Over a decade ago, I partnered with some colleagues to establish a Facebook group that refuted misinformation about the H1N1 vaccine. It was a challenging, if futile task. At the time, public health agencies had little active engagement on social media. Few seemed to recognize the growing importance of “Web 2.0” (as it was called at the time) as a communications tool that could be used positively, but equally as a vector for spreading fear and sowing doubt. Frustrated with our experience, we made our way on to the agenda of a subsequent public health conference where we described the tactics and tropes of the anti-vaccine movement, and did our best to convince public health professionals to take social media, and the antivaccine movement, seriously. The anti-vaccine movement was highly organized and growing, and public health was not.
Looking at all that work in hindsight, it’s remarkable but also entirely predictable that we are in our current situation. But what I didn’t realize back in 2009 was how much social media companies stood to gain from the anti-vaccine movement. In January 2021 we are in the midst of a deadly pandemic that has already killed millions, and continues to kill thousands daily. Despite hospital intensive care units that are at capacity, there is ongoing disease denial and deliberate minimization of the harms of COVID-19 infections. There is limited but strident opposition to basic, simple public health measures, like distancing and masks. And despite newly-developed vaccines showing high rates of efficacy and good safety profiles, there is considerable and widespread vaccine hesitancy.
The Center for Countering Digital Hate (CCDH) recently published a report, The Anti-Vaxx Playbook, that describes in detail how key members of the anti-vaccine movement are collaborating and partnering in new ways to exploit the COVID-19 pandemic, create consistent anti-vaccine messaging, and destroy confidence in vaccination. The report is based on observations from the National Vaccine Information Center (NVIC)’s conference held online in 2020. Misleadingly titled “Protecting Health and Autonomy in the 21st Century“, this event brought together a long list of anti-vaccine advocates with the apparent goal of helping participants more effectively push back against science, evidence, and public health measures.
In early 2020 the CCDH put out a report entitled The Anti-Vaxx Industry which examined anti-vaccine social media, noting that 409 different English language anti-vaccine accounts had 58 million followers, with evidence that collectively, followers had grown approximately 19% since 2019. The COVID-19 pandemic has been a booming business opportunity for anti-vaxxers and social media alike. The CCDH named four different sub-communities of anti-vaxxers:
- Campaigners are full-time, anti-vaccine professionals who may be seen as “experts”. They make a living based on promoting anti-vaccine sentiment and ideas. Their examples include: Informed Consent Action Network (Del Bigtree), Children’s Health Defence (Robert F. Kennedy Jr.), and the National Vaccine Information Center (NVIC).
- Entrepreneurs leverage and amplify vaccine fears to sell content, products and services. Examples include Rashid Buttar, Ty and Charlene Bollinger, David Wolfe, Judy Mikovits, and the biggest, Joseph Mercola.
- Conspiracists focus on vaccines from a conspiracy angle, but vaccines are not their full-time focus. They may also be entrepreneurs. Examples they listed include Brian Rose, David Icke, and Patrick Bet-David.
- Communities are groups that share anti-vaccine ideas and stories, usually in Facebook Groups. Examples include “Stop Mandatory Vaccination”, “Vaccine Re-education Discussion Forum”, “Vaccine Choices”, and many more hidden, private groups.
Certainly there is some overlap in these categories, and while I might quibble with their classifications, it’s worth acknowledging that anti-vaccine sentiment and rhetoric can be driven by a variety of motivations. While Facebook and other providers took some steps to address anti-vaccine sentiment after measles outbreaks in the US, the measures were largely ineffective in preventing its continued growth on the platforms. For example, Robert F. Kennedy Jr, who has touted COVID-related conspiracies since the beginning of the pandemic, has seen his Instagram following rise from 121,000 at the beginning of the pandemic to 792,000 today. He is just one example of the number of anti-vaccine advocates who have seen large increases in audience and reach. This type of growth is continuing largely unabated, probably because the CCDH has estimated that the anti-vaccine movement could be generating up to $1 billion in advertising revenue across the different platforms. Facilitating and spreading vaccine misinformation is highly profitable.
The master narrative
Despite the disparate group of individuals that are driving anti-vaccine sentiment, messaging has consolidated around a few key messages. NVIC’s virtual conference in October 2020 was accessible to anyone that registered, and CCDH attended. Prominent speakers included Barbara Loe Fisher (NVIC), Joseph Mercola, Del Bigtree, Robert F. Kennedy Jr., Sherri Tenpenny, and Andrew Wakefield. CCDH noted that these speakers see COVID-19 as a historic opportunity:
A number of speakers at the NVIC conference presented the Covid pandemic as an historic opportunity to popularise anti-vaccine sentiment. Robert F. Kennedy Jr. told activists listening to the conference “All of the truths that we’ve been trying to broadcast for many, many years. There are people hearing it and the impact and those seeds are landing on very fertile ground.” The disgraced physician Andrew Wakefield echoed these sentiments, saying “The population who are aware of these issues has grown dramatically in the face of coronavirus, Covid-19. It is now an issue for discussion by everyone.” Other anti-vaxxers such as Sherri Tenpenny highlighted the Covid pandemic as an opportunity to build a wider movement with campaigners against masks and lockdowns: “We need everyone to get politically active, get behind this cause, get behind Hugs Over Masks, get behind MAD, Mothers Against Distancing, get behind the NVIC, the National Vaccine Information Center, get behind the things that we’re doing over at vaxxter.com, and Courses for Mastery, and our boot camp course that open enrolment is coming up again, the end of September. All the things that we’re doing, we need all hands on deck. We need everybody to release their fear from their brains, get rid of their masks, go hug people and absolutely say no. Wake up your community.”
There are three key messages identified by the CCDH that are overlapping and common across these different speakers. They are recurrent and you will see them, in some form, in almost all anti-COVID-19-vaccine messaging:
- COVID-19 is not dangerous. Talking points: There are few deaths, and death reports are exaggerated. “It’s just the flu.” “It will just go away on its own.”
- COVID-19 vaccines are dangerous. Talking points: “The vaccines were rushed.” “The vaccines are killing people.” “Natural” immunity is better. Other treatments (e.g., hydroxychloroquine) are safer and better. “Vaccines are toxic.” “Vaccines will change your DNA/destroy your immune system.” etc. etc.
- Vaccine advocates cannot be trusted. Talking points: “It’s politics over health.” “It’s Big Pharma profits over health.” Vaccines are “too big to fail” and manufacturers are “not liable for injuries.” “Bill Gates! Bill Gates! Bill Gates!”
Adapting the Master Narrative
The Master Narrative is easily adaptable to target specific groups. The CCDH lists four, and describes how messaging is being modified to make the messaging more appealing:
Alternative health advocates
- “COVID-19 is not dangerous” becomes “Alternative health products can prevent or treat COVID-19.” This is simply an extension of what we have documented repeatedly at this blog – the unending array of unproven or ineffective products touted as effective because someone has something to sell.
- “The COVID-19 vaccine is dangerous” is translated to “Alternative health experts say the vaccine is dangerous.” Another recurrent topic on this blog, where we have documented the efforts of naturopaths, chiropractors, homeopaths and other providers who do not practice based on scientific standards. Some of these practitioners are repeating misinformation and leveraging their perceived credibility as “professionals”.
- “Vaccine advocates cannot be trusted” becomes “Vaccine advocates suppress alternative health.” This is something that any health professional who advocates for science-based medicine hears all the time. By criticizing unproven or disproven remedies, we are dogmatic, not open to new ideas, and beholden to the pharma-industrial complex.
- “COVID-19 is not dangerous” is translated to “COVID is a Scamdemic.” The message becomes: COVID-19 doesn’t exist, or has never been isolated. Or it’s all due to 5G.
- “The COVID-19 vaccine is dangerous” is translated to “The vaccine is designed to control you or kill you.” Vaccination (this one at least) will apparently usher in some sort of totalitarian society. Microchips in the vaccines (really tiny ones) will track you and cause mind control.
- “Vaccine advocates cannot be trusted” becomes “COVID is a Plandemic”. The pandemic was all intentional, to create the need for lockdowns and infringements on civil liberties. The vaccine will be used to kill millions as part of “The Great Reset” which will destroy the global economy.
Parents of young children
- “COVID-19 is not dangerous” is translated to “Children are not at risk from COVID-19.” The rare but real harms to children from COVID-19 are ignored.
- “The COVID-19 vaccine is dangerous” is translated to “Children could suffer lifelong illness.” Consistent with long-standing anti-vaccine messaging, the COVID-19 vaccine is already being linked, without any evidence, to possible long-term consequences like diabetes, lupus, and auto-immune diseases.
- “Vaccine advocates cannot be trusted” becomes “Vaccine advocates are targeting children.” While no current COVID-19 vaccines are approved for children and children are not a priority group for vaccination, anti-vaccination advocates are targeting parents who are considering enrolling children in COVID-19 vaccine clinical trials.
Black and other ethnic or marginalized communities
- “COVID-19 is not dangerous” is translated to “COVID-19 does not affect minorities.” Despite objective evidence to the contrary that has become more and more apparent over time, some anti-vaxxers have claimed that African-Americans are less likely to be infected or harmed by COVID-19.
- “The COVID-19 vaccine is dangerous” is translated to “Vaccines are unsafe for minorities.” Rhetoric has criticized the poor representation of minorities in clinical trials, including vaccine clinical trials. Others have stated that the vaccine is an explicit attempt to kill minorities.
- “Vaccine advocates cannot be trusted” becomes “Vaccine advocates are linked to historical and structural racism.” The very real mistreatment and abuse of minorities in medical experiments and clinical trials in the past is being stoked and highlighted to heighten suspicion of the motives of health professionals that advocate for COVID-19 vaccination.
Taking action and countering the master narrative: Don’t spread the virus
In a traditional communications format, like conventional media, it’s generally important to rebut and counter incorrect information, while guarding against being drawn into a false equivalence debate. Social media platforms, however, are driven entirely by algorithms that determine what you see, and are designed not to give you factual information, but to maximize your engagement and time on the platform. The CCDH recommends not engaging with misinformation being spread online, noting that engagement only helps its reach. Social medial with extreme and inflammatory content generate a lot of views, because they generate a lot of reactions. The old blogging maxim DNFTT (Do Not Feed the Troll) still holds.
Rather than responding to anti-vaccine sentiment on social media, the CCDH recommends private messaging and contact, especially when it’s someone you know. Sending a DM, they argue, may limit the spread of misinformation and may lead to better outcomes.
Finally, the CCDH recommends sharing science-based information and pro-vaccine messaging. If you’ve received your COVID-19 vaccine, share it online – like our own David Gorski did on Twitter. They sum it up as follows.
Vaccinating others against anti-vaccine messaging
To prevent the spread of misinformation, one approach is to vaccinate individuals against it. This is consistent with the idea of “pre-bunking” that David Gorski has discussed previously. Science advocates should focus on countering the anti-vaccine “master narrative” whenever possible. Messaging and approaches the CCDH recommends includes:
- Tell the stories of those who have fallen ill through COVID-19 or from other vaccine-preventable diseases. Highlight how anti-vaccinationists target the parents of children who have been affected by these diseases.
- Put a human face on the development of the vaccine, highlighting the individuals that helped develop these products. This may help counter conspiracy ideas about the motivation of those scientists.
- Share clips and posts from recipients of the vaccine. This will reduce anxiety, especially for the early recipients.
- Expose the anti-vax methods and their own playbook. Show how anti-vaxxers are manipulating messaging and social media. Highlight how grifters are profiting from their anti-vaccination positions. Point out the Master Narrative they are using.
- Use different platforms: Instagram, TikTok, YouTube, Twitter, Facebook: Identify influential message carriers to share pro-vaccine messages.
- Create spaces for answering questions and addressing concerns: Make credible people accessible on social media to respond to questions.
Conclusion: A failure to act
The COVID-19 pandemic is the public health crisis of this generation. Despite the appearance of a brand new infectious disease – and within months, an effective vaccine, the anti-vaccine movement has built enough strength to potentially threaten our ability to bring this disease under control. These groups are highly organized, social-media savvy, and are coordinating effectively. Public health advocates and agencies are still playing a game of catch up and struggling to use social media effectively after more than a decade. The CCDH Anti-Vaxx Playbook is fascinating reading and highly recommended for anyone that wants to better understand the social media tactics of the anti-vaccine movement and become a more effective science, medicine, and vaccine advocate.