Anti-vaccine activism

Anti-vaccine activism, also called the "anti-vax" movement,^[1] is organized activity to show opposition to vaccination, often designed to increase vaccine hesitancy by disseminating misinformation or disinformation.^[2] Although myths, conspiracy theories, misinformation and disinformation spread by the anti-vaccination movement and fringe doctors increase vaccine hesitancy and public debates around the medical, ethical, and legal issues related to vaccines, there is no serious hesitancy or debate within mainstream medical and scientific circles about the benefits of vaccination.^[3]

Anti-vaccination activist holding a sign at a 2010 Tea Party Express rally

Rally of the Anti-Vaccination League of Canada in 1919

18th and 19th century

Ideas that would eventually coalesce into anti-vaccine activism have existed for longer than vaccines themselves.^[4] Some philosophical approaches (e.g. homeopathy, vitalism) are incompatible with the microbiological paradigm that explains how the immune system and vaccines work. Vaccine hesitancy and anti-vaccine activism exist within a broader context that involves cultural tradition, religious belief, approaches to health and disease, and political affiliation.^[3]

Opposition to variolation for smallpox (a predecessor to vaccination) was organized as early as the 1820s around the premise that vaccination was unnatural and an attempt to thwart divine judgment.^[5] Religious arguments against inoculation, the earliest arguments against vaccination, were soon advanced.^[6] For example, in a 1722 sermon entitled "The Dangerous and Sinful Practice of Inoculation", the English theologian Reverend Edmund Massey argued that diseases are sent by God to punish sin and that any attempt to prevent smallpox via inoculation is a "diabolical operation".^[7] It was customary at the time for popular preachers to publish sermons, which reached a wide audience. This was the case with Massey, whose sermon reached North America, where there was early religious opposition, particularly by John Williams. A greater source of opposition there was William Douglass, a medical graduate of Edinburgh University and a Fellow of the Royal Society, who had settled in Boston.^{[8]: 114–22}

Vaccination itself was invented by British physician Edward Jenner, who published his findings on the efficacy of the practice for smallpox in 1798. By 1801, the practice had been widely endorsed in the scientific community, and by several world leaders. Philadelphia physician John Redman Coxe, noting that even then false accounts were circulated of negative effects of vaccination, wrote,

"Such are the falsehoods which impede the progress of the brightest discovery which has ever been made! But the contest is in vain! Time has drawn aside the veil which obstructed our knowledge of this invaluable blessing; and in the examples of the Emperor of Constantinople, of the Dowager Empress of Russia, and the King of Spain, we may date the downfall of further opposition."^[9]

Coxe's expectation of an end to opposition to vaccination proved premature, and through much of the nineteenth century, the principles, practices and impact of vaccination were matters of active scientific debate. The principles behind vaccination were not clearly understood until the end of the nineteenth century. The importance of hygiene in the preparation, storage, and administration of vaccines was not always understood or practiced. Reliable statistics on vaccine efficacy and side effects were difficult to obtain before the 1930s.^[3]

Anti-Compulsory Vaccination League

In the United Kingdom, the Compulsory Vaccination Act of 1853 required that every child be vaccinated within three or four months of birth.^[10] It set a precedent for the state regulation of physical bodies, and was fiercely resisted.^[11] The following year, in 1854, John Gibbs published the first anti-compulsory-vaccination pamphlet, Our Medical Liberties.^[12] By the 1860s, anti-vaccinationism in Britain was active in the working class, labor aristocracy, and lower middle class. It had become associated with alternative medicine and was part of a larger culture of social and political dissent that included both labor unions and religious dissenters. ^[11][13]

In June 1867, the publication "Human Nature" campaigned in the United Kingdom against "The Vaccination Humbug",^[14] reporting that many petitions had been presented to Parliament against Compulsory Vaccination for smallpox, including from parents who alleged that their children had died through the procedure, and complaining that these petitions had not been made public. The journal reported the formation of the Anti-Compulsory Vaccination League "To overthrow this huge piece of physiological absurdity and medical tyranny", and quoted Richard Gibbs (a cousin of John Gibbs) who ran the Free Hospital at the same address as stating "I believe we have hundreds of cases here, from being poisoned with vaccination, I deem incurable. One member of a family dating syphilitic symptoms from the time of vaccination, when all the other members of the family have been clear. We strongly advise parents to go to prison, rather than submit to have their helpless offspring inoculated with scrofula, syphilis, and mania".^[14]

Notable members of the Anti-Compulsory Vaccination League included James Burns, George Dornbusch and Charles Thomas Pearce.^[15] After the death of Richard B. Gibbs in 1871, the Anti-Compulsory Vaccination League "languished"^[10] until 1876 when it was revived under the leadership of Mary Hume-Rothery and the Rev. W. Hume-Rothery.^[16] The Anti-Compulsory Vaccination League published the Occasional Circular which later merged into the National Anti-Compulsory Vaccination Reporter.^[17]

Anti-Vaccination Society of America

In the United States, many states and local school boards established immunization requirements, beginning with a compulsory school vaccination law in Massachusetts in 1855.^[12] The Anti-Vaccination Society of America was founded in 1879, after a visit to the United States by British anti-vaccine activist William Tebb,^[18] and opposed compulsory smallpox vaccination for smallpox from the final decades of the 19th century through the 1910s.^[19] During this period, smallpox vaccination was the only form of vaccination that was widely practiced, and the society published a periodical opposing it, called Vaccination.^[20]

A series of American legal cases, beginning in various states and culminating with that of Henning Jacobson of Massachusetts in 1905, upheld the mandating of compulsory smallpox vaccination for the good of the public. The court ruled in Jacobson v. Massachusetts that "the liberty secured by the Constitution of the United States to every person within its jurisdiction does not import an absolute right in each person to be, at all times and in all circumstances, wholly freed from restraint. There are manifold restraints to which every person is necessarily subject for the common good".^[12]

London Society for the Abolition of Compulsory Vaccination

 

"Death the Vaccinator", published by the London Society for the Abolition of Compulsory Vaccination in the late 1800s

In 1880, William Tebb enlarged and reorganized the Anti-Compulsory Vaccination League in the UK with the formation of the London Society for the Abolition of Compulsory Vaccination, with William Young as secretary.^[17] The Vaccination Inquirer, established by Tebb in 1879, was adopted as the official organ of the Society.^[17] A series of fourteen "Vaccination Tracts" was begun by Young in 1877 and completed by Garth Wilkinson in 1879. William White was the first editor of the Vaccination Inquirer and after his death in 1885, he was succeeded by Alfred Milnes.^[17] Frances Hoggan and her husband authored an article for the Vaccination Inquirer in September 1883 which argued against compulsory vaccination.^[21] The London Society focused on lobbying parliamentary support in the 1880s and early 1890s.^[17] They gained support from several members of the House of Commons of which the most prominent was Peter Alfred Taylor, the member for Leicester, which was described as the "Mecca of antivaccination".^[22]

The National Anti-Vaccination League

The UK movement grew, and as the influence of the London Society overshadowed the Hume-Rotherys and it took the national lead,^[16] it was decided in February 1896 to re-form the Society as The National Anti-Vaccination League.^[17] Arthur Phelps was elected as president.^[17] In 1898, the league took on a school leaver named Lily Loat, who was elected as the league's Secretary by 1909.^[23] In 1906, George Bernard Shaw wrote a supportive letter to the National Anti-Vaccination League, equating methods of vaccination with "rubbing the contents of the dustpan into the wound".^[24]

Anti-Vaccination League of America

In 1908, the Anti-Vaccination League of America was created by Charles M. Higgins and industrialist John Pitcairn Jr.,^[25] with anti-vaccination campaigns focused on New York and Pennsylvania.^[25] Members were opposed to compulsory vaccination laws.^[26] Higgins was the League's chief spokesman and pamphleteer.^[27] Historian James Colgrove noted that Higgins "attempted to overturn the New York State's law mandating vaccination of students in public schools".^[26] The League should not be confused with the Anti-Vaccination Society of America, that was formed in 1879.^[25] Higgins was criticized by medical experts for spreading misinformation and ignoring facts as to the efficacy of vaccination.^[28][29] The League dissolved after the death of Higgins in 1929.^[30]

20th century

Anti-vaccine activism ebbed for much of the twentieth century, but never completely vanished. In the UK, the National Anti-Vaccination League continued to publish new issues of its journal until 1972,^[23] by which time the global campaign for smallpox eradication through vaccination had made the disease so uncommon that compulsory vaccination for smallpox was no longer required in the United Kingdom.^[31]

New vaccines were developed and used against diseases such as diphtheria and whooping cough. In the UK, these were often introduced on a voluntary basis, without arousing the same kind of anti-vaccination response that had accompanied compulsory smallpox vaccination.^[31]

In the United States, numerous measles outbreaks occurred in the 1960s and 1970s, and were shown to be more frequent in states that lacked mandatory vaccination requirements. This led to calls in the 1970s for a national level vaccination requirement for children entering schools. Joseph A. Califano Jr. appealed to state governors, and by 1980, all 50 states legally required vaccination for school entrance. Many of these laws allowed exemptions in response to lobbyists. In New York State, a 1967 law allowed exemptions from receiving polio vaccine for members of religious organizations such as Christian Scientists.^[12]

21st century

Lancet MMR autism fraud

Main article: Lancet MMR autism fraud

Anti-vaccine activism in the 2000s regained prominence through exploratory research based on 12 cases that made claims about a link between the MMR vaccine and autism.^[32] These claims were subsequently extensively investigated and found to be false, and the original study turned out to be based on faked data. The scientific consensus is that there is no link between the MMR vaccine and autism, and that the MMR vaccine's benefits in preventing measles, mumps, and rubella greatly outweigh its potential risks.^[33]

The idea of an autism link was first suggested in the early 1990s and came to public notice largely as a result of the 1998 Lancet MMR autism fraud, which Dennis K Flaherty at the University of Charleston characterised as "perhaps the most damaging medical hoax of the last 100 years".^[34] The fraudulent research paper authored by Andrew Wakefield and published in The Lancet falsely claimed the vaccine was linked to colitis and autism spectrum disorders. The paper was retracted in 2010^[35] but is still cited by anti-vaccine activists.^[36]

The claims in the paper were widely reported,^[37] leading to a sharp drop in vaccination rates in the UK and Ireland. Promotion of the claimed link, which continued in anti-vaccination propaganda for the next three decades despite being refuted,^[38][39] was estimated to have led to an increase in the incidence of measles and mumps, resulting in deaths and serious permanent injuries.^[40][41] Following the initial claims in 1998, multiple large epidemiological studies were undertaken. Reviews of the evidence by the Centers for Disease Control and Prevention,^[42] the American Academy of Pediatrics, the Institute of Medicine of the US National Academy of Sciences,^[43] the UK National Health Service,^[44] and the Cochrane Library^[33][45] all found no link between the MMR vaccine and autism.^[46] Physicians, medical journals, and editors^{[47][48][49][50][51]} have described Wakefield's actions as fraudulent and tied them to epidemics and deaths.^[52][53]

An investigation by journalist Brian Deer found that Wakefield, the author of the original research paper linking the vaccine to autism, had multiple undeclared conflicts of interest,^[54][55] had manipulated evidence,^[56] and had broken other ethical codes. After a subsequent 2.5-year investigation, the General Medical Council ruled that Wakefield had acted "dishonestly and irresponsibly" in doing his research, carrying out unauthorized procedures for which he was not qualified, and acting with "callous disregard" for the children involved.^[57] Wakefield was found guilty by the General Medical Council of serious professional misconduct in May 2010, and was struck off the Medical Register, meaning he could no longer practise as a physician in the UK.^[58]

The Lancet paper was partially retracted in 2004 and fully retracted in 2010, when Lancet's editor-in-chief Richard Horton described it as "utterly false" and said that the journal had been deceived.^[59] In January 2011, Deer published a series of reports in the British Medical Journal,^[60][61][62] in which a signed editorial stated of the journalist, "It has taken the diligent scepticism of one man, standing outside medicine and science, to show that the paper was in fact an elaborate fraud."^[63][64] A 2011 journal article described the vaccine-autism connection as "the most damaging medical hoax of the last 100 years".^[46]

Wakefield continues to promote anti-vaccine beliefs and conspiracy theories in the United States.^[65] In February 2015, Wakefield denied that he bore any responsibility for the measles epidemic that started at Disneyland among unvaccinated children that year. He also reaffirmed his discredited belief that "MMR contributes to the current autism epidemic".^[66] By that time, at least 166 measles cases had been reported. Paul Offit disagreed, saying that the outbreak was "directly related to Dr. Wakefield's theory".^[67] Wakefield and other anti-vaccine activists were active in the American-Somali community in Minnesota, where a drop in vaccination rates was followed by the largest measles outbreak in the state in nearly 30 years in 2017.^[68][69][70]

The anti-vaccination movement was historically apolitical, but in the 2010s and 2020s the movement in the United States has increasingly targeted conservatives.^[2] As measles outbreaks increased, so did calls to eliminate exemptions from vaccine administration. As of 2015, 19 American states had suggested legislation to eliminate or increase the difficulty of exemptions, including California.^[12] Concurrently, American anti-vaccine activists reached out to libertarian and right-leaning groups such as the Tea Party movement to broaden their base. While earlier anti-vaccination activists focused on health impacts and safety of vaccines, recent themes increasingly involve philosophical arguments about liberty, medical freedom and parental rights.^[2]

With the growing anti-vaccine movement from the 2010s onwards, the United States has seen a resurgence of certain vaccine-preventable diseases. The measles virus lost its elimination status in the US as the number of measles cases continued to rise in the late 2010s with a total of 17 outbreaks in 2018 and 465 outbreaks in 2019 (as of 4 April 2019).^[71]

2019 measles outbreaks

Vaccine hesitancy led to declining rates of vaccination for measles, culminating in the 2019–2020 measles outbreaks. The most significant of these in proportion to national population was the 2019 Samoa measles outbreak.^[72]

In July 2018, two 12-month-old children died in Samoa after receiving incorrectly prepared MMR vaccinations.^[73] These two deaths were picked up by anti-vaccine groups and used to incite fear towards vaccination on social media, causing the government to suspend its measles vaccination programme for ten months, despite advice from the WHO.^[74][75] The incident caused many Samoan residents to lose trust in the healthcare system.^[76] UNICEF and the World Health Organization estimate that the measles vaccination rate in Samoa fell from 74% in 2017 to 34% in 2018,^[77][78] similar to some of the poorest countries in Africa.^[79]

In August 2019, an infected passenger on one of the more than 8,000 annual flights between New Zealand and Samoa probably brought the disease from Auckland to Upolu.^[73] A full outbreak of measles began on the island in October 2019 and continued for the next four months. As of 6 January 2020, there were over 5,700 cases of measles and 83 deaths, out of a Samoan population of 200,874.^[80][81] Over three per cent of the population were infected.^[82] The cause of the outbreak was attributed to decreased vaccination rates, from 74% in 2017 to 31–34% in 2018, even though nearby islands had rates near 99%.^[82][81] a rate of 14.3 deaths per 1000 infected) and 5,520 cases (2.75% of the population) of measles in Samoa.^[83][82][81] Sixty-one out of the first 70 deaths were four years old and under, and all but seven were under 15.^[84][85] After the outbreak, anti-vaxxers employed racist tropes and misinformation to credit the scores of measles deaths to poverty and poor nutrition or even to the vaccine itself, but this has been discounted by the international emergency medical support that arrived in November and December.^[73] There was no evidence of acute malnutrition, clinical vitamin A deficiency, or immune deficiency as claimed by various anti-vaxxers.^[73]

COVID-19 pandemic activism

Further information: COVID-19 vaccine misinformation and hesitancy and COVID-19 misinformation

During the COVID-19 pandemic, anti-vaccine activists undertook various efforts to hinder people who wanted to receive the vaccines, with such activities occurring in countries including Australia,^[86] Israel,^[87] the United Kingdom,^[88] and the United States.^[89] These included attempts to physically blockade vaccination sites, and making false reservations for vaccination appointments to clog up vaccination booking systems. Protests were also organized by the activists to raise awareness for their cause.^[90]

In some instances, anti-vaccine rhetoric has been traced to state-sponsored internet troll activities designed to create social dissension.^[91][92] Worldwide, foreign disinformation campaigns have been associated with declining vaccination rates in target countries.^[93] Anti-vaccine activism online both before and during the pandemic has been linked to extreme levels of falsehoods, rumours, hoaxes, and conspiracy theories.^[2][94][95]

Anti-vaccine activists have falsely claimed in social media posts that numerous deaths or injuries had to do with reactions to vaccines. In one highly publicized instance in early 2023, after Buffalo Bills football player Damar Hamlin experienced an in-game episode of commotio cordis, there was an increase in rhetoric and disinformation from figures such as Charlie Kirk and Drew Pinsky making unfounded claims about Hamlin's cardiac arrest and COVID-19 vaccines.^[96][97][98] In another 2023 incident, college basketball player Bronny James experienced cardiac arrest at the Galen Center at the University of Southern California, leading to assertions that this was a result of receiving a COVID-19 vaccine; it was later revealed that the episode had been caused by a congenital heart defect.^[99] Also, anti-vaccine activists believed Foo Fighters drummer Taylor Hawkins died in 2022 from the COVID-19 vaccine, while in actuality it was a drug overdose.^[100] In December 2023, The New York Times published a detailed investigation of the distortion and misrepresentation of the circumstances surrounding the death of 24-year-old George Watts Jr. by Robert F. Kennedy Jr. and other anti-vaccine activists.^[101]

Prominent biomedical researcher Peter Hotez, asserted that he and other American scientists who publicly defend vaccines have been attacked on social media, harassed with threatening emails, intimidated, and confronted physically by opponents of vaccination. He further attributes the increase in aggressiveness of the anti-vaccination movement to the influence of the extreme wing of the Republican Party. Hotez estimates that roughly 200,000 preventable deaths from COVID-19, mainly among Republicans, occurred in the US because of refusal to be vaccinated.^[102] A 2023 study published in the Journal of the American Medical Association found "evidence of higher excess mortality for Republican voters compared with Democratic voters in Florida and Ohio after, but not before, COVID-19 vaccines were available to all adults in the US".^[103]

Strategies and tactics

Arguments used

In a 2002 paper in the British Medical Journal, two medical historians suggested that the arguments made against the safety and effectiveness of vaccines in the late 20th century are similar to those of the early anti-vaccinationists. Both the 19th and 20th century arguments included "vaccine safety issues, vaccine failures, infringement of personal liberty, and an unholy alliance between the medical establishment and the government to reap huge profits for the medical establishment at the expense of the public."^[104] However, the authors only considered the use of "newspaper articles and letters, books, journals, and pamphlets to warn against the dangers of vaccination", and did not address the impact of the internet.^[104] Comments on YouTube videos during the COVID-19 pandemic clustered similarly around "concerns about side-effects, effectiveness, and lack of trust in corporations and government".^[105]

Misrepresentation

In some instances, anti-vaccine organizations have used names intended to sound non-partisan on the issue: e.g. National Vaccine Information Center (USA), Vaccination Risk Awareness Network (Canada), Australian Vaccination Network.^[95] In November 2013 the Australian Vaccination Network was ordered by the New South Wales Administrative Decisions Tribunal to change their name so that consumers are aware of the anti-vaccination nature of the group. Lateline reported that former AVN president Meryl Dorey "claimed she was a victim of hate groups and vested interests" in response to the ruling.^[106]

Information quality

Although physicians and nurses are still rated as the most trusted source for vaccine information, some vaccine-hesitant individuals report being more comfortable discussing vaccines with providers of complementary and alternative (CAM) treatments.^[3] With the rise of the internet, many people have turned online for medical information.^[107] In some instances, anti-vaccine activists seek to steer people away from vaccination and health-care providers and towards alternative medicines sold by certain of the activists.^[108]

Anti-vaccination writings on the internet have been argued to be characterized by a number of differences from medical and scientific literature. These include:

• Promiscuous copying and reduplication.^[109]
• Ignoring corrections, even when an initial report or data point is shown to be false.^[95][110]
• Lack of references, difficulty in checking sources and claims.^[111]
• Personal attacks on individual doctors.^[112][2][95]
• A high degree of interlinkage between sites.^[109][113]
• Dishonest or fallacious arguments.^[114][95]

For example, a 2020 study examined Instagram posts related to the HPV vaccine, which can prevent some types of cancer. Anti-vaccine posts were more likely than pro-vaccine posts to be sent by non-healthcare individuals, to include personal narratives, and to reference other Instagram users, links, or reposts. Anti-vaccine posts were also more likely to involve concealment or distortion, particularly conspiracy theories and unsubstantiated claims. In total, 72.3% of antivaccine posts made inaccurate claims, including exaggerating the risks of vaccines and minimizing risks of disease.^[115]

Disinformation tactics

A number of specific disinformation tactics have been noted in anti-vaccination messaging, including:^[95][116]

• Conspiracies theories alleging lies, trickery, cover-ups, and secret knowledge^[116]
• Messages crafted for psychological appeal rather than truthfulness^[117]
• Fake experts^[116]
• Impossible expectations:^[116] claiming that anything less than 100% certainty in a scientific claim implies doubt, and that doubt means there is no consensus^[118]
• Selective cherry-picking: using obscure or debunked sources while ignoring counter-evidence and scientific consensus^[116][95]
• Shifting hypotheses:Continually introducing new theories about vaccines being harmful; moving to new claims when existing ones are shown to be false^[95]
• Misrepresentation, false logic and illogical analogies^[116][95]
• Personal attacks on critics, ranging from online criticism, publicly revealing personal details, and threats, to offline acitivities such as legal actions, targeting of employers, and violence^[95][112][2]

Economics of vaccine disinformation

Information is more likely to be believed after repeated exposure. Disinformers use this illusory truth effect as a tactic, repeating false information to make it feel familiar and influence belief.^[119] Anti-vaccine activists have leveraged social media to develop interconnected networks of influencers that shape people's opinion, recruit allies, impact policy^[2] and monetize vaccine-related disinformation.^[120] In 2022, the Journal of Communication published a study of the political economy underlying vaccine disinformation. Researchers identified 59 English-language "actors" that provided "almost exclusively anti-vaccination publications". Their websites monetized disinformation through appeals for donations, sales of content-based media and other merchandise, third-party advertising, and membership fees. Some maintained a group of linked websites, attracting visitors with one site and appealing for money and selling merchandise on others. Their activities to gain attention and obtain funding displayed a "hybrid monetization strategy". They attracted attention by combining eye-catching aspects of "junk news" and online celebrity promotion. At the same time, they developed campaign-specific communities to publicize and legitimize their position, similar to radical social movements.^[120]

Misrepresentation of the Vaccine Adverse Event Reporting System

In the United States, the Vaccine Adverse Event Reporting System (VAERS) is used to gather information on potential vaccine adverse reactions, but is susceptible to unverified reports, misattribution, underreporting, and inconsistent data quality.^[121] Raw, unverified data from VAERS has often been used by the anti-vaccine community to justify misinformation regarding the safety of vaccines; it is generally not possible to find out from VAERS data if a vaccine caused an adverse event, or how common the event might be.^[122]

Legal action

Since Republicans gained a majority in the House in January 2023, the House Judiciary Committee has used legal action to actively oppose both disinformation research and government involvement in fighting disinformation. One of the projects targeted is the Virality Project, which has examined the spread of false claims about vaccines. The House Judiciary Committee has sent letters, subpoenas, and threats of legal action to researchers, demanding notes, emails and other records from researchers and even student interns, dating back to 2015. Institutions include the Stanford Internet Observatory at Stanford University, the University of Washington, the Atlantic Council's Digital Forensic Research Lab and the social media analytics firm Graphika. Researchers emphasize that they have academic freedom to study disinformation as well as freedom of speech to report their results.^{[123][124][125]}

Despite conservative claims that the government acted to censor speech online, "no evidence has emerged that government officials coerced the companies to take action against accounts".^[123] The actions of the House Judiciary Committee have been described as an "attempt to chill research,”^[123] creating a "chilling effect"^[124] through increased time demands, legal costs and online harassment of researchers.^[124][123]

Harassment

Persons undertaking efforts to counter vaccine misinformation, including public health experts who use social media, have been targeted for harassment by anti-vaccine activists.^[2][112] For example, Slovakian physician Vladimír Krčméry was a prominent member of the government advisory team during the COVID-19 pandemic in Slovakia, and was the first person in that country to receive a COVID-19 vaccine. Due to his prominent role in the vaccination campaign, Krčméry and his family became a target of anti-vaccine activists, who physically threatened him and his family.^[126]

In June 2023, Texas-based physician and researcher Peter Hotez tweeted his concerns about Robert F. Kennedy Jr. sharing misinformation about vaccines on Joe Rogan's podcast. Rogan, Kennedy, and Twitter owner Elon Musk asked Hotez to participate in a debate on the podcast. Upon declining the invitation, Hotez was harassed by their fans, with anti-vaccine activist Alex Rosen confronting him at his home.^{[112][127][128]}

In his book The Deadly Rise of Anti-science: A Scientist's Warning, Hotez describes how he and other scientists who publicly defend vaccines have been attacked on social media, harassed with threatening emails, intimidated, and confronted physically by opponents of vaccination. He attributes the increase in aggressiveness of the anti-vaccination movement to the influence of the extreme wing of the Republican Party.^[129][130] Hotez estimates that roughly 200,000 preventable deaths from COVID-19, mainly among Republicans, occurred in the US because of refusal to be vaccinated.^[131][132]

At the extreme end, opposition to vaccination has resulted in substantial violence against vaccinators. In Pakistan, "more than 200 polio team workers have lost their lives" (team members include not only vaccinators but police and security personnel) from "targeted killing and terrorism" while working on polio vaccination campaigns.^[133]

Countering anti-vaccine activism

Various efforts have been suggested and undertaken to address concerns about vaccines and counter anti-vaccine disinformation. Efforts include social media advertising campaigns, by public health organizations, in support of public health goals.^[134][105]

Best practices for combating vaccine mis- and disinformation include addressing issues openly, clearly identifying areas of scientific consensus and areas of uncertainty, and being sensitive to the cultural and religious values of communities.^{[135][136][32]} In countering anti-vaccine disinformation, both factual and emotional aspects need to be addressed.^[137]

Whether people will update a mistaken belief is complicated and involves psychological factors and social goals as well as accuracy of information.^{[138][119][117]} There is some evidence that both debunking and "pre-bunking" of disinformation can be effective, at least in the short term.^{[119][117][139][140]} Elements that may help to correct inaccurate information include: warning people before they are exposed to misinformation; high perceived credibility of message sources, affirmations of identity and social norms; graphical presentation; and focusing attention on clear core messages.^[141] Alternative explanations of a situation need to fit plausibly into the original scenario and ideally indicate why the incorrect explanation was previously thought to be correct.^[138]

The cultivation of critical thinking, health and science awareness, and media literacy skills are all recommended to help people more critically assess the credibility of the information they see.^[32] People who seek out multiple reputable news sources at local and national levels are more likely to detect disinformation than those who rely on few sources from a particular viewpoint.^[142] Particularly on social media, beware of sensational headlines that appeal to emotion, fact-check information broadly (not just through your usual sources), and consider possible agendas or conflicts of interest of those relaying information.^[143][144]

Operation of social media

Other suggestions for countering anti-vaccine activism focus on changing the operation of social media platforms. Interventions such as accuracy nudges and source labelling change the context in which information is presented.^[145] For example, correct information can be directly presented to counter disinformation.^[146][147] Other possibilities include flagging or removing misleading information on social media platforms.^{[148][149][150]} Research suggests that a majority of individuals in the United States would support the removal of harmful misinformation posts and the suspension of accounts. This position is less popular with Republicans than Democrats.^[151]

While private entities like Facebook, Twitter and Telegram could legally establish guidelines for moderation of information and disinformation on their platforms (subject to local and international laws)^{[152][144][153]} such companies do not have strong incentives to control disinformation or to self-regulate. Algorithms that are used to maximize user engagement and profits can lead to unbalanced, poorly sourced, and actively misleading information.^{[154][155][156]}

Criticized for its role in vaccine hesitancy, Facebook announced in March 2019 that it would provide users with "authoritative information" on the topic of vaccines.^[157] Facebook introduced several policies chosen to reduce the impact of anti-vaccine content, without actually removing it. These included reducing the ranking of anti-vaccine sources in searches and not recommending them; rejecting ads and targeted advertising that contained vaccine misinformation; and using banners to present vaccine information from authoritative sources. A study examined the six months before and after the policy changes. It found a moderate but significant decrease in the number of likes for anti-vaccine posts following the policy changes. Likes of pro-vaccine posts were unchanged.^[158] Facebook has been criticized for not being more aggressive in countering disinformation.^[159] In response to efforts to police misinformation, anti-vaccine communities on social media have adopted coded language to refer to vaccinated persons and the vaccines themselves.^[160]

Supply-side interventions reduce circulation of misinformation directly at their sources through actions such as application of social media policies, regulation, and legislation.^[145] A study published in the journal Vaccine examined advertisements posted in the three months prior to the Facebook's 2019 policy changes. It found that 54% of the anti-vaccine advertisements on Facebook were placed by just two organizations, funded by well-known anti-vaccination activists.^[161][162] The Children's Health Defense / World Mercury Project chaired by Robert F. Kennedy Jr. and Stop Mandatory Vaccination, run by campaigner Larry Cook, posted 54% of the advertisements. The ads often linked to commercial products, such as natural remedies and books.^[163] Kennedy was suspended from Facebook in August 2022,^[164] but reinstated in June 2023.^[165]

In 2023, however, state governments that were politically aligned with anti-vaccine activists successfully sought a preliminary injunction to prevent the Biden Administration from seeking to pressure social media companies into fighting misinformation. The order issued by United States Court of Appeals for the Fifth Circuit "severely limits the ability of the White House, the surgeon general, [and] the Centers for Disease Control and Prevention... to communicate with social media companies about content related to Covid-19... that the government views as misinformation".^[166] In October 2023, this injunction was paused by the Supreme Court of the United States, pending further litigation.^[167]

Use of algorithms and data

Algorithms and user data can be used to identify selected subgroups who can then be provided with specialized content. This type of approach has been used both by anti-vaccine activists^[32][2] and by health providers who hope to counter vaccine-related disinformation.^{[168][169][170]} For example, in the United States, the CDC’s Social Vulnerability Index (SVI) has been used to identify communities that have traditionally been under-served or are at elevated risk for infection, morbidity, and mortality.^[168] Programs have been developed in such communities to address disinformation and vaccine hesitancy.^[171]

Community engagement

Steps have been taken to counter anti-vaccine messaging by directly engaging with communities. Outreach efforts include call centers and texting campaigns, partnering with local community leaders, and holding community-based vaccine clinics.^{[171][169][172]} Creating digital and science literacy resources and distributing them via schools, libraries, municipal offices, churches and other community groups can help to counter misinformation in under-resourced communities.^[173]

The Black Doctors Covid-19 Consortium in Philadelphia is one example of a successful direct outreach initiative.^[174] Another is the New York State Vaccine Equity Task Force.^[171] In line with the Strategic Advisory Group of Experts (SAGE)'s 3C's model, outreach to communities has focused on addressing mistrust and increasing Confidence, providing information to improve risk assessment (Complacency), and improving access to COVID-19 vaccines (Convenience). It has been necessary to counter disinformation in all three areas.^[170][171]

Recommendations for combating vaccine disinformation include increasing the presence of trusted health agencies and credible information on social media, partnering with social media platforms to promote evidence-based public health information, and identifying and responding to emerging concerns and disinformation campaigns.^[170] Networked communities of public health officials and other stakeholders, connecting with the public through a variety of credible and trusted messengers, are recommended. Sharing of messages through such networks could help to debunk and counter highly networked and coordinated disinformation attacks.^[2]

A networked community approach would differ from the current model of US public health communication, which tends to rely on a single credible messenger (e.g. Anthony Fauci) and is susceptible to disinformation attacks. To deal with disinformation, community networks would need to address issues of liberty and human rights as well as vaccine safety, effectiveness and access. Networks could also help to show support for those attacked by anti-vaccine activists.^[2]

See also

• Anti-vaccinationism in chiropractic
• Big Pharma conspiracy theories
• COVID-19 vaccine misinformation and hesitancy
• Germ theory denialism
• List of anti-vaccination groups
• oral polio AIDS hypothesis
• Vaccine misinformation
• Vaccines and autism
  • MMR vaccine and autism
  • Thiomersal and vaccines

References

1. Benoit, Staci L.; Mauldin, Rachel F. (2021-11-17). "The "anti-vax" movement: a quantitative report on vaccine beliefs and knowledge across social media". BMC Public Health. 21 (1): 2106. doi:10.1186/s12889-021-12114-8. ISSN 1471-2458. PMC 8596085. PMID 34789206.
2. Carpiano, Richard M; Callaghan, Timothy; DiResta, Renee; et al. (2023). "Confronting the evolution and expansion of anti-vaccine activism in the USA in the COVID-19 era". Lancet. 401 (10380): 967–970. doi:10.1016/S0140-6736(23)00136-8. ISSN 0140-6736. PMC 9981160. PMID 36871571.
3. Dubé, Ève; Ward, Jeremy K.; Verger, Pierre; MacDonald, Noni E. (1 April 2021). "Vaccine Hesitancy, Acceptance, and Anti-Vaccination: Trends and Future Prospects for Public Health". Annual Review of Public Health. 42 (1): 175–191. doi:10.1146/annurev-publhealth-090419-102240. ISSN 0163-7525. PMID 33798403. S2CID 232774243. the scientific and medical consensus on the benefits of vaccination is clear and unambiguous
4. Tolley, Kim (2023). Vaccine Wars: The Two-Hundred Year Fight for School Vaccinations (1 ed.). Johns Hopkins University Press. ISBN 978-1-4214-4761-2.
5. "Smallpox". Medical Heritage Library. 22 September 2019. Citing Edmund Massey, "A Sermon against the Dangerous and Sinful Practice of Inoculation, preached at St. Andrew's Holborn", July 8, 1722.
6. Andrew Dickson White (1896). "Chapter X. Theological Opposition To Inoculation, Vaccination, And The Use Of Anaesthetics". A History Of The Warfare Of Science With Theology In Christendom. New York: Appleton & Co.
7. Early religious opposition:
   • White AD (1896). "Theological opposition to inoculation, vaccination, and the use of anæsthetics". A History of the Warfare of Science with Theology in Christendom. New York: Appleton.
   • Bazin H (September 2001). "The ethics of vaccine usage in society: lessons from the past". Endeavour. 25 (3): 104–108. doi:10.1016/S0160-9327(00)01376-4. PMID 11725304.
   • Noble M (December 2005). "Ethics in the trenches: a multifaceted analysis of the stem cell debate". Stem Cell Reviews. 1 (4): 345–376. CiteSeerX 10.1.1.465.2410. doi:10.1385/SCR:1:4:345. PMID 17142878. S2CID 21775014.
8. Williams G (2010). Angel Of Death; the story of smallpox. Basingstoke, UK: Palgrave Macmillan. pp. 87–94. ISBN 978-0-230-27471-6.
9. John Redman Coxe, Practical Observations on Vaccination, Or, Inoculation for the Cow-pock (1802), p. 125.
10. Tizard, Ian R. (2023). "Chapter 12 – The rise of anti-vaccine societies in Britain". A History of Vaccines and their Opponents. Academic Press. pp. 167–179. ISBN 978-0-443-13434-0.
11. Durbach, Nadja (2005). Bodily Matters: The Anti-Vaccination Movement in England, 1853–1907. Duke University Press. pp. 41–42. ISBN 978-0-8223-3423-1.
12. Cawkwell, Philip B.; Oshinsky, David (October 2015). "Childhood vaccination requirements: Lessons from history, Mississippi, and a path forward" (PDF). Vaccine. 33 (43): 5884–5887. doi:10.1016/j.vaccine.2015.08.087. PMID 26409142.
13. Fitzpatrick, Michael (2005). "Review: The Anti-Vaccination Movement in England, 1853–1907. Nadja Durbach". Journal of the Royal Society of Medicine. 98 (8). Duke University Press: 384–385. ISBN 0-8223-3423-2. ISSN 0141-0768. PMC 1181850.
14. "Philip Hoare: When you play virtual war games, spare a thought for the real veterans". The Independent. 2003-04-20. Archived from the original on 2022-06-18. Retrieved 2020-09-13.
15. Barrow, Logie. (2016). Independent Spirits Spiritualism and English Plebeians, 1850–1910. Routledge. pp. 186–187. ISBN 978-1-138-66565-1
16. "Rothery, Mary Catherine Hume (1824–1885), campaigner for medical reform and author". Oxford Dictionary of National Biography (online ed.). Oxford University Press. 2004. doi:10.1093/ref:odnb/49483. ISBN 978-0-19-861412-8. Retrieved 2020-05-28. (Subscription or UK public library membership required.)
17. Porter, Dorothy; Porter, Roy (1988). "The Politics of Prevention: Anti-Vaccinationism and Public Health in Nineteenth-Century England". Medical History. 32 (3): 231–252. doi:10.1017/s0025727300048225. PMC 1139881. PMID 3063903.
18. "History of Anti-vaccination Movements". College of Physicians of Philadelphia. March 8, 2012. Retrieved 2015-02-11.
19. Karie Youngdahl (March 8, 2012). . College of Physicians of Philadelphia. Archived from the original on 2015-03-02. Retrieved 2015-02-11.
20. "The Anti-Vaccination Society of America: Correspondence | History of Vaccines".
21. "Frances Hoggan MD 1843–1927". Breconshire Local & Family History Society (BLFHS) Cymdeithas Hanes Lleol a Theuluoedd Brycheiniog Newsletter 70 – October 2017.
22. "Antivaccination Propaganda: The Bane And Its Antidote". The British Medical Journal. 2 (2166): 50–52. 1902. doi:10.1136/bmj.2.2166.50. PMC 2401264. PMID 20760356. S2CID 32125316.
23. Kramer, Molly Baer (2004). "Loat, Lily (1879/80–1958), anti-vaccination activist". Oxford Dictionary of National Biography (online ed.). Oxford University Press. doi:10.1093/ref:odnb/50749. ISBN 978-0-19-861412-8. Retrieved 2020-09-13. (Subscription or UK public library membership required.)
24. Yang, Jennifer. (2014). "Contemporary debates on vaccination policies have historical parallels in Ransom Center's collections". Ransom Center Magazine. Retrieved 20 June 2021.
25. Walloch, Karen L. (2015). The Antivaccine Heresy: Jacobson v. Massachusetts and the Troubled History of Compulsory Vaccination in the United States. University of Rochester Press. pp. 4–5. ISBN 978-1-58046-537-3
26. Colgrove, James. (2006). State of Immunity: The Politics of Vaccination in Twentieth-Century America. University of California Press. pp. 52–54. ISBN 978-0-520-24749-9
27. Altenbaugh, Richard J. (2018). Vaccination in America: Medical Science and Children's Welfare. Palgrave. p. 51. ISBN 978-3-319-96348-8
28. Tolley, Kim (May 2019). "School Vaccination Wars: The Rise of Anti-Science in the American Anti-Vaccination Societies". History of Education Quarterly. 59 (2): 161–194. doi:10.1017/heq.2019.3.
29. "Antivaccinationists in Albany". Journal of the American Medical Association. 64 (6): 520. Feb 6, 1915.
30. Colgrove, James. (2006). State of Immunity: The Politics of Vaccination in Twentieth-Century America. University of California Press. p. 74. ISBN 978-0-520-24749-9
31. Millward, Gareth (2019). "Chapter 2: Smallpox". Vaccinating Britain: Mass vaccination and the public since the Second World War [Internet]. Manchester University Press.
32. Wang, Yuxi; McKee, Martin; Torbica, Aleksandra; Stuckler, David (1 November 2019). "Systematic Literature Review on the Spread of Health-related Misinformation on Social Media". Social Science & Medicine. 240: 112552. doi:10.1016/j.socscimed.2019.112552. ISSN 0277-9536. PMC 7117034. PMID 31561111.
33. Di Pietrantonj, C; Rivetti, A; Marchione, P; Debalini, MG; Demicheli, V (2021-11-22). "Vaccines for measles, mumps, rubella, and varicella in children". Cochrane Database of Systematic Reviews. 2021 (11): CD004407. doi:10.1002/14651858.CD004407.pub5. PMC 8607336. PMID 34806766.
34. Flaherty, Dennis K. (October 2011). "The vaccine-autism connection: a public health crisis caused by unethical medical practices and fraudulent science". The Annals of Pharmacotherapy. 45 (10): 1302–1304. doi:10.1345/aph.1Q318. ISSN 1542-6270. PMID 21917556. S2CID 39479569.
35. Dyer, Clare (2 February 2010). "Lancet retracts Wakefield's MMR paper". BMJ. 340: c696. doi:10.1136/bmj.c696. ISSN 0959-8138. PMID 20124366. S2CID 43465004.
36. "Public Health Education". Kyra Schwartz Technical Writing Samples. Retrieved 3 February 2019.
37. Goldacre, B. (30 August 2008). . The Guardian. London. Archived from the original on 6 February 2015. Retrieved 30 August 2008. Alt URL
38. Hussain, Azhar; Ali, Syed; Ahmed, Madiha; Hussain, Sheharyar (2018). "The Anti-vaccination Movement: A Regression in Modern Medicine". Cureus. 10 (7): e2919. doi:10.7759/cureus.2919. ISSN 2168-8184. PMC 6122668. PMID 30186724.
39. Gross, Liza (26 May 2009). "A Broken Trust: Lessons from the Vaccine–Autism Wars". PLOS Biology. 7 (5): e1000114. doi:10.1371/journal.pbio.1000114. ISSN 1544-9173. PMC 2682483. PMID 19478850.
40. McIntyre, P; Leask, J (2008). "Improving uptake of MMR vaccine". The BMJ. 336 (7647): 729–30. doi:10.1136/bmj.39503.508484.80. PMC 2287215. PMID 18309963.
41. Pepys MB (December 2007). "Science and serendipity". Clinical Medicine. 7 (6): 562–78. doi:10.7861/clinmedicine.7-6-562. PMC 4954362. PMID 18193704.
42. . Centers for Disease Control and Prevention. 22 August 2008. Archived from the original on 7 April 2008. Retrieved 21 December 2008.
43. Institute of Medicine (US) Immunization Safety Review Committee (17 May 2004). . Institute of Medicine of the National Academy of Sciences. doi:10.17226/10997. ISBN 978-0-309-09237-1. PMID 20669467. Archived from the original on 26 October 2009. Retrieved 13 June 2007.
44. "MMR The facts". NHS Immunisation Information. 2004. Archived from the original on 7 January 2013. Retrieved 19 September 2007.
45. Di Pietrantonj, Carlo; Rivetti, Alessandro; Marchione, Pasquale; Debalini, Maria Grazia; Demicheli, Vittorio (20 April 2020). "Vaccines for measles, mumps, rubella, and varicella in children". The Cochrane Database of Systematic Reviews. 4 (4): CD004407. doi:10.1002/14651858.CD004407.pub4. ISSN 1469-493X. PMC 7169657. PMID 32309885.
46. Flaherty, Dennis K (October 2011). "The vaccine-autism connection: a public health crisis caused by unethical medical practices and fraudulent science". Annals of Pharmacotherapy. 45 (10): 1302–4. doi:10.1345/aph.1Q318. PMID 21917556. S2CID 39479569.
47. Gever, John (5 January 2011). "BMJ Lifts Curtain on MMR-Autism Fraud". MedPage Today. Retrieved 8 January 2011.
48. Godlee, F (January 2011). "The fraud behind the MMR scare". The BMJ. 342 (jan06 1): d22. doi:10.1136/bmj.d22. S2CID 73020733.
49. Deer, Brian (6 January 2011). "Brian Deer: Piltdown medicine: The missing link between MMR and autism". BMJ Group Blogs. Retrieved 8 January 2011.
50. "Link between MMR Vaccines and Autism conclusively broken". IB Times. 7 January 2011. Retrieved 8 January 2011.
51. Broyd, Nicky (6 January 2011). "BMJ Declares Vaccine-Autism Study 'an Elaborate Fraud', 1998 Lancet Study Not Bad Science but Deliberate Fraud, Claims Journal". WebMD Health News. Retrieved 8 January 2011.
52. Poland GA, Jacobson RM (13 January 2011). "The age-old struggle against the antivaccinationists". The New England Journal of Medicine. 364 (2): 97–99. doi:10.1056/NEJMp1010594. PMID 21226573. S2CID 39229852.
53. Jasek, Marissa (6 January 2011). . WWAY Newschannel 3. Archived from the original on 24 July 2011. Retrieved 7 January 2011.
54. The Sunday Times 2004:
    • Deer, Brian (22 February 2004). "Revealed: MMR research scandal". The Sunday Times. London. Retrieved 23 September 2007.
    • Deer, Brian (2007). "The Lancet scandal". Retrieved 23 September 2007.
55. 2004 BBC documentary:
    • Deer, Brian (2007). "The Wakefield factor". Retrieved 23 September 2007.
    • Deer, Brian (2004). "Dispatches. MMR: What They Didn't Tell You". The BMJ. 329 (7477): 1293. doi:10.1136/bmj.329.7477.1293. PMC 534460.
56. Deer, Brian (8 February 2009). . The Sunday Times. London. Archived from the original on 27 February 2014. Retrieved 9 February 2009.
57. Triggle, Nick (28 January 2010). "MMR scare doctor 'acted unethically', panel finds". BBC News. from the original on 28 January 2010. Retrieved 28 January 2010.
58. Triggle, Nick (24 May 2010). "MMR doctor struck off register". BBC News. Retrieved 24 May 2010.
59. Boseley, Sarah (2 February 2010). "Lancet retracts 'utterly false' MMR paper". The Guardian. London. Retrieved 14 January 2015.
60. Deer B (2011). "How the case against the MMR vaccine was fixed". The BMJ. 342 (jan05 1): c5347. doi:10.1136/bmj.c5347. PMID 21209059.
61. Deer B (11 January 2011). "How the vaccine crisis was meant to make money". The BMJ. 342 (jan11 4): c5258. doi:10.1136/bmj.c5258. PMID 21224310. S2CID 37724643.
62. Deer B (18 January 2011). "The Lancet's two days to bury bad news". The BMJ. Retrieved 2021-08-05.
63. Godlee F, Smith J, Marcovitch H (2011). "Wakefield's article linking MMR vaccine and autism was fraudulent". The BMJ. 342: c7452. doi:10.1136/bmj.c7452. PMID 21209060. S2CID 43640126.
64. Deer, Brian (2011). "Wakefield's article linking MMR vaccine and autism was fraudulent". The BMJ. 342: c5347. doi:10.1136/bmj.c5347. PMID 21209059.
65. Boseley, Sarah (18 July 2018). "How disgraced anti-vaxxer Andrew Wakefield was embraced by Trump's America". The Guardian.
66. Ziv, Stav (February 10, 2015). "Andrew Wakefield, Father of the Anti-Vaccine Movement, Responds to the Current Measles Outbreak for the First Time". Newsweek. Retrieved 17 February 2015.
67. Axelrod, Jim (10 February 2015). "Doctor blames discredited autism research for measles outbreak". CBS News. Retrieved 16 February 2015.
68. Dyer, Owen (16 May 2017). "Measles outbreak in Somali American community follows anti-vaccine talks". BMJ. 357: j2378. doi:10.1136/bmj.j2378. ISSN 1756-1833. PMID 28512183. S2CID 27124692.
69. Sohn, Emily (May 3, 2017). "Understanding The History Behind Communities' Vaccine Fears". NPR.
70. Sun, Lena H. (9 April 2023). "Anti-vaccine activists spark a state's worst measles outbreak in decades". Washington Post.
71. "Measles | Cases and Outbreaks | CDC". www.cdc.gov. 24 March 2019. Retrieved 28 March 2019.
72. "Ministry of Health Press Release 1 – Measles Epidemic – Samoa". ReliefWeb. Government of Samoa. 16 November 2019. from the original on 1 December 2019.
73. Deer, Brian (20 December 2019). "Samoa's perfect storm: How a collapse in vaccination rates killed more than 70 children". The Telegraph. London, UK. ISSN 0307-1235. from the original on 21 December 2019.
74. Agence France-Presse (28 November 2019). "Samoa measles outbreak: WHO blames anti-vaccine scare as death toll hits 39". The Guardian. UK. from the original on 29 November 2019.
75. Jackson, Lagipoiva Cherelle; Lyons, Kate (17 December 2019). "'These babies should not have died': How the measles outbreak took hold in Samoa". The Guardian. UK. ISSN 0261-3077. from the original on 18 December 2019.
76. Clarke, Melissa (8 December 2019). "Anatomy of an epidemic: How measles took hold of Samoa". ABC News. Australian Broadcasting Corp. from the original on 10 December 2019.
77. Whyte, Chelsea (6 December 2019). "Samoan government takes drastic measures to fight measles outbreak". New Scientist. from the original on 10 December 2019. Retrieved 8 December 2019.
78. "Samoa: WHO and UNICEF estimates of immunization coverage: 2018 revision" (PDF). World Health Organization. 2018. (PDF) from the original on 8 December 2019.
79. Kwai, Isabella (19 December 2019). "'Why My Baby?' How Measles Robbed Samoa of Its Young". The New York Times. US. from the original on 31 December 2019.
80. "Two more deaths from measles in samoa over new year period". Radio New Zealand. 7 January 2020. from the original on 7 January 2020.
81. "Population & Demography Indicator Summary". Samoa Bureau of Statistics. 22 December 2019. from the original on 8 December 2019.
82. Government of Samoa (22 December 2019). "National Emergency Operation Centre, update on the measles outbreak: (press release 36) 22 December, 2019". @samoagovt. Archived from the original on 16 March 2020. Retrieved 22 December 2019.
83. "Samoa, Fiji and Tonga – Measles outbreak (DG ECHO, WHO, UNICEF and media) (ECHO Daily Flash of 25 November 2019) – Samoa". ReliefWeb. UN Office for the Coordination of Humanitarian Affairs (OCHA). 25 November 2019. from the original on 2 December 2019.
84. Government of Samoa (9 December 2019). "National Emergency Operation Centre, update on the measles outbreak: (press release 23) 9 December". @samoagovt. Archived from the original on 16 March 2020. Retrieved 22 December 2019.
85. Barrett, Jonathan (9 December 2019). "Decorated with butterflies, infant-sized coffins sent to measles-ravaged Samoa". Reuters. New York, NY, US. from the original on 10 December 2019.
86. Cassidy, Caitlin (October 4, 2021). "Anti-vaxxers trying to disrupt Australian rollout by making fake vaccine bookings". The Guardian.
87. . The Times of Israel. February 8, 2021. Archived from the original on April 5, 2021.
88. Roberts, Lizzie (December 19, 2021). "Anti-vaxxers block-book appointments to stop people getting life-saving Covid jab". The Daily Telegraph.
89. Schwartz, Matthew S. (January 31, 2021). "LA COVID-19 Vaccinations Delayed By Protesters". NPR.
90. "How COVID-conspiracists and anti-vaxxers are getting organised and making money". Sky News.
91. Howard, Jacqueline (August 24, 2018). "Why Russian trolls stoked US vaccine debates". CNN.
92. Dettmer, Jamie (November 18, 2021). "Russian Anti-Vaccine Disinformation Campaign Backfires". Voice of America.
93. Wilson, Steven Lloyd; Wiysonge, Charles (1 October 2020). "Social media and vaccine hesitancy". BMJ Global Health. 5 (10): e004206. doi:10.1136/bmjgh-2020-004206. ISSN 2059-7908. PMC 7590343. PMID 33097547.
94. Grimes, David Robert (12 March 2021). "Medical disinformation and the unviable nature of COVID-19 conspiracy theories". PLOS ONE. 16 (3): e0245900. Bibcode:2021PLoSO..1645900G. doi:10.1371/journal.pone.0245900. ISSN 1932-6203. PMC 7954317. PMID 33711025.
95. Kata, Anna (28 May 2012). "Anti-vaccine activists, Web 2.0, and the postmodern paradigm – An overview of tactics and tropes used online by the anti-vaccination movement". Vaccine. 30 (25): 3778–3789. doi:10.1016/j.vaccine.2011.11.112. ISSN 0264-410X. PMID 22172504. S2CID 38720733.
96. Ecarma, Caleb (January 3, 2023). "Right-Wingers Are Exploiting Damar Hamlin's Medical Emergency to Push Anti-Vax Conspiracies". Vanity Fair. from the original on January 4, 2023. Retrieved January 4, 2023.
97. Payton, L'oreal Thompson (January 3, 2023). "Blaming Damar Hamlin's cardiac arrest on the COVID vaccine is "wildly and irresponsibly speculative," says expert". Fortune. from the original on January 16, 2023. Retrieved January 5, 2023.
98. Loka, Gayathri (January 9, 2023). "False: Damar Hamlin collapsed due to COVID-19 vaccine poisoning". Logically. Retrieved February 7, 2023.
99. Polacek, Scott. "Bronny James' Collapse Caused by Heart Defect; Confidence He'll Return to Basketball". Bleacher Report. Retrieved 2023-08-26.
100. O'Rourke, Ciara (March 29, 2022). "Social media post claims without evidence Foo Fighters drummer Taylor Hawkins died from COVID-19". PolitiFact.
101. Thompson, Stuart A. (13 December 2023). . The New York Times. Archived from the original on December 15, 2023. Retrieved 18 December 2023.
102. Hotez, Peter J. (2023). The Deadly Rise of Anti-science: A Scientist's Warning. Johns Hopkins University Press. ISBN 978-1421447223.
103. Wallace, Jacob; Goldsmith-Pinkham, Paul; Schwartz, Jason L. "Excess Death Rates for Republican and Democratic Registered Voters in Florida and Ohio During the COVID-19 Pandemic". {{cite journal}}: Cite journal requires |journal= (help)
104. Wolfe, Robert M; Sharp, Lisa K (24 August 2002). "Anti-vaccinationists past and present". BMJ : British Medical Journal. 325 (7361): 430–432. doi:10.1136/bmj.325.7361.430. ISSN 0959-8138. PMC 1123944. PMID 12193361.
105. Teng, Shasha; Jiang, Nan; Khong, Kok Wei (6 May 2022). "Using big data to understand the online ecology of COVID-19 vaccination hesitancy". Humanities and Social Sciences Communications. 9 (1): 1–15. doi:10.1057/s41599-022-01185-6. ISSN 2662-9992. S2CID 257095447.
106. "Australian Vaccination Network told to change its name". Lateline. Australian Broadcasting Corporation. 25 November 2013. Retrieved 30 January 2014.
107. Rainie, Lee (26 November 2000). "The Online Health Care Revolution". Pew Research Center: Internet, Science & Tech.
108. Brumfiel, Geoff (May 12, 2021). "For Some Anti-Vaccine Advocates, Misinformation Is Part Of A Business". NPR.
109. Wolfe, R; Sharp, L; Lipsky, M (June 26, 2002). "Content and design attributes of antivaccination web sites" (Reprint). JAMA. 287 (24): 3245–8. doi:10.1001/jama.287.24.3245. PMID 12076221.
110. Zollo, Fabiana; Bessi, Alessandro; Vicario, Michela Del; et al. (24 July 2017). "Debunking in a world of tribes". PLOS ONE. 12 (7): e0181821. Bibcode:2017PLoSO..1281821Z. doi:10.1371/journal.pone.0181821. ISSN 1932-6203. PMC 5524392. PMID 28742163.
111. Davies, P; Chapman, S; Leask, J (2002). "Antivaccination activists on the world wide web". Arch Dis Child. 87 (1): 22–5. doi:10.1136/adc.87.1.22. PMC 1751143. PMID 12089115.
112. Pendergrast, Tricia; Royan, Regina; Arora, Vineet (2023-06-23). "Peter Hotez is not alone: Online harassment of doctors is a public health issue". STAT. Retrieved 2023-06-23.
113. Johnson, Neil F.; Velásquez, Nicolas; Restrepo, Nicholas Johnson; et al. (June 2020). "The online competition between pro- and anti-vaccination views". Nature. 582 (7811): 230–233. Bibcode:2020Natur.582..230J. doi:10.1038/s41586-020-2281-1. ISSN 1476-4687. PMID 32499650. S2CID 218625185.
114. Ed Friedlander. "The Anti-Immunization Activists: A Pattern of Deception". Retrieved 2006-11-02.
115. Massey, PM; Kearney, MD; Hauer, MK; et al. (3 December 2020). "Dimensions of Misinformation About the HPV Vaccine on Instagram: Content and Network Analysis of Social Media Characteristics". Journal of Medical Internet Research. 22 (12): e21451. doi:10.2196/21451. PMC 7746500. PMID 33270038.
116. MacDonald, Noni E (5 November 2020). "Fake news and science denier attacks on vaccines. What can you do?" (PDF). Canada Communicable Disease Report. 46 (1112): 432–435. doi:10.14745/ccdr.v46i1112a11. PMC 7799877. PMID 33447164. S2CID 230647269.
117. Ecker, Ullrich K. H.; Lewandowsky, Stephan; Cook, John; et al. (January 2022). "The psychological drivers of misinformation belief and its resistance to correction". Nature Reviews Psychology. 1 (1): 13–29. doi:10.1038/s44159-021-00006-y. hdl:1983/889ddb0f-0d44-44f4-a54f-57c260ae4917. ISSN 2731-0574. S2CID 245916820.
118. Cranor, Carl F. (5 September 2008). "Public Health: The Tobacco Strategy Entrenched". Science. 321 (5894): 1296–7. doi:10.1126/science.1162339. S2CID 153706560.
119. van der Linden, Sander (March 2022). "Misinformation: susceptibility, spread, and interventions to immunize the public". Nature Medicine. 28 (3): 460–467. doi:10.1038/s41591-022-01713-6. ISSN 1546-170X. PMID 35273402. S2CID 247384353.
120. Herasimenka, Aliaksandr; Au, Yung; George, Anna; et al. (24 December 2022). "The political economy of digital profiteering: communication resource mobilization by anti-vaccination actors". Journal of Communication. 73 (2): 126–137. doi:10.1093/joc/jqac043. PMC 10066223. PMID 37016634. Retrieved 27 January 2023.
121. Shimabukuro, TT; Nguyen, M; Martin, D; DeStefano, F (August 2015). "Safety monitoring in the Vaccine Adverse Event Reporting System (VAERS)". Vaccine. 33 (36): 4398–4405. doi:10.1016/j.vaccine.2015.07.035. PMC 4632204. PMID 26209838.
122. "Vaccine Adverse Event Reporting System (VAERS)". www.cdc.gov. 2019-02-27. Retrieved 2019-12-06.
123. Myers, Steven Lee; Frenkel, Sheera (19 June 2023). "G.O.P. Targets Researchers Who Study Disinformation Ahead of 2024 Election". The New York Times.
124. Starks, Tim (25 September 2023). "Analysis | GOP legal attacks create a chilling effect on misinformation research". The Washington Post.
125. "Misinformation research is buckling under GOP legal attacks". The Washington Post. 23 September 2023.
126. Krempaský, Ján. "Zachránil tisícky životov, antivaxeri sa mu vyhrážali smrťou. Zomrel Vladimír Krčméry". domov.sme.sk (in Slovak). Retrieved 21 December 2022.
127. Munce, Megan Fan (2023-06-19). "COVID-19 expert Peter Hotez harassed outside his home by anti-vaccine advocates". Houston Chronicle. Retrieved 2023-09-19.
128. Maruf, Ramishah (2023-06-19). "A prominent vaccine scientist says he was 'stalked' in front of home after Joe Rogan Twitter exchange | CNN Business". CNN. Retrieved 2023-09-19.
129. Nowogrodzki, Julian (21 September 2023). "Vaccine specialist Peter Hotez: scientists are 'under attack for someone else's political gain'". Nature. 621 (7980): 681–682. Bibcode:2023Natur.621..681N. doi:10.1038/d41586-023-02981-z. PMID 37735191. S2CID 262073883.
130. "In 'Deadly Rise of Anti-Science,' vaccine researcher Peter Hotez sounds the alarm on science denial". WBUR / Here & Now. September 19, 2023.
131. Bostwick, Will (19 September 2023). "Anti-Science Views Are Literally Killing Us, Peter Hotez Warns". Texas Monthly.
132. Hotez, Peter J. (2023). The Deadly Rise of Anti-science: A Scientist's Warning. Johns Hopkins University Press. ISBN 978-1421447223.
133. Wahid, Braira; Kumari, Babita; Saifullah, Khaled Mohammed; Idrees, Muhammad (March 2023). "The History and Current Killings of Polio Vaccinators in Pakistan: A Need for Targeted Surveillance Strategy". Asian Pacific Journal of Public Health. 35 (2–3): 183–188. doi:10.1177/10105395231158866. PMC 10185917. PMID 36856226. S2CID 257257554.
134. Athey, Susan; Grabarz, Kristen; Luca, Michael; Wernerfelt, Nils (January 26, 2023). "Digital public health interventions at scale: The impact of social media advertising on beliefs and outcomes related to COVID vaccines". PNAS. 120 (5): e2208110120. Bibcode:2023PNAS..12008110A. doi:10.1073/pnas.2208110120. PMC 9945974. PMID 36701366.
135. "How to Address COVID-19 Vaccine Misinformation". Centers for Disease Control and Prevention. 3 November 2021.
136. "Transparency, communication and trust: The role of public communication in responding to the wave of disinformation about the new Coronavirus". OECD Policy Responses to Coronavirus (COVID-19). Organisation for Economic Co-operation and Development. 3 July 2020. Retrieved 25 January 2023.
137. Stolle, Lucas B.; Nalamasu, Rohit; Pergolizzi, Joseph V.; et al. (November 2020). "Fact vs Fallacy: The Anti-Vaccine Discussion Reloaded". Advances in Therapy. 37 (11): 4481–4490. doi:10.1007/s12325-020-01502-y. ISSN 1865-8652. PMC 7509825. PMID 32965654.
138. Lewandowsky, Stephan; Ecker, Ullrich K. H.; Seifert, Colleen M.; Schwarz, Norbert; Cook, John (December 2012). "Misinformation and Its Correction: Continued Influence and Successful Debiasing". Psychological Science in the Public Interest. 13 (3): 106–131. doi:10.1177/1529100612451018. ISSN 1529-1006. PMID 26173286. S2CID 261453468.
139. Zhao, Sihong; Hu, Simeng; Zhou, Xiaoyu; et al. (11 January 2023). "The Prevalence, Features, Influencing Factors, and Solutions for COVID-19 Vaccine Misinformation: Systematic Review". JMIR Public Health and Surveillance. 9: e40201. doi:10.2196/40201. ISSN 2369-2960. PMC 9838721. PMID 36469911.
140. Walter, Nathan; Brooks, John J.; Saucier, Camille J.; Suresh, Sapna (10 November 2021). "Evaluating the Impact of Attempts to Correct Health Misinformation on Social Media: A Meta-Analysis". Health Communication. 36 (13): 1776–1784. doi:10.1080/10410236.2020.1794553. ISSN 1041-0236. PMID 32762260. S2CID 221076451.
141. Paynter, Jessica; Luskin-Saxby, Sarah; Keen, Deb; et al. (30 January 2019). "Evaluation of a template for countering misinformation—Real-world Autism treatment myth debunking". PLOS ONE. 14 (1): e0210746. Bibcode:2019PLoSO..1410746P. doi:10.1371/journal.pone.0210746. ISSN 1932-6203. PMC 6353548. PMID 30699155.
142. Atske, Sara (22 February 2021). "3. Misinformation and competing views of reality abounded throughout 2020". Pew Research Center's Journalism Project. Retrieved 19 January 2023.
143. West, Jevin D.; Bergstrom, Carl T. (13 April 2021). "Misinformation in and about science". Proceedings of the National Academy of Sciences. 118 (15): e1912444117. Bibcode:2021PNAS..11812444W. doi:10.1073/pnas.1912444117. ISSN 0027-8424. PMC 8054004. PMID 33837146.
144. Fellmeth, Robert C. (20 January 2023). "Social media must balance 'right of free speech' with audience 'right to know'". The Hill. Retrieved 24 January 2023.
145. Tay, Li Qian; Lewandowsky, Stephan; Hurlstone, Mark J.; Kurz, Tim; Ecker, Ullrich K. H. (5 October 2023). "A focus shift in the evaluation of misinformation interventions". Harvard Kennedy School Misinformation Review. doi:10.37016/mr-2020-124. S2CID 263715886.
146. Bode, Leticia; Vraga, Emily K. (August 2015). "In Related News, That Was Wrong: The Correction of Misinformation Through Related Stories Functionality in Social Media: In Related News". Journal of Communication. 65 (4): 619–638. doi:10.1111/jcom.12166. S2CID 142769329.
147. Ozturk, Pinar; Li, Huaye; Sakamoto, Yasuaki (January 2015). "Combating Rumor Spread on Social Media: The Effectiveness of Refutation and Warning". 2015 48th Hawaii International Conference on System Sciences. pp. 2406–2414. doi:10.1109/HICSS.2015.288. ISBN 978-1-4799-7367-5. S2CID 1822644.
148. Lanius, Candice; Weber, Ryan; MacKenzie, William I. (12 March 2021). "Use of bot and content flags to limit the spread of misinformation among social networks: a behavior and attitude survey". Social Network Analysis and Mining. 11 (1): 32. doi:10.1007/s13278-021-00739-x. ISSN 1869-5469. PMC 7954364. PMID 33747252.
149. Yaraghi, Niam (April 9, 2019). "How should social media platforms combat misinformation and hate speech?". Brookings.
150. Desai, Angel N; Ruidera, Diandra; Steinbrink, Julie M; Granwehr, Bruno; Lee, Dong Heun (15 May 2022). "Misinformation and Disinformation: The Potential Disadvantages of Social Media in Infectious Disease and How to Combat Them". Clinical Infectious Diseases. 74 (Suppl 3): e34–e39. doi:10.1093/cid/ciac109. ISSN 1058-4838. PMC 9384020. PMID 35568471.
151. Kozyreva, Anastasia; Herzog, Stefan M.; Lewandowsky, Stephan; et al. (14 February 2023). "Resolving content moderation dilemmas between free speech and harmful misinformation". Proceedings of the National Academy of Sciences of the United States of America. 120 (7): e2210666120. Bibcode:2023PNAS..12010666K. doi:10.1073/pnas.2210666120. ISSN 1091-6490. PMC 9963596. PMID 36749721.
152. "First Amendment and Censorship". Advocacy, Legislation & Issues. 13 June 2008. Retrieved 25 January 2023.
153. Nossel, Suzanne (29 April 2021). "Social Media, Free Speech, and the Scourge of Misinformation". American Federation of Teachers. Retrieved 24 January 2023.
154. Bauder, David; Liedtke, Michael (October 4, 2021). "Whistleblower says Facebook routinely chose 'profit over safety' when it came to misinformation". Fortune. Retrieved 26 January 2023.
155. "Doomscrolling and negativity bias: The way we consume news may be detrimental to our health". What's New in Publishing | Digital Publishing News. 26 October 2020. Retrieved 27 January 2023.
156. Sutcliffe, Chris (October 1, 2021). "'Disinformation is a business': media execs explore how to demonetize falsehoods". The Drum. Retrieved 26 January 2023.
157. Graham, Jefferson (March 7, 2019). "Facebook announces anti-vaxx crackdown, will block ads with vaccine misinformation". USA Today. Retrieved March 8, 2019.
158. Gu, Jiayan; Dor, Avi; Li, Kun; et al. (25 March 2022). "The impact of Facebook's vaccine misinformation policy on user endorsements of vaccine content: An interrupted time series analysis". Vaccine. 40 (14): 2209–2214. doi:10.1016/j.vaccine.2022.02.062. ISSN 0264-410X. PMID 35246311. S2CID 247206495.
159. Beckett, Lois (6 January 2021). "Misinformation 'superspreaders': Covid vaccine falsehoods still thriving on Facebook and Instagram". The Guardian.
160. Kennedy, Brigid (July 22, 2021). "How anti-vaccine groups are camouflaging themselves on Facebook". The Week.
161. Jamison, Amelia M.; Broniatowski, David A.; Dredze, Mark; et al. (2020). "Vaccine-related advertising in the Facebook Ad Archive". Vaccine. 38 (3): 512–520. doi:10.1016/j.vaccine.2019.10.066. PMC 6954281. PMID 31732327.
162. "Majority of anti-vaxx ads on Facebook are funded by just two organizations". The Guardian. November 14, 2019. Retrieved November 14, 2019.
163. Sun, Lena H. (16 November 2019). "Majority of anti-vaccine ads on Facebook were funded by two groups". Washington Post.
164. "Facebook and Instagram ban US anti-vaccine group". Le Monde. 19 August 2022.
165. Lima, Cristiano (5 June 2023). "Instagram reinstates Robert Kennedy Jr. after launch of presidential bid". Washington Post.
166. Cole, Devan (October 3, 2023). "Federal appeals court extends limits on Biden administration communications with social media companies to top US cybersecurity agency". CNN.
167. Cole, Devan (October 20, 2023). "Supreme Court lifts restrictions on Biden administration communications with social media companies". CNN.
168. Bicher, Martin; Rippinger, Claire; Zechmeister, Melanie; et al. (2 May 2022). "An iterative algorithm for optimizing COVID-19 vaccination strategies considering unknown supply". PLOS ONE. 17 (5): e0265957. Bibcode:2022PLoSO..1765957B. doi:10.1371/journal.pone.0265957. ISSN 1932-6203. PMC 9060336. PMID 35499997.
169. Fressin, Francois; Wen, Amy; Shukla, Samta; Mok, Kelly; Chaguturu, Sreekanth (July 23, 2021). "How We Achieved More Equitable Vaccine Distribution: Social Vulnerability Analytics Are Necessary, But Not Sufficient". Health Affairs Blog. doi:10.1377/forefront.20210721.568098.
170. Schmitzberger, Florian F.; Scott, Kirstin W.; Nham, Wilson; et al. (30 June 2022). "Identifying Strategies to Boost COVID-19 Vaccine Acceptance in the United States". Rand Health Quarterly. 9 (3): 12. ISSN 2162-8254. PMC 9242559. PMID 35837516.
171. Dada, Debbie; Djiometio, Joseph Nguemo; McFadden, SarahAnn M.; et al. (1 February 2022). "Strategies That Promote Equity in COVID-19 Vaccine Uptake for Black Communities: a Review". Journal of Urban Health. 99 (1): 15–27. doi:10.1007/s11524-021-00594-3. ISSN 1468-2869. PMC 8751469. PMID 35018612. S2CID 245856528.
172. Lacy, Leandra; Solosi, Izabela (27 May 2022). "Addressing the Social Determinants of Health May Help Increase COVID-19 Vaccine Uptake | Urban Institute". Urban Institute.
173. AuYoung, Mona; Rodriguez Espinosa, Patricia; Chen, Wei-ting; et al. (April 2023). "Addressing racial/ethnic inequities in vaccine hesitancy and uptake: lessons learned from the California alliance against COVID-19". Journal of Behavioral Medicine. 46 (1–2): 153–166. doi:10.1007/s10865-022-00284-8. PMC 8783654. PMID 35066696. S2CID 246166545.
174. Lopez-Lloreda, Claudia (April 23, 2021). "Meet the Black Physicians Bringing Covid Vaccines to Hard-Hit Philadelphia Communities". Smithsonian Magazine. Retrieved December 25, 2021.