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[Editor’s note: Today is a holiday in the U.S.; so I decided to revise and update a recent post that you might have seen elsewhere last week. This version is a bit longer and includes information that popped up this weekend. I’ll be back with all original material next Monday.]

It’s hard for me to believe that I’ve now been writing about the antivaccine movement on a regular basis for the last 15 years. In fact, it blows my mind that the first big splash I made writing about antivaccine conspiracy theories dates back to June 2005, when I took on the utterly awful article simultaneously published in Rolling Stone and Salon.com, “Deadly Immunity“. The article was by Robert F. Kennedy, Jr. and was basically a conspiracy theory that claimed that the CDC “knew” that the mercury-containing preservative thimerosal, which was in several childhood vaccines until 2002, caused autism but that it “covered up” the data showing it at a conference in 2000 held at the Simpsonwood Conference Center near Atlanta. It was the first example I had ever encountered of what I now like to call the “central conspiracy theory of the antivaccine movement“. Little did I know then that the conspiracy theory of “they knew, but covered it up” was (and is) the primary structure of nearly all antivaccine conspiracy theories. Now that thimerosal has been gone from vaccines for 18 years it’s been supplanted by the “CDC whistleblower” conspiracy theory (featured in the 2016 conspiracy film disguised as a documentary VAXXED ), in which a senior CDC scientist supposedly admitted that the CDC “knew” that vaccines cause autism but manipulated data in one of its studies to cover up the link. Plus ça change…

This leads me to the question of a COVID-19 vaccine. Most scientists with direct knowledge of vaccine development agree that the projections that we’ll have a vaccine for this new coronavirus within 12-18 months (much less by the end of the year, as was recently promised) are incredibly, even unrealistically, optimistic. Although there has been an unprecedented international effort to develop a safe and effective vaccine, as yet we only have candidates, a few of which are at the very beginning of clinical testing. Predictably, as they do during every pandemic and major epidemic, such as H1N1, Ebola, and Zika virus, antivaxxers are spinning conspiracy theories about how the COVID-19 pandemic is a “Plandemic” or a plot to force everyone to be vaccinated, complete with Bill Gates conspiracy theories and claims that there will be microchips in the new COVID-19 vaccine. The conspiracy mongering and pre-emptive push by antivaxxers to discredit a coronavirus vaccine are so blatant that they made the mainstream media last week, for example in this op-ed by Kevin Roose for the New York Times:

The other night, midway through watching a clip from “Plandemic” — a documentary that went viral on social media last week, spreading baseless lies and debunked nonsense about the coronavirus to millions of Americans overnight — I had a terrifying thought:

What if we get a Covid-19 vaccine and half the country refuses to take it?

It occurred to me that all the misinformation we’ve seen so far — the false rumors that 5G cellphone towers fuel the coronavirus, that drinking bleach or injecting UV rays can cure it, that Dr. Anthony Fauci is part of an anti-Trump conspiracy — may be just the warm-up act for a much bigger information war when an effective vaccine becomes available to the public. This war could pit public health officials and politicians against an anti-vaccination movement that floods social media with misinformation, conspiracy theories and propaganda aimed at convincing people that the vaccine is a menace rather than a lifesaving, economy-rescuing miracle.

Scariest of all? It could actually work.

He’s not wrong.

Roose goes on to point out that the antivaccine movement is far better at social media messaging than most public health advocates:

I’ve been following the anti-vaccine community on and off for years, watching its members operate in private Facebook groups and Instagram accounts, and have found that they are much more organized and strategic than many of their critics believe. They are savvy media manipulators, effective communicators and experienced at exploiting the weaknesses of social media platforms. (Just one example: Shortly after Facebook and YouTube began taking down copies of “Plandemic” for violating their rules, I saw people in anti-vaccine groups editing it in subtle ways to evade the platforms’ automated enforcement software and reposting it.)
In short, the anti-vaxxers have been practicing for this. And I’m worried that they will be unusually effective in sowing doubts about a Covid-19 vaccine for several reasons.

I’ve been following the antivaccine movement for even longer, I’ll wager, and I know that Roose is correct here. It wasn’t always true, though, that the antivaccine movement was media- and social media-savvy. Indeed, early on I used to make fun of the cluelessness of antivaccine advocates on using blogs (Twitter and Facebook were only in their infancy). Then, when they made their first major forays onto Twitter to try to promote the “CDC whistleblower” antivaccine conspiracy theory, I made fun of the ham-handedness of it all. That was nearly six years ago, and six years have made a big difference. Antivaxxers now have media-savvy con men like Del Bigtree fronting for them, generating content, spreading conspiracy theories, and hyping controversy.

If you want an idea of how much more skilled antivaxxers have become, consider Plandemic, the video featuring disgraced scientist Judy Mikovits and the mother of all COVID-19 conspiracy theories. I’ve said all along that the video going viral was a planned event, and it turns out that I was correct. The ever-astute Anna Merlan discovered that an ex-Google employee and QAnon believer named Zach Vorhies conceived and executed a plan to make the video go viral, and it worked. She also reported that Vorhies has ties to the antivaccine movement, including Del Bigtree and Robert F. Kennedy, Jr., having appeared on The Highwire With Del Bigtree as the “Google whistleblower” who, apparently, revealed Google’s nefarious plans to alter its search algorithms to deprioritize antivaccine misinformation. It was Vorhies, in fact, who introduced Mikovits to Mikki Willis, the filmmaker who produced the video and served as her interviewer.

To give you an idea what a disadvantage science communicators are now at, there was a study published in Nature by investigators at George Washington University, Michigan State University, Los Alamos National Laboratory, and the University of Miami. The study mapped the conversation about vaccines on Facebook during the 2019 measles outbreaks and compared provaccine pages and groups to antivaccine pages and groups. The authors found a complex landscape involving nearly 100 million users “partitioned into highly dynamic, interconnected clusters across cities, countries, continents and languages.” Key findings included that there were nearly three times as many active antivaccine communities as pro-vaccine communities but that, although the pro-vaccine communities tended to have more followers/members, the antivaccine pages were growing faster.

Here’s where the problem lies. The pro-vaccine groups tended to be peripheral and homogeneous. Of course, it’s kind of hard for them not to be homogeneous, given that the key messages pro-vaccine groups want to promote is that vaccines are safe and effective, they prevent deadly disease, and they do not cause all the health problems attributed to them by antivaccine groups. The antivaccine groups, in contrast, interacted with way more groups. The authors proposed seven reasons why antivaccine misinformation has spread so much:

  1. Although smaller numerically, antivaccine clusters tend to become more central within the networks mapped compared to provaccine clusters. The antivaccine clusters become entangled with a large number of undecideds, while pro-vaccine clusters tend to be more peripheral, thus remaining ignorant of the conflict and gaining the wrong impression that they are winning.
  2. Contrary to the view of “undecideds,” it turns out that the undecided individuals are not passive, but active, producing the highest growth of new out-links and becoming entangled with antivaccine clusters.
  3. Antivaccine individuals form more than twice as many clusters as provaccine individuals, providing a larger number of sites for engagement than provaccine populations and a much better ability for antivaccine networks to become central.
  4. Antivaccine clusters aren’t just about vaccines. They provide a number of potentially attractive narratives that “blend topics such as safety concerns, conspiracy theories and alternative health and medicine, and also now the cause and cure of the COVID-19 virus.”
  5. Antivaccine clusters showed the highest growth during the measles outbreak of 2019, while pro-vaccine clusters showed the lowest growth.
  6. Medium-sized anti-vaccination clusters grow the most. Whereas larger anti-vaccination clusters take up the attention of the pro-vaccination population, these smaller clusters can expand without being noticed.
  7. Geography is a favorable factor for the anti-vaccination population. Anti-vaccination clusters either self-locate within cities, states or countries, or remain global.

Roose further adds about the study:

The researchers found that Facebook pages pushing accurate pro-vaccine information were mostly clustered in an insular group, while the anti-vaccine pages treated vaccine resistance as a kind of political campaign, and used different messages to reach different types of undecided “voters.” A page promoting holistic health remedies might start seeding doubts about vaccines among liberal yoga moms, while a page promoting resistance to government-mandated vaccines might appeal to conservatives and libertarians.

This is, of course, the sort of thing that those of us who’ve been following the antivaccine movement have known for a long time, which is one reason why we’ve been so vocal about the links between “integrative medicine” and alternative medicine and antivaccine views.

The depressing theoretical prediction from this modeling is that, if current trends continue, antivaccine support on Facebook will become dominant in a little more than a decade. Obviously, this is just one model, but its findings otherwise are fairly consistent with other research on the spreading of misinformation on social networks.

Unfortunately, as Roose further notes it’s also true that a new coronavirus vaccine, whenever it is developed, will be a perfect target for antivaccine conspiracy theories. For one thing, vaccine candidates are being rushed through development at an unprecedented pace, and vaccine candidates are likely to be fast-tracked through the regulatory approval process. This observation has led even pro-vaccine advocates express concern that, given all the haste, corners might be cut and safety testing might be deficient. Heck, I’ve worried about the same thing, knowing that any serious adverse events showing up later that were missed in the clinical trials leading to approval of the vaccine will be used to discredit not just a coronavirus vaccine, but all vaccines. Antivaxxers will use any such debacle to claim that all vaccines are inadequately tested and therefore unsafe. Moreover, organizations demonized by the antivaccine movement will be the ones promoting the vaccines, organizations such as the Bill and Melinda Gates Foundation, the CDC, and the World Health Organization, will be at the center of the distribution of any new vaccine. If you know anything about the antivaccine movement, you know that the conspiracy theories will practically write themselves, because the groundwork has already been laid. Various existing conspiracy theories will be combined in different combinations, with new misinformation sprinkled in, to sow fear, uncertainty, and doubt about vaccines.

Then, of course, there will be mandates. It’s a virtual certainty that, once a vaccine is approved, it will be added to the list of vaccines that children will be required to have had in order to attend school. It’ll also almost certainly be added to the vaccines required for most health care workers, which already includes influenza and DTaP vaccines. It might even be required for international travel. If there’s one thing that antivaxxers are good at, it’s weaponizing “health freedom” and “parental rights” arguments to attract right wing anti-regulation small government conservatives, as I’ve described many times. That’s the reason why the antivaccine movement has increasingly found a home in the Republican Party over the last several years, or, at the very least, the Republican Party has demonstrated itself all-too-willing to pander to antivaccine conspiracy theories for votes, as was observed during the second GOP Presidential Debate of the 2016 election cycle, when the most telling part about vaccines was how Ben Carson reversed his previous strong stand in favor of mandates to “go all squishy” on them.

Just this weekend, Sarah Zhang wrote in The Atlantic:

There is no COVID-19 vaccine, but there are already COVID-19 vaccine conspiracies. Even as vaccines for the disease caused by SARS-CoV-2 are being held up as the last hope for a return to normalcy, misinformation about them is spreading. A more fraught scenario for science communication is hard to imagine: a novel vaccine, probably fast-tracked, in the middle of a highly politicized and badly mishandled pandemic.

“I was initially optimistic that, when people felt the need for a COVID-19 vaccine, the anti-vaccination movement would undergo a period of retreat,” says Peter Hotez, a vaccine scientist at Baylor College of Medicine, who has himself become a frequent target of vaccine skeptics. “It’s actually had the effect of reinvigorating the anti-vaccine movement.”

I admire Dr. Hotez to death, but until recently he really was quite naïve about the antivaccine movement, as are many doctors and scientists. I even fell into that category several years ago, thinking that vaccines are the victims of their own success and that, because we don’t see the mass suffering now due to the diseases we now vaccinate against, the return of such an infectious disease (or diseases) would lead antivaxxers to reassess. However, this reaction of the antivaccine movement to COVID-19 should have been very predictable, just based on the experience from last year. As we saw then, with the return of measles in so many places due to low uptake of the MMR vaccine, the antivaccine movement was unmoved. In fact, it doubled down. Del Bigtree, for instance, taped a yellow Star of David to his shirt saying unvaccinated, thus comparing himself and antivaxxers to Jews during the Holocaust, about as offensive analogy as I can think of. Other antivaxxers likened their movement to the civil rights movement, a similarly offensive analogy.

Despite the image of antivaxxers being hippy dippy, granola crunching lefties, in fact, antivaccine views are roughly equally prevalent on the political right and the left, and this has been true for a long time. However, over the last decade (and in particular since the passage of SB 277 in California to outlaw nonmedical exemptions to school vaccine mandates), increasingly the antivaccine movement has been appealing to the right more than the left through the use of conservative-friendly rhetoric of “freedom”, “parental rights”, and the portrayal of school vaccine mandates as overweening government overreach. What was once a bipartisan consensus on the value of school vaccine mandates has been becoming increasingly politicized.

While it is true that there are certainly still left wing antivaxxers, the most prominent of which are Robert F. Kennedy, Jr. and Marianne Williamson, right now, in 2020, the loudest antivaccine voices are nearly all on the right. It was thus at least somewhat predictable that in the era of lockdowns to slow the spread of COVID-19 antivaxxers would ally themselves increasingly with right wing anti-lockdown protesters, and, unfortunately, that is what has happened, as I noted right here over a month ago.

Unfortunately, as Zhang and Hotez note, we haven’t exactly made it hard for the COVID-19 denier/antivaccine alliance:

Hotez points to a number of recent missteps that have given vaccine skeptics ammunition: unrealistically rosy timelines for a vaccine; the appointment of a former pharma executive with $12.4 million worth of vaccine-company stock options to lead the White House’s new vaccine initiative (he is now divesting); even the name of the Trump administration’s vaccine initiative itself, Operation Warp Speed. “A ridiculous metaphor,” Hotez says, “that plays right into the hands of the anti-vaccine lobby” by emphasizing swiftness rather than safety.

The terrible thing about the name “Operation Warp Speed” and the rush for a COVID-19 vaccine is that it produces very reasonable concerns that we’re going to fast, that there are incentives to cut corners, that the FDA will fast track the vaccine at the expense of safety in a manner even worse than how it’s fast-tracked cancer drugs that are expensive and produce no benefit in terms of absolute survival based on surrogate markers. In fact, many of those warning against sacrificing safety for speed are pro-vaccine advocates like Dr. Hotez and, yes, me.

One thing’s for sure. Whenever a COVID-19 vaccine is finally approved, there will be a disinformation campaign launched by antivaxxers the likes of which we’ve never seen before. We need to prepare.

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Posted by David Gorski

Dr. Gorski's full information can be found here, along with information for patients. David H. Gorski, MD, PhD, FACS is a surgical oncologist at the Barbara Ann Karmanos Cancer Institute specializing in breast cancer surgery, where he also serves as the American College of Surgeons Committee on Cancer Liaison Physician as well as an Associate Professor of Surgery and member of the faculty of the Graduate Program in Cancer Biology at Wayne State University. If you are a potential patient and found this page through a Google search, please check out Dr. Gorski's biographical information, disclaimers regarding his writings, and notice to patients here.