Health policy experts call for confronting anti-vaccine activism with life-saving counter narratives
A 21-person commission of public health experts convened by The Lancet urges the development of networked communities that simultaneously share information with different audiences about the health and economic benefits of vaccines
Peer-Reviewed PublicationFOR IMMEDIATE RELEASE
Public and private sector health officials and public policymakers should team up immediately with community leaders to more effectively disseminate accurate narratives regarding the life-saving benefits of vaccines to counter widespread, harmful misinformation from anti-vaccine activists in the United States, according to a new Viewpoint piece in The Lancet, led by authors at Boston University School of Public Health (BUSPH), University of California, Riverside (UCR), and The Stanford Internet Observatory Cyber Policy Center (SIO) at Stanford University.
Published in the leading international medical journal on Friday, March 3, the Viewpoint provides valuable insight into the recent developments of US-based anti-vaccine activism and proposes strategies to confront this dangerous messaging.
“Messages of health freedom gained traction during the pandemic, turning members of the public against public health messages and prevention-focused activities, including vaccination,” says second author Timothy Callaghan, associate professor of health law, policy & management at BUSPH, and who was one of three lead writers of the Viewpoint, along with lead author Richard Carpiano, public policy professor at UCR, and third author Renee DiResta, technical research manager at SIO.
In the Viewpoint, the authors and 18 other leading public health experts describe a perfect storm that allowed anti-vaccine activism, once a fringe subculture, to become a well-organized form of right-wing identity with narratives that associate refusing vaccines with personal liberty. This narrative was consistently repeated and amplified by social media influencers, pro-Donald Trump political operatives, and right-wing blogs, podcasts, and other media as the COVID-19 pandemic spread worldwide.
The authors underscore the need to consistently amplify accurate science and information through multiple communication channels, to avoid the spread of inaccurate or misleading information to people through limited sources.
“This is a matter of life and death,” says Carpiano. “People don't always see it that way. We've forgotten how many people have died, have been sick, or continue to get sick from COVID-19 as well as many other vaccine-preventable diseases.”
The paper comes out at a time when more than 1.1 million people have died from COVID-19, and the worldwide toll is estimated at 6.8 million. The disease continues to spread as vaccines have been found to greatly reduce illnesses that require hospitalization or result in death.
Anti-vaccination activism has existed as long as there have been vaccines. But the movement picked up steam in 1998 when British physician Andrew Wakefield published a now-discredited study that falsely claimed a link between childhood vaccines and autism.
In more recent years, however, anti-vaccine messaging shifted in large part from health-effect concerns to conservative and libertarian political identity arguments of medical freedom and parental rights. This was prompted in part by legislative efforts in several states to eliminate personal belief exemptions from school vaccination requirements in response to falling child vaccination rates and vaccine-preventable disease outbreaks. But these arguments were confined to childhood vaccines and were somewhat contained.
Since the COVID-19 pandemic affected the entire population, it brought on a vast expansion of not only anti-vaccine activism, but more broadly, anti-public health activism as people faced the inconveniences of mask-wearing, social distancing, closed restaurants and bars, and cancelations of concerts and other events that draw crowds.
Celebrities, wellness influencers, partisan pundits, and certain scientists and clinicians, among others, joined the fray, often spreading false and misleading claims about vaccinations. The increasing number of voices found larger audiences, which meant more votes for right-wing candidates, and greater monetization of right-leaning social and media outlets.
“As celebrities, influencers, and politicians started speaking out negatively about vaccination, growing segments of the American public were exposed to these messages, shifting troubling proportions of the US public who had previously vaccinated in other contexts against getting vaccinated for COVID-19,” Callaghan says.
The result was more people becoming ill.
“Political leaders were sadly, particularly effective anti-vaccine messengers, and because of that, we now have clear disparities in COVID-19 vaccination rates across party lines” he says.
Meanwhile, pro-vaccine messaging has been based on the statements of individual public health experts, such as former director of the National Institute of Allergy and Infectious Diseases Anthony Fauci and director of the US Centers for Disease Control and Prevention Rochelle Walensky, who the authors say are outgunned.
Callaghan, Carpiano, and DiResta were part of the Commission on Vaccine Refusal, Acceptance, and Demand in the USA that The Lancet convened to examine issues surrounding COVID-19 vaccine acceptance uptake, acceptance, and hesitancy. The membership is composed of 21 national experts from public health, vaccine science, law, ethics, public policy, and the social and behavioral sciences.
The group recommends the development of networked communities that simultaneously share information with different audiences about the health and economic benefits of vaccines. This would preempt the well-funded messaging of the antivaccine movement.
“Without concerted efforts to counter the anti-vaccine movement, the USA faces an ever-growing burden of morbidity and mortality from an increasingly under-vaccinated, vaccine hesitant society,” the authors conclude in the paper.
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About Boston University School of Public Health
Founded in 1976, Boston University School of Public Health is one of the top five ranked private schools of public health in the world. It offers master's- and doctoral-level education in public health. The faculty in six departments conduct policy-changing public health research around the world, with the mission of improving the health of populations—especially the disadvantaged, underserved, and vulnerable—locally and globally.
JOURNAL
The Lancet
METHOD OF RESEARCH
Commentary/editorial
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Confronting the evolution and expansion of anti-vaccine activism in the USA in the COVID-19 era
ARTICLE PUBLICATION DATE
2-Mar-2023
COI STATEMENT
The Lancet Commission on Vaccine Refusal, Acceptance, and Demand in the USA is cohosted by the Yale Institute for Global Health and the Baylor College of Medicine. All authors are Commissioners. PJH is a developer of a COVID-19 vaccine construct, which was licensed by Baylor College of Medicine to Biological E, a commercial vaccine manufacturer for scale-up, production, testing, and licensure. NTB reports personal fees from WHO, Centers for Disease Control and Prevention, Sanofi, and Merck outside of the submitted work. RMC reports receiving research grant funding from Novo Nordisk Foundation (Denmark), outside of the submitted work. RL reports grants from Pfizer, GlaxoSmithKline, Sanofi Pasteur, and Merck, and personal fees from BIO, outside of the submitted work. YAM is a member of a Data Safety Monitoring Board for Pfizer and is a site Principal Investigator for a Pfizer vaccine trial, outside the submitted work. MMM reports personal fees from law firms representing retail pharmacies, generic drug companies, and a health insurer that have sued branded drug companies for marketing and antitrust law violations, outside of the submitted work, and serves as an adviser to Verily Life Sciences on a mobile app designed to facilitate safe return to work and school during COVID-19. DJO reports grants from the US National Institutes of Health, outside the submitted work. DAS reports personal fees from Pfizer, Janssen, and Moderna, is on advisory boards and receives compensation from these companies for time attending meetings, and reports grants from Merck, outside of the submitted work. All other authors declare no competing interests.
50 leading national organizations unite to curb infodemic of health and science misinformation and disinformation
The Coalition for Trust in Health & Science launches new long-term initiative to support the science-based health decisions of the public through credible information and enhanced trust in health and science organizations and professionals
Business AnnouncementThe Coalition for Trust in Health & Science today announced its formation and public launch during the 2023 American Association for the Advancement of Science (AAAS) Annual Meeting in Washington, D.C. The alliance was formed to unite leading organizations from across the entire health ecosystem to advance trust and factual science-based decision-making. The partnership aims to achieve a measurable increase in the public’s willingness – and ability – to access evidence-based information necessary to make the best personally appropriate health decisions for themselves, their families and the communities in which they live and work. Enhancing the perception and reality of the trustworthiness of the health and medical system is a key element of this goal.
“The United States is experiencing a tidal wave of misinformation and disinformation, which has real-world health impacts, such as preventable misery and deaths, and is escalating already dangerously high levels of mistrust and distrust in healthcare, public health and science,” said Reed Tuckson, M.D., convener of the Coalition for Trust in Health & Science. “Addressing this infodemic is fundamental to the values of the Coalition’s members and, together, we can and will make a positive impact on the health of individuals and the nation.”
Coalition’s Focus on Supporting Americans’ Health Decisions
The Coalition is focused on supporting Americans’ health decisions by helping them navigate the increasing amount of information available from an increasing number of sources. This is a long-term effort to address longstanding challenges around trust and new challenges brought on by the proliferation of social media.
The collective effort of the Coalition is focused on correcting misinformation and countering disinformation that decrease trust in health, healthcare, public health and science and that has the potential to harm the public’s health.
Coalition Aims to Provide Rapid Responses to Particularly Egregious Disinformation
A key aspect of the Coalition’s plan is to mobilize the breadth of its network of members to facilitate rapid-cycle debunking of particularly egregious disinformation and misinformation incidents that continue to emerge with concerning frequency and that have the potential to harm the public. Additionally, the Coalition has begun the creation of an online interactive Compendium of relevant programs operated or sponsored by Coalition members for the purposes of sharing ideas; stimulating collaboration; facilitating research while also identifying research gaps; enabling research findings to inform ongoing and new initiatives; supporting the spread of effective strategies; and fostering measurement of collective impact.
“Countering dangerous disinformation quickly and effectively is essential to public health,” said Sudip Parikh, chief executive officer of AAAS and executive publisher of the Science family of journals. “We are excited to be part of the Coalition for Trust in Health & Science and to work with other organizations that share the same vision for addressing the current crisis in trust plaguing the scientific landscape, encouraging evidence-based health choices, and addressing misinformation and disinformation. This collective collaboration has the potential to achieve the vision of evidence-based decision making in healthcare far more effectively than individual action.”
50 Member Organizations Representing Diverse Interests Join Coalition
The alliance is currently comprised of 50 national organizations representing basic and applied science organizations; health academicians; health services researchers; pharmaceutical manufacturers; physicians, nurses, pharmacists and other professional disciplines; public health professionals; health insurers; health regulators; ethicists; health humanists; foundations; health consumer organizations; and health consulting, policy and communications organizations.
Members share the Coalition’s vision that “All people have equitable access to and confidence in the accurate, understandable and relevant information necessary to make personally appropriate health decisions.” Additionally, members have pledged to 1) Support efforts to advance people’s scientific and health literacy, earn public trust and improve health outcomes and health equity, and 2) Work individually and collectively to correct misinformation and counter disinformation that threatens people’s health and well-being.
Current members include:
- AAAS
- Academy Health
- Accreditation Council for Continuing Medical Education
- AHIP
- American Academy of Nursing
- American Association of Colleges of Osteopathic Medicine
- American Association of Colleges of Pharmacy
- Association of American Medical Colleges (AAMC)
- American Board of Internal Medicine
- ABIM Foundation
- American College of Physicians
- American College of Preventive Medicine
- American Hospital Association
- American Medical Association
- American Nurses Association
- American Physical Society
- American Psychological Association
- American Public Health Association
- American Society of Tropical Medicine and Hygiene
- America’s Physician Groups
- Arnold Gold Foundation
- Association of American Indian Physicians
- BCG
- Berman Institute of Bioethics
- BIO
- Black Coalition Against COVID
- Council of Medical Specialty Societies
- Federation of American Hospitals
- Foundation for the National Institutes of Health
- Henry Schein Co.
- Institute for Healthcare Improvement
- Josiah Macy Jr. Foundation
- KFF
- KPMG LLP
- LifePoint Health
- National Association for Home Care & Hospice
- National Association of Hispanic Nurses
- National Black Nurses Association
- National Board of Osteopathic Medical Examiners
- National Coalition of Ethnic Minority Nurse Associations
- National Committee for Quality Assurance
- National Council of Asian Pacific Islander Physicians
- National Health Council
- National Hispanic Medical Association
- National Medical Association
- National Pharmaceutical Association
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing
- Real Chemistry
- Research!America
- The John A. Hartford Foundation Inc.
- The Hastings Center & PhRMA
The Coalition is managed by the Core Convening Committee, which includes the following initial members:
- Reed Tuckson, M.D., chair and co-founder, Black Coalition Against COVID (BCAC)
- Bill Novelli, Professor Emeritus, Georgetown University and former chief executive officer, AARP
- Julie Gerberding, M.D., M.P.H., chief executive officer, Foundation for the National Institutes of Health
- Mary Naylor, Ph.D., R.N., Marian S. Ware Professor, Gerontology, and director of the NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing
- Sudip Parikh, Ph.D., chief executive officer, AAAS
- Mary Woolley, president, Research!America
- Elaine Arkin, consultant
Documented Impact of Misinformation on Health
Misinformation has been shown to have an adverse impact on health, with a World Health Organization review in September 2022 showing that infodemics and misinformation affect people’s health behaviors.[i] For example:
- A study showed that even brief exposure to COVID-19 vaccine misinformation made people less likely to want a COVID-19 vaccine,[ii] even though it is estimated that U.S. vaccination efforts prevented more than 18 million hospitalizations and more than 3 million additional deaths.[iii]
- In South Africa, government officials reduced citizen access to antiretroviral drugs due to the false belief that HIV did not cause AIDS, a concept known as AIDS denialism. This action can be attributed to causing more than 330,000 deaths between 2000 and 2005.[iv],[v]
- In the late 1990s, an inaccurate study claimed that immunization with measles/mumps/rubella (MMR) vaccines caused autism.[vi] Even though the study was retracted, the claim continued to be widely accepted and led to lower immunization rates in Western Europe and North America over the next 20 years.[vii]
About The Coalition for Trust in Health & Science
The Coalition for Trust in Health & Science was formed in early 2023 to combat the current infodemic of misinformation and disinformation in health, healthcare, public health and science. Currently comprised of dozens of national organizations focused on health and science, the Coalition is focused on enhancing the public’s trust in the collective health ecosystem and supporting science-based decisions that are critical to improved health outcomes and the reduction of premature deaths. For more information visit coalitionfortrustinscience.org.
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[i] Borges do Nascimento IJ, Pizarro AB, Almeida JA et al. Infodemics and misinformation: a systematic review of reviews. Bull World Health Organ. 2022;100(9):544-561. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9421549/
Accessed February 10, 2023.
[ii] Loomba S, de Figueiredo A, Piatek SJ, de Graaf K, Larson HJ. Measuring the impact of COVID-19 vaccine misinformation on vaccination intent in the UK and USA. Nature Human Behavior. 2021;5:337-348.https://www.nature.com/articles/s41562-021-01056-1. Accessed February 10, 2023.
[iii] Fitzpatrick MC, Moghadas SM, Pandey A, Galvani AP. Two years of U.S. COVID-19 vaccines have prevented millions of hospitalizations and deaths. The Commonwealth Fund. December 13, 2022. https://www.commonwealthfund.org/blog/2022/two-years-covid-vaccines-prevented-millions-deaths-hospitalizations. Accessed February 10, 2023.
[iv] Chigwedere P, Seage GR, Gruskin S, Lee TH, Essex M. Estimating the lost benefits of antiretroviral drug use in South Africa. J Acquir Immune Defic Syndr. 2008:49(4):410-415. https://pubmed.ncbi.nlm.nih.gov/19186354/10.1097/qai.0b013e31818a6cd5. Accessed February 10, 2023.
[v] https://www.ncbi.nlm.nih.gov/books/NBK572166/. Accessed February 13, 2023.
[vi] https://www.ncbi.nlm.nih.gov/books/NBK572166/. Accessed February 13. 2023.
[vii] Hussain A, Ali S, Ahmed M, Hussain S. The anti-vaccination movement: a regression in modern medicine. Cureus. 2018;10(7):32919. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6122668/. Accessed February 13, 2023.
