outbreak dropped as the crisis deepened. For better or worse, the United States is never going back to the time when health experts reached a consensus that would then be tidily communicated at press conferences and faithfully summarized on the nightly news to a trusting public. Influencers with huge audiences have amassed enormous power over public perception. And no matter what the official policy happens to be—toward vaccines, masks, or other precautions—someone will have the motive and the means to undermine it.
My team at the Stanford Internet Observatory is part of the Virality Project, a collaborative research effort to track misinformation about the COVID-19 vaccine rollout around the world. When we saw a spike in social-media content within anti-vaccine communities portraying the Johnson & Johnson halt as evidence of terrible problems with COVID-19 vaccines, and vaccination writ large, we were not surprised; anti-vaxxer echo chambers are full of conspiracy theories. Although anti-vaccine activists remain few in number, their propaganda occasionally spreads to Pat Buchanan fans, corgi fanciers, neighborhood-swap groups, and other seemingly unrelated niche communities.
The conversation about the safety of COVID-19 vaccines has expanded to include influencers with a following many orders of magnitude larger than that of the average anti-vax activist. These influencers can more easily reach Americans who are genuinely hesitant—people who have received other shots and have had their children vaccinated but are wary, even under threat from a deadly coronavirus, of getting new medical intervention that lacks a long track record of safety. The drivers of hesitancy are varied: deep-seated aversions grounded in religious beliefs, bad prior experiences, or distrust of the pharmaceutical industry; more immediate doubts about the safety of a specific vaccine relative to the risk of the disease it prevents; and the influence of a person’s friends, relatives, and social group. The effect of what one sees or reads, the weight of the prevailing opinion of one’s social group, is both powerful and hard to measure. Researchers can’t say which tweet or YouTube video tipped someone into a decision not to vaccinate. We can see only which posts people are liking and sharing, and which commentators and news outlets are getting the most attention.
News articles from most media properties, including Fox News, reported on the Johnson & Johnson pause with accuracy and nuance, my colleagues at the Virality Project noted. (In researching this article, I asked Fox for comment about the striking contrast between its reporting and Carlson’s commentary and have not yet received a response.) Many publications even described the pause as evidence that the regulatory system was working.
How that news coverage was subsequently interpreted is another matter. Facebook users regularly share links with their own comments on top. Of all such posts about the Johnson & Johnson situation, one of the most popular came from the self-described “news analyst & hip-hop artist” An0maly—an influencer, but not a mainstream media personality by any definition of the term. He reposted a CNN article, adding his own commentary about government dishonesty. An0maly has 1.5 million Facebook followers.
The day after Carlson’s video appeared on Facebook, Fauci criticized his comments on CNN as “a typical crazy conspiracy theory.” Carlson hit back with another segment declaring that he believed in science and was not anti-vaccine. Then he once again began asking tendentious questions. Alluding to Fauci’s calls for continued caution among vaccinated people, Carlson asked of the vaccines, “If this stuff works, why can’t you LIVE like it works? What are you really telling us here?” (Facebook added a pop-up warning to the second video, with a link to some fact-checks.)
Americans’ loss of faith in authority has become highly consequential during the pandemic. In some cases, institutional experts have undercut their own credibility. A year ago, leading health agencies were slow to call for masks. Some experts went so far as to construct a noble lie, downplaying masks’ benefits as a way of keeping the general public from buying up equipment that health-care workers needed. Fortunately, some prominent commentators urged people to wear masks before the CDC or World Health Organization did, but that only reinforced the perception of institutional bumbling. In a noisy communication ecosystem within a low-trust social environment, expert opinion becomes just one input among many. Institutional experts’ disadvantage is compounded by the fact that many nonexperts are far more visible in health debates, despite having built their following on other topics entirely. The era of the influencer has replaced the era of the expert. If you have a massive audience that trusts you, your opinion—like Carlson’s—is one that scientists must reckon with, even if it is wrong.
Institutional authorities are caught in a quandary: If they acknowledge uncertainty about something important (such as whether masks are helpful) or admit that they are playing for time (because they are still figuring out the cause of a rare blood clot), they risk losing public confidence. Precise explanations may be too complex. Oversimplified but easily grasped messages may backfire—and create an opening for people bent on discrediting official expertise. Perhaps the most important thing the FDA and the CDC can do is straightforwardly explain what they know as a given situation evolves. This requires communicating with frequent updates and considerable nuance—not something that state or federal health agencies have been particularly adept at doing during the pandemic.
Competing for attention in the current media ecosystem means doing more than tweeting out official press releases and making Fauci available for cable-news interviews. Public-health authorities can focus on getting information to noninstitutional experts—people who are not in positions of authority but have developed their own audiences, can convey nuance, and understand the communication techniques of influencers. Research has shown that one of the most effective ways to reduce vaccine hesitancy related to childhood immunizations is via direct conversations between parents and trusted pediatricians. That’s difficult to scale, and those interactions tend to be much more limited than one’s constant interactions with a peer group or social-media influencers. So pediatricians have made themselves visible on TikTok, YouTube, Facebook, and other online spaces where parents discuss their children’s health, growing online communities for which they make videos and reply in the comments. On the subject of COVID-19 vaccines specifically, Black physicians have created Clubhouse rooms to engage directly with their community. They have day jobs but have determined that prioritizing communication is a key vector in improving health outcomes.
We all are living through a transition in how information circulates. Sorting out the new dynamics of influence—the processes of how media and social media can best curate and promote authoritative information, on health and other matters—will take years. Research into debunking misinformation consistently reiterates the value of more credible messengers and more tailored messages. The influencers who spread misinformation understand how to gain the confidence of people they will never meet, make content that captures attention, and persuade audiences to take action. Meanwhile, public-health institutions have not evolved, and whether a better institutional communications strategy is the solution at this point isn’t clear anyway. An updated model of distributed expertise would empower more trusted local experts and activate community organizations that can engage empathetically with the concerns of vaccine-hesitant groups. Fauci can’t personally counter every social-media conspiracy theory about the Johnson & Johnson vaccine, but family doctors, religious leaders, and other community officials can do plenty to reassure the public.