Public and private sector health officials and public policymakers should team up immediately with community leaders to more effectively disseminate accurate narratives regarding the life-saving benefits of vaccines to counter widespread, harmful misinformation from anti-vaccine activists.
Such is the message of a UC Riverside-led viewpoint piece published Thursday, March 2, in the leading international medical journal, The Lancet.
We need to consistently amplify the best science and find the best ways of communicating so that people are hearing it through multiple channels instead of through one or two sources."
Richard M. Carpiano, lead author on the paper and public policy professor at UCR
"This is a matter of life and death. People don't always see it that way," he added. "We've forgotten how many people have died, have been sick, or continue to get sick from COVID-19 as well as many other vaccine-preventable diseases."
The paper comes out just after California marked the grim milestone of more than 100,000 COVID-19 deaths. Nationally, more than 1.1 million people have died, and the worldwide toll is estimated at 6.8 million. The disease continues to spread as vaccines have been found to greatly reduce illnesses that require hospitalization or result in death.
Carpiano and 20 leading public health experts describe in The Lacent paper a perfect storm that still allows anti-vaccine activism, once a fringe subculture, to become a well-organized form of right-wing identity with narratives that associate refusing vaccines with personal liberty. This narrative was consistently repeated and amplified by social media influencers, pro-Donald Trump political operatives, and right-wing blogs, podcasts, and other media as the COVID-19 pandemic spread worldwide.
Anti-vaccination activism has existed as long as there have been vaccines, Carpiano said. But the movement picked up steam in 1998 when British physician Andrew Wakefield published a now-discredited study that falsely claimed a link between childhood vaccines and autism.
In more recent years, however, anti-vaccine messaging shifted in large part from health-effect concerns to conservative and libertarian political identity arguments of medical freedom and parental rights. This was prompted in part by legislative efforts in California and other states to eliminate personal belief exemptions from school vaccination requirements in response to falling child vaccination rates and vaccine-preventable disease outbreaks.
Still, these arguments were confined to childhood vaccines and thus were "rather contained," Carpiano said.
Since the COVID-19 pandemic affected the entire population, it brought on a vast expansion of not only anti-vaccine activism, but more broadly, anti-public health activism as people faced the inconveniences of mask-wearing, social distancing, closed restaurants and bars, and cancelations of concerts and other events that draw crowds.
"Anti-public health activism and sentiments, unfortunately, became tied up increasingly with right-wing politics," Carpiano said.
Celebrities, wellness influencers, partisan pundits, and certain scientists and clinicians, among others, joined the fray, often spreading false and misleading claims about vaccinations. The increasing number of voices found larger audiences, which meant more votes for right-wing candidates, and greater monetization of right-leaning social and media outlets.
"Values became important and useful when science wasn't there to back up certain anti-vaccine claims," Carpiano said. "And so, people could claim, 'Well, it's about personal choice. It's about me as a parent. It's about state overreach,' which are harder things to argue against than things like, 'Do vaccines cause autism?"
The result was more people becoming ill.
"We start to see where party affiliation and political leaning become strangely and concerningly robust predictors of vaccine uptake and even mortality and hospitalization rates," he said.
Meanwhile, pro-vaccine messaging has been based on the statements of individual public health experts, such as former director of the National Institute of Allergy and Infectious Diseases Anthony Fauci and director of the U.S. Centers for Disease Control and Prevention Rochelle Walensky, who are outgunned.
"Fauci, for example, gets attacked on different fronts by different groups that, instead of focusing on the science issue he is discussing, often use ad hominem or personal attacks about him unrelated to that issue and even conspiracy theories," Carpiano said. "Such a lone expert model of communicating to the public is very susceptible to being discredited, but not necessarily through legitimate points."
Carpiano was part of a 21-member Commission on Vaccine Refusal, Acceptance, and Demand in the USA put together by The Lancet to examine issues surrounding COVID-19 vaccine acceptance uptake, acceptance, and hesitancy. The membership is composed of national experts from public health, vaccine science, law, ethics, public policy, and the social and behavioral sciences.
The group recommends the development of networked communities that simultaneously share information with different audiences about the health and economic benefits of vaccines. This would preempt the well-funded messaging of the antivaccine movement.
"Without concerted efforts to counter the anti-vaccine movement, the USA faces an ever-growing burden of morbidity and mortality from an increasingly under-vaccinated, vaccine-hesitant society," the paper concludes.
University of California – Riverside
Carpiano, R.M., et al. (2023) Confronting the evolution and expansion of anti-vaccine activism in the USA in the COVID-19 era. The Lancet. doi.org/10.1016/S0140-6736(23)00136-8.
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