‘To vaccinate, or not to vaccinate’ is a debate that has captured the imagination of social media users as the COVID-19 virus stays resilient. With the plethora of misinformation travelling through the Internet daily, it is paramount that the public health agencies utilize the reach of the social media to engage local communities and dispel vaccine fears, argues Ruchi Hajela, a LSE Media and Communications alumna and former researcher on the Oxford Internet Institute’s Computational Propaganda project.

On 30 January 2020, the World Health Organisation (WHO) declared COVID-19 to be a Public Health emergency of international concern. On 2 February 2020, the organisation warned against the public health consequences of an ‘infodemic’: an abundance of information that makes it hard for people to find trustworthy sources and reliable guidance when they need it.

In recent months, receiving forwarded messages related to COVID-19 in the format of YouTube links about alternative treatments, (news) clippings, prescriptions on letter headed papers and vaccine-related memes in closed family WhatsApp groups has been an everyday affair for many of us. A few days after Russian president Vladimir Putin announced the country had developed a safe vaccine for the virus, links to an online story claiming Putin’s daughter had died after receiving the second dose of the ostensible vaccine started circulating on social media. The story was later debunked by factcheckers as false. I received the link to this story on a family WhatsApp group, where members were surprised to hear this was false because it came from an online news website that to them appeared authentic.

Results from a recently conducted nationally representative survey of 8000 respondents across UK and the US of which some were exposed to misinformation and the rest to facts, shows that recent misinformation around a COVID-19 vaccine induces a fall in vaccination intent among those who would otherwise “definitely” vaccinate by 6.4 percentages points in the UK and 2.4 in the US, with larger decreases found in intent to vaccinate to protect others.

The European Commission has identified misinformation (unintentionally erroneous information) and disinformation (verifiably false or misleading information created, presented and disseminated for economic gain or to intentionally deceive the public) on public health issues as among the most dangerous types of false information.

Governments around the world have adopted different measures to deal with the problem of misinformation specific to COVID-19, ranging from criminalising false information about the coronavirus (eg in several EU countries and South Africa) to establishing specialist units to track and address false items (UK) and arresting citizens and journalists believed to be spreading false stories related to the illness (as seen in many countries in the EU and Asia). The swift introduction and use of legislation in this regard has been criticised for its potential in restricting legitimate reporting of the pandemic.

Misinformation about vaccines

Talking specifically about misinformation about vaccines, a 2019 report published by UK-based charity, the Royal Society for Public Health, states that “finding new and innovative ways to counteract ‘fake news’ about vaccines is likely to be a major battle to be fought in the coming years”. Across Europe and the US, preventable diseases like measles have seen outbreaks fueled by many years of anti-vaccine fears propagated on social media. In Brazil, fears about the dangers of yellow fever vaccine circulated via WhatsApp reportedly impeded government’s efforts to vaccinate its citizens.

Some social media accounts held by ‘anti-vaxxers’ (i.e., proponents of the anti-vaccine movement) have increased their following by at least 7.8 million people since 2019, with 31 million people following anti-vaccine groups on Facebook and 17 million people subscribing to similar accounts on YouTube, according to a recent report by the Centre for Countering Digital Hate (CCDH). In total, the report found the presence of 58 million followers across 409 anti-vax English language social media accounts. While most of the accounts are run from the US, their digital presence means the negative impact is not geographically contained. The CCDH calculates that the anti-vaccine movement could realise US$1 billion in annual revenues for social media firms. According to a vaccine advocacy campaign called Stronger, anti-vaccine messages have received more than 4.5 billion views since March 2020, up 60% compared with pre-Covid times.

Online and offline, anti-vaccination campaigns have rebranded themselves with a focus on civil liberties and medical freedom, as evidenced by demonstrations at London’s Trafalgar Sqaure where protestors were urged to “Come together, resist and act”. An analysis of public posts from October 2009 through October 2019 on more than 200 Facebook pages revealed this increase in discussion about vaccines as an issue of civil liberty.

In the face of much criticism, social media firms have taken steps to curb the spread of COVID-19 related false information on their platforms. For instance, WhatsApp limited forwarding messages to one chat in order to limit the spread of rumours and ‘fake news.’ Facebook has introduced new measures such as downranking anti-vaccine pages and prioritizing expert led vaccination related pages in its search results. YouTube has gone a step further and announced its plans to remove videos related to misinformation about a Covid-19 vaccine, in addition to a ban on videos that promote false information about the illness itself.

However, such measures need to be complemented with initiatives aimed at empowering the citizens to identify misleading content when they encounter it as we have seen increasing incidents of citizens unknowingly becoming ‘spreaders’ of false news because they are unable to differentiate between genuine messages and mis- or disinformation.

To test this, I conducted a content analysis of 1311 user comments on vaccination-specific pages on Facebook in 2018. The analysis highlighted:

• Users engaged more with posts on pro- and anti-vaccination pages, posting longer comments and a greater number of comments directed at each other.
• In comparison, on official pages of UK-based public health agencies where posts included verified information, comments were significantly shorter in length and were directed at the main post, indicating less engagement.
• The quality of discussion in the comment spaces of pro and anti-vaccination pages was seen to be poor with reactions and unreferenced claims constituting a significant majority of the discourse.
• Similar views expressed by different users resulting in echo chambers were also prevalent in comments across all pages. Users, through their comments, were not seen to be questioning each other’s claims.

This implies that users are more likely to encounter unverified claims in echo chambers, which in the absence of debate and opposing views is likely to further their beliefs and attitudes (both pro and anti) towards vaccination. Facebook has since tweaked its algorithm so that trusted sources of vaccines are ranked higher in search results.

Public Health Agencies need to create awareness

So as efforts to discover a vaccine for COVID-19 continue at record-breaking speed, what can be done to ensure take up once it has been approved? To start with, public health bodies, international organisations and WHO need to combat anti-vaccination fears with evidence and success stories of how vaccines have eradicated previously deadly diseases such as Polio and Tetanus.

• Health agencies will need to proactively engage local communities and amplify messaging around the benefits of vaccines, as the WHO is running trials in Uganda and a couple of Southeast Asian countries. Experts must listen to the local communities to understand their fears and frame their messaging accordingly.
• The language or messaging around the need to vaccinate must change from merely recommending vaccines to insisting people get it.
• As many celebrities are the face of an anti-vaccination movement, it would be potentially beneficial to rope in popular national celebrities for important vaccines campaigns. In India, Bollywood star Amitabh Bachchan’s popularity and mass appeal (as an actor and face of the polio eradication campaign) played an important role in helping India emerge Polio free in 2014.
• NGOs and independent local organisations can also play a role in advocating the benefits of vaccines as citizens skeptical of experts or health authorities are more likely to believe independent organisations without any conflict of interest.
• Globally coordinated messaging might be more impactful than fragmented efforts by different nations.

Flagging misinformation and disinformation

At the same time, it is becoming increasingly important to emphasise critical thinking and digital literacy, starting from students at various levels of education. Social media companies could also promote digital literacy tools, like the Google Reverse Image Search, or campaigns which would help users identify mis and disinformation.

The UK government is running an online campaign to combat false information about the coronavirus and offers the following SHARE checklist:

1. Source – make sure information comes from a trusted source
2. Headline – always read beyond the headline
3. Analyse – check the facts
4. Retouched – does the image or video look as though it has been doctored?
5. Error – look out for bad grammar and spelling

Messages related to health, science, culture and politics make their way into our phones all the time, instead of trusting them as facts, it is worth thinking of them as content which has been created with a purpose. Before forwarding such messages, it would be worth doing a quick check on one’s own beliefs as well. When in doubt, use fact checking websites such as www.Factcheck.org (UK), www.altnews.in (India) and www.snopes.com (US) to verify the authenticity of a message or news piece. Given the crucial role that vaccination is likely to play in alleviating the impact of the pandemic, it is more essential than ever to limit the spread of inaccurate information.

This article gives the views of the author, and not the position of the Media@LSE blog, nor of the London School of Economics and Political Science.