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Vaccine misinformation and social media
On Aug 19, 2019, British Prime Minister
Boris Johnson outlined plans for a
summit of social media firms to discuss
how to promote accurate information
about vaccination. The announcement
accompanied the news that WHO
no longer considers the UK to have
eliminated measles. Coverage of the
second dose of the measles–mumps–
rubella (MMR) vaccine in the country
has fallen to 87%, lower than the 95%
required for herd immunity. “I am
afraid people have just been listening
to that superstitious mumbo-jumbo
on the Internet, all that antivax stuff,
and thinking that the MMR vaccine is
a bad idea”, commented Johnson on a
visit to a hospital in southwest England.
“That’s wrong. Please get your kids
vaccinated.”
On both sides of the Atlantic,
measles is resurgent. In 2017, there
were 284 cases in England and Wales,
increasing to 991 in 2018. In the
53 countries of the WHO European
Region, cases of measles leapt from
5273 in 2016, to 83 540 in 2018. In
the past year, the caseload in Ukraine
alone exceeded 50 000 cases. The USA
is likely to have around 2000 cases of
measles in 2019, having had 372 in
2018. Wherever cases are spiking, there
is a simple explanation: inadequate
coverage with both doses of the
measles-containing vaccine, which
can occur for all kinds of reasons.
Ukraine has had shortages in supply,
serious problems with its health-care
system, and a simmering conflict with
Russia that has left 1·6 million people
internally displaced. But beyond
the issues of access, the Ukrainian
population’s confidence in vaccines has
also wavered.
WHO defines vaccine hesitancy
as a “delay in acceptance or refusal
of vaccines despite availability of
vaccination services”. The effect
has been around for as long as
vaccination. But the advent of social
media has offered an unprecedented
opportunity to amplify and spread
www.thelancet.com/digital-health Vol 1 October 2019 e258
antivaccination messages. “What
was previously a fringe opinion is
becoming a transnational movement”,
said David Broniatowski (School of
Engineering and Applied Science,
George Washington University,
Washington, DC, USA). “The unique
thing about social media is that they
allow messages to propagate very
quickly and for communities to form.”
A study of antivaccination sentiment
on Facebook focused on the page
for a local paediatrician’s clinic in the
USA. Yet the investigators identified
commentators from 36 states and
eight nations. A survey by the Royal
Society for Public Health found that
50% of British parents of children
younger than 5 years regularly
encountered negative messages about
vaccination on social media.
It is difficult to assess the extent
to which exposure to such messages
affects people’s opinions. It is probable
that the posts mostly bounce around
online echo chambers. But even a
small effect can be meaningful. “If
you are talking about herd immunity,
all you need is for coverage to drop
a few percentage points to go
from no epidemic to epidemic”,
explains Broniatowski. “It just takes
a minority of parents deciding to
delay vaccination long enough for
their children to be exposed to the
pathogen.” In which case, misleading
health information on social media
might push vaccine hesitancy to the
point of disaster. “We have all the
underlying issues around access, people
not being able to get appointments or
not knowing where to go, and then
on top you have all that stuff on social
media discouraging parents from
having their kids vaccinated”, said Heidi
Larson (London School of Hygiene and
Tropical Medicine, London, UK). “That
can be the last straw, the thing that
causes the system to snap.”
Vish Viswanath (Harvard TH Chan
School of Public Health, Boston, MA,
USA) points out that the general public
can be split into three groups. There is For the study on
a minority of staunch opponents of antivaccination sentiment see
https://doi.org/10.1016/
vaccination who are unlikely to shift j.vaccine.2019.03.003
their opinion. There is a larger group For the survey by the Royal
of people who have been persuaded Society for Public Health see
of the importance of vaccines and are https://www.rsph.org.uk/
uploads/assets/uploaded/
just as unlikely to shift their opinion. 3b82db00-a7ef-494c-
And then there are those in the 85451e78ce18a779.pdf
middle. “These people are trying to do For the study by Broniatowski
the right thing but they have doubts et all see https://www.ncbi.nlm.
nih.gov/pmc/articles/
and they have questions, and they PMC6137759/
can be vulnerable to antivaccination
messages”, said Viswanath. “That is
where you see the damage.”
The traditional media previously
served as a moderating force,
filtering scientific information and
fact-checking, however imperfectly,
for their audience. But that model
has broken down. “Social media
platforms have a responsibility to let
users know where the information
they are reading comes from”, said
Beth Hoffman (Center for Research
on Media, Technology, and Health,
University of Pittsburgh School of
Medicine, Pittsburgh, PA, USA), who
co-authored the Facebook study. “It is
very easy for non-credible sources to
look like credible sources. As a society,
we really need to work on providing
people with the media literacy skills
and education so that they can figure
out which sources of information are
reputable.”
A wide range of drivers lie behind
vaccine hesitancy, including conspiracy
theories, general distrust, belief in
alternatives, or concerns about safety.
Some social media posts can be
classified as misinformation, eg, the
Instagram notice that reads “so, a baby
can handle 8–9 viruses all at once via
vaccination, but cannot handle one
single virus when it’s wild caught?”.
Disproving such assertions is relatively
straightforward. Indeed, the majority
of comments alongside the Instagram
post do just that.
Other messages fall into the
category of disinformation, such
as posts claiming that babies have
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died, suffered severe disabilities, or
developed autism as a result of being
vaccinated. These posts are trickier
to counteract. “Disinformation
requires an institutional response”,
said Viswanath. “We should be able to
figure out where the disinformation
is coming from and take appropriate
action. It has to be conceptualised
and treated very differently from
misinformation.” Still other messages
do not easily fall into either category.
Matters are further complicated
by the risk of establishing false
equivalence. A study co-authored
by Broniatowski found that Russian
trolls tweeted both provaccine
and antivaccine messages in an
effort to foment discord and create
the impression that the subject
remains a matter of debate. In
such circumstances, responding to
antivaccination arguments can be
counterproductive. “Repeating canards
still means you are acknowledging and
broadcasting them, and that can leave
the impression that the antivaccination
perspective is a legitimate one”,
Viswanath told The Lancet Digital
Health.
Besides, the majority of messages
fall by the wayside. A search of Twitter
for #vaccinescauseautism, reveals a
woman (or bot) who tweets things
like “so glad I didn’t get my beautiful
children vaccinated but it looks
like the majority have already been
brainwashed” and “my baby boy
got measles but he’s doing great all
thanks to his unweakened immune
system”. But the account only has six
followers—scarcely worth troubling
with. More than half of Twitter
messages go unshared. Nonetheless,
certain posters have a huge profile.
Take the man who tweeted in 2014,
e259 www.thelancet.com/digital-health Vol 1 October 2019
“healthy young child goes to doctor,
gets pumped with massive shot of
many vaccines, doesn’t feel good
and changes - AUTISM. Many such
cases!”. He is now president of the USA
(Donald Trump has since urged parents
to vaccinate their children).
The social media networks have
started to take action. In August 2019,
Pinterest announced that searches on
its site for vaccine-related topics, such
as measles or vaccine safety, will only
turn up links to reputable public health
organisations. The results will not be
accompanied by recommendations,
comments, or advertisements. The
move was welcomed by WHO’s
director-general Tedros Adhanom
Ghebreyesus. “We hope to see other
social media platforms around the
world following Pinterest’s lead”, he
stated. More than 300 million people
visit the Pinterest website or access its
app every month. A large number but
nowhere near the reach of Facebook,
which has 2·4 billion users every
month. Earlier this year, Facebook
stated that it would no longer
recommend content that included
misinformation about vaccines and
it would reject advertisements that
carried misinformation.
The platforms have to thread a
fine line between censorship and
helping to facilitate the dissemination
of dangerous misinformation.
Instagram has blocked hastags
that make patently false claims
such as #vaccinescauseaids and has
said that it will ban hashtags that
become associated with misleading
information in the future, although
it will not target those who express
antivaccination opinions. Youtube
has removed advertisements from
antivaccination videos, meaning
that the posters will not make any
money. Twitter ensures that when
users search for vaccine-related topics
in the UK, the first result is for the
National Health Service. In the USA,
the same search first turns up a link to
the Department of Health and Human
Services. But scroll down the page and
antivaccination messages abound.
“Social media is not all the same”,
adds Broniatowski. “The platform
matters a great deal.” Facebook, for
example, has administrators and
content is largely shared within
groups, whereas Twitter is full of bots.
So Facebook might be best advised
to focus on setting standards for
its administrators, whereas Twitter
could turn its attention to making it
harder for automated accounts to be
promoted.
“Some of the issues are transitional”,
said Larson. “Social media platforms
opened their doors relatively recently;
I think we are still deciding where to
draw the boundaries.” She believes
that the medical community needs
to be proactive. “Official websites
could be far more responsive; parents
complain about not being able to find
answers to the questions they have”,
said Larson. “A lot of public health
officials have been anxious about
going into social media, especially the
older generation, but that is where the
public are to be found these days. We
are facing this growing gap between
where the scientific and official
information lives and where the public
is going. That has to change.”
Talha Burki
Copyright © 2019 The Author(s). Published by
Elsevier Ltd. This is an Open Access article under the
CC BY 4.0 license.