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Head To Head Public Health

Should spreading anti-vaccine misinformation be criminalised?

BMJ 2021; 372 doi: (Published 17 February 2021) Cite this as: BMJ 2021;372:n272

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  1. Melinda C Mills, professor of demography and sociology and director, Leverhulme Centre for Demographic Science1,
  2. Jonas Sivelä, senior researcher, infectious disease control and vaccinations2
  1. 1University of Oxford and Nuffield College, UK
  2. 2Finnish Institute for Health and Welfare (THL), Helsinki, Finland
  1. Correspondence to: MC Mills melinda.mills{at}, J Sivelä jonas.sivela{at}

The spread of false health information casts a shadow over required vaccine coverage. Melinda Mills says that we must, reluctantly, consider criminalising people who deliberately spread false information—but Jonas Sivelä argues that the definitions are too murky and that criminalisation may do more harm than good

Yes—Melinda Mills

Vaccination is a miracle of medicine and is the proposed way out of covid-19.1 But not everyone agrees. Some people spread vaccine disinformation—false information with malicious intent—or misleading misinformation, based on incorrect beliefs.

Both of these can increase vaccine hesitancy, which the World Health Organization has listed as one of the top 10 health threats.2 And the consequences can be real. Although measles vaccinations saved 23 million lives, misinformation was linked to the disease’s resurgence.3

The many faces of false information

False information about vaccines is heterogeneous, spread by groups ranging from anti-vaccine libertarians protecting civil liberties to concerned parents and health conscious people.4 It is nothing new—from the Anti-Vaccination Leagues of the 1880s, fighting infringements of personal liberty,5 to the persistence of the fraudulent Wakefield study linking the MMR vaccine to autism (despite its retraction).6 Spreading falsehoods can be lucrative, and some people allegedly benefit from spreading conspiracy theories and selling coronavirus cures.27

Simple, emotive, and compelling disinformation can sow doubt and distrust by exploiting perceived U turns in scientific knowledge or by presenting government or public health decisions as establishment failures. “Merchandising doubt” is effective, from denying a link between cigarettes and cancer to questioning climate change or national election results.8 Doubt destabilises, polarises, and erodes trust.

We are also facing an “infodemic”—an overabundance of information, both factual and false. In uncertain conditions people struggle to sort through complex, evolving information: 25% of Americans report having unwittingly shared fake news stories.9 A majority (70-83%) of Americans and Europeans …

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