Previously, Broniatowski published research on how Russian anti-vaccine bots and trolls were mobilized during the 2016 presidential election.1 That paper was followed earlier this year by a study on how vaccine communications have been weaponized through identity politics.2

His latest paper an analysis of 204 Facebook pages of anti-vax groups traces how a large measles outbreak at Disneyland in 2015 led to the emergence of a common anti-vaccine narrative, “emphasizing civil rights and freedom from elitist government vaccine opposition.”3

“Our results demonstrate how the vaccine opponent discourse has increased in volume and evolved over time, with three distinct phases: vaccine opposition becomes mainstream, popular media spokesmen target civil liberties pages, and civil liberties pages promote state-level political mobilization,” Broniatowski and colleagues concluded.

Hospital Infection Control & Prevention asked Broniatowski to comment on the implications of these findings on an eventual COVID-19 vaccine in the following interview, which has been edited for length and clarity.

HIC: Do you think this established vaccine resistance will affect the uptake of an eventual COVID-19 vaccine?

Broniatowski: “Yes. One of the things that is interesting about the COVID discourse online is that it really draws pretty heavily on what we’ve seen before in the anti-vaccine communities. A lot of the things we are seeing around COVID not just about a vaccine but wearing masks are basically a page out of the anti-vaxxer playbook. A lot of the strategies and approaches that these vaccine opponents have been using and really developing and testing for the last five years have parallels in COVID-19. We saw the movie “Vaxxed” released in 2016, and that really put civil liberties as an issue on the map. Before that it was localized in California and it was one of many issues. That [film] really made it an issue. People learned a lesson these kinds of movies are effective. Then we saw “Plandemic” show up in the COVID discourse. This is another professionally produced movie. So, we are seeing similar sorts of strategies.

HIC: Will the widely perceived politicized response to the pandemic be an issue in refusing vaccine?

Broniatowski: I think we can expect to see that when a COVID-19 vaccine is available there is going be a sort of hardcore group of people that will oppose it. It could be a pretty precarious situation because any vaccine that gets released if we are talking about releasing it on the timeline that the president has said there is already going to be the perception that it was rushed. There is going to be all the political overtones of that. That is going make things a little more dicey, and then on top on that we have all these existing narratives and rationales for why people shouldn’t take it. What our studies show is we have very motivated groups of people who are actively mobilizing in state-level politics. Not only are we going to see people refusing to take it as individuals, but I think we are probably going to start seeing groups of people mobilizing to pass legislation to make it harder for us to reach herd immunity using the vaccine.

HIC: There has been some concern expressed about protests and security at vaccine administration sites.

Broniatowski: We have already seen in our data that Facebook pages have been used to organize rallies and protests. Given that people are already feeling pretty willing to mobilize around things like masks. Certainly, if there is a perception that an available vaccine is mandatory or in some way interferes with people’s civil liberties, we can expect to see some degree of action around that.

HIC: Civil liberties issues would seem to be in conflict with vaccines required for school attendance or mandatory flu immunization at many healthcare facilities.

Broniatowski: There are a few different versions of this. One of them is that you have people who are saying it is their own choice whether or not their children get vaccinated. That generally applies to childhood vaccinations, so we are talking about [measles, mumps, rubella]. In other cases for example, flu vaccine there are some cases where workplaces will mandate flu vaccine … if you work for a healthcare organization or hospital. The employer will generally require that you take the flu vaccine. There are similar kinds of mandates in other settings. We might see opposition to that crop up around COVID. For example, if we start to see workplaces say you are not allowed to come into work unless you get the COVID vaccine, then people will seek legislative interventions [claiming] workplace discrimination, something like that.

HIC: Just to clarify: If a COVID-19 vaccine is approved under a Food and Drug Administration emergency use authorization, the general consensus is it could not be mandated. You also note these anti-vaccine groups are not restricted to Facebook but have a presence across social media.

Broniatowski: Of course, it’s not just Facebook, there are several different platforms. I haven’t personally engaged with Facebook’s policy team regarding this, but there certainly are a lot of people who are requesting that they do more. People who are using Facebook are very sophisticated in the way they are doing it. Facebook has become more strict on vaccine misinformation. But that doesn’t necessarily equate to the civil liberties argument. We are walking a fine line here. It’s one thing to say it’s demonstrably false that vaccines cause autism. We know that leads to hesitation on vaccinating and allows all sorts of bad things. So, they are not going to allow that particular statement to be on a social media platform. That is clearly misinformation. But what if you are saying something like attend a rally at such and such a place? “We are going to talk about vaccines and you can learn what your options are.” For the anti-vaccine community, that is code for “Come to our rally and we are going to tell you all the ways to oppose vaccination.” Should Facebook say you are not allowed to organize? That becomes problematic. If you try to disallow these groups, you push them onto another platform.

HIC: Why do these groups seem so drawn to conspiracy theories?

Broniatowski: There are a few reasons. I don’t think that any of these are the complete reason, but they are contributing factors. First of all, a lot of conspiracy-oriented groups incorporate anti-vaccine tropes. For example, QAnon has been in the news a lot recently. They have incorporated anti-vaccine tropes into their mythology also chemtrails, antifluoride, flat earth. Just about every conspiracy theory under the sun shows up in some form or another on QAnon. They don’t necessarily care if the conspiracy theories are right or wrong in many cases they contradict each other. It allows the theory itself to spread and gives them something to hang their hat on.

Beyond that, conspiracy-oriented thinking has been present in anti-vaccine discourse, basically, since there has been anti-vaccine discourse. When you are talking about opposing vaccination, you are fundamentally talking about especially in the civil liberties world issues of health freedom. In this particular case, it is about do you have a choice about whether or not you want to be vaccinated? If you believe the government or somebody who is vaccinating is out to get you, if you believe some conspiracy theory like people are going to profit off of your poor health you are more likely to refuse to be vaccinated. If you just leave it at it’s your choice to vaccinate or not [most people] think it’s a good idea. You have to tell them it’s their choice and give them a “why” it is a good choice not to vaccinate. It’s framed as freedom of choice, but the implicit assumption is vaccine is not the right choice. This is something public health officials could take advantage of. If we make the cases that vaccination is the right choice and appeal to people’s values everybody wants to save lives. If we can make the case that vaccinations save lives in a convincing manner and do that in a way that is culturally sensitive, that will work in our favor.

REFERENCES

  1. Broniatowski DA, Jamison AM, Qi S, et al. Weaponized health communication: Twitter bots and Russian trolls amplify the vaccine debate. Am J Public Health 2018;108:1378-1384.
  2. Broniatowski DA,  Quinn SC, Dredze M, Jamison AM. Vaccine communication as weaponized identity politics. Am J Public Health 2020;110:617-618.
  3. Broniatowski DA, Jamison AM, Johnson NF, et al. Facebook pages, the “Disneyland” measles outbreak, and promotion of vaccine refusal as a civil right, 2009-2019. Am J Public Health 2020;110:S312-S318.