The Vaccine Blog

The online antivaccine movement in the age of COVID 19

The online anti vaccine movement in the age of COVID 19


  • Introduction


There have always been trends in how people have communicated around complex issues. This is true whether it is online, or in-person discussions or debates. Antivaccine movements are certainly no exception. The online antivaccine movement in the age of COVID 19 exemplifies this. It's not necessarily new in and of itself. The online anti-vaccination movement in the age of COVID 19 merits particular attention, however, because of how quickly misinformation and disinformation around the virus and vaccine can spread. Obviously, culture and communication around any topic varies with time. The online antivaccine movement around COVID vaccine and others isn`t unique in this regard. However, it is distinctive in that it can cause large-scale harm. This is true all across the vaccine hesitancy spectrum. There is an impact whether an individual is slightly concerned, is on the fence experiencing hesitancy towards vaccinations, or is outright antivaccine. With that,  observing trends in misinformation spread will allow us to combat this during future outbreaks, epidemics and pandemics. 

  • The questions asked


With that, what are the main questions asked? An enquiring individual might ask; why are vaccines necessary? Is the COVID vaccine safe? (spoiler alert; yes,it is) How do vaccines work in the body? This is of course not a comprehensive list of questions that may be asked. The reasons and motivations behind hesitancy and antivaccine activism are diverse. In many cases, there are many contributing factors, rather than just single queries. This depends on the individual`s background, experiences, and many other factors. 


Such diversity is also reflected in the research. Every study one can find on the topic of antivaccine perceptions highlights a range of issues that contribute to such ideologies. As I've discussed, a more accurate way to antivaccine movements is as a framework of interlinked scientific, social, philosophical and psychological issues, rather than a single isolated issue. This understanding will allow the development of strategies that account for how nuanced the issue actually is. Remember, when we're dealing with the antivaccine movement, we are dealing with people. People are dynamic, and so of course the statistics and other parameters of vaccine confidence are highly variable. 


For example, a 2020 study published by Rebekah Reuben and various colleagues investigates mistrust of the medical profession, higher disgust sensitivity among various other factors contribute to vaccination hesitation  The authors found that “the results from this study suggest that the vaccine hesitant parent is of younger age, lower educational attainment, and greater religiosity with little trust in their physician and higher in disgust sensitivity. Taken together, these attributes begin to paint a picture of who is vaccine hesitant, and provide further insight into the demographic and attitudinal predictors needed to create successful public health messaging.” Further, a 2021 study published by Shu-Fang Shih and colleagues investigated hesitancy about vaccinations specifically in the context of COVID 19 vaccinations. Risk perceptions, safety and efficacy concerns were strongly related to hesitation, which in turn related to vaccine rejection. 


Vaccine-resistant perceptions have also been widely studied in the context of social media. A 2021 study published by Dr. Goran Muric and colleagues investigated a public Twitter/ X dataset of antivaccine content, as well as vaccine misinformation and conspiracies. The authors found that predominantly, low-credibility websites were shared. However, when credible sites were shared, “were cited with false and misleading conclusions. Sometimes” antivaccine advocates would share legitimate scientific papers documenting rare side effects of the vaccines, while overemphasising the observed adverse effects and calling for vaccine boycotts. Sharing a scientific study in a tweet provides an illusion of credibility. Cherry-picking desirable sentences and relying on the fact that most of the audience will not make an effort to read a scientific paper in detail is a very effective strategy for manipulation.“


In a 2023 Turkish study, Salih Aslan and several colleagues studied parents`reasoning for refusing childhood vaccinations. Consistent with other studies in the area, the authors found that “parents have concerns for many different reasons related to vaccines and immunisation policies.” They also caution that their findings cannot be generalised to all parents rejecting vaccinations, or those experiencing concern or hesitation. However, it is also true that such findings provide insight into why certain individuals hold particularly polarised views around vaccinations. 


In the online antivaccine movement in the age of COVID 19, this is more important day by day. People are exposed to more and more views each moment they are online. In other words; we are exposed to a huge number of ideas in very short timeframes. Of course, we won't process all these ideas consciously. The sheer number of social media posts, videos, articles, and other content would make this impossible. Rather, I believe we take in all this information on a more subconscious level, and by doing so it shapes our perceptions on a. This makes our own worldviews more nuanced. This in turn means more sophisticated approaches will be needed simply to scratch the surface of new-age movements against vaccinations. This is not to mention addressing them and making real change. 


Further, think about how varied these ideas we are exposed to already are. Anyone with an Internet connection can post ideas. That means that we are exposed to ideas from people of all backgrounds, cultures, and ethnicities  from all over the world. Now, this is not inherently a bad thing. The ability to adapt our own worldview in accordance with new ideas and information is important. It`s a key marker of intellectual honesty. However, it does mean that it will be difficult to standardise approaches to addressing new-age antivaccination movements. These principles I`ve discussed are only going to become more relevant in the coming years and decades. This is because the internet and exponential information spread,  will become more deeply integrated into our daily lives. 

  • Addressing online activism against vaccines


With that, is there a way to address modern activism by anti vaccine groups, despite this added complexity the online element of it adds? As I said, there is no single answer. However, there are several avenues of research being pursued in the area. 




One approach supported by research is simply fact-checking. However, this finding comes with several important caveats. The first is that it's not about facts; but about who is stating them. The research finds that this is apparently important in online messaging too, as well as in-person. This adds further support to the well-understood principle that trust in messengers is essential for the public to accept accurate information. When I say this, I mean that trust only increases the likelihood of such information being accepted. It doesn`t necessarily guarantee it. In addition, a huge number of other variables dictate whether information will be accepted. The target audience, the psychological state of the individual when reading the information, among many many others. 


However, to understand important themes and principles it is important to look at the research. A 2022 observational study published by Haoning Xue and colleagues investigated COVID 19 vaccine fact-checking posts on Facebook/ Meta. The author's most prominent finding was that “hospitals play a key role in disseminating facts and correcting misinformation. Although hospitals receive less engagement than other information sources, the comments expressed more positive emotions compared to other information sources. This suggests that hospitals should invest more in generating engaging public health campaigns on social media. Regarding overall emotions in the comments, fact-checking posts from health media and hospitals were associated with lower levels of anger, fear, and sadness in the comments, while posts from third-party fact checkers were associated with higher levels of anger in the comments. “

Inoculation, or “prebunking”


Fact checking is effective. However, perceptions have already been skewed after misinformation and disinformation is shared by anti vaccine groups and individuals, or by those who are vaccine hesitant. The damage is done, unfortunately. So it is much easier and efficient to point out features of incorrect information before the public is exposed to it (this is actually similar to how vaccines themselves work). More colloquially called “prebunking”, the idea is to “inoculate” the public against any misinformation or disinformation they may encounter in the future. Another element of this approach that makes it so effective is that it is self-directed. That is, the individual has control over how they approach misinformation. Nobody is telling them what to do. The reason this is so important is that experiencing a lack of control is a common theme among anti vaccine groups, and among those who experience vaccine hesitancy.  


Such an approach was studied in a 2021 paper published by Brian Hughes and colleagues. The authors investigated variability in how disinformation about COVID 19 vaccines was received and interpreted in different French-speaking regions. They found that “fact-based inoculation messages performed equally well to narrative/rhetoric-based messages, and equally well to hybrid methods that used both fact and narrative/rhetorical techniques. It seems possible that a similar approach could be pursued to develop francophone public health messages based on persuading audiences away from anti-vaccine and COVID-denialist viewpoints. “  This highlights a second crucial caveat of online communication. The audience. Differing languages among audiences may be linked with differing cultures. This in turn can impact acceptance of public health messaging or indeed messaging around any other important topic. Of course, the world is more multicultural now than ever before with the ease of communication and travel. However, in some cases cultures are very well preserved and this can and does impact online messaging. 


Despite this, there is strong evidence that prebunking works across diverse audiences. For example, a 2022 study published in Frontiers in Psychology investigated prebunking as a strategy for conferring “large-scale psychological resistance against fake news. “ The authors found that “promoting accurate beliefs about COVID-19, and encouraging healthier, safer behaviours related to COVID-19 prevention, would certainly answer this call. Indeed, COVID-19 health messaging can harness both ways in which inoculation theory is used to protect healthier beliefs and actions: building resistance to unhealthy influence, like conspiracy theories, and encouraging healthier behaviours, like social distancing and wearing a mask in public. “




These approaches do, however, miss one key element of how people make decisions. Emotion. Logical decision-making and emotion are often perceived as being separate when in fact they are very closely integrated. Both of the previously discussed approaches lack an emotional component. Thus, individually they are not as effective as they have the potential to be. However combining facts with emotive stories is a key way to capture the attention of the masses. Perhaps some individuals have experienced severe adverse effects from infectious diseases. Others may have had family members , or other loved ones who experienced such consequences of infection.  This would lead to accurate information being disseminated on a large scale. The best way to tap into emotions is via stories, which is the strategy I'll discuss next. 


I`ll focus on a single example here. In 2022, the site Vaccines Today posted a story of a family that tragically lost a son to long term consequences of a childhood measles infection..


            “I`ll never forget my parents coming back from the doctor. They had been told that    Max had subacute sclerosing panencephalitis (SSPE), a fatal result of measles infection for which there is no cure.  


They were also told that he had two or three weeks to live. It was devastating.”


Max and his brother Julian had lived a normal early childhood; school, ice hockey, playing, and other outings. They were a typical busy, bustling family. 


However, when Max was 6 months old, something happened that would change the family's lives forever. Max caught measles. He was too young to receive the MMR vaccine, which is generally given at 1 year old, and boosted at 4 to 5 years of age. After enduring a high fever and difficulty breathing for a few weeks,  Max had recovered…..


Or so it appeared…


9 years later, Max began having difficulty balancing, performing at school, and had seizures. After progressively deteriorating, Max was diagnosed with SSPE. It generally occurs 7-10 years after the initial measles infection.  Eventually, Max`s condition deteriorated so much that he had to be placed in a hospice. Soon after, he died.”


Nothing is more tragic for any parent of any age, background or ethnicity than outliving their child. There are no words that can really describe the loss - all one can really do is offer solidarity and compassion. It won't be surprising, then, that this resonated with a huge amount of people. It is the most-read article on the Vaccines Today site since it was launched in 2011. Also, there is a list of comments from individuals sharing their personal experiences of family members contracting and in some cases, passing away from measles infection. 

  • Summary and conclusion


In sum, it's important to remember that when we are addressing activism against vaccines, we are addressing people. People are diverse, and so the motivations behind online anti vaccination activism are too. This is reflected in the research. It has been found that motivations range from low perceived disease risk to low perceived safety and effectiveness to mistrust to even higher disgust sensitivity. Also, we are exposed to a huge range of ideas online. This makes it very difficult to develop standardised approaches to combating online advocacy against vaccines.  


However, research has identified several methods that may reduce the spread of misinformation and disinformation. The first is simple fact-checking, with the important caveat that who is sharing the facts matters. Despite issues with mistrust towards health professionals and health authorities, they do remain the most trusted source of information by far. With that, it is crucial that healthcare workers and health authorities are given the correct tools and support to address misinformation online. 


It is also highly effective to point out features of misinformation/ disinformation to the public before they encounter it. Colloquially called “prebunking”, this involves helping the public to build knowledge around what incorrect or misleading information online may look like. This reduces the likelihood of people falling prey to misinformation subsequent times they encounter it. 


However, these lack an emotional component, and humans are highly emotional decision makers. With that, including emotional stories of those who suffered from vaccine preventable diseases can also be highly effective at capturing the attention of the masses and restoring vaccine confidence on a large scale. 


Integrating all three of these approaches into social media campaigns is the best strategy to connect with people and increase vaccine confidence for many years and decades to come. Thanks for reading!

  • References;


  1. Mistrust of the medical profession and higher disgust sensitivity predict parental vaccine hesitancy - PMC
  2. Vaccine Hesitancy and Rejection of a Vaccine for the Novel Coronavirus in the United States - PMC
  3. COVID-19 Vaccine Hesitancy on Social Media: Building a Public Twitter Data Set of Antivaccine Content, Vaccine Misinformation, and Conspiracies
  4. Why Turkish Parents Refuse Childhood Vaccination? A Qualitative Study - PMC
  5. COVID-19 Vaccine Fact-Checking Posts on Facebook: Observational Study - PMC
  6. Cultural Variance in Reception and Interpretation of Social Media COVID-19 Disinformation in French-Speaking Regions - PMC
  7. The Prevalence, Features, Influencing Factors, and Solutions for COVID-19 Vaccine Misinformation: Systematic Review
  8. Inoculating Against Fake News About COVID-19 - PMC
  9. 'I lost my brother to measles' - VaccinesToday