The Vaccine Blog

Do free speech laws protect conspiracies and disinformation?

Do free speech laws protect conspiracies and disinformation?


  • Introduction;


A bombshell report recently published revealed that in spring 2020, the U.S military began a disinformation campaign that doubted the effectiveness of China's Sinovac vaccine, even outright calling it “fake” at points. It also cast suspicion on China, as this was both where the virus and its vaccine originated. 


From this story, it is clear that with increasing advancement in social media algorithms has also come the ever-increasing risk of encountering disinformation. Many people have probably heard the term “misinformation” before, but not disinformation. As such, they may ask “what is the difference between misinformation and disinformation?” I`ve discussed these differences before, so won't go into huge detail again. However, in brief, misinformation isn`t always intentionally shared, but disinformation is. Disinformation sharing tends to be part of a more concerted effort to spread fake news for any number of reasons. There may be financial, personal, or professional reasons. In some cases, all of these are factors that motivate an individual to share disinformation. 


Of course, fake news can have varying degrees of impact. This depends on how many people engage with the original made-up fact or facts, whether people sharing it have large audiences, social media algorithms, among many others. There may also be other factors we are not even aware of influencing how far fake news spreads. This has the potential to negatively impact lives all over the world for years, decades and even centuries to come. With that, in this post I'll discuss what exactly is disinformation vs misinformation, as well as the cause and effects of fake news (for instance, the effect of fake news on social media). I`ll also ask questions such as what is the meaning of free speech? What are the limits of free speech? And finally, I`ll discuss how to respond to disinformation while protecting free speech?


I`ll mainly focus on the impact on health in this article, as that is the key focus of my work. However, disinformation can and does also influence outcomes of political elections, the economy, trust in media organizations among many others. Further, once its consequences have been set into action they're very, very difficult to reverse. Think modern online anti vaccine/ anti science movements. Huge amounts of time, funding and other resources are being put into combatting disinformation circulated as part of such campaigns.


So, we`ve established that misinformation and disinformation have an overwhelmingly negative impact. Also, I've said that its impacts are difficult to reverse. It follows that preventative approaches, rather than doing damage control, is the strategy with the most long term benefit. To prevent disinformation from spreading, we need to understand the drivers of it. People ask a lot of questions around this -  “”what is the main difference between disinformation and misinformation”, “what is the key difference between misinformation and disinformation”, or other variations of these.


These are valid questions; however one important aspect of it might not come to mind on first glance at this topic. However, it's actually closely linked, and something that's part of many people`s value systems. I`ll explain why. And I'm sure the article title was a spoiler, but this key driver is the desire for free speech - that's what I`ll focus on in this article. Before I delve deeper into this topic, I`ll say that of course free speech isn't the only factor driving such movements. It`s a complex framework of interlinked issues. That said, free speech is an important theme that runs through both historical and contemporary (modern) anti vaccine and other anti science movements. So it is beyond crucial to understand what it is first of all, some impacts it has had, and also some benefits and drawbacks to limiting free speech with respect to health. 


  1. What is the meaning of free speech? What are the limits of free speech?


With that, what is free speech, exactly? What are the limits of free speech? The details of the definition can vary across sources - but generally it involves the right of individuals to express opinions, thoughts, and so on, in any manner, without fear of retaliation. It's quite a broad principle. 


That's beneficial in one sense in that that makes it quite inclusive. In the other sense, it makes it quite difficult to define what its limits and boundaries are - or if there should even be any. These concerns become all the more relevant when we talk about free speech in the context of healthcare. People's lives hang in the balance in a very literal sense. In a single moment, disinformation can be shared among families, friends, communities, and entire countries. Disinformation can also be shared internationally during health emergencies such as outbreaks, pandemics, and epidemics. 


Evidence shows a long trail of devastation from sharing inaccurate information among people. Online, talking in-person, churches, community meetings, any form of group interaction really, large or small- the principles remain the same. In cases of more extremist groups members tend to be highly interconnected, highly polarized, and generally engage only with those who have similar perceptions to the group. They see only a very narrow range of perceptions that people can have about vaccines and healthcare more broadly. Some may then believe that this small sample represents what the whole population thinks. 


This can result in these groups becoming a focal point from where fake news is shared. Such disinformation is very often shocking, sensationalist, and gets significant traction online.The same principle can also apply to messaging offline such as protests. It won't be surprising that fake news and the sentiments linked to it spread very quickly. These features of this information can recruit new members to such groups at exponential rates. This only exacerbates  the whole process. 


When you're aware of this, it won't be surprising that misinformation and disinformation are surprisingly prevalent. It is in fact so common that literature frequently refers to an “infodemic” - that is, an epidemic of fake news. But exactly how much content online is actually outright wrong and shared for nefarious reasons? According to a 2021 study published by Shuai Zhang and colleagues, disinformation sharing increased exponentially with COVID-19 cases at the beginning of the pandemic  Further, one large-scale study of conspiracies and false information from 87 countries across 25 languages. Shockingly, the authors found that 82% of claims from 2,311 reports from Facebook, Twitter and online newspapers were false. According to a further study, 14.8% of the U.S-based study population  believed that pharmaceutical companies created the SARS-CoV2 virus, with 28.3% believing that the Chinese government created the virus as a bioweapon. The same study found that out of 155,353 tweets posted between December 31st, 2019, and March 13, 2020 over half of the tweets stigmatized Asian populations in relation to COVID-19, with conspiracy theorists referring to SARS CoV2 as “Wuhan/Chinese Virus.” Attitudes towards conspiracies also vary with geographical location. A study of 1, 499,227 vaccine-related tweets from 1st June 2011 to 30th April 2019 found that negative tweets most commonly originate in Netherlands, Japan, Canada, and the United States. 


 For instance, a 2023 study published by Ammara Malik and colleagues investigated the antecedents and consequences of sharing inaccurate information among adults on social media during COVID 19. The authors carried a systematic literature review of 26 international studies published from January to September 2021. Such studies were from regions such as the USA, Nigeria, and Bangladesh. They found that “misinformation sharing could have profound consequences for individuals and society and impede the efforts of government and health institutions to manage the crisis.”  Further, other recent analyses have found that trust in health authorities and policymakers can be eroded to varying degrees, and cell towers have even been torched by arsonists in response to claims that 5G caused COVID-19. Evidence-based websites, peer reviewed journals and other credible sources can be replicated by actors in such fake news movements. This in turn can destroy the credibility of the originals. In other cases, patients refused to take ibuprofen and anti-inflammatory medications due to the false assumption that they could increase the risk of contracting SARS-CoV2 (this is the name of the virus itself, while COVID 19 only refers to the set of symptoms that can occur after becoming infected). . However at worst, circulating disinformation can be fatal when individuals do not accept vaccination or other public health precautions. 


  1. How to respond to disinformation while protecting free speech?


With that, what is the best way to approach this?What are the limits of free speech? Another important challenge is defining how to respond to disinformation while protecting free speech. 


I`ve talked about the meaning of free speech, and I`ve said that it is a relatively broad principle. The positive element of it being so broad is that it is very inclusive, and allows very diverse thoughts and opinions to be communicated. However, the negative impacts of this is that it's difficult to define what the boundaries of free speech are. Is it when one person is at risk? Five? Fifteen? Fifty? What is difficult is that there is no standard answer to this question. People form  very diverse values throughout their lives, and that means everyone will have different answers to questions like this. There is a very strong body of knowledge about vaccines and other public health interventions, and hundreds of studies confirming their safety and effectiveness. Recent research led by the World Health Organisation has confirmed that global immunization efforts have saved ” an estimated 154 million lives or the equivalent of 6 lives every minute of every year – over the past 50 years. The vast majority of lives saved – 101 million – were those of infants.”  The website of the WHO also states that “over the past 50 years, vaccination against 14 diseases (diphtheria, Haemophilus influenzae type B, hepatitis B, Japanese encephalitis, measles, meningitis A, pertussis, invasive pneumococcal disease, polio, rotavirus, rubella, tetanus, tuberculosis, and yellow fever) has directly contributed to reducing infant deaths by 40% globally, and by more than 50% in the African Region.” So scientifically, there is significant evidence in support of pharmaceutical and non-pharmaceutical interventions in public health. 


Of course, despite this there are many people who don't accept one or more of these interventions. This wouldn't be such an ethically complex issue if public health interventions only affected the individual. If one person decided to stop taking antihypertensives (blood pressure medication) against their doctor's advice, for example, clearly this isn't a good decision for them. Unregulated high blood pressure has been found to be linked with increased risk for preventable emergency department visits, chest pain, heart attacks and heart failure -  so it won't be surprising that it is a major cause of premature death worldwide. So, if a patient stops taking antihypertensive medication, they are certainly placing themselves at serious risk. However, here is the key point. They are placing themselves and only themselves at risk. 


This isn't the case when we talk about delaying or rejecting vaccines, masks, and other public health interventions. This causes very large-scale harm, so much so that in 2019, the WHO listed vaccine hesitancy as one of the top threats to global health alongside Ebola virus, climate change, and antibiotic resistance. Further, a study from 2022 estimates that for every 1% decrease in vaccine hesitancy, up to 45 deaths per million inhabitants could be averted. Not only this, it`s also well-known that unvaccinated or undervaccinated individuals can act as viral reservoirs. This can cause insufficient levels of vaccination to reach herd immunity, and outbreaks of infectious diseases that were previously controlled. These include the most contagious diseases such as measles, pertussis (whooping cough), polio, among many others. 


With that, discontinuing an individual medicine against medical advice cannot be compared to rejecting or delaying vaccination in terms of the harm to others. This is where the ethical question comes in - how do we respond to disinformation while protecting free speech? I would argue that the first step is developing methods to identify the former. In my view, disinformation can be slightly easier to identify than misinformation as it tends to be the more extremist type of fake news. If someone is sharing false information with the goal of achieving engagement, it is likely they will make it more provocative. However, it can definitely be more insidious. I`d argue that for that reason, more rigorous algorithms and methods of fact checking could be developed in the coming decades. Also, more rigorous definitions of disinformation could be developed, as the current definition we use (intentionally sharing inaccurate information) is quite broad. There are also various other questions to ask. What kinds of information? What qualifies as a negative intent vs questioning or sharing opinions?


  1. Conclusion

  1. References
  1. US military launched a secret anti-vax campaign in the Philippines – here’s why I’m not surprised
  2. Antecedents and Consequences of Misinformation Sharing Behavior among Adults on 
  3. A Deadly Infodemic: Social Media and the Power of COVID-19 Misinformation
  4. The Role of Social Media in Health Misinformation and Disinformation During the COVID-19 Pandemic: Bibliometric Analysis - PMC
  5. Health disinformation & social media - PMC
  6. Strategies to counter disinformation for healthcare practitioners and policymakers - PMC
  7. Characterizing the COVID-19 Infodemic on Chinese Social Media: Exploratory Study - PMC
  8. COVID-19–Related Infodemic and Its Impact on Public Health: A Global Social Media Analysis
  9. Constructing and Communicating COVID-19 Stigma on Twitter: A Content Analysis of Tweets during the Early Stage of the COVID-19 Outbreak
  10. Headache medication and the COVID-19 pandemic - PMC
  11. Vaccine Hesitancy on Social Media: Sentiment Analysis from June 2011 to April 2019 - PMC
  12. Contribution of vaccination to improved survival and health: modelling 50 years of the Expanded Programme on Immunization - The Lancet
  13. Global immunization efforts have saved at least 154 million lives over the past 50 years
  14. Hypertension.
  15. Ten threats to global health in 2019
  16. Impact of vaccine hesitancy on secondary COVID-19 outbreaks in the US: an age-structured SIR model - PMC
  17. Vaccine Hesitancy: Contemporary Issues and Historical Background - PMC