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Wednesday, October 25, 2023

COVID-19 vaccine misinformation and hesitancy

A protest against COVID-19 vaccination in London, United Kingdom

Anti-vaccination activists and other people in many countries have spread a variety of unfounded conspiracy theories and other misinformation about COVID-19 vaccines based on misunderstood or misrepresented science, religion, and law. These have included exaggerated claims about side effects, misrepresentations about how the immune system works and when and how COVID-19 vaccines are made, a story about COVID-19 being spread by 5G, and other false or distorted information. This misinformation has proliferated and may have made many people averse to vaccination. This has led to governments and private organizations around the world introducing measures to incentivize or coerce vaccination, such as lotteries, mandates, and free entry to events, which has in turn led to further misinformation about the legality and effect of these measures themselves.

In the US, some prominent biomedical scientists who publicly advocate vaccination have been attacked and threatened in emails and on social media by anti-vaccination activists.

Misinformation

An anti-vax sticker altered to promote vaccines in north London

Various false theories have spread in different parts of the world regarding the COVID-19 vaccines.

COVID-19 and variant related claims

Prevalent COVID-19 skepticism

Prior to the vaccine launch many citizens expressed skepticism that COVID-19 was a serious disease or that their countries had cases or high number of cases of the disease during 2020 and 2021. This prior skepticism that was pushed by the late President of Tanzania, John Pombe Magufuli is seen as a leading reason for vaccine hesitancy within the country. Magufuli declared Tanzania COVID-19 free in mid-2020 and pushed herbal remedies, praying and steam inhalation as remedies to COVID-19.

Delta variant and vaccines

As the delta variant of COVID-19 began to spread globally, disinformation campaigns seized on the idea that COVID-19 vaccines had caused the delta variant, despite the fact that the vaccines cannot replicate the virus. A French virologist likewise falsely claimed that antibodies from vaccines had created and strengthened COVID-19 variants through a previously debunked theory of Antibody-dependent Enhancement.

A related debunked theory, out of India, claimed that COVID-19 vaccines were lowering people's ability to withstand new variants instead of boosting immunity.

The website Natural News published an article in July 2021 claiming that CDC director Rochelle Walensky admitted that COVID-19 vaccines do not protect against the delta variant and that vaccinated people could be superspreaders due to having a higher viral load. Walensky actually said in a press briefing that vaccinated and unvaccinated people could have "similarly high" viral loads when infected with the delta variant, but did not say that vaccinated people had a higher viral loads or were "super-spreaders". She also stated that the vaccine "continues to prevent severe illness, hospitalization, and death", even against the delta variant. A July 2021 study in the New England Journal of Medicine reported that the Pfizer–BioNTech COVID-19 vaccine was 88 percent effective in preventing symptomatic infections caused by the delta variant.

Organized crime

Fake vaccines

In July 2021, Indian police arrested 14 people for administering doses of fake salt water vaccines instead of the Oxford–AstraZeneca COVID-19 vaccine at nearly a dozen private vaccination sites in Mumbai. The organizers, including medical professionals, charged between $10 and $17 for each dose, and more than 2,600 people paid to receive the vaccine.

Interpol issued a global alert in December 2020 to law enforcement agencies in its member countries to be on the lookout for organized crime networks targeting COVID-19 vaccines, physically and online. The WHO also released a warning in March 2021 after many ministries of health and regulatory agencies received suspicious offers to supply vaccines. They also noted that some doses of the vaccines were being offered on the dark web priced between $500 and $750, but there was no way to verify the distribution pipeline.

Fake vaccination cards

In the United States, there was a surge of individuals either looking to purchase fake vaccination cards, alter medical records to show vaccination, or create fake vaccination cards to sell. In Hawaii a vacationer was arrested after it was discovered she had a fake vaccination card, a California doctor was arrested for falsifying patients' vaccination records, and three state troopers in Vermont were arrested for helping create false cards. In August 2021 US Customs and Border Prevention agents seized 121 packages with more than 3,000 fake vaccination cards that had been shipped from Shenzhen to be distributed in the US.

Check Point research released in August 2021 showed that fake vaccination cards were being sold via messaging apps and priced between $100 and $120 a card. Interpol announced that they were seeing a direct correlation between countries requiring negative COVID-19 tests to enter the country and the increased number of provided fake vaccination cards.

Medical claims

Claims of inefficacy

Protesters against vaccination with yellow poster stating: "60% of Covid deaths are jabbed people" (among other references to conspiracy theories)

Recurrent claims, based on misinterpretation of statistical data, have been made regarding the efficacy of COVID-19 vaccines. A frequent fallacy consisted in concluding on the ineffectiveness (or low effectiveness) of vaccines after noticing the apparently high proportion of vaccinated patients among COVID-19-related hospitalisations and deaths, without taking into account the high proportion of vaccinated people among the general population, thus committing the base rate fallacy; or without taking into account the tendency of people at higher risk of developing severe illness from COVID-19 to be vaccinated in priority, thus ignoring the Yule–Simpson effect.

In the United Kingdom, a report from the Scientific Pandemic Influenza Group on Modelling (SPI-M), published in March 2021, predicted that 60% of hospitalisations and 70% of deaths would be among people who had received two doses of the vaccine, despite the latter remaining highly effective. The report stated: "This (modelling) is not the result of vaccines being ineffective, merely uptake being so high".

Multiple studies have confirmed the effectiveness of a booster dose given on top of the two normal doses of the Pfizer–BioNTech COVID-19 vaccine. There is evidence that those who have received a boosted dose experience reduced severity of infection, in addition to reduced likelihood of developing COVID-19 to begin with.

On January 17, 2023, Ron DeSantis claimed, "Almost every study now has said with these new boosters, you're more likely to get infected with the bivalent booster," but PolitiFact rated that claim False, noting that, on the contrary, a "study found that the bivalent booster is 30% effective in preventing infection from the virus."

mRNA vaccines are not vaccines

Financial analyst and self-help entrepreneur David Martin claimed that mRNA vaccines do not fit the U.S. Centers for Disease Control and Prevention's (CDC) or the U.S. Food and Drug Administration's (FDA) definitions of a vaccine because they do not prevent transmission of SARS-CoV-2, the virus that causes COVID-19. While research has been ongoing to evaluate the effect of vaccination on SARS-CoV 2 transmission, neither the CDC nor the FDA stipulate that vaccines must stop transmission of a virus, both stating that a vaccine is a product that stimulates the immune system to produce immunity to an infectious agent.

Altering human DNA

The use of mRNA-based vaccines for COVID-19 has been the basis of misinformation circulated in social media, wrongly claiming that the use of RNA somehow alters a person's DNA. The DNA alteration conspiracy theory was cited by a Wisconsin hospital pharmacist who deliberately removed 57 vaccine vials from cold storage in December 2020 and was subsequently charged with felony reckless endangerment and criminal damage to property by Ozaukee County prosecutors.

mRNA in the cytosol is very rapidly degraded before it would have time to gain entry into the cell nucleus (mRNA vaccines must be stored at very low temperature to prevent mRNA degradation). Retrovirus can be single-stranded RNA (just as SARS-CoV-2 vaccine is single-stranded RNA) which enters the cell nucleus and uses reverse transcriptase to make DNA from the RNA in the cell nucleus. A retrovirus has mechanisms to be imported into the nucleus, but other mRNA lack these mechanisms. Once inside the nucleus, creation of DNA from RNA cannot occur without a primer, which accompanies a retrovirus, but which would not exist for other mRNA if placed in the nucleus. Thus, mRNA vaccines cannot alter DNA because they cannot enter the nucleus, and because they have no primer to activate reverse transcriptase.

Because of misinformation suggesting that COVID-19 might alter DNA, some academics insisted that mRNA vaccines were not a "gene therapy" to prevent the spread of this misinformation, but others said that mRNA vaccines were a gene therapy because they introduce genetic material into cells.

Reproductive health

In a December 2020 petition to the European Medicines Agency, German physician Wolfgang Wodarg and British researcher Michael Yeadon suggested, without evidence, that mRNA vaccines could cause infertility in women by targeting the syncytin-1 protein necessary for placenta formation. Their petition to halt vaccine trials soon began circulating on social media. A survey of young women in the United Kingdom later found that more than a quarter would refuse COVID-19 vaccines out of concerns for their effects on fertility. A study in Andrologia found that Google searches relating to a supposed link between vaccination against COVID-19 and adverse effects on fertility increased following the Emergency Use Authorization of COVID vaccines in the United States, indicating that concerns about alleged impacts on fertility are a major contributor to vaccine hesitancy. Syncytin-1 and the SARS-CoV-2 spike protein targeted by the vaccines are largely dissimilar, sharing a sequence of only four amino acids out of several hundred. A study conducted on 44 rats injected with the Pfizer–BioNTech COVID-19 vaccine at doses over 300 times the human dose by body weight and 44 rats injected with placebo found no statistically significant evidence of any adverse effects on the fertility of female rats or on the health of the offspring of rats (the 3% lower pregnancy rate found in the vaccine group was not statistically significant). David Gorski wrote on Science-Based Medicine that Wodarg and Yeadon were "stoking real fear [...] based on speculative nonsense".

False claims that a vaccinated person could "shed" SARS-CoV-2 spike proteins, allegedly causing menstrual irregularities or other harmful effects on the reproductive health of non-vaccinated women who are in proximity to them, such as miscarriage, were cited by the Centner Academy, a private school in Miami, which announced it would not employ teachers who received the COVID-19 vaccine. Other businesses refused to serve vaccinated customers, citing concerns that vaccinated people could shed the virus. Some promoters of this claim have recommended the use of face masks and social distancing to protect themselves from those who have been vaccinated. Gynecologist and medical columnist Jen Gunter stated none of the vaccines currently approved in the United States "can possibly affect a person who has not been vaccinated, and this includes their menstruation, fertility, and pregnancy".

Risk of diseases

Bell's palsy

In late 2020, claims circulated on social media that the Pfizer–BioNTech COVID-19 vaccine caused Bell's palsy in trial participants. Several pictures which had originally been published prior to 2020 accompanied these posts, and were falsely labeled as these participants. During the trial, four of the 22,000 trial participants indeed developed Bell's palsy. The FDA observed that the "frequency of reported Bell's palsy in the vaccine group is consistent with the expected background rate in the general population".

Debate is still ongoing about whether or not there is a causal link between any of the major COVID-19 vaccines and Bell's palsy. However, experts agree that even if an association exists, it occurs extremely rarely and the effect is small (~10 cases per 100,000 vs 3-7 cases per 100,000 in a typical pre-pandemic year). Bell's palsy is usually temporary and known to occur following many vaccines.

Blood clots

Videos posted to Facebook and Instagram have claimed without evidence that 62 percent of people given an mRNA vaccine develop blood clots, and that Pfizer's COVID-19 vaccine causes blood to clot "in a minute or two". Studies have found possible causal links between the AstraZeneca and Janssen COVID-19 vaccines and a rare clotting disorder known as thrombosis with thrombocytopenia syndrome (TTS), but the risk is low for most people, with 47 confirmed reports of the condition out of more than 15 million recipients of the Janssen vaccine in the United States as of October 2021. A 2021 study published in the British Medical Journal suggested that SARS-CoV-2 infection is approximately 200 times more likely to cause blood clots in patients than the AstraZeneca vaccine.

Cancer

The website Natural News has published claims that mRNA vaccines for COVID-19 can cause cancer by inactivating tumor-suppressing proteins. This claim was based on a misrepresentation of a 2018 study at Memorial Sloan Kettering Cancer Center (MSKCC), which did not involve the mRNA used in vaccines. The study found that transcription errors in certain mRNA molecules could disrupt production of tumor-suppressing proteins. However, mRNA used in vaccines is made artificially, and poses no risk of transcription errors once made.

Prion disease

A widely reposted 2021 Facebook post claiming that the mRNA vaccines against COVID-19 could cause prion diseases was based on a paper by J. Bart Classen. The paper was published in Microbiology and Infectious Diseases, whose publisher, Scivision Publishers, is included in Beall's list of publishers of predatory journals. Classen's only published evidence for his claim was a brief summary of an "unspecified analysis of the Pfizer/BioNTech COVID-19 vaccine", according to NewsGuard. Vincent Racaniello, professor of microbiology and immunology at Columbia University, described the claim as "completely wrong". Previous mRNA vaccines have been tested in humans, and were not found to cause prion disease. The mRNA contained in the vaccine is degraded within a few days of entering the cells of a person receiving it and does not accumulate in the brain. The U.S. Alzheimer's Association has stated that currently available COVID-19 vaccines are safe for persons with Alzheimer's disease and other forms of dementia.

Polio vaccine as a claimed COVID-19 carrier

Social media posts in Cameroon pushed a conspiracy theory that polio vaccines contained COVID-19, further complicating polio eradication beyond the logistical and funding difficulties created by the COVID-19 pandemic.

Antibody-dependent enhancement

Antibody-dependent enhancement (ADE) is the phenomenon in which a person with antibodies against one virus (i.e. from infection or vaccination) can develop worse disease when infected by a second closely related virus, due to a unique and rare reaction with proteins on the surface of the second virus. ADE has been observed in vitro and in animal studies with many different viruses that do not display ADE in humans. Researchers acknowledge that "Fundamentally, this question should be asked of all vaccine candidates under development, despite the rarity of the phenomenon."

Prior to the pandemic, ADE was observed in animal studies of laboratory rodents with vaccines for SARS-CoV, the virus that causes severe acute respiratory syndrome (SARS). However, as of 27 January 2022 there have been no observed incidents with vaccines for COVID-19 in trials with nonhuman primates, in clinical trials with humans, or following the widespread use of approved vaccines. Molecular simulations indicate that ADE might play a role in new strains such as delta, but none in the strains that the vaccines were originally designed for. Anti-vaccination activists cited ADE as a reason to avoid vaccination against COVID-19.

Vaccines contain aborted fetal tissue

In November 2020, claims circulated on the web that the Oxford–AstraZeneca COVID-19 vaccine contained tissue from aborted fetuses. While it is true that cell lines derived from a fetus aborted in 1970 plays a role in the vaccine development process, the molecules for the vaccine are separated from the resulting cell debris. Several other COVID-19 vaccine candidates use fetal cell lines descended from fetuses aborted between 1972 and 1985. No fetal tissue is present in these vaccines.

Spike protein cytotoxicity

In 2021, anti-vaccination misinformation circulated on social media saying that SARS-CoV-2 spike proteins were "very dangerous" and "cytotoxic". At that time, all COVID-19 vaccines approved for emergency use either contained mRNA or mRNA precursors for the production of the spike protein. This mRNA consists of instructions which, when processed in cells, cause production of spike proteins, which trigger an adaptive immune response in a safe and effective manner.

Acquired immunodeficiency syndrome

In October 2021, the website The Exposé used data published by the UK Health Security Agency (UKHSA), which misleadingly indicated that COVID-19 infection rates were higher among fully-vaccinated than unvaccinated people, to falsely claim that the COVID-19 vaccines were not only ineffective but were also causing vaccinated people to develop AIDS "much faster than anticipated". The website's claims were cited in a speech by Brazilian president Jair Bolsonaro. The video of Bolsonaro's speech was removed from Facebook, Instagram and YouTube for violating their policies regarding COVID-19 vaccines.

In January 2022, The Exposé promoted a conspiracy theory claiming that Germans fully-vaccinated against COVID-19 "[would] have full blown Covid-19 vaccine induced acquired immunodeficiency syndrome (AIDS) by the end of [the month]."

Vaccines as a cause of death

United States

Claims have been made that data from the United States Department of Health and Human Services's Vaccine Adverse Event Reporting System (VAERS) reveals a hidden toll of COVID-19 vaccine related deaths. This claim have been debunked as a misleading misrepresentation by anti-vaccine sources. The VAERS is known to report and store co-occurring health events with no proof of causation, including suicides, mechanical incidents (car accident), natural deaths by chronic diseases, old age and others. The websites Medalerts.org by the National Vaccine Information Center, a known and leading anti-vaccine center, and OpenVAERS have been linked to this misinformation. Comparative studies of VAERS, which look at relative reporting rates, have found that the data does not support these claims.

A 2021 transparency report from Facebook found that the most popular shared link in the United States from January to March was an article from the South Florida Sun-Sentinel about a doctor's death two weeks after getting a COVID-19 vaccine. The medical examiner later found no evidence of a link to the vaccine, but the article was promoted and twisted by anti-vaccine groups to raise doubt about vaccine safety. Anti-vaccine activists Robert F. Kennedy Jr. and Del Bigtree have suggested without evidence that the death of Baseball Hall of Fame member Hank Aaron was caused by receiving the COVID-19 vaccine. Aaron's death was reported as being due to natural causes, and medical officials did not believe the COVID-19 vaccine had any adverse effect on his health.

On October 7, 2022, Florida Surgeon General Dr. Joseph Ladapo issued a press release discouraging men aged 18 to 39 from taking the COVID-19 vaccine since a study by the Florida Department of Health concluded vaccinated men of the age group had an 84% increased likelihood of dying from heart problems. The study was neither peer-reviewed, nor published in a scientific journal, while its authors, source of funding, and methods of analysis were not disclosed. The study faced ample criticism, contending misrepresentation of data, that the time frame for examining deaths was too long, a lack of transparency, and that the efficacy and safety of the vaccines were ignored. Steve Kirsch, an entrepreneur who promotes COVID-19 vaccine misinformation, cited the study as proof that mRNA vaccines are fatal to children. A study published in JAMA showed an increased risk for myocarditis within seven days of vaccination. The group with most recorded cases (males aged 16 to 17) had 106 per million doses, though the actual incidence is likely higher due to overall underreporting. 96% of patients were hospitalized, but most cases were mild and patients typically experienced symptomatic recovery by discharge.

Taiwan

The Falun Gong-affiliated news channel New Tang Dynasty Television spread misrepresentation of Taiwan's VAERS surveillance data to suggest COVID-19 vaccines, including the Taiwanese-developed Medigen vaccine, killed more people than the virus.

Other countries

Similar misrepresentation of known "deaths after vaccination" as "deaths due to vaccination" have been mentioned in various countries, including Italy, Austria, South Korea, Germany, Spain, USA, Norway, Belgium, Peru, and Canada. These have been debunked as misrepresentation of the cases and data.

Vaccine contains tracking agent

In November 2021, a White House correspondent for the conservative outlet Newsmax falsely tweeted that the Moderna vaccine contained luciferase "so that you can be tracked."

Vaccine 'reversal' and detox

In November 2021, erroneous claims arose that a "detox bath" of epsom salt, borax and bentonite clay can remove the effects of the vaccine. In fact, a rapid review of literature shows that no known mechanism exists for removing a vaccine from a vaccinated person.

Approved vaccines "not available" in the United States

Under U.S. FDA regulations, a product approved under an Emergency Use Authorization (EUA) is considered "legally distinct" from a product that has received full approval by the FDA. Besides differences in naming and labeling to account for its approval, and increased FDA oversight over its production, there are no formulaic differences between the EUA and approved versions of a vaccine, and the two are considered interchangeable once approved. For example, the Pfizer vaccine has been labeled as "Pfizer–BioNTech COVID-19 Vaccine" since distribution began, but was assigned the United States Adopted Name "Comirnaty" upon its approval.

Some anti-vaccine advocates have made claims surrounding scenarios where this distinction is allegedly applicable; claims have been made that no FDA-approved vaccine is "available" in the United States because doses labeled as "Pfizer–BioNTech COVID-19 Vaccine" were still being distributed, and not "Comirnaty". This claim was cited by a group of Louisiana Republican lawmakers, Senator Ron Johnson, and in a lawsuit filed by the First Liberty Institute against a COVID-19 vaccine mandate implemented by the U.S. military. In the case of the latter, the plaintiffs claimed that the mandate applied specifically to Comirnaty only, and not the "experimental" Pfizer–BioNTech COVID-19 Vaccine.

Another claim was that the approved version does not share the same liability protection as the version produced under an EUA. Under the Public Readiness and Emergency Preparedness (PREP) Act, individuals are eligible for compensation via the Countermeasures Injury Compensation Program (CICP) for severe outcomes or death caused by COVID-19 countermeasures such as vaccines. This applies generally to all COVID-19 vaccines, including those not yet given formal approval.

Vaccines as an "operating system"

Beginning in 2021, misinformation started circulating on the Internet claiming that the COVID-19 vaccines are actually "operating systems". This claim stems from a statement on the Moderna website which likens mRNA vaccines to operating systems simply as an analogy. It did not literally state that the vaccines are operating systems, and therefore proponents of this claim are committing the reification fallacy.

Socially based claims

Claims about a vaccine before one existed

Multiple social media posts promoted a conspiracy theory claiming that in the early stages of the pandemic, the virus was known and that a vaccine was already available. PolitiFact and FactCheck.org noted that no vaccine existed for COVID-19 at that point. The patents cited by various social media posts reference existing patents for genetic sequences and vaccines for other strains of coronavirus such as the SARS coronavirus. The WHO reported that as of 5 February 2020, despite news reports of "breakthrough drugs" being discovered, there were no treatments known to be effective; this included antibiotics and herbal remedies not being useful.

On Facebook, a widely shared post claimed in April 2020 that seven Senegalese children had died because they had received a COVID-19 vaccine. No such vaccine existed, although some were in clinical trials at that time.

Magnetization

Some social media users have falsely asserted COVID-19 vaccines cause people to become magnetized such that metal objects stick to their bodies. Video clips of people showing magnets sticking to the injection site have been spread on social media platforms such as Instagram, Facebook, Twitter, YouTube, and TikTok, claiming that vaccination implants a microchip in people's arms. Called by Republicans as an expert witness before a June 2021 hearing of the Ohio House Health Committee, anti-vaccine activist Sherri Tenpenny promoted the false claim, adding, "There's been people who have long suspected that there's been some sort of an interface, yet to be defined interface, between what's being injected in these shots and all of the 5G towers."

5G-compatible chips are about 13 times too large to fit through the needles used to administer COVID-19 vaccines, whose internal diameter is between 0.26 and 0.41 millimeters. Most microchips do not contain ferromagnetic components, being made mostly of silicon. It is possible for smooth objects such as magnets to stick to one's skin if the skin is slightly oily. No COVID-19 vaccines authorized for use in the U.S. or Europe contain magnetic or metal ingredients or microchips. Instead the vaccines contain proteins. lipids, water, salts, and pH buffers.

Disappearing needles

Twitter and YouTube users circulated video clips purporting to show that vaccine injections given to health care workers were staged for the press using syringes with "disappearing needles". The syringes used were actually safety syringes, which automatically retract the needle once the vaccine is injected in order to reduce accidental needlestick injuries to nurses and lab workers.

Political divides and distrust in government

Discourses against COVID vaccines became part of QAnon's set of beliefs, as adherents used the pandemic to promote the conspiracy theory. In 2021, Romana Didulo, a QAnon-affiliated Canadian conspiracy theorist calling herself the "Queen of Canada" caused her online followers to harass Canadian businesses and public authorities with demands that they cease all measures related to combating the pandemic. She was apprehended in late November after calling on her 73,000 Telegram followers to "shoot to kill" all healthcare workers administering COVID-19 vaccines.

Anti-government groups such as sovereign citizens and freemen on the land also took part in the anti-vaccine movement.

During lockdowns in Bulgaria, many Roma neighborhoods claimed that they were subject to lockdowns without proper explanations even though the level of infections to other parts of the country were higher than their neighborhoods. The communities already held a distrust of institutions and the government, and helped create an even more strained relationship and lack of trust.

In France, Florian Philippot and Nicolas Dupont-Aignan, right-wing candidates to the 2022 presidential election, have both cast doubts about the vaccine's effectiveness and safety.

Government investigations

In December 2022, vaccine-skeptical Florida Governor Ron DeSantis requested the impaneling of a grand jury to "investigate criminal or wrongful activity in Florida relating to the development, promotion, and distribution of vaccines purported to prevent COVID-19 infection, symptoms, and transmission", specifically mentioning statements made by drug manufacturers and federal officials.

Vaccine hesitancy

A CDC Fact sheet about COVID-19 vaccines

Hong Kong

In Hong Kong, the lower perceived risk of catching COVID-19 when it was under control, misinformation about the vaccines' side effects and efficacy, as well as political events and distrust of the HKSAR government, contributed to a low rate of vaccination. To some extent, similar complacency occurred in Taiwan, Macau, and mainland China. Many Hongkongers felt that the government was actively pushing the SinoVac vaccine despite its lower efficacy compared with BioNTech and AstraZeneca. Older residents might believe the BioNTech vaccine lead to severe side effects. Officials also stated that people with "uncontrolled severe chronic diseases" should not receive the SinoVac vaccine and urged those who weren't sure to consult with their doctors first. Conspiracy theories about the government spread as well due to a packaging issue with the BioNTech vaccine. Skepticism of Western and preventive medicine further contributed to the hesitancy.

Towards the end of May 2021, about 19% of Hongkongers had received their first dose and 13.8% their second. By 1 January 2022, 62% of the population was fully vaccinated, but as of 7 February, only 33% of those aged 80 or older had received one dose. As Omicron subvariants spread across the city, a study showed that 15% of those aged 80 or older who weren't immunized at all died after contracting the disease, compared with 3% of those who got two SinoVac shots and 1.5% of those who received two BioNTech doses.

United States

Vehicle with vaccine conspiracy theories written on it

In the United States, COVID-19 vaccine hesitancy varies largely by region; however, regardless of region, medical professionals are vaccinated at higher rates than the general public. Estimates from two surveys were that 67% or 80% of people in the U.S. would accept a new vaccination against COVID-19, with wide disparity by education level, employment status, ethnicity, and geography. A US study conducted in January 2021 found that trust in science and scientists was strongly correlated with likelihood to get vaccinated for COVID-19 among those who had not already gotten vaccinated. In March 2021, 19% of US adults claimed to have been vaccinated while 50% announced plans to get vaccinated.

A 2022 study found a link between online COVID-19 misinformation and early vaccine hesitancy and refusal. Despite a strong association between vaccine hesitancy and Republican vote share at the US county and state levels, the authors found that the associations between vaccine outcomes and misinformation remained significant when accounting for political, demographic, and socioeconomic factors.

In the United States, vaccine hesitancy could be seen in certain social groups due to lack of trusted medical sources, traumatic past experiences with medical care and widespread theories. Distrust can be seen in the African American population where many see the history in the United States of using African Americans as experiments, such as the Tuskegee experiments and the work of J. Marion Sims, as basis to refuse the vaccine.

According to The New York Times, only 28 percent of Black New Yorkers ages 18 to 44 years were fully vaccinated as of August 2021, compared with 48 percent of Latino residents and 52 percent of White residents in that age group. Interviewees cited mistrust of the government, personal experiences of medical racism, and historical medical experimentation on Black people such as the Tuskegee Syphilis Study as reasons for their reluctance to be vaccinated. A professor from the University of Warsaw in Poland, claimed that her research found that medical mistrust was higher in nations that had experienced Soviet-style communism in the past, and vaccine hesitancy could be seen if the countries introduced compulsory vaccination regulations. Medical mistrust is also seen in Russia where one person described a lack of understanding what the vaccine is and claimed that if there was more statistics and research about the Sputnik V and other Russian made vaccines they would be more "loyal". She also stated that there was also mistrust over the lack of consistent medical information about the vaccine coming from many sources including the authorities of the region.

According to prominent biomedical researcher Peter Hotez, he and other scientists who publicly defend vaccines have been attacked on social media, harassed with threatening emails, intimidated, and confronted physically by opponents of vaccination. He further attributes the increase in aggressiveness of the anti-vaccination movement to the influence of the extreme wing of the Republican Party. Hotez estimates that roughly 200,000 preventable deaths from COVID-19, mainly among Republicans, occurred in the US because of refusal to be vaccinated.

Countermeasures

COVID-19 passes

Some countries are using vaccination tracking systems, apps, or passports that are labeled as passes to allow individuals certain freedoms. In France, every adult must present a "pass sanitaire" before entering specific locations such as restaurants, cafes, museums, and sports stadiums after a new law was passed in July 2021. Italy reported a 40% increase in the number of people who received the first dose of the vaccine after a governmental decree in September 2021 requiring a health pass for all workers either in the public or private sectors starting in October 2021. Similar passes have been put into effect in countries such as Slovenia and Greece. Lithuania introduced vaccination certificates that citizens 12-years and older must show to enter most public indoor spaces.

Encouragement by public figures and celebrities

Many public figures and celebrities have publicly declared that they have been vaccinated against COVID-19, and encouraged people to get vaccinated. Many have made video recordings or otherwise documented their vaccination. They do this partly to counteract vaccine hesitancy and COVID-19 vaccine conspiracy theories.

Politicians

Many current and former heads of state and government ministers have released photographs of their vaccinations, encouraging others to be vaccinated, including Kyriakos Mitsotakis, Zdravko Marić, Olivier Véran, Mike Pence, Joe Biden, Barack Obama, George W. Bush, Bill Clinton, the Dalai Lama, Narendra Modi, Justin Trudeau, Alexandria Ocasio-Cortez, Nancy Pelosi and Kamala Harris.

Elizabeth II and Prince Philip announced they had the vaccine, breaking from protocol of keeping the British royal family's health private. Pope Francis and Pope Emeritus Benedict both announced they had been vaccinated. In a call-in-television special President Vladimir Putin told listeners that he had received the Sputnik V vaccine and stressed that all the vaccines were safe.

Media personalities

Today was a good day. I have never been happier to wait in a line. If you're eligible, join me and sign up to get your vaccine. Come with me if you want to live!

Arnold Schwarzenegger

Dolly Parton recorded herself getting vaccinated with the Moderna vaccine she helped fund, she encouraged people to get vaccinated and created a new version of her song "Jolene" called "Vaccine". Several other musicians like Patti Smith, Yo-Yo Ma, Carole King, Tony Bennett, Mavis Staples, Brian Wilson, Joel Grey, Loretta Lynn, Willie Nelson, and Paul Stanley have all released photographs of them being vaccinated and encouraged others to do so. Grey stated "I got the vaccine because I want to be safe. We've lost so many people to COVID. I've lost a few friends. It's heartbreaking. Frightening."

Many actors including Amy Schumer, Rosario Dawson, Arsenio Hall, Danny Trejo, Mandy Patinkin, Samuel L. Jackson, Arnold Schwarzenegger, Sharon Stone, Kate Mulgrew, Jeff Goldblum, Jane Fonda, Anthony Hopkins, Bette Midler, Kim Cattrall, Isabella Rossellini, Christie Brinkley, Cameran Eubanks, Hugh Bonneville, Alan Alda, David Harbour, Sean Penn, Amanda Kloots, Ian McKellen and Patrick Stewart have released photographs of themselves getting vaccinated and encouraging others to do the same. Judi Dench and Joan Collins announced they have been vaccinated.

Please and reassure yourself why getting vaxxed is the move. Save a life or two. Who knows?

Ariana Grande

Other TV personalities such as Martha Stewart, Jonathan Van Ness, Al Roker and Dan Rather released photographs of themselves getting vaccinated and encouraged others to do the same. Stephen Fry also shared a photograph of being vaccinated; he wrote, "It's a wonderful moment, but you feel that it's not only helpful for your own health, but you know that you're likely to be less contagious if you yourself happen to carry it ... It's a symbol of being part of society, part of the group that we all want to protect each other and get this thing over and done with." Sir David Attenborough announced that he has been vaccinated. Dutch TV personality Beau van Erven Dorens got his vaccination on live TV in his late-night talk show on 3 June 2021.

Athletes

Magic Johnson and Kareem Abdul-Jabbar released photographs of themselves getting vaccinated and encouraged others to do the same; Abdul-Jabbar said, "We have to find new ways to keep each other safe."

Specific communities

Romesh Ranganathan, Meera Syal, Adil Ray, Sadiq Khan and others produced a video specifically encouraging ethnic minority communities in the UK to be vaccinated including addressing conspiracy theories stating "there is no scientific evidence to suggest it will work differently on people from ethnic minorities and that it does not include pork or any material of fetal or animal origin."

Oprah Winfrey and Whoopi Goldberg have spoken about being vaccinated and encouraged other black Americans to be so. Stephanie Elam volunteered to be a trial volunteer stating "a large part of the reason why I wanted to volunteer for this COVID-19 vaccine research – more Black people and more people of color need to be part of these trials so more diverse populations can reap the benefits of this medical research."

Experiences of prior hesitant individuals and others

Many news articles, TV interviews and posts on social media appeared in 2021 to highlight either the anger of individuals whose children or immune compromised family members either caught COVID-19 or were impacted by vaccine hesitancy or those who were vaccine hesitant and later tested positive. The Chief Medical Officer for England, Prof. Chris Whitty, tweeted in September 2021 that "The majority of our hospitalised Covid patients are unvaccinated and regret delaying their vaccines" with about 60% of all hospitalisations due to COVID-19 in the UK being of unvaccinated individuals. While some cases have allowed for more discussions to open up about the vaccine and the effects of the disease, some still have remaining hesitancy about the vaccination process, others have expressed their regret for not pushing the vaccine or determination to get vaccinated.

Targeted lockdowns and fines

Austria and Germany both announced in late 2021 that they would introduce lockdowns for only unvaccinated citizens. In Greece those who refuse to get vaccinated and are above the age of 60 will be fined 100 euros a month, with the payments put towards a hospital service fund. In Singapore, all citizens who chose not to get vaccinated must pay their medical bills in full if they test positive and receive hospital care, while in Ukraine all teachers and government officials who remain unvaccinated were placed on unpaid leave, and restaurants, shopping malls and fitness centers must have 100% of their employees vaccinated to operate.

Vaccine lotteries and benefits

The Kremlin announced in 2021 that it was supporting a lottery that would give 1,000 chosen vaccinated individuals the equivalent of $1,350. The Mayor of Moscow also announced that the city would give away five cars every week to vaccinated residents. In the United States, many states such as Alaska, Pennsylvania, and Ohio, along with cities and universities, offered scholarships, money, and physical items in lotteries. These benefits had varying success in raising vaccination numbers. In July 2021, the Polish government launched the National Vaccination Programme Lottery to encourage vaccinations against COVID-19. It was open to people aged 18 years and over who had completed the COVID-19 vaccination programme and had registered for the lottery by September 30, 2020. The final prize draw took place on October 6, 2021, and there were two cash prizes of PLN 1 million (US$264,000) and two Toyota C-HR cars to be won.

First Capital Bank, based out of Malawi, issued a statement that they would only give the annual performance bonuses to vaccinated employees.

Vaccine mandates

In France, since September 2021, all health care workers must have received at least one dose of the vaccine to continue working with any resisters suspended without pay. Additional worker groups that have been mandated to do so earlier in the year are military members and firefighters. In November 2021, Austria announced that it would introduce a nationwide vaccine mandate.

In the United States, many businesses, schools and universities, healthcare providers, and governmental and state departments have enacted vaccine mandates. While many of the mandates allow for a person to opt out due to medical or religious reasons and be regularly tested, the federal mandate signed in September 2021 did not include this option. Additionally some of the mandates are focused only on specific groups such as Rutgers University which only mandated the vaccine for students and health-care and public-safety employees. The mandates have seen push back with a New York Judge temporarily blocking one for healthcare workers who claimed they could not opt out due to religious reasons, and Arizona Attorney General Mark Brnovich suing the Biden administration for its vaccine mandate for federal employees and private businesses with over 100 employees. Additional push back on vaccine mandates were seen at local levels with at least one sheriff's department in California announcing they would not enforce any vaccine mandates as "the last line of defense from tyrannical government overreach", while others have seen mass resignation.

Anti-vaccine activism

From Wikipedia, the free encyclopedia
Anti-vaccination conspiracy theorist at a 2010 Tea Party Express rally
Rally of the Anti-Vaccination League of Canada in 1919

Anti-vaccine activism is organized activity designed to increase vaccine hesitancy, often by disseminating misinformation or disinformation. Although myths, conspiracy theories, misinformation and disinformation spread by the anti-vaccination movement and fringe doctors increases vaccine hesitancy and public debates around the medical, ethical, and legal issues related to vaccines, there is no serious hesitancy or debate within mainstream medical and scientific circles about the benefits of vaccination.

18th and 19th century

Ideas that would eventually coalesce into anti-vaccine activism have existed for longer than vaccines themselves. Some philosophical approaches (e.g. homeopathy, vitalism) are incompatible with the microbiological paradigm that explains how the immune system and vaccines work. Vaccine hesitancy and anti-vaccine activism exist within a broader context that involves cultural tradition, religious belief, approaches to health and disease, and political affiliation.

Opposition to variolation for smallpox (a predecessor to vaccination) was organized as early as the 1820s around the premise that vaccination was unnatural and an attempt to thwart divine judgment. Religious arguments against inoculation, the earliest arguments against vaccination, were soon advanced. For example, in a 1722 sermon entitled "The Dangerous and Sinful Practice of Inoculation", the English theologian Reverend Edmund Massey argued that diseases are sent by God to punish sin and that any attempt to prevent smallpox via inoculation is a "diabolical operation". It was customary at the time for popular preachers to publish sermons, which reached a wide audience. This was the case with Massey, whose sermon reached North America, where there was early religious opposition, particularly by John Williams. A greater source of opposition there was William Douglass, a medical graduate of Edinburgh University and a Fellow of the Royal Society, who had settled in Boston.

Vaccination itself was invented by British physician Edward Jenner, who published his findings on the efficacy of the practice for smallpox in 1798. By 1801, the practice had been widely endorsed in the scientific community, and by several world leaders. Philadelphia physician John Redman Coxe, noting that even then false accounts were circulated of negative effects of vaccination, wrote, "Such are the falsehoods which impede the progress of the brightest discovery which has ever been made! But the contest is in vain! Time has drawn aside the veil which obstructed our knowledge of this invaluable blessing; and in the examples of the Emperor of Constantinople, of the Dowager Empress of Russia, and the King of Spain, we may date the downfall of further opposition". Coxe's expectation of an end to opposition to vaccination proved premature, and through much of the nineteenth century, the principles, practices and impact of vaccination were matters of active scientific debate. The principles behind vaccination were not clearly understood until the end of the nineteenth century. The importance of hygiene in the preparation, storage, and administration of vaccines was not always understood or practiced. Reliable statistics on vaccine efficacy and side effects were difficult to obtain before the 1930s.

Anti-Compulsory Vaccination League

In the United Kingdom, the Compulsory Vaccination Act of 1853 required that every child be vaccinated within three or four months of birth. It set a precedent for the state regulation of physical bodies, and was fiercely resisted. In 1854. John Gibbs published the first anti-compulsory-vaccination pamphlet, Our Medical Liberties. By the 1860s, anti-vaccinationism in Britain was active in the working class, labor aristocracy, and lower middle class, all of which were under economic stress. It had become associated with alternative medicine and was part of a larger culture of social and political dissent that included both labor unions and religious dissenters. 

In June 1867, the publication "Human Nature" campaigned in the United Kingdom against "The Vaccination Humbug", reporting that many petitions had been presented to Parliament against Compulsory Vaccination for smallpox, including from parents who alleged that their children had died through the procedure, and complaining that these petitions had not been made public. The journal reported the formation of the Anti-Compulsory Vaccination League "To overthrow this huge piece of physiological absurdity and medical tyranny", and quoted Richard Gibbs (a cousin of John Gibbs) who ran the Free Hospital at the same address as stating "I believe we have hundreds of cases here, from being poisoned with vaccination, I deem incurable. One member of a family dating syphilitic symptoms from the time of vaccination, when all the other members of the family have been clear. We strongly advise parents to go to prison, rather than submit to have their helpless offspring inoculated with scrofula, syphilis, and mania".

Notable members of the Anti-Compulsory Vaccination League included James Burns, George Dornbusch and Charles Thomas Pearce. After the death of Richard B. Gibbs in 1871, the Anti-Compulsory Vaccination League "languished" until 1876 when it was revived under the leadership of Mary Hume-Rothery and the Rev. W. Hume-Rothery. The Anti-Compulsory Vaccination League published the Occasional Circular which later merged into the National Anti-Compulsory Vaccination Reporter.

Anti-Vaccination Society of America

In the United States, many states and local school boards established immunization requirements, beginning with a compulsory school vaccination law in Massachusetts in 1855. The Anti-Vaccination Society of America was founded in 1879, after a visit to the United States by British anti-vaccine activist William Tebb, and opposed compulsory smallpox vaccination for smallpox from the final decades of the 19th century through the 1910s. During this period, smallpox vaccination was the only form of vaccination that was widely practiced, and the society published a periodical opposing it, called Vaccination.

A series of American legal cases, beginning in various states and culminating with that of Henning Jacobson of Massachusetts in 1905, upheld the mandating of compulsory smallpox vaccination for the good of the public. The court ruled in Jacobson v. Massachusetts that "the liberty secured by the Constitution of the United States to every person within its jurisdiction does not import an absolute right in each person to be, at all times and in all circumstances, wholly freed from restraint. There are manifold restraints to which every person is necessarily subject for the common good".

London Society for the Abolition of Compulsory Vaccination

"Death the Vaccinator", published by the London Society for the Abolition of Compulsory Vaccination in the late 1800s

In 1880, William Tebb enlarged and reorganized the Anti-Compulsory Vaccination League in the UK with the formation of the London Society for the Abolition of Compulsory Vaccination, with William Young as secretary. The Vaccination Inquirer, established by Tebb in 1879, was adopted as the official organ of the Society. A series of fourteen "Vaccination Tracts" was begun by Young in 1877 and completed by Garth Wilkinson in 1879. William White was the first editor of the Vaccination Inquirer and after his death in 1885, he was succeeded by Alfred Milnes. Frances Hoggan and her husband authored an article for the Vaccination Inquirer in September 1883 which argued against compulsory vaccination. The London Society focused on lobbying parliamentary support in the 1880s and early 1890s. They gained support from several members of the House of Commons of which the most prominent was Peter Alfred Taylor, the member for Leicester, which was described as the "Mecca of antivaccination".

The National Anti-Vaccination League

The UK movement grew, and as the influence of the London Society overshadowed the Hume-Rotherys and it took the national lead, it was decided in February 1896 to re-form the Society as The National Anti-Vaccination League. Arthur Phelps was elected as president. In 1898, the league took on a school leaver named Lily Loat. By 1909 she was elected as the league's Secretary. In 1906, George Bernard Shaw wrote a supportive letter to the National Anti-Vaccination League, equating methods of vaccination with "rubbing the contents of the dustpan into the wound".

Anti-Vaccination League of America

In 1908, the Anti-Vaccination League of America was created by Charles M. Higgins and industrialist John Pitcairn Jr., with anti-vaccination campaigns focused on New York and Pennsylvania. Members were opposed to compulsory vaccination laws. Higgins was the League's chief spokesman and pamphleteer. Historian James Colgrove noted that Higgins "attempted to overturn the New York State's law mandating vaccination of students in public schools". The League should not be confused with the Anti-Vaccination Society of America, that was formed in 1879. Higgins was criticized by medical experts for spreading misinformation and ignoring facts as to the efficacy of vaccination. The League dissolved after the death of Higgins in 1929.

20th century

Anti-vaccine activism ebbed for much of the twentieth century, but never completely vanished. In the UK, the National Anti-Vaccination League continued to publish new issues of its journal until 1972, by which time the global campaign for smallpox eradication through vaccination had made the disease so uncommon that compulsory vaccination for smallpox was no longer required in the United Kingdom.

New vaccines were developed and used against diseases such as diphtheria and whooping cough. In the UK, these were often introduced on a voluntary basis, without arousing the same kind of anti-vaccination response that had accompanied compulsory smallpox vaccination.

In the United States, numerous measles outbreaks occurred in the 1960s and 1970s, and were shown to be more frequent in states that lacked mandatory vaccination requirements. This led to calls in the 1970s for a national level vaccination requirement for children entering schools. Joseph A. Califano Jr. appealed to state governors, and by 1980, all 50 states legally required vaccination for school entrance. Many of these laws allowed exemptions in response to lobbyists. In New York State, a 1967 law allowed exemptions from receiving polio vaccine for members of religious organizations such as Christian Scientists.

21st century

Lancet MMR autism fraud

Anti-vaccine activism in the 2000s was greatly spurred by fraudulent research that made a false claim of a link between the MMR vaccine and autism. These claims have been extensively investigated and found to be false. The scientific consensus is that there is no link between the MMR vaccine and autism, and that the MMR vaccine's benefits in preventing measles, mumps, and rubella greatly outweigh its potential risks.

The idea of an autism link was first suggested in the early 1990s and came to public notice largely as a result of the 1998 Lancet MMR autism fraud, characterised as "perhaps the most damaging medical hoax of the last 100 years". The fraudulent research paper authored by Andrew Wakefield and published in The Lancet falsely claimed the vaccine was linked to colitis and autism spectrum disorders. The paper was retracted in 2010 but is still cited by anti-vaccine activists.

The claims in the paper were widely reported, leading to a sharp drop in vaccination rates in the UK and Ireland. Promotion of the claimed link, which continues in anti-vaccination propaganda despite being refuted, has led to an increase in the incidence of measles and mumps, resulting in deaths and serious permanent injuries. Following the initial claims in 1998, multiple large epidemiological studies were undertaken. Reviews of the evidence by the Centers for Disease Control and Prevention, the American Academy of Pediatrics, the Institute of Medicine of the US National Academy of Sciences, the UK National Health Service, and the Cochrane Library all found no link between the MMR vaccine and autism. Physicians, medical journals, and editors have described Wakefield's actions as fraudulent and tied them to epidemics and deaths.

An investigation by journalist Brian Deer found that Wakefield, the author of the original research paper linking the vaccine to autism, had multiple undeclared conflicts of interest, had manipulated evidence, and had broken other ethical codes. After a subsequent 2.5-year investigation, the General Medical Council ruled that Wakefield had acted "dishonestly and irresponsibly" in doing his research, carrying out unauthorized procedures for which he was not qualified, and acting with "callous disregard" for the children involved. Wakefield was found guilty by the General Medical Council of serious professional misconduct in May 2010 and was struck off the Medical Register, meaning he could no longer practise as a physician in the UK.

The Lancet paper was partially retracted in 2004 and fully retracted in 2010, when Lancet's editor-in-chief Richard Horton described it as "utterly false" and said that the journal had been deceived. In January 2011, Deer published a series of reports in the British Medical Journal, in which a signed editorial stated of the journalist, "It has taken the diligent scepticism of one man, standing outside medicine and science, to show that the paper was in fact an elaborate fraud." A 2011 journal article described the vaccine-autism connection as "the most damaging medical hoax of the last 100 years".

Wakefield continues to promote anti-vaccine beliefs and conspiracy theories in the United States. In February 2015, Wakefield denied that he bore any responsibility for the measles epidemic that started at Disneyland among unvaccinated children that year. He also reaffirmed his discredited belief that "MMR contributes to the current autism epidemic". By that time at least 166 measles cases had been reported. Paul Offit disagreed, saying that the outbreak was "directly related to Dr. Wakefield's theory". Wakefield and other anti-vaccine activists were active in the American-Somali community in Minnesota, where a drop in vaccination rates was followed by the largest measles outbreak in the state in nearly 30 years in 2017.

The anti-vaccination movement was historically apolitical, but in the 2010s and 2020s the movement in the United States has increasingly targeted conservatives. As measles outbreaks increased, so did calls to eliminate exemptions from vaccine administration. As of 2015, 19 American states had suggested legislation to eliminate or increase the difficulty of exemptions, including California. Concurrently, American anti-vaccine activists reached out to libertarian and right-leaning groups such as the Tea Party movement to broaden their base. While earlier anti-vaccination activists focused on health impacts and safety of vaccines, recent themes increasingly involve philosophical arguments about liberty, medical freedom and parental rights.

With the growing anti-vaccine movement from the 2010s onwards, the United States has seen a resurgence of certain vaccine-preventable diseases. The measles virus lost its elimination status in the US as the number of measles cases continued to rise in the late 2010s with a total of 17 outbreaks in 2018 and 465 outbreaks in 2019 (as of 4 April 2019).

2019 measles outbreaks

Vaccine hesitancy led to declining rates of vaccination for measles, culminating in the 2019–2020 measles outbreaks. The most significant of these in proportion to national population was the 2019 Samoa measles outbreak.

In July 2018, two 12-month-old children died in Samoa after receiving incorrectly prepared MMR vaccinations. These two deaths were picked up by anti-vaccine groups and used to incite fear towards vaccination on social media, causing the government to suspend its measles vaccination programme for ten months, despite advice from the WHO. The incident caused many Samoan residents to lose trust in the healthcare system. UNICEF and the World Health Organization estimate that the measles vaccination rate in Samoa fell from 74% in 2017 to 34% in 2018, similar to some of the poorest countries in Africa.

In August 2019, an infected passenger on one of the more than 8,000 annual flights between New Zealand and Samoa probably brought the disease from Auckland to Upolu. A full outbreak of measles began on the island in October 2019 and continued for the next four months. As of 6 January 2020, there were over 5,700 cases of measles and 83 deaths, out of a Samoan population of 200,874. Over three per cent of the population were infected. The cause of the outbreak was attributed to decreased vaccination rates, from 74% in 2017 to 31–34% in 2018, even though nearby islands had rates near 99%. a rate of 14.3 deaths per 1000 infected) and 5,520 cases (2.75% of the population) of measles in Samoa. 61 out of the first 70 deaths were aged four and under and all but seven were aged under 15. After the outbreak, anti-vaxxers employed racist tropes and misinformation to credit the scores of measles deaths to poverty and poor nutrition or even to the vaccine itself, but this has been discounted by the international emergency medical support that arrived in November and December. There was no evidence of acute malnutrition, clinical vitamin A deficiency, or immune deficiency as claimed by various anti-vaxxers.

COVID-19 pandemic activism

During the COVID-19 pandemic, anti-vaccine activists undertook various efforts to hinder people who wanted to receive the vaccines, with such activities occurring in countries including Australia, Israel, the United Kingdom, and the United States. These included attempts to physically blockade vaccination sites, and making false reservations for vaccination appointments to clog up vaccination booking systems. Protests were also organized by the activists to raise awareness for their cause.

In some instances, anti-vaccine rhetoric has been traced to state-sponsored internet troll activities designed to create social dissension. Worldwide, foreign disinformation campaigns have been associated with declining vaccination rates in target countries. Anti-vaccine activism online both before and during the pandemic has been linked to extreme levels of falsehoods, rumours, hoaxes, and conspiracy theories.

Anti-vaccine activists have falsely claimed in social media posts that numerous deaths or injuries had to do with reactions to vaccines. In one highly publicized instance in early 2023, after Buffalo Bills football player Damar Hamlin experienced an in-game episode of commotio cordis, there was an increase in rhetoric and disinformation from figures such as Charlie Kirk and Drew Pinsky making unfounded claims about Hamlin's cardiac arrest and COVID-19 vaccines. In another 2023 incident, college basketball player Bronny James experienced cardiac arrest at the Galen Center at the University of Southern California, leading to assertions that this was a result of receiving a COVID-19 vaccine; it was later revealed that the episode had been caused by a congenital heart defect.

Strategies and tactics

Arguments used

In a 2002 paper in the British Medical Journal, two medical historians suggested that the arguments made against the safety and effectiveness of vaccines in the late 20th century are similar to those of the early anti-vaccinationists. Both the 19th and 20th century arguments included "vaccine safety issues, vaccine failures, infringement of personal liberty, and an unholy alliance between the medical establishment and the government to reap huge profits for the medical establishment at the expense of the public." However, the authors only considered the use of "newspaper articles and letters, books, journals, and pamphlets to warn against the dangers of vaccination", and did not address the impact of the internet. Comments on youtube videos during the COVID-19 pandemic clustered similarly around "concerns about side-effects, effectiveness, and lack of trust in corporations and government".

Misrepresentation

In some instances, anti-vaccine organizations have used names intended to sound non-partisan on the issue: e.g. National Vaccine Information Center (USA), Vaccination Risk Awareness Network (Canada), Australian Vaccination Network. In November 2013 the Australian Vaccination Network was ordered by the New South Wales Administrative Decisions Tribunal to change their name so that consumers are aware of the anti-vaccination nature of the group. Lateline reported that former AVN president Meryl Dorey "claimed she was a victim of hate groups and vested interests" in response to the ruling.

Information quality

Although physicians and nurses are still rated as the most trusted source for vaccine information, some vaccine-hesitant individuals report being more comfortable discussing vaccines with providers of complementary and alternative (CAM) treatments. With the rise of the internet, many people have turned online for medical information. In some instances, anti-vaccine activists seek to steer people away from vaccination and health-care providers and towards alternative medicines sold by certain of the activists.

Anti-vaccination writings on the internet have been argued to be characterized by a number of differences from medical and scientific literature. These include:

  • Promiscuous copying and reduplication.
  • Ignoring corrections, even when an initial report or data point is shown to be false.
  • Lack of references, difficulty in checking sources and claims.
  • Personal attacks on individual doctors.
  • A high degree of interlinkage between sites.
  • Dishonest or fallacious arguments.

For example, a 2020 study examined Instagram posts related to HPV vaccine, which can prevent some types of cancer. Antivaccine posts were more likely than provaccine posts to be sent by non-healthcare individuals, to include personal narratives, and to reference other Instagram users, links, or reposts. Antivaccine posts were also more likely to involve concealment or distortion, particularly conspiracy theories and unsubstantiated claims. 72.3% of antivaccine posts made inaccurate claims, including exaggerating the risks of vaccines and minimizing risks of disease.

Disinformation tactics

A number of specific disinformation tactics have been noted in anti-vaccination messaging, including:

  • Conspiracies theories alleging lies, trickery, cover-ups, and secret knowledge
  • Messages crafted for psychological appeal rather than truthfulness
  • Fake experts
  • Impossible expectations: claiming that anything less than 100% certainty in a scientific claim implies doubt, and that doubt means there is no consensus
  • Selective cherry-picking: using obscure or debunked sources while ignoring counter-evidence and scientific consensus
  • Shifting hypotheses: Continually introducing new theories about vaccines being harmful; moving to new claims when existing ones are shown to be false
  • Misrepresentation, false logic and illogical analogies
  • Personal attacks on critics, ranging from online criticism, publicly revealing personal details, and threats, to offline acitivities such as legal actions, targeting of employers, and violence

Economics of vaccine disinformation

Information is more likely to be believed after repeated exposure. Disinformers use this illusory truth effect as a tactic, repeating false information to make it feel familiar and influence belief. Anti-vaccine activists have leveraged social media to develop interconnected networks of influencers that shape people's opinion, recruit allies, impact policy and monetize vaccine-related disinformation. In 2022, the Journal of Communication published a study of the political economy underlying vaccine disinformation. Researchers identified 59 English-language "actors" that provided "almost exclusively anti-vaccination publications". Their websites monetized disinformation through appeals for donations, sales of content-based media and other merchandise, third-party advertising, and membership fees. Some maintained a group of linked websites, attracting visitors with one site and appealing for money and selling merchandise on others. Their activities to gain attention and obtain funding displayed a "hybrid monetization strategy". They attracted attention by combining eye-catching aspects of "junk news" and online celebrity promotion. At the same time, they developed campaign-specific communities to publicize and legitimize their position, similar to radical social movements.

Misrepresentation of the Vaccine Adverse Event Reporting System

In the United States, the Vaccine Adverse Event Reporting System (VAERS) is used to gather information on potential vaccine adverse reactions, but is susceptible to unverified reports, misattribution, underreporting, and inconsistent data quality. Raw, unverified data from VAERS has often been used by the anti-vaccine community to justify misinformation regarding the safety of vaccines; it is generally not possible to find out from VAERS data if a vaccine caused an adverse event, or how common the event might be.

Legal action

Since Republicans gained a majority in the House in January 2023, the House Judiciary Committee has used legal action to actively oppose both disinformation research and government involvement in fighting disinformation. One of the projects targeted is the Virality Project, which has examined the spread of false claims about vaccines. The House Judiciary Committee has sent letters, subpoenas, and threats of legal action to researchers, demanding notes, emails and other records from researchers and even student interns, dating back to 2015. Institutions include the Stanford Internet Observatory at Stanford University, the University of Washington, the Atlantic Council's Digital Forensic Research Lab and the social media analytics firm Graphika. Researchers emphasize that they have academic freedom to study disinformation as well as freedom of speech to report their results.

Despite conservative claims that the government acted to censor speech online, "no evidence has emerged that government officials coerced the companies to take action against accounts". The actions of the House Judiciary Committee have been described as an "attempt to chill research,” creating a "chilling effect" through increased time demands, legal costs and online harassment of researchers.

Harassment

Persons undertaking efforts to counter vaccine misinformation, including public health experts who use social media, have been targeted for harassment by anti-vaccine activists. For example, Slovakian physician Vladimír Krčméry was a prominent member of the government advisory team during the COVID-19 pandemic in Slovakia, and was the first person to in that country to receive a COVID-19 vaccine. Due to his prominent role in the vaccination campaign, Krčméry and his family became a target of anti-vaccine activists, who physically threatened him and his family.

In June 2023, Texas-based physician and researcher Peter Hotez tweeted his concerns about Robert F. Kennedy Jr. sharing misinformation about vaccines on Joe Rogan's podcast. Rogan, Kennedy, and Twitter owner Elon Musk asked Hotez to participate in a debate on the podcast. Upon declining the invitation, Hotez was harassed by their fans, with anti-vaccine activist Alex Rosen confronting him at his home.

In his book The Deadly Rise of Anti-science: A Scientist's Warning, Hotez describes how he and other scientists who publicly defend vaccines have been attacked on social media, harassed with threatening emails, intimidated, and confronted physically by opponents of vaccination. He attributes the increase in aggressiveness of the anti-vaccination movement to the influence of the extreme wing of the Republican Party. Hotez estimates that roughly 200,000 preventable deaths from COVID-19, mainly among Republicans, occurred in the US because of refusal to be vaccinated.

At the extreme end, opposition to vaccination has resulted in substantial violence against vaccinators. In Pakistan, "more than 200 polio team workers have lost their lives" (team members include not only vaccinators but police and security personnel) from "targeted killing and terrorism" while working on polio vaccination campaigns.

Countering anti-vaccine activism

Various efforts have been suggested and undertaken to address concerns about vaccines and counter anti-vaccine disinformation. Efforts include social media advertising campaigns, by public health organizations, in support of public health goals.

Best practices for combating vaccine mis- and disinformation include addressing issues openly, clearly identifying areas of scientific consensus and areas of uncertainty, and being sensitive to the cultural and religious values of communities. In countering anti-vaccine disinformation, both factual and emotional aspects need to be addressed.

Whether people will update a mistaken belief is complicated and involves psychological factors and social goals as well as accuracy of information. There is some evidence that both debunking and "pre-bunking" of disinformation can be effective, at least in the short term. Elements that may help to correct inaccurate information include: warning people before they are exposed to misinformation; high perceived credibility of message sources, affirmations of identity and social norms; graphical presentation; and focusing attention on clear core messages. Alternative explanations of a situation need to fit plausibly into the original scenario and ideally indicate why the incorrect explanation was previously thought to be correct.

The cultivation of critical thinking, health and science awareness, and media literacy skills are all recommended to help people more critically assess the credibility of the information they see. People who seek out multiple reputable news sources at local and national levels are more likely to detect disinformation than those who rely on few sources from a particular viewpoint. Particularly on social media, beware of sensational headlines that appeal to emotion, fact-check information broadly (not just through your usual sources), and consider possible agendas or conflicts of interest of those relaying information.

Operation of social media

Other suggestions for countering anti-vaccine activism focus on changing the operation of social media platforms. Interventions such as accuracy nudges and source labelling change the context in which information is presented. For example, correct information can be directly presented to counter disinformation. Other possibilities include flagging or removing misleading information on social media platforms. Research suggests that a majority of individuals in the United States would support the removal of harmful misinformation posts and the suspension of accounts. This position is less popular with Republicans than Democrats.

While private entities like Facebook, Twitter and Telegram could legally establish guidelines for moderation of information and disinformation on their platforms (subject to local and international laws) such companies do not have strong incentives to control disinformation or to self-regulate. Algorithms that are used to maximize user engagement and profits can lead to unbalanced, poorly sourced, and actively misleading information.

Criticized for its role in vaccine hesitancy, Facebook announced in March 2019 that it would provide users with "authoritative information" on the topic of vaccines. Facebook introduced several policies chosen to reduce the impact of anti-vaccine content, without actually removing it. These included reducing the ranking of anti-vaccine sources in searches and not recommending them; rejecting ads and targeted advertising that contained vaccine misinformation; and using banners to present vaccine information from authoritative sources. A study examined the six months before and after the policy changes. It found a moderate but significant decrease in the number of likes for anti-vaccine posts following the policy changes. Likes of pro-vaccine posts were unchanged. Facebook has been criticized for not being more aggressive in countering disinformation. In response to efforts to police misinformation, anti-vaccine communities on social media have adopted coded language to refer to vaccinated persons and the vaccines themselves.

Supply-side interventions reduce circulation of misinformation directly at their sources through actions such as application of social media policies, regulation, and legislation. A study published in the journal Vaccine examined advertisements posted in the three months prior to the Facebook's 2019 policy changes. It found that 54% of the anti-vaccine advertisements on Facebook were placed by just two organizations, funded by well-known anti-vaccination activists. The Children's Health Defense / World Mercury Project chaired by Robert F. Kennedy Jr. and Stop Mandatory Vaccination, run by campaigner Larry Cook, posted 54% of the advertisements. The ads often linked to commercial products, such as natural remedies and books. Kennedy was suspended from Facebook in August 2022, but reinstated in June 2023.

In 2023, however, state governments that were politically aligned with anti-vaccine activists successfully sought a preliminary injunction to prevent the Biden Administration from seeking to pressure social media companies into fighting misinformation. The order issued by United States Court of Appeals for the Fifth Circuit "severely limits the ability of the White House, the surgeon general, [and] the Centers for Disease Control and Prevention... to communicate with social media companies about content related to Covid-19... that the government views as misinformation". In October 2023, this injunction was paused by the Supreme Court of the United States, pending further litigation.

Use of algorithms and data

Algorithms and user data can be used to identify selected subgroups who can then be provided with specialized content. This type of approach has been used both by anti-vaccine activists and by health providers who hope to counter vaccine-related disinformation. For example, in the United States, the CDC’s Social Vulnerability Index (SVI) has been used to identify communities that have traditionally been under-served or are at elevated risk for infection, morbidity, and mortality. Programs have been developed in such communities to address disinformation and vaccine hesitancy.

Community engagement

Steps have been taken to counter anti-vaccine messaging by directly engaging with communities. Outreach efforts include call centers and texting campaigns, partnering with local community leaders, and holding community-based vaccine clinics. Creating digital and science literacy resources and distributing them via schools, libraries, municipal offices, churches and other community groups can help to counter misinformation in under-resourced communities.

The Black Doctors Covid-19 Consortium in Philadelphia is one example of a successful direct outreach initiative. Another is the New York State Vaccine Equity Task Force. In line with the Strategic Advisory Group of Experts (SAGE)'s 3C's model, outreach to communities has focused on addressing mistrust and increasing Confidence, providing information to improve risk assessment (Complacency), and improving access to COVID-19 vaccines (Convenience). It has been necessary to counter disinformation in all three areas.

Recommendations for combating vaccine disinformation include increasing the presence of trusted health agencies and credible information on social media, partnering with social media platforms to promote evidence-based public health information, and identifying and responding to emerging concerns and disinformation campaigns. Networked communities of public health officials and other stakeholders, connecting with the public through a variety of credible and trusted messengers, are recommended. Sharing of messages through such networks could help to prebunk and counter highly networked and coordinated disinformation attacks.

A networked community approach would differ from the current model of US public health communication, which tends to rely on a single credible messenger (e.g. Anthony Fauci) and is susceptible to disinformation attacks. To deal with disinformation, community networks would need to address issues of liberty and human rights as well as vaccine safety, effectiveness and access. Networks could also help to show support for those attacked by anti-vaccine activists.

Politics of Europe

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