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World Immunisation Week: Anti-Vaccine Misinformation

Updated: Jun 30, 2023

Anti-vaccine misinformation, the viral threat confounding medical science



Vaccines and vaccination programmes have been one of the most impactful medical advancements in history; they save millions of lives every year [1]. Globally, the measles vaccines alone prevent almost 3 million infant deaths a year [2]. Vaccines and immunisation programmes have given us the ability to prevent and control many infectious diseases that were once common scourges.


In the 20th century, before it was effectively eradicated by a global immunisation programme led by the World Health Organisation (WHO) in the late 1970s, smallpox killed between 300 and 500 million people; far more than all the terrible wars that ravaged the last century [3].


As the COVID-19 pandemic has demonstrated, vaccines are vital for global health security and play a critical role in containing outbreaks of infectious diseases and combatting the spread of antimicrobial resistance.


Ironically, their very success led to some complacency with some people no longer fully appreciating the importance of vaccines for public health.


Two or three generations of people in the developed world have grown to adulthood with no direct experience of diseases like polio, smallpox and diphtheria, beyond being vaccinated as children and taking their own children to be vaccinated. Until COVID-19 arrived, safe water, better housing, improved nutrition, modern waste management, antibiotics, and vaccines had made the dangers of infectious diseases little more than a distant memory for those fortunate enough to have been born in developed, high-income countries (HICs).


But with the rise of the internet, vaccines and immunisation programmes have faced a threat far worse than complacency. Today the biggest threat to immunisation programmes in HICs is anti-vaccine misinformation. So far, its impact has been manageable in HICs because the standards of healthcare are high and overall vaccine rates remained high in the population as a whole, but the impact of anti-vaccine misinformation in low- and middle-income countries (LMICs) could be much worse.


Every year millions of people die from infectious diseases. In 2019, the year before the COVID-19 pandemic, 13·7 million people worldwide died from infectious syndromes, 3 million of those deaths occurred in children under the age of 5 years [4]. Around 94% of those infectious disease deaths occur in LMICs. While 46% of those deaths are from diseases for which we still don’t have a registered vaccine, shockingly, 54% of them are from diseases we do have vaccines for; people died not because there was no vaccine but because they never received the existing vaccines [5, 6].


If we add anti-vaccine misinformation to the existing problems to the many factors impacting vaccine accessibility and uptake in low- and middle-income countries such as cost, lack of local infrastructure, government priorities, conflicts, and local culture, the results could be catastrophic.


Without the internet, my position as a regional account director of a healthcare communications agency might not exist. In the past two decades, access to medical information online has dramatically changed the dynamics of the healthcare industry and mostly for the better.


The public have more access to information on maintaining their health and caring for loved ones than ever before. Much of the available information is accurate and unbiased. Bridges M&C is proud of the work we do with professionals, pharmaceutical companies and not-for- profit organisations (NPOs) to make medical knowledge that was once inaccessible to the lay public, accessible and understandable in clear and accurate formats. Unfortunately, much of the medical information available online, particularly regarding vaccines, is not accurate or unbiased and can only be classified as misinformation.


Misinformation regarding vaccines is plentiful and all too easy to find. Recent research analysing YouTube videos on immunisation found that 32% were anti-vaccination; and as is often the case online, such anti and negative content scores higher ratings and generates more views than pro-vaccine videos [7].


A similar analysis of MySpace blogs on HPV immunisation found that 43% portrayed immunisation negatively, often citing inaccurate data sourced from vaccine-critical organisations [8]. In Canada a study tracking the sharing of influenza vaccine information on social media networks, such as Facebook, Twitter, YouTube, and Digg found that of the top search results during the study period, 60% promoted anti-vaccination sentiments [9]. And this is not a new phenomenon. Back in 2002, a study that used Google and seven other popular search engines to search for 'vaccination' and 'immunization', concluded that 43% of websites were anti-vaccination (including all of the first 10 results on Google) [10].


Often these sites position themselves as ‘pro-safe vaccines’ rather than as anti-vaccine, invoking parental concerns regarding protecting their children from harm. They will use misleading expressions with no evidence to back them up, such as, ‘many doctors agree’, or ‘a growing number of scientists believe.’ Often the sites reference other vaccine-critical organisations or research that has long been debunked and refuted, dismissing the counter evidence as evidence itself of some obscure conspiracy to trick the public into getting vaccines involving doctors, big pharma and world governments.


A clear example of these strategies as used by anti-vaccine groups is continued popularity of the paper by former British doctor and researcher, Andrew Wakefield, which lent credence to the claim of a connection between the measles, mumps, and rubella (MMR) vaccine and development of autism in young children [11]. Several subsequent studies disproved a causal association between the MMR vaccine and autism [12,13], and Wakefield was eventually struck off the UK Medical Registry after a journalistic investigation revealed that Wakefield had received funding for the research from litigants in a case against vaccine manufacturers, a clear conflict of interest which he never declared to his co-workers or the medical authorities [14,15].


Yet despite the overwhelming evidence against it the paper is still frequently cited by anti-vaccine groups and arguments against it are dismissed as evidence of the collusion between doctors, the pharmaceutical industry, and government to deny the harm vaccines supposedly cause. This makes it clear that simply presenting the facts to refute such misinformation is unlikely to counter the emotional and rhetorical appeals of these sites as such facts are dismissed as part of a bigger conspiracy.


The anti-vaccine campaign against the MMR vaccine has been frighteningly effective. There have been measles outbreaks and deaths in HICs where the disease was thought to have been eradicated in recent years, including in the United Kingdom, Europe and the United States with the latest cases being reported by the Center for Diseases Control and Prevention in March of 2023 [16]. Such outbreaks are alarming in HICs but they are tragic when they occur in an LMICs like Sudan where compounding factors such as conflict, degraded healthcare systems, poverty and famine exacerbate the situation. In 2022, just 388 laboratory-confirmed cases resulted in 46 infant deaths in Sudan [17].

The online anti-vaccination sites have many tactics for pushing their messaging and furthering their agendas. Among them are, skewing science, shifting hypotheses, censoring opposition, attacking critics, claiming to be 'pro-safe vaccines', and not 'anti-vaccine', claiming that vaccines are 'toxic' or 'unnatural', and many more. Although deceitful and dishonest, these tactics are often effective.


One study presented participants with a selection of 40 sites supposedly offering medical information on vaccines. Of the 40 sites, 22 gave inaccurate and or anti-vaccine information and only 18 gave accurate information. Of the student participants, 59% accepted all the sites as accurate, and 53% left the exercise with significant misconceptions about vaccines [18].


Other research which involved the parents of young children, showed that compared to visiting a control site with accurate information, visiting an anti-vaccine site for as little as five to 10 minutes increased perceptions of vaccination risks and decreased perceptions of the risks of vaccine omission [19].


Another study also found that the anti-vaccine sentiments that developed from viewing the websites still persisted five months later, resulting in the children of those parents receiving fewer vaccinations than recommended [20].


The role of online, anti-vaccination misinformation cannot be overstated in the rise and spread of the anti-vaccination movement. The rise of anti-vaccination movements, first seen in the HICs of the West but now increasingly being seen around the world is a major public health threat.


Their success can be seen in the difference in COVID-19 death rates among the vaccinated and unvaccinated in the United States and the return of measles as a direct consequence of people not having their children vaccinated and populations around the world failing to reach the immunisation threshold for MMR vaccines.


I am not a philosopher or human rights lawyer and I am not here to debate the merits of the greater good over individual rights but as a professional medical and healthcare communicator it is obvious to me and all the healthcare professionals I work with that anti-vaccine messaging, although inaccurate, misleading and often damn right false, does have an effect. And it is also obvious that the resulting increased incidence of infectious diseases not only puts an avoidable strain on national healthcare systems but also causes fatal casualties.


The ease and speed with which misinformation spreads is not a new phenomenon. More than 300 years ago Johnathon Swift wrote, “Falsehood flies, and Truth comes limping after it.”


But the rise of the internet in recent years and the declining public trust in traditional news media and so-called ‘scientific elites’ has seen the power and speed of misinformation increase exponentially.


The modern ‘conspiracy’ strategy has also given the peddlers of misinformation a powerful tool with which to defend their lies. Now, when doctors, scientists and politicians point out their falsehoods and refute them with facts they simply respond, “Well they would say that, they’re part of the secret cabal,” and lead their followers further down the dark rabbit hole of conspiracy.


But that does not mean that we, as stakeholders in public healthcare, can just give up and stop refuting them. All of us - physicians, researchers, educators, politicians, civil servants, and even the humble medical and healthcare communicators - must keep telling the truth, provide the evidence, and reassure the public if we are ever to curb the influence of the anti-vaccination movement.


There are steps that can be taken but if we are to go to war with the peddlers of misinformation, we also need to understand the enemy and their tactics. We need qualitative studies to better understand how and why so many people accept falsehoods and reject science.


The social media companies which allow vaccine misinformation to run wild on their platforms also have a huge part to play if we are to stem the flood of misinformation.


Unfortunately, it seems, inflammatory negativity, and conspiracy theories are more profitable content for them than accurate scientific reporting; so, whether they will see the light and choose to act in a responsible manner or whether it will require some form of political and legislative intervention is above my pay grade. But we should all be holding them to account.


We also need to do more to educate the general public, particularly new parents on the importance of vaccines for individual and global health. On the topic of education, we also need to start teaching children critical thinking and critical reading skills so that as a society we are less likely to accept supposed ‘facts’ without checking the sources.


But above all, we need to work to win back the public’s trust so that they are willing once again to believe in experts and institutions.


Article is written by Regional Account Director at Bridges M&C John Battersby


References:

[1] World Health Organization. Immunization Agenda 2030: A Global Strategy to Leave No One Behind. Available at: https://www.who.int/teams/immunization-vaccines-and-biologicals/strategies/ia2030. Accessed 17 April 2023.


[2] Patel, M. K., Dumolard, L., Nedelec, Y., Sodha, S. V., Steulet, C., Gacic-Dobo, M., ... & Goodson, J. L. (2019). Progress toward regional measles elimination—worldwide, 2000–2018. Morbidity and Mortality Weekly Report, 68(48), 1105. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6897527/.


[3] D.A. Henderson Smallpox: the death of a disease: the inside story of eradicating a worldwide killer, 2009 Prometheus Books. Podcast available at: https://www.carnegiecouncil.org/media/podcast/20091028b-smallpox-the-death-of-a-disease-the-inside-story-of-eradicating-a-worldwide-killer.


[4] Gray, A., & Sharara, F. (2022). Global and regional sepsis and infectious syndrome mortality in 2019: a systematic analysis. The Lancet Global Health, 10, S2. https://www.sciencedirect.com/science/article/pii/S2214109X22001310.


[5] Global Burden of Disease, Institute for Health Metrics and Evaluation (IHME). Data accessed on 07/2020. https://www.healthdata.org/.


[6] Frenkel, L. D. (2021). The global burden of vaccine-preventable infectious diseases in children less than 5 years of age: Implications for COVID-19 vaccination. How can we do better?. Allergy and Asthma Proceedings, 42(5), 378–385. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8677503/.


[7] Keelan, J., Pavri-Garcia, V., Tomlinson, G., & Wilson, K. (2007). YouTube as a source of information on immunization: a content analysis. JAMA, 298(21), 2482-2484. https://pubmed.ncbi.nlm.nih.gov/18056901/.


[8] Keelan, J., Pavri, V., Balakrishnan, R., & Wilson, K. (2010). An analysis of the Human Papilloma Virus vaccine debate on MySpace blogs. Vaccine, 28(6), 1535-1540. https://pubmed.ncbi.nlm.nih.gov/20003922/.


[9] Seeman, N., & Rizo, C. (2010). Assessing and responding in real time to online anti-vaccine sentiment during a flu pandemic. Healthcare Quarterly (Toronto, Ont.), 13, 8-15. https://pubmed.ncbi.nlm.nih.gov/20959725/.


[10] Davies, P., Chapman, S., & Leask, J. (2002). Antivaccination activists on the world wide web. Archives of Disease in Childhood, 87(1), 22-25. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1751143/.


[11] Wakefield, A. J., Murch, S. H., Anthony, A., Linnell, J., Casson, D. M., Malik, M., ... & Walker-Smith, J. A. (1998). RETRACTED: Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. The Lancet, 351(9103), 637-641. https://www.thelancet.com/journals/a/article/PIIS0140-6736(97)11096-0/fulltext.


[12] Taylor, B., Miller, E., Farrington, C., Petropoulos, M. C., Favot-Mayaud, I., Li, J., & Waight, P. A. (1999). Autism and measles, mumps, and rubella vaccine: no epidemiological evidence for a causal association. The Lancet, 353(9169), 2026-2029. https://pubmed.ncbi.nlm.nih.gov/10376617/.


[13] Fombonne, E., & Chakrabarti, S. (2001). No evidence for a new variant of measles-mumps-rubella–induced autism. Pediatrics, 108(4), e58-e58. https://pubmed.ncbi.nlm.nih.gov/11581466/.


[14] Meikle, J., & Boseley, S. (2010). MMR row doctor Andrew Wakefield struck off register. The Guardian, 24. https://www.theguardian.com/society/2010/may/24/mmr-doctor-andrew-wakefield-struck-off. Accessed 17 April 2023.

[15] Deer, B. (2004). Revealed: MMR research scandal. The Sunday Times, 22(02), 2004. https://www.thetimes.co.uk/article/revealed-mmr-research-scandal-7ncfntn8mjq. Accessed 17 April 2023.


[16] Measles (Rubeola). Measles Cases and Outbreaks. Centers for Disease Control and Prevention. https://www.cdc.gov/measles/cases-outbreaks.html. Accessed 17 April 2023.

[17] Measles - South Sudan (2023, February 10). World Health Organization. https://www.who.int/emergencies/disease-outbreak-news/item/2023-DON440#:~:text=Two%20outbreaks%20of%20measles%20were,to%20begin%20in%20March%202023. Accessed 17 April 2023.


[18] Kortum, P., Edwards, C., & Richards-Kortum, R. (2008). The impact of inaccurate Internet health information in a secondary school learning environment. Journal of Medical Internet Research, 10(2), e986. https://www.jmir.org/2008/2/e17.


[19] Betsch, C., Renkewitz, F., Betsch, T., & Ulshöfer, C. (2010). The influence of vaccine-critical websites on perceiving vaccination risks. Journal of Health Psychology, 15(3), 446-455. https://pubmed.ncbi.nlm.nih.gov/20348365/.


[20] Downs, J. S., de Bruin, W. B., & Fischhoff, B. (2008). Parents’ vaccination comprehension and decisions. Vaccine, 26(12), 1595-1607. https://www.sciencedirect.com/science/article/abs/pii/S0264410X08000315?via%3Dihub.




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