Richard M. Carpiano, Timothy Callaghan et al, ‘Confronting the evolution and expansion of anti-vaccine activism in the USA in the COVID-19 era’, The Lancet, Volume 401, Issue 10380, March 18, 2023
doi.org/10.1016/S0140-6736(23)00136-8
Vaccine hesitancy is probably as old as vaccines itself. People have, through the years, distrusted vaccines, for various reasons, even as the results in terms of health outcomes were obvious. In recent years, with high decibel social media amplification, the movement has grown stronger than the few stragglers here and there of the past. Post pandemic, the anti-vax campaign has been reflected in the poor levels of uptake of COVID vaccinations, even when they were available free of cost, as in India. The authors look at the entire history of the vaccination movement in the U.S., paring it down to the specifics of post pandemic hesitancy and disbelief. However, the resonance of the movement is in every nation in the world that is struggling to up the ante and increase vaccination coverage.
A look at the past
Vaccines are the tools by which nations can achieve protection from mortality and morbidity from serious, life threatening infections for their people. The invention of the small pox vaccine in 1796 began the era of vaccinations and over the years, the technologies and processes involved in developing vaccines have grown smarter and advanced, allowing for a fast tracking previously unthinkable in medicine. Parallelly, vaccine hesitancy also grew seeing a milestone when Wakefield’s article in The Lancet, which was later withdrawn, drew a link between autism and the vaccine against rubella, mumps and measles.
While acknowledging the leap in geometric progression post pandemic, the authors trace that in the years preceding the COVID-19 pandemic, anti-vaccine activism became more visible in the U.S., mainly through three distinct developments.
Before the pandemic, anti-vaccine activism was increasingly aligned with conservative political identity. Secondly, the paper notes, anti vaxxers organised themselves into proper groups and networks that lobbied state legislatures and promoted conservative political candidates with anti-vaccine positions. The leveraging of social media, including using common naming conventions, branding and cross promotions, to spread their ideas started even before the pandemic. Harassment and threats to health-care and public health professionals began on social media, in the form of orchestrated attacks and troll bots.
When COVID-19 struck
The authors pointed out that the COVID-19 pandemic exacerbated the evolution of the lobby and magnified the reach of vaccine misinformation. “Anti-vaccine activists, who for many years spoke primarily to niche communities hesitant about childhood vaccinations, have used traditional and social media to amplify vaccine-related mistruths about COVID-19 vaccines while also targeting historically marginalised racial and ethnic communities.”
The start of the COVID-19 vaccine trials and its rather unprecedented wide media coverage seemed to provide opportunities for anti-vaccine activists to discredit the vaccine development and evaluation process, particularly since it was fast tracked considering the urgency of the pandemic. “As the national roll-out of vaccinations began, they highlighted stories of purported side-effects (and conspiracy theories) and worked to undermine public confidence in vaccine safety and efficacy among a broader public audience who were searching for information about whether to vaccinate,” the authors note.
“Notably, the activists treated the identification of adverse effects (such as myocarditis) by scientific authorities as more evidence of conspiracy rather than a demonstration of how vaccine safety systems operate.” It also helped that their messages seemed to resonate with the President at the helm of the U.S. during the pandemic, Donald Trump.
All these efforts contributed to COVID-19 vaccine hesitancy and expanded the movement, with early indications suggesting that this hesitancy could now also be extended towards other vaccines.
Strategies and recommendations
The authors recommend immediate action to counter these dynamics and respond to the anti-vaccine movement. “Fundamentally, the public health, scientific, and policy communities must recognise that anti-vaccine campaigns are networked.” Despite not being a unit formally, and operating as independent entities, they are deeply networked and with evangelical zeal come together to amplify and propagandise any information that is anti-vaccine in nature. Though the health network is more formal, its engagement with social media, or funding status may not allow it to be a formidable opposing force.
Therefore, the authors suggest three strategies to combat this in the U.S. Firstly, they call to develop networked communities capable of reaching the public at the right time, at the right place, and with the right messenger about vaccine-related information — especially to pre-empt and pre-bunk well-funded and amplified messages disseminated by the anti-vaccine movement. Secondly, interdisciplinary and intersectoral collaborations are essential for developing effective responses. Finally, these networked and coordinated communities should be leveraged to counter relevant trends in anti-vaccine efforts, including separating narratives about liberty from anti-vaccine attitudes and mitigating anti-vaccine activist harassment of public health communicators.
The paper indicates the importance of the need to comprehend the implications of this ‘recent evolution of anti-vaccine activism on vaccination uptake and the promotion of sound public health strategies.’
It highlights an urgent issue in health care globally, one that nations will do well to intercept before it grows any further.
