What does “antivaccine” really mean since the pandemic hit?

I’ve been writing about the antivaccine movement and antivaxxers for close to a quarter of a century. Here’s a brief history. I first encountered them on Usenet—does anyone remember Usenet?—in the late 1990s and then began writing about them on my personal blog beginning in late 2004. Then in 2008 I joined Science-Based Medicine as a regular contributor, later eventually becoming its managing editor, and since then have written more articles on vaccines, antivaccine misinformation, and the antivaccine movement than I can easily catalogue, often shared between SBM and my personal blog in either the same or revised versions. As I was contemplating what to write for Monday, having come off of a long holiday weekend, it occurred to me that it’s been over 12 years since I last wrote a post specifically about what I mean when I refer to someone or someone’s claims as “antivaccine”. I had been thinking about updating that post for a while, going back at least to times when I noted how “new school” antivaxxers who started out being against just COVID-19 vaccines were so rapidly becoming indistinguishable from the “old school” antivaxxers from before the pandemic, in particular how “new school” antivaxxers were adopting the same deceptive tropes to argue against vaccinating children against COVID-19 that “old school” antivaxxers had deployed against, for example, vaccinating against measles with the MMR.

It’s also important to me to try to update that old post because these days there are more antivaxxers than ever out there trying do deflect criticism in an old way, namely by accusing vaccine advocates of reflexively labeling anyone who has “concerns” about COVID-19 vaccines as “antivax”. While certainly, I try to avoid doing that, reserving the term for those who set off my disinformation antennae with real antivax talking points, I do have to concede that this sort of reflexive labeling does occasionally occur. That’s another reason why I decided that I needed to update my old post, to minimize that tendency.

While many things have changed, a lot of things have stayed the same with respect to antivaccine arguments, which led me to think that an update—or a rethinking, if you will, of my 2010 post was long overdue, just as I decided a month ago that an update to my post from 2009 about “brave maverick doctors” was in order. I joked in that post that, in some ways, it’s easy to echo the concurring opinion in Jacobellis v. Ohio by Justice Potter Stewart, where he famously wrote about pornography:

I shall not today attempt further to define the kinds of material I understand to be embraced within that shorthand description [“hard-core pornography”]; and perhaps I could never succeed in intelligibly doing so. But I know it when I see it, and the motion picture involved in this case is not that.

While it’s still as true in 2022 as it was in 2010 that I “know it when I see it” as far as antivaccine propaganda goes, I also realize that it’s important to try to define “antivaccine” in such a way that those who haven’t been paying attention to the antivaccine movement for well over two decades can start to recognize it too. I’ll use an analogy. This summer and fall, I helped teach a class for our incoming interns on basic surgical skills, such as tying knots and suturing. When you’ve been a surgeon over 30 years, such skills are part of what we like to call “muscle memory”. I just do them without thinking. However, when I had to stop and think through the individual steps in such a way as to teach beginners how to do the different kinds of knots and stitches, I soon realized that it’s very, very hard to break down something that I have been able to do without thinking about it into individual steps. Those of you who have ever had to teach beginners how to do a multistep task that you’ve done for so long that you don’t have to think about it any more will appreciate the analogy, namely that breaking down the patterns and characteristics that identify an antivaxxers is like teaching knot tying to interns.

I can identify antivax misinformation very easily without thinking much about it, having internalized the pattern recognition necessary to do it, but conveying that information in a useful fashion to those unfamiliar with antivaccine arguments is not a trivial task. However, that does not mean that the task impossible. It’s also true that the difficulty is compounded by the fact that there are a number of different flavors of antivaccine views ranging from—I kid you not—the view that vaccines are a tool of Satan to depopulate the earth (and even make you a “hybrid of Satan”) to much milder views, such as opposition to vaccine mandates, which might or might not be associated with antivaccine views.

It’s also important to realize that most people who buy into antivaccine views do so out of ignorance, because they have been misled, rather than due to stupidity or lack of intelligence. Now, as 12 years ago, I’ll repeat that, when I “go medieval” on antivaccine activists (usually more at my not-so-secret other blog than here at SBM), my ire is almost always reserved for leaders of the antivaccine movement, who spread the misinformation and disinformation that deceives people susceptible to it. Unfortunately, though, if there’s one thing that I’ve observed over the last 12 years, it’s that, once someone starts down the path towards being antivaccine, there is a strong tendency for that person to go further and further down the rabbit hole. You have only to look at how so many “new school” antivaxxers, who only started to fear vaccines thanks to the demonization of the new COVID-19 vaccines, have increasingly embraced “old school” antivax claims demonizing all vaccines.

Another point that I’d like to emphasize is that it’s not a binary question whether one is antivax. It’s not “provaccine” or “antivaccine.” It’s a continuum, ranging from vaccine advocates who suffer greatly from harassment for their efforts to antivax conspiracy theorists who view vaccines as poison and think that vaccines will turn you into a demon. (I’m not joking about that latter part.) Similarly, there’s an important interface between whether someone thinks vaccines are dangerous versus what they think about public health policy choices related to vaccines, which I will address near the end. (Yes, I’m referring to, “I’m not antivax; I’m anti-mandate.”)

The antivaccine movement in 2022 compared to 2010: The same, but different

In 2010, I noted something that is just as true today as it was then; so that’s where I’ll start. I’ve discovered that, when I’m actually in an exchange with someone whom I suspect of having antivaccine views, one rather reliable way of differentiating fear based on what they’ve read online from real antivaccine views is to ask a simple question: Which vaccines do you think that in general, barring medical contraindications, all children should receive? If the answer is “none” then I’m pretty much done; I know I’m almost certainly dealing with an antivaxxer. I will, however, note that this question may require some prodding and follow up to get an answer. Rarely am I able to get a definitive answer on the first try, because most antivaxxers, particularly if they’ve been antivax for a while, are a bit more wary and careful about answering such questions. At some level, they sense that I’m trying to get them to admit that they are antivaccine. Even so, if I ask something like, “If you had it to do all over again, would you vaccinate your child?” or “If you have another child, will you vaccinate that child?” I will usually eventually get the candid response I’m looking for.

If my first doesn’t provide a definitive answer, then a good follow up question is: Are there any vaccines that you consider to be safe? (I leave out effective for this question, because even most antivaxxers will concede that most vaccines currently approved are effective.) If the answer is “none”, that’s easy. They’re antivax. If they hem and haw and try to waffle and equivocate, then the answer is that they’re almost certainly antivax but sense what I’m trying to do and are trying to avoid being ensnared in what they consider to be trap. Sometimes the really clever ones will name a single vaccine (tetanus vaccines are their favorite), thinking that that will mollify me. It won’t work because, as I like to say, this ain’t my first rodeo.

It is important to point out here that there has emerged a significant new wrinkle since the pandemic hit. That difference, unsurprisingly, relates to how COVID-19 vaccines are perceived compared to all the other “old” and “established” vaccines that have been on the current CDC schedule of recommended vaccines for years; i.e., the “new school” anti-COVID-19 vaccine variety of antivaxxers compared to “old school” antivaxxers who used to blame vaccines for autism back in the day. As I’ve said, two years since the first COVID-19 vaccines were granted emergency use approval (EUA), there’s less and less daylight between the two, as, unfortunately, I predicted there would be.

I would also point out that in December 2020 it was much more understandable—to me, at least—that many would be wary and suspicious of the new vaccines. Two years on, it’s much less understandable, given their safety record. On the other hand, there are other differences between 2022 and 2010. First, in 2010 social media was still in its relative infancy, and antivaxxers had not mastered it. They have now. Second, and more importantly, in 2010 antivaxxers were still fringe. Now there exist large networks that promote antivax disinformation that misuse data from the Vaccine Adverse Events Reporting System (VAERS) to falsely blame vaccines for all manner of horrors and spread antivax disinformation, such as AIER, the Brownstone Institute, and contrarian doctors publishing bad science and reviews that portray vaccinating against COVID-19 as at best useless and at worse dangerous. While it’s true that antivaxxers were doing that in 2010, their papers rarely achieved much traction. That was because the doctors and scientists doing it then were fringe and had always been fringe. Today, there are a number of formerly well-respected physicians and scientists doing what Andrew Wakefield and Dr. Mark Geier used to do back in the day; only they seem more credible for it because of their prior reputation. (I’m talking to you Dr. Vinay Prasad and Dr. John Ioannidis.)

Worse, antivax disinformation has infested conventional media and become public policy in some states, such as Florida, where Gov. Ron DeSantis appointed a COVID-19 conspiracy theorist, crank, and antivaxxer named Dr. Joseph Ladapo to be Surgeon General and thus in charge of the state’s entire public health apparatus. Unsurprisingly, he promptly started using his office to discourage vaccinating children against COVID-19, even faking science to do it. Given the antivax propaganda apparatus that has developed over the last few years, it can be harder to distinguish “on the ground” real antivax true believers from those who have become vaccine hesitant due to the relentless drumbeat of disinformation coming from AstroTurf groups, conservative news outlets, and even government officials like Dr. Ladapo. Indeed, antivax disinformation appears on an almost nightly basis on the most watched cable news station, Fox News, with pundits like Tucker Carlson regularly regurgitating antivax talking points to audiences of millions.

Conspiracy theories über alles

The single biggest change that I’m going to make in my assessment of how to recognize an antivaxxer now as compared to 2012 grows from a revelation that I came to a few years after my post on recognizing what makes an antivaxxer, namely that all antivaccine beliefs are rooted in conspiracy theories, specifically what I have called the central conspiracy theory of the antivaccine movement. In 2014, that conspiracy theory was simple. Basically, repeating and believing antivaccine conspiracy theories is arguably the strongest indicator that you are dealing with an antivaxxer, so much so that if you see someone spewing antivax conspiracy theories and being utterly resistant to questioning them, that in and of itself is enough to identify an antivaxxer. Indeed, all antivax conspiracy theories tend to be variations on a theme, namely that “They” know that vaccines don’t work/are harmful, but “They” covered it up. It’s the same conspiracy theory at the heart of, for example, Kevin Trudeau’s famous book Natural Cures “They” Don’t Want You to Know About. In the US this central conspiracy theory posits that the Centers for Disease Control and Prevention (CDC) “knew” that vaccines cause autism. In fact, if you believe these conspiracy theories, the CDC itself has demonstrated that vaccines cause autism but has assiduously covered up all evidence, the first and most notable example being the Simpsonwood conspiracy theory.

The Simpsonwood conspiracy theory derives its name from the Simpsonwood Conference Center, where the CDC held a conference in 2000 to discuss the evidence relating to thimerosal-containing vaccines and autism. It was first brought to popular attention by Robert F. Kennedy, Jr. in his infamously bad “expose” called Deadly Immunity, simultaneously published in both Rolling Stone and Salon.com. I discussed this conspiracy theory in detail way back in 2005, after RFK Jr. first published it. So did Skeptico and Lindsay Beyerstein.

So what is the Simpsonwood conspiracy theory? Basically, as I explained both in 2005 and 2014 (and a few times between). If you believe the antivaccine movement, it was all about covering up a link between the mercury-containing vaccine preservative thimerosal and autism. In reality, the Simpsonwood conference was all about examining evidence from the Vaccine Safety Datalink (VSD), a collaborative effort between the CDC’s Immunization Safety Office and nine managed care organizations (MCOs) established in 1990 to monitor immunization safety and address the gaps in scientific knowledge about rare and serious events following immunization to determine if there really was a reason for concern about thimerosal in vaccines. Although the decision had been made in 1999 to remove thimoerosal from childhood vaccines, the decision hadn’t been fully implemented yet, and the CDC wanted to determine whether there was any cause for concern. It was hardly the action of a group that wanted to “cover up” anything, particularly the bit about publishing the entire transcript. None of this, however, prevented antivaccine activists, particularly the branch known as the “mercury militia” for its affinity for the set of antivaccine beliefs associated with mercury in vaccines as a cause of autism, from dreaming up all manner of conspiracy theories.

In reality, there was nothing nefarious going on at Simpsonwood. It was all rather mundane, actually. A preliminary result of an analysis by CDC epidemiologist Thomas Verstraeten, MD seemed to indicate an elevated risk of autism. However, in further analyses that eliminated confounders, the risk continued to fall until it disappeared, and that’s the analysis that was ultimately published, as I explained in detail.

Nearly a decade later, antivaxxers reinvented the “CDC coverup” conspiracy theory about vaccines into the “CDC whistleblower” conspiracy theory. In less than two years, this conspiracy theory became the basis of VAXXED: From Coverup to Catastrophe, a propaganda movie disguised as a documentary by Andrew Wakefield and Del Bigtree. I’ll leave you with my detailed review of the film, for interested readers who might want to see the full depth of the conspiracy theory and how it is just another iteration of the central conspiracy theory of the antivaccine movement, this time with the CDC having supposedly “covered up” evidence that the MMR vaccine causes autism.

Does any of this sound familiar? Specifically, does the claim that the CDC “knew” that thimerosal in vaccines caused autism but covered it up or that the CDC “knew” that the MMR cause autism but covered it up remind you of all the conspiracy theories that the CDC “knows” that COVID-19 vaccines are causing all sorts of harm but have “covered it up” or even that COVID-19 vaccines are causing people to “die suddenly” but covered it up? Or that the CDC is supposedly so compromised by big pharma that the “fix was in” for ACIP to recommend COVID-19 vaccination for children?

You get the idea. When it comes to identifying committed antivaxxers, seeing them spout some variation of the central conspiracy theory of the antivaccine movement and being unwilling to question it are such good indicators of an antivaxxer that you need go no further.

But what if a potential antivaxxer won’t give you such a clear indicator. Fear not! There are others, such as…

“Vaccines don’t work”? “Vaccines are dangerous”? They’re both!

If you look at the types of arguments used to oppose vaccination, they will almost always boil down to two different flavors, either that vaccines don’t work or that vaccines are dangerous—often both. Like the slogan “Tastes great, less filling”, both of these claims often co-exist to differing degrees, with some anti-vaccinationists arguing that both are true: Vaccines don’t work and they are dangerous.

This being the real world, one has to remember that vaccines are not perfect. They are not 100% effective, and there can be rare serious side effects. What differentiates anti-vaccine cranks from, for example, scientists who deal with issues of efficacy versus side effects and potential complications all the time, is exaggeration far beyond what the scientific data will support. For example, if the influenza vaccine is less efficacious than perhaps we would like (which is true), then it must be useless. More recently, if COVID-19 vaccines do not halt transmission completely, then they “don’t stop transmission” at all and are therefore useless. (Never mind that, even if it were true that the vaccine doesn’t stop transmission at all—which it isn’t—there is still great value in preventing severe disease and death due to COVID-19.) This is, in essence, the Nirvana fallacy, wherein if something is not perfect it is claimed to be utterly worthless. Part and parcel of this approach involves the complement, namely vastly exaggerating the potential side effects and complications due to vaccines to paint them as being far more dangerous than the diseases they prevent. In addition, anti-vaccine activists frequently attribute harms to vaccines that the existing scientific data definitely don’t support as being reasonable or legitimate. The claim that vaccines cause autism is the most famous, but it is far from the only one of these sorts of claims. It’s not uncommon to hear fallacious claims that vaccines cause autoimmune diseases, asthma, and a general “weakening” of the immune system, among others, all of which have been resurrected and repurposed to demonize COVID-19 vaccines.

One of the most famous examples of exaggerated harm or nonexistent risks is the infamous “toxin” gambit. This fallacious argument claims that there are all sorts of scary chemicals in vaccines. Of course, there are all sorts of chemicals with scary names in vaccines, just as there are all sorts of chemicals with scary names in almost everything, from food to clothing to household cleaners, among others. The dose makes the poison, and the amounts of these chemicals, such as formaldehyde, are tiny. As we’ve pointed out time and time again, for instance, the amount of formaldehyde in vaccines is so tiny that it’s overwhelmed by the amount of formaldehyde made as a byproduct of normal metabolism. Unsurprisingly, this gambit has been resurrected for COVID-19 vaccines, in the form of demonization of the lipid nanoparticles used to carry the mRNA to cells and even to the spike protein used as an antigen. Even the old antivax claim that there are “aborted fetal parts” in vaccines has been reborn and recast for COVID-19 vaccines, and new versions have been invented, such as faux environmental “concern” that horseshoe crab blood was used to make COVID-19 vaccines and, more recently, the use of moth cells to make a conventional protein-based COVID-19 vaccine.

Overall, the “tastes great, less filling”-type anti-vaccine claims that vaccines are dangerous and don’t work, can be differentiated from scientifically valid concerns about the efficacy and safety of vaccines on the basis of how evidence is treated and the types of arguments that are used. Scientists, of course, tend to be a lot more measured and express an appropriate level of uncertainty when discussing the evidence for their concerns; anti-vaccine activists are under no such constraints. That’s why, for example, when scientists discuss declining efficacy of COVID-19 vaccines due to the rise of variants like Delta and Omicron, they bring numbers and point out that these variants can also evade “natural immunity” due to infection with prior variants, whereas antivaxxers claim that the evidence means that COVID-19 vaccines never worked and that “natural immunity” is lifelong.

Antivaccine, not pro-safe vaccine

If there’s one thing I’ve learned in nearly 18 years blogging about vaccines and the pseudoscience used to attack them, it’s that no one—well, almost no one—considers himself “anti-vaccine.” This is very easily verifiable in the outraged reaction elicited from people like J.B. Handley (who simultaneously gloats about the decline in confidence in vaccines among parents, just as antivaxxers today gloat about how distrust of COVID-19 vaccines has led to distrust of the entire vaccine schedule among many parents), Jenny McCarthy, and Dr. Jay Gordon when they are described as “anti-vaccine. Jenny McCarthy, for instance, used to reliably retort, “I’m not ‘anti-vaccine.’ I’m pro-safe vaccine.” An alternative response was, “What I really am is ‘anti-toxins’ in the vaccines.” Meanwhile, Dr. Gordon will say the same thing while simultaneously saying that he doesn’t give a lot of vaccines and foolishly admitting in the comments of a blog post that some parents have actually had to persuade him to vaccinate “reluctantly”.

These days, people like Drs. Vinay Prasad, Joseph Ladapo, and other formerly “reputable” doctors howl indignantly when it’s even hinted that they are antivaccine and, much like antivaxxers 12 years ago, conflate observations that they are repeating old antivax talking points with being called antivaccine, even when it’s pointed out that the intent is to educate them about what they are saying. “Oh, no,” they will respond in essence, “we’re not ‘antivaccine.’ We’re just trying to argue that the COVID-19 vaccines aren’t safe enough for children”. Unfortunately, they do it using very similar tropes that “old school” antivaxxers used to use back in the day to argue against the whole vaccine schedule.

Approaching the evidence

If there’s one thing that distinguishes science from the way the anti-vaccine and similar movements approach evidence, it’s that the anti-vaccine movement values anecdotes over careful science. This was true in the past, where antivax websites used to serve up numerous anecdotes about vaccines causing autism using the classic post hoc ergo propter hoc fallacy that in essence argues because one thing happened before another, that thing must have caused it. Similarly, so did antivax movies such as The Greater Good and VAXXED. Now, antivaxxers serve up examples of people who “died suddenly” as indicating that COVID-19 vaccine kills, even when they can’t actually show that vaccines were responsible and ignore the history of conditions like sudden arrhythmic death syndrome (SADS), a condition usually due inherited genetics that predisposes young people to sudden cardiac arrest. These days, all cases of SADS that antivaxxers find out about are portrayed as evidence that COVID-19 vaccines are killing young people in huge numbers. There’s even a new movie about it, Died Suddenly, which is so full of misinformation that it portrays people caught on camera fainting before there were even COVID-19 vaccines as evidence that the vaccines are killing young healthy people.

Perhaps one of the most characteristic aspects of the anti-vaccine movement is the same one that is shared by virtually every denialist movement, be it denying the science of climate change, evolution, or scientific medicine. That is the use of logical fallacies, cherry picking of the evidence, and distortion of the science. One of the best example of cherry picking and distortion of evidence engaged in by anti-vaccine activists is still, even after 12 years, a set of graphs I discovered before my 2010 post by a man named Raymond Obomsawin, in which he tried to represent as “proof vaccines didn’t save us”. As I pointed out in my response, this was intellectual dishonesty at its most naked. Basically, Obomsawin deceptively conflated mortality and incidence. Worse, he also chose his graphs in a way that parts of the data were left out. Obomsawin’s disingenuous approach to the evidence was mirrored by naturopath David Mihalovic, who wrote the infamous “9 Questions That Stump Every Pro-Vaccine Advocate and Their Claims“. Dr. Crislip answered each and ever one of these “nine questions” without difficulty.

Examples of antivaxxers doing exactly this sort of thing with data about COVID-19, COVID-19 vaccines, masks, and “lockdowns” are too numerous to discuss, although I will mention briefly a subset of this technique, the misrepresentation of VAERS data to demonize vaccines, a technique that has been, alas, also adopted by physicians whom I would not have considered antivax before the pandemic.

Reaction to criticism

Science is, if you’ll forgive the term, a highly Darwinian process. To be a scientist, you have to have a thick skin, because you’ll need it. Reviewers, mentors, other scientists, and virtually anyone to whom you present your results will be picking away at them, looking for flaws, looking for reasons to invalidate your conclusions. There’s nothing personal in it (usually); it’s how the process of science works. Similarly, those who have an appreciation for science understand that it’s a rough-and-tumble world where scientists have to be able to defend their work. Yes, it’s messy as hell, but it works. It may take a lot longer than we’d like and be a lot more confusing than the public likes, but over time hypotheses that don’t hold up are weeded out, to be replaced by those that do. Scientists understand this, and most know not to become too distressed by criticism. True, scientists are human and can’t always separate themselves from their science; sometimes they lash out at criticism. However, for the most part, they don’t react the same way as denialists do when criticized. More importantly, contrary to scientists, it’s rare for antivaxxers to change their mind due to the evidence.

The anti-vaccine movement shares another characteristic with denialists of all stripes, and that’s an intolerance to criticism. Instead of answering it with science (which they can’t do), they tend to answer criticism with vitriol and conspiracy mongering. After all, when it’s all a conspiracy between the government and big pharma to “suppress” the data that allegedly show that vaccines cause autism, then anyone who speaks out for that viewpoint must be hopelessly compromised by relationships between big pharma and his university, even if such relationships need to be made up or extrapolated beyond all relationship to reality (a.k.a. the pharma shill gambit). If the critic is a woman, then she must have been the victim of a date-rape drug.

Perhaps the best way of describing how anti-vaccine groups react to criticism is to point out that their first response tends to be to try to suppress criticism rather than to answer it. Usually, this is accomplished through ad hominem attacks and now, in the age of social media, engineering targeted harassment of their critics on social media platforms, harassment that sometimes spills over into real life, with antivaxxers personally confronting the objects of their hatred, such as when Austin Bennett physically attacked California Sen. Richard Pan in 2019, a result of the increasingly violent rhetoric of the antivaccine movement.

Since the pandemic, the virulence of the reaction to criticism and against the beleaguered public health community trying to mitigate the worst harms of the pandemic has skyrocketed to even worse levels. I’ll leave you with just one term here: Nuremberg 2.0, the old antivax idea that public health officials advocating for vaccines should be subjected to trial by a Nuremberg-style tribunal for their supposed crimes, a fantasy more virulent and violent than ever but repurposed for public health officials who advocated masks, “lockdowns”, and then vaccine mandates to control COVID-19. For example:

Or Dr. Roger Hodkinson:

Let’s just say that if you see someone reacting this way to criticism of antivax misinformation, they’re almost certainly an antivaxxer, even the ones who question whether the rhetoric has gone too far.

The politics of antivax

As much as in general I hesitate to discuss partisan politics on this blog, when it comes to antivax disinformation it is now impossible to avoid discussing the sea change in the political orientation of the antivaccine movement as a whole over the last 12 years, specifically how tight the association has become between the antivaccine movement and the Republican Party and even far-right groups like the Proud Boys. This was not always the case—or even the case in 2010, when I wrote the original version of this post.

Indeed, back when I first started writing about the antivaccine movement in 2004, there existed an exaggerated if not outright false stereotype that antivaxxers tended to be hippy-dippy crunchy lefties, particularly suburban moms, in liberal enclaves like Marin County or Manhattan. To be sure, there was such a contingent of a “back to nature” crowd, but in reality that stereotype was very wrong in a number of ways. There has always been a libertarian right wing component to the antivaccine movement, for example, General Bert Stubblebine III’s Natural Solutions Foundation and others with extreme distrust of the government, including government-recommended vaccine schedules. Basically, as I’ve discussed many times, the antivaccine movement back then encompassed the right and left, and antivax views tended to be fairly evenly distributed among them.

Then came the pandemic. Before there were even any COVID-19 vaccines, antivaxxers quickly allied themselves with COVID-19 conspiracy theorists, anti-“lockdown” protesters, and QAnon, with fascists becoming an increasingly common sight now at antivaccine rallies and antivaccine rhetoric becoming increasingly violent. Even “liberal icon” Robert F. Kennedy, Jr. has addressed fascist groups without a hint of irony.

This association became undeniable with the “Defeat the Mandates” rally in January, after which a number of journalists noted the increasingly tight association between the antivaccine movement and the far right, with reports about how far right extremists have “jumped on the antivaccine bandwagon” are recruiting antivaxxers and how prevalent far right groups were at the rally. (I even noted the similarities and differences between “Defeat the Mandates” in 2022 and Jenny McCarthy’s “Green Our Vaccines” rally 14 years earlier.) I’ve long said that, if you scratch an “anti-mandate” activist, nine times out of ten (at least!) you’ll find an antivaxxer. As I also like to say, “Come for the freedom, stay for the antivax conspiracy theories”, which sums up how antivax messages of “freedom” and “parental rights” used to attack vaccine mandates resonated with conservatives in much the same way that they had begun to do when antivaxxers opposed SB 277, the California law that banned nonmedical exemptions, in 2015.

I won’t belabor the point, other than to emphasize that, as much as the antivaccine movement encompassed a wider range of politics 12 years ago (and arguably might have leaned left a bit), right now, in 2022, it is impossible to deny that it has morphed into primarily a right wing movement. That means that my updated definition of what constitutes “antivaccine” has to account for that, particularly given how, for example, that former hotbed of antivax activism, Marin County, now has one of the highest rates of COVID-19 vaccination. Basically, vaccines, particularly COVID-19 vaccines, have, like it or not, become a political issue, a political signifier, even.

So what does “antivaccine” really mean in 2022 and beyond?

As I noted in 2010, distinguishing true antivaccine rhetoric from hesitancy or just general ignorance is not always easy. In this post, I’ve attempted to update my take on what “antivaccine” really means for our current time. To help, I’ll recap a bullet-pointed summary of the characteristics I’ve just discussed, which are mostly the same as in 2010 but rearranged somewhat”

• Conspiracy mongering about vaccines
• The “vaccines don’t work” gambit
• The “vaccines are dangerous” gambit
• Claiming to be “pro-safe vaccine” while being unrelentingly critical about vaccines
• Preferring anecdotes over science and epidemiology
• Cherry picking and misrepresenting the evidence, often using logical fallacies
• Trying to silence criticism rather than responding to it
• Tendency to be politically right wing

Someone who is antivaccine will almost certainly use at least three or four of these techniques. Indeed, when these eight techniques fail to suffice, they make up more.

In updating my post, I again feel obligated to caution my readers. We have to be careful about leaping to the conclusion that someone is antivaccine. That’s where the “I know it when I see it” test can backfire. Fortunately, over the last two decades I can count on the fingers of one hand (with one or two fingers left over) the times when I might have prematurely called someone “antivax” who turned out not to be. It happens, and when it does I just apologize, correct myself, and move on. So should you.

It was also with some trepidation that I added the bullet point about being right wing. Even though right now the antivaccine movement has, thanks to its alliance with “anti-lockdown” and “antimask” movements, been nearly completely subsumed as particularly fanatical foot soldiers in a more general far right wing political movement, that’s not to say that there aren’t still a lot of left-wing antivaxxers around. That’s why I say, even as I added that last bullet point, apply it carefully, and remember that, by itself, it can’t be decisive. You need at least three or four more bullet points to go along with it. Similarly, if someone is clearly progressive or left wing, that does not mean they aren’t antivax. After all, 10-20 years ago it tended to be liberal coastal enclaves where vaccine hesitancy and resistance were the highest and measles outbreaks as a result more common. Politics can shift, sometimes dramatically and rapidly. The last 10-15 years have shown us that with respect to the antivaccine movement. There’s no reason the same thing couldn’t at some future happen in the opposite direction. However, right now, a lot of antivaccine conspiracy theories go along with pro-“freedom” and anti-“mandate” rhetoric.

Finally remember that, now as then, the anti-vaccine movement is a denialist movement, very similar to deniers of anthropogenic climate change, science-based medicine, and evolution. As such, it uses the same fallacious strategies and distortions of science to promote its agenda and reacts the same way to criticism. Similarly, the antivaccine movement is also far more about ideology than it is about science, which is why it remains so stubbornly resistant to reason and science. Finding an effective means to counter its message will likely require developing effective general strategies to counter science denialist movements of all types, including and emphasis, in particular on medical conspiracy theories, which the antivaccine movement is but one that is a subset of all the sort of conspiracy theories that undergird all science denial.

Sadly, as much as certain aspects of what “antivaccine” means have changed, such as the politics and the global infrastructure that promotes distrust of vaccines, the central core has remained largely the same, and that core was a variant of a conspiracy theory in 2010 and remains so in 2022.