WASHINGTON — For as long as there have been vaccines, there have been people like Winnie Harrison who shun them.
Harrison, 67, a former educator and mother of four, became an ardent disbeliever in immunizations after her first child had an adverse reaction to a measles, mumps, and rubella shot some three decades ago. But it wasn’t until recent years that she and other skeptics began to forge online connections, fostering fear about vaccines and what doctors call a growing ecosystem of health misinformation that has only ramped up amid the coronavirus pandemic.
The founder of the Connecticut Vaccine Rights League, Harrison administers her group’s Facebook page, one of hundreds, if not hundreds of thousands, nationwide that dole out testimonials from antivaccine activists and celebrities, memes of doctors sharing now discredited claims about vaccines — and, more recently, warnings about the forthcoming COVID-19 vaccines.
“I would never take it,” she said in an interview. “Most people recover from this virus. I am not dismissing it. It is very real. But so are vaccine problems.”
As drugmakers close in on vaccines to tame an outbreak that has killed more than 260,000 people in the United States alone, medical professionals and online disinformation researchers are warning that an expanding antivaccine movement — bolstered by far-right opponents of coronavirus lockdowns — could undermine efforts to get Americans to take the shots and end the pandemic. They are urging health authorities, hospitals, and pharmaceutical companies to invest heavily in public education to counter the misinformation, build confidence in the vaccines, and explain how they could help save lives, reopen schools and businesses, and return the US to normal.
“Vaccines are one of our greatest health care achievements,” said Dr. Bisola Ojikutu, an infectious disease specialist at Massachusetts General and Brigham and Women’s hospitals. “The same energy that was placed into development and distribution of a coronavirus vaccine should have been placed in messaging and community engagement.”
Excitement in the medical community has been building as three companies — Moderna, Pfizer, and AstraZeneca — recently released data showing their COVID-19 vaccines were highly effective.
But doctors and disinformation researchers have seen trouble looming since the earliest days of pandemic shutdowns, as misinformed or intentionally false and deceptive content spread through the internet like wildfire and conspiracy theories abounded over the virus’s origins, symptoms, and cures. Around that time, antivaccine groups saw huge increases in content and engagement, and started to merge efforts with conspiratorial actors, far-right groups, and activists protesting health measures ordering schools and businesses to close, researchers said.
The environment of fear and uncertainty created prime conditions for some of the top antivaccine activists to make an even broader push against science and government measures to protect public health.
“They are downplaying the pandemic, they are encouraging people not to wear masks, they are leading reopening protests, and then they also see this as an opportunity to erode confidence in vaccinations overall,” said Renée DiResta, the technical research manager at the Stanford Internet Observatory and one of the lead experts in the study of online narrative manipulation and the so-called antivaxxer movement.
Some public health experts are urging President-elect Joe Biden to add misinformation researchers to his coronavirus task force. But complicating any efforts to respond to the outbreak has been President Trump, who has frequently minimized the dangers of the pandemic, fueled political polarization in the nation’s response, and had, until this week, held up the presidential transition. In the midst of it all, doctors and researchers have often referred to him as the “disinformation super spreader.”
Trump has a history of sharing falsehoods to undermine vaccines dating to at least 2007. But this year he has boasted about the speed with which some vaccines have been created under a federal initiative known as “Operation Warp Speed” in an attempt to claim credit for the achievement.
Since the early 1800s, antivaccine activists have opposed immunizations based on largely the same themes, such as pseudoscientific claims that they are unsafe and harmful, causing sudden infant death syndrome, autism, and other side effects. But in more recent years, many vaccine opponents now also argue that policies requiring vaccination for school or work are a violation of their freedom of choice and civil liberties, according to research by DiResta.
Some believe businesses that manufacture vaccines are motivated by profits and can easily escape liability should something go wrong. Increasingly, outlandish conspiracy theories are circulating that the coronavirus vaccine in particular could alter people’s DNA or even transform them into 5G wireless antennas, DiResta said.
In many ways, “vaccines are a victim of their own success,” she wrote in a 2018 paper. “Absent the sight of individuals afflicted by communicable diseases, increasing numbers of people seem to be more afraid of vaccines than of the diseases they prevent.”
Vaccination has made major contributions to world health, eradicating polio and smallpox in the US, and eliminating a deadly cattle virus around the world known as rinderpest. Doctors also have seen its success in controlling measles, spurring hope that disease, too, could possibly be completely stamped out from society one day.
But the latest push against vaccines began to take shape after Andrew Wakefield, a former British physician, and other colleagues released a now discredited 1998 study that falsely linked the measles, mumps, and rubella, or MMR, vaccine to behavioral regression and developmental disorder. Vaccination rates for MMR dropped by about 2 percent in the US, and even more in the United Kingdom and Ireland, in the wake of the study.
The arrival of social media accelerated interconnections among activists’ and created fresh forms of opposition, with those on the left shifting their message to appeal to the libertarian right, DiResta said.
Opponents now span class and political lines, including celebrities like Alicia Silverstone and Jim Carey, as well as Robert F. Kennedy Jr., who has become one of the top antivaccine influencers on Instagram. An order just last summer by Massachusetts Governor Charlie Baker that nearly all students in the state under the age of 30 get a flu vaccine this year sparked protests outside the State House.
And in the wake of the pandemic, antivaccine activists have not only increasingly “discovered, engaged with, and amplified” each other but also other far-right and extreme conspiracy groups, such as QAnon, said Graham Brookie, director and managing editor of the Atlantic Council’s Digital Forensic Research Lab. One rabbit hole, he said, can easily lead to the next.
An October report by the Centre for Countering Digital Hate found 31 million people follow antivaccine Facebook groups and 17 million people subscribe to similar channels on YouTube. Antivaccine activists saw followings of their social media accounts grow by at least 7 million people since 2019, it said. Doctors who publicly urge vaccinations have reported being harassed online by those activists in recent years, making some physicians hesitant to speak out.
There is little coherency to how people are drawn into opposition, said Jonathan Corpus Ong, an associate professor at the University of Massachusetts Amherst and research fellow at the Harvard Kennedy School. Some vaccine opponents fall in through wellness and alternative medicine culture; others are believers in conspiracy theories about the pharmaceutical industry, the influence of Microsoft cofounder Bill Gates, and 5G wireless signals. Some support Trump but oppose his push for a coronavirus vaccine. Others might cheer the president’s vaccine efforts but are skeptical about immunization plans will fall to Biden to implement.
Researchers with the nonprofit First Draft — which collected 14 million tweets and posts from Facebook and Instagram about vaccination in English, Spanish, and French ― found a large amount of the content fell under a common theme: perpetuating the unsubstantiated claim that the quest for profits by pharmaceutical companies undermined the safety of all vaccines.
As the US prepares to distribute coronavirus vaccines, researchers said policymakers need to understand how even innocuous-seeming posts work in tandem across social media sites to shape people’s attitudes, said Seb Cubbon, one of the research analysts on the study.
Doctors and researchers see some positive signs. A Gallup poll released this month found about 58 percent of Americans were willing to get a COVID-19 vaccination, up from a low of 50 percent in September. Studies show about 75 percent of the population needs to be vaccinated to control the outbreak.
A poll of nearly 20,000 adults in 27 countries released in August by the World Economic Forum found 74 percent said they would get a vaccine if it were available. The US figure then was 67 percent, roughly where it was in a late July Gallup poll.
The Centers for Disease Control and Prevention is developing education materials on coronavirus vaccination, according to its COVID-19 handbook. Twitter and Facebook have implemented stricter controls to keep coronavirus falsehoods and conspiracy theories from spreading on their social networks.
But doctors and disinformation researchers said those measures will not suffice and are likely to leave large information gaps or “data voids” in search engines, which could lead people down the wrong path. Health and government officials must also understand how internet users could be micro-targeted. “We will see all the same tactics and trends that went after voters pivot to going to vaccines,” said P.W. Singer, a political scientist and author of “LikeWar: The Weaponization of Social Media.”
In Black communities, a sordid history of racial experimentation and continued barriers to health because of structural racism have contributed to a justifiable distrust in vaccines, doctors said. In Latino communities, Spanish-language medical disinformation has largely gone unchecked and narratives “are receiving high levels of engagement ... where there are low health literacy skills,” said Jacobo Licona, who leads disinformation research at the firm EquisLabs.
To reach people across communities, doctors emphasized the importance of recruiting trusted and popular messengers with varied cultural backgrounds and language skills. Vaccinations, they said, should be widely available not only in local pharmacies and medical clinics but also in schools and on college campuses.
Ong, the UMass professor, urged that public education campaigns point to history, to the immense benefits of past immunization campaigns. “We have been vaccinated against polio and hepatitis, so many have worked over time,” he said.
The longer it takes to develop accurate and positive vaccine messages, the harder it will be for them to break through with some people. Harrison started her Facebook group in 2015, about a year after a measles outbreak at Disneyland spurred mostly Democratic legislators in California and other state legislatures to expand vaccine requirements.
To critics that say she is spreading disinformation, Harrison responds that people are entitled to express their opinions. Hers, she adds, are based on personal experience: Two years in and out of hospitals with her son after he fell ill with pneumonia, allergies, and asthma following an MMR vaccination.
“This wasn’t just something that I just woke up one day and said I am going to listen to whoever — some stranger — on the internet,” she said, adding that she doesn’t believe large pharmaceutical companies have people’s best interests in mind.
Ojikutu, the MGH specialist, and other doctors stressed that there can be medical complications with vaccines — although rare and often mild — but that investment in vaccines benefits the public in huge ways.
“It is totally reasonable to have your own beliefs, but when those beliefs get in the way of yourself, your children, parents, or other people, that’s when it becomes problematic,” Ojikutu said.