As researchers, pharma companies, and governments around the world are racing to make a vaccine against the pandemic coronavirus in record time, there’s a growing concern that many Americans won’t want it when it arrives. In a series of recent polls, only about half of US adults say they would get a Covid-19 vaccine, even though more than 1,000 people are still dying from the disease every day in the US. Some of those surveyed are rightly concerned about the perils of rushed science. But according to one poll conducted by Yahoo News/YouGov, more than a quarter of Americans would decline a shot in part because they believe Microsoft cofounder Bill Gates is trying to slip them a microchip.
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Conspiracy theories thrive in times of great uncertainty, and the coronavirus pandemic has proven to be a petri dish for particularly harmful ones. This one can be traced back to May 4, when a little-known filmmaker named Mikki Willis posted a 26-minute video called Plandemic to Facebook, YouTube, Vimeo, and a designated website. It featured a discredited scientist describing a bizarre, unsubstantiated plot by global elites like Gates to use a vaccine against the virus to seize power. These ideas, hailing from many sources, had already been swirling on many parts of the internet and were congealing into a narrative involving Gates and microchips, but the Plandemic video became their biggest signal boost. According to an analysis by The New York Times, the video spent about three days incubating on Facebook pages dedicated to conspiracy theories and the anti-vaccine movement. Then, like any efficient pathogen, it went viral. Just a week after its release, the now widely debunked video had been viewed more than 8 million times.
But it didn’t have to be that way. So says Joe Smyser, CEO of the Public Good Projects, or PGP, a public health nonprofit that specializes in using social network analysis to implement large-scale behavioral change programs. His group has built online surveillance tools for tracking outbreaks of misinformation, disinformation, and downright conspiracies. He says they saw most of the sharing activity that fueled this particular theory’s eventual virality within the first 24 hours. “It was right there in the data,” he says. “We didn’t have to wait days to respond to it, because the outcome was predictable. What was lacking was coordination.”
Smyser wants to bring coordination to combating a growing anti-vaccine movement that contributed to a record outbreak of measles last year—the worst in four decades. This week, his organization is launching a vaccine advocacy campaign unlike any other before.
Called Stronger, it aims to take the fight to anti-vaccine organizers where they’ve long had the upper hand: on social media. To do so, PGP plans to conscript the vast but largely silent majority of Americans who support vaccines into any army of keyboard warriors trained to block, hide, and report vaccine misinformation. (According to a recent Gallup poll, 84 percent of Americans say vaccinating children is important.) The effort is backed by a number of pro-immunization coalitions and the National Foundation for Infectious Diseases, and has funding from BIO, the world’s largest biotechnology lobbying group. “We have this tradition in the US that vaccines are solely the domain of public health workers who are trained to not get into fights,” says Smyser. “I think that’s a very antiquated perspective, and it’s left those on the public health side completely outgunned in this new era of social media.”
For nearly as long as there have been vaccines, public health agencies have shied away from a combative approach with people who disagree with their recommendations. Vaccines are unequivocally one of the most transformative technologies in human history. Until vaccines eradicated smallpox, the disease killed millions of children each year—between 300 million to 500 million during the 20th century alone. In 1988, at the start of a worldwide vaccine campaign, approximately 350,000 children were paralyzed by polio each year. In 2018, the virus sickened just 33.
Up until the late 1990s, public health officials in the US were able to rely on this fact; vaccines spoke for themselves. They worked so well that diseases like measles began to fade from public consciousness. But that meant they didn’t seem so scary anymore. So when a now-discredited bit of fraudulent science that linked childhood vaccines with autism showed up in 1998, at the same time that news and socializing was starting to migrate online, doubts about vaccines found fallow ground and became the seeds of the modern anti-vaccination movement.
“What we’re seeing today is one of the drawbacks of not having had a strong tradition of investment in vaccine education or communications,” says Glen Nowak, director of the Center for Health & Risk Communication at the University of Georgia and former director of media relations at the Center for Disease Prevention and Control. Nowak first joined the CDC in 1999 as the head of communications for the National Immunization Program. He says that one reason agencies like the CDC and local health departments aren’t able to keep up with the deluge of vaccine-related misinformation on social media boils down to a lack of resources. They wield only small teams of people who have to run every Tweet and Facebook post up the chain for fact-checking and clearance. “Most government agencies can’t use social media in a social way,” he says.
But the other reason is more intentional and harder to solve with budget boosts: It’s that public health agencies are supposed to represent the entire spectrum of beliefs held by American voters. The CDC sits within the Department of Health and Human Services, which reports to the White House. County and state health departments belong to a governor’s office. Being pro-vaccine might be the official recommendation, but advocating too hard for it can get political, and fast.
“That makes it difficult for public health workers to become fighters,” says Nowak. Getting into a public spat with people opposed to vaccines is not helpful for government agencies. The payoff is bigger, says Nowak, if they focus on providing research and scientific evidence about the risks and benefits of vaccines to doctors who are directly educating parents. Doing anything other than neutrally presenting facts could undermine public health agencies’ authority. “If someone’s going to take on critics of vaccines in a strong and aggressive way, it’s probably going to have to be someone outside an official government public health agency,” he says.
That’s the void into which Smyser is launching Stronger. And it’s one he knows well. After doing dual PhDs in philosophy and public health at UC San Diego, Smyser went to the CDC for a fellowship in evaluating the effectiveness of public health interventions against smoking and e-cigarette use. In 2016, he took over as head of PGP, which had been founded three years prior by former New York City health commissioner Tom Farley. His first big project there was mapping how pro-vaping rhetoric spreads across social media. PGP’s investigation found that over half of Tweets about e-cigarettes came from bots dedicated to promoting misinformation about the safety of vaping.
In October, the organization launched a similar project to peel back the curtain on anti-vaccine activism online. With funding from the New York State Health Foundation, PGP purchases data from Zignal Labs—petabytes of public posts on Facebook, Twitter, YouTube, blogs, web forums, and other websites. PGP’s team of social network analysts parse the data and monitor it using a dashboard that identifies power users, conversational themes, and emerging misinformation hot spots.
PGP had been in talks with BIO before the pandemic hit about leveraging this tool, which they call VECTR, for a national pro-vaccine campaign. But the uptick in vaccine opposition driven by coronavirus conspiracies lent the effort a new urgency. In a press conference last month, Smyser said that social media messaging urging Americans to reject immunizations has tripled since the pandemic began—from 5,400 mentions per day to 14,400. VECTR revealed that this spike has been driven by increasing connections between a core group of about 200 leaders of the anti-vaccine movement—mostly concerned parents—and conspiracy-peddling cults like QAnon, as well as the conservative operators behind anti-lockdown protests. “All of a sudden we’re seeing a lot of cause-stacking going on,” says Smyser.
To combat this maelstrom of misinformation, PGP plans to recruit people who think vaccines are a vital public good and who have a track record of activism—doing things like signing petitions or attending demonstrations. Those people will sign up to receive information about how to combat vaccine-related misinformation when they see it. When a particular piece of misinformation is either about to be seen by millions of people, or has just reached that point, alerts will go out from PGP telling these volunteers what to look for and recommending language for counter-posting. Their idea is to create an army of debunkers who can quickly be mobilized into action. Having enough people is paramount; there’s safety in numbers when posting on a topic that’s likely to spawn a vigorous online battle.
A common tactic of vaccine opponents is to “swarm” people who speak up for immunization programs, such as public officials, physicians, or scientists. During a swarm, a few power users will send legions of followers to attack that person on different social media platforms, bombarding their profiles with an avalanche of consistent ant-vaccine messaging. If that doesn’t do the trick, intimidation campaigns can be escalated—editing Wikipedia pages into smear screeds, voting doctors’ reviews on Google and other sites down into oblivion, doxxing doctors and scientists, and even issuing death threats. Smyser’s idea is for Stronger followers to “show some love” to individuals who come under attack, flooding their pages and social media feeds with evidence-based vaccine information, writing positive reviews, and reporting abusive users.
Similar tactics have been taken up by a group of doctors, nurses, and other health care workers, called Shots Heard Round the World, which The New York Times profiled in March. But Smyser wants to go even bigger, recruiting thousands of everyday people who have some free time now and then to join the digital scrum. “In the anti-vaccine world we see about 129 people generating talking points for hundreds of thousands of people,” says Smyser. “These people call their legislators. They call up public health officials to harass them. We want to train up an army to use the same kinds of tools, but with facts and science on their side.”
But will it actually work? That’s where it’ll come down to the specifics.
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It’s taken a while for researchers to come to consensus on how effective debunking actually is. In large part that’s because of a phenomenon called the “backfire effect” which is the notion that attempts to correct a misperception just cause people to dig in their heels and become more entrenched in their beliefs. This term gained notoriety from an influential 2010 study called “When Corrections Fail,” led by University of Michigan public health policy researcher Brendan Nyhan. More recent studies have called this finding into question, and Nyhan himself has written that the backfire effect is probably quite rare and that, in general, debunking “can make people’s beliefs in specific claims more accurate.”
In a forthcoming publication, Timothy Caulfield, a health law and policy professor at the University of Alberta and a serial debunker, outlines the state of the science. He has found that fears of backfire effects are overblown and that there is a growing body of evidence that suggests correcting misinformation is in fact an important health policy activity. But the timing and type of counter-messaging really matters. He lists some actions to take: Use facts, avoid jargon, find trustworthy sources, lead with the corrective information. And some to avoid: Don’t shame, ridicule, or marginalize; don’t target hard-core believers; aim for the general public instead.
But much of the evidence that countering misinformation can change people’s minds comes from studies of less politically and emotionally charged misinformation than vaccines. And these sorts of tactics don’t yet have a proven track record when it comes to changing anti-vaccine sentiment, as Nyhan points out. “We still don’t know very much about how effective any kind of pro-vaccine messaging is at changing people’s behavior,” he says. At most, public policy researchers have been able to assess how parents’ attitudes change in response to different communication strategies. But connecting the dots between survey results and any changes in vaccination rates has been much harder.
Nyhan, who’s written extensively about when it’s appropriate for the media to cover misinformation, worries that a campaign like PGP’s might inadvertently do more harm than good, not because of the backfire effect but because social media algorithms feed off of controversy. “In trying to correct misinformation, are you actually creating the kind of engagement that causes platforms to amplify those messages to more people who otherwise wouldn’t see it?” he asks.
How effective PGP’s approach turns out to be will depend a lot on the specific messaging the group encourages its volunteers to propagate, says Nyhan. For example, he says, if they could rally people to advocate for closing vaccine-exemption loopholes in state policies, that could go a long way. Such laws make it harder for parents to seek nonmedical exemptions to vaccinating their children who attend public schools. They’ve also become a political flashpoint, galvanizing new ranks of anti-vaccine activists. In a hyper-partisan 2015 vote, California did away with exemptions for religious and personal beliefs. In the following years, the rate of vaccinated kindergarteners crept steadily upward. But by 2019, the state’s vaccination rates slipped again, as parents found other ways of opting out.
Last year Nyhan argued in The New York Times that the focus on anti-vaccine content on social media can obscure a robust body of research that shows the rates of unvaccinated children correlates most closely to a state’s vaccine requirement policies. In other words, policy matters more than public persuasion. That’s why he’s skeptical that an approach like PGP’s is going to make much of a dent.
It’s a sentiment Nowak shares. “Battling these people in these online spaces may have some value, but I’m not sure it’s going to have as much impact as reaching pregnant mothers with good information or tightening vaccine exemption laws,” says Nowak. “That’s where we can really make a difference, not in some Twitter war.”
They also worry that a campaign like Stronger could distract from a much bigger vaccination crisis. In the last three months, vaccination figures have plummeted, both in the US and abroad—not because of viral conspiracy theories but because of an actual virus: SARS-CoV-2. The novel coronavirus—which has killed more than 400,000 people globally, and infected nearly 7.5 million—has diverted critical public health resources away from vaccination programs. Amid the pandemic, parents are also keeping their kids home, fearful of going to the doctor’s office where they might catch Covid-19. According to a recent report by the CDC, pediatricians’ orders for all non-influenza vaccines declined by more than 3 million doses from March 13 to April 13 compared with the same period last year. Internationally, the picture is equally grim. With mass immunization programs paused in at least two dozen countries, the World Health Organization estimates more than 100 million children worldwide could be vulnerable to measles.
“In terms of public health priorities and new investments, by far, restarting the childhood immunization programs that have been on hold for months should be at the top,” says Nyhan. “We want to make sure that those kids are getting their shots first and foremost.”
Because PGP is expressly not a public health agency, and the funding of its Stronger campaign isn’t coming from government coffers, these two goals don’t seem to be in conflict, at least for now. And Nyhan’s own studies show that traditional public health messaging isn’t an effective intervention. So Smyser’s attitude is, why not give something new a try?
In the last 20 years, in the US confidence in vaccines has dropped to levels that threaten herd immunity against many vaccine-preventable diseases. Those Gallup poll figures showing 84 percent of Americans support vaccinating children are actually down from 94 percent in 2001. Maintaining herd immunity requires a sufficiently large chunk of the population, typically in excess of 93 percent, to be vaccinated. “What happened in those 20 years?” says Smyser. “It’s not like new information came out. So what happened? The rise of misinformation. And every day it just makes people question a little more, erodes trust in science a little more, gets people who were on the fence to tip over. I don’t think it’s appropriate anymore to call this a fringe movement. And I don’t think it’s appropriate anymore to say we can solve this with a better infographic.”
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