Even covid-19 can’t kill the anti-vaccination movementBMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m2184 (Published 04 June 2020) Cite this as: BMJ 2020;369:m2184
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During a pandemic, you might expect everyone to say they want a vaccine—but that’s not what a study of 1000 people in New York over 24-26 April found.
“Only 59% of respondents said they would get a vaccine and only 53% would give it to their children,” says Scott Ratzan, distinguished lecturer at the New York based CUNY Graduate School of Public Health and Health Policy.1
Since the project began in March, Ratzen’s group has asked the question three times, and each time the proportion is low. “It’s concerning. I would have thought numbers would go up. I didn’t expect to see it so negative.”
In their first poll on 27-29 March, 62% said they would have a coronavirus vaccine, with 19% saying they would decline it and 19% unsure. The latest poll, conducted at the start of May, found that 31% would have a vaccine immediately with 48% saying they would if their doctor recommended it; 12% would reject a vaccine outright. Ratzan also asked if they would volunteer for a coronavirus vaccine clinical trial. Just 31% expressed an interest.
He attributes much of the negativity in his surveys around a coronavirus vaccine to a small but incredibly vocal movement. “The anti-vaccination movement is going to make covid-19 more difficult to get under control,” he told The BMJ.
In 2019, the World Health Organization named vaccine hesitancy as one of the top 10 threats to global health. The call was made amid numerous measles outbreaks, when global uptake rates for the measles, mumps, and rubella vaccine slipped to 85%, down from the required target of 95%.2
In the new covid-19 world, confusion and fear has only exacerbated the situation. Conspiracy theories and misinformation have circulated widely, from links with 5G masts to claims that Bill Gates is using vaccine developments to microchip the population. The week of 24 April—world immunization week—a false story circulated that one of the first volunteers in the Oxford University covid-19 vaccine clinical trial had died from complications.3
While relatively small, the anti-vaccination movement actively uses social media to amplify its messaging and target people who are unsure about vaccines, particularly parent groups. A study of more than 500 Facebook ads between December 2018 and February 2019 found that 145 featured anti-vaccination sentiment, reaching audiences of between 5000 and 50 000 people. Researchers found that 54% of anti-vaccination ads came from just two organisations: the World Mercury Project and Stop Mandatory Vaccinations.4
Facebook told The BMJ that it rejects ads that include vaccine misinformation and has removed hundreds of thousands of posts containing harmful misinformation relating to covid-19 and a potential vaccine while also directing people to articles with accurate information. Yet despite concerted efforts by social media companies, WHO has “seen anti-covid-19 vaccine sentiment in social media,” says Katherine O’Brien, director of the department of immunization, vaccines, and biologicals at WHO. “We don’t have a vaccine yet and already there is an anti-vaccination voice on it.”
“We have to take this seriously,” she told The BMJ. “Vaccination isn’t just an individual choice; it protects those who can’t be vaccinated.”
Fuel to the fire
“Covid-19 will die out before the anti-vaccination movement,” says Barry Bloom, research professor of public health at the Harvard TH Chan School of Public Health. Rather than being cowed, he says the movement has been invigorated by the pandemic.
Bloom has noted how many of the hundreds of protestors at a Wisconsin anti-lockdown demonstration were carrying anti-vaccination signs. He says there is a “new phenomenon” of TV networks, such as Fox News, airing their views.5
Since the outbreak began, there has been an influx of more extreme views, especially from those who are suspicious of government control, says Dorit Reiss, a law professor at University of California Hastings College of the Law, who monitors the anti-vaccination movement. With vaccine hesitancy at record rates, coupled with economic hardship, scepticism of government, and growing annoyance at lockdown measures, there are opportunities for anti-vaccination campaigners to target those vulnerable to anti-vaccination sentiment, she says.
Reiss is particularly concerned about the fast tracking of vaccines. “The anti-vaccination community will latch on to anything that goes wrong and will use that to create fear. We should expect that.”
Indeed, an analysis of more than three million social media posts a day from January to mid-March 2020 found most comments keen on a vaccine.6 But, says Heidi Larson, director of the Vaccine Confidence Project (VCP) at the London School of Hygiene and Tropical Medicine, “one of the more dominant concerns is that new covid-19 vaccines will be developed too quickly—that they won’t be safe enough.”
Bloom has no doubt the movement will resist any forced implementation of a covid-19 vaccine. “These are new vaccines, never been used before. There will be lots of possibilities to sow doubt,” he says. A jab based on the measles vaccine—a particular area of hate for the movement—would immediately be a target. Any rush to roll out a new vaccine will be used as ammunition and evidence of a loss of civil liberties. And the movement will not hesitate to point to political corruption and big pharma conspiracies if those with money have priority access when a vaccine becomes available.
Yet Reiss says she has also seen more “on-the-fence views” since the pandemic started, with more sympathy for public health and support of its efforts. Media reports quote anti-vaccination campaigners who say they are wavering in their beliefs as a result of covid-19 and who may be more inclined to have a vaccine.78
This sentiment is reflected in early findings of an 18 month study tracking online conversations and conducting global polls to measure attitudes about the coronavirus. Led by the VCP, one poll in mid-March found around 7% of Britons would decline a covid-19 vaccine if it existed. This dropped to 5% when a second poll was conducted in early April—although this wasn’t a trend in all countries. March polling found 18% of French people would refuse a coronavirus vaccine.6
O’Brien believes the pandemic is an opportunity to bolster support for vaccinations. “People are seeing the impact that life threatening diseases have, major disruption to the structure of society, our relationships, jobs, and lives. This pandemic is a reminder of the success of vaccines.”
Bloom says the dialogue needs to start now. “We could wait a year and a half until we get a vaccine, but I don’t think that’s a good idea, especially if covid-19 still presents a threat.” He calls for a vast advocacy campaign led by respected individuals alongside mass screening of social media with harmful misinformation removed.
Getting communication right is critical, says Ratzan. “The pandemic is showing our vulnerabilities when it comes to vaccines and vaccine hesitancy—and it raises the matter of how we protect for future pandemics.”
“This isn’t just a rights matter,” he says, “This is a community protection matter. Vaccines are our only hope. We can’t mess this one up.”
I have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.
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