Photo by Charles Deluvio from Unsplash

A collective sigh of relief emerged as news of effective COVID-19 vaccines made global headlines. The breakthrough gives a glimmer of hope for the return of normalcy to people’s lives. Now is an opportune time for public health communities to develop distribution plans that include interventions to dispel the surging misinformation around COVID-19 vaccines. 

While some people oppose vaccines others have shown growing skepticism. When asked if people would get immunized once vaccines are available, about 30% in the US said they were unsure and 20% in the UK said they were unlikely to. People have expressed fear that vaccine development is being rushed while others opposed the government’s intervention in a mass immunization program. But how is the mistrust of vaccines spreading during a pandemic? 

As more people turn to online mediums for information, the anti vaccination movement has tapped into the power and scale of the Internet. Anti-vaxx influencers use the Internet to selectively share scientific information from open access journals on social media, escalating uncertainty and spreading misinformation. It has catalyzed networks with 31 million people following anti-vaccine groups on Facebook and 7 million people subscribing to similar accounts on YouTube. 

The growing anti-vaxx movement is a driver of vaccine hesitancy - a reluctance of refusal to vaccinate despite the availability of vaccines. It is a serious threat to global health especially at a time when COVID-19 vaccines must reach at least 70% of a community to provide immunity.

Confidence in the importance of vaccines - rather than only in their safety or effectiveness - is most strongly linked with vaccine uptake. Trust in the government is also strongly associated with vaccine acceptance while political instability and religious extremism reduce vaccine confidence. The current spread of misinformation and “fake news” around COVID-19 vaccines threatens vaccine confidence even before the antidote hits the market.  

As the Internet becomes a battleground for the anti-vaccination movement, Quilt.AI set out to answer a fundamental question - how is this movement gaining momentum online? We conducted a qualitative analysis of social media platforms to decipher the narratives and profiles of those pushing the anti-vaccination agenda. 

For a deeper dive, our team also looked into the Indian anti-vaxx landscape. India has the worlds’ largest immunization program but our analysis shows growing vaccine hesitancy could threaten progress. Our research looked into how social media platforms and search behavior is used by the anti-vaxx movement in India, what promotional messages are used and how this growing movement should be tackled with actionable interventions.

DNA of the Anti-vaccine Movement

The anti-vaccination movement is global. Tech companies and search engines have clamped down on anti-vaxxers - leading them to go underground and grow in size and influence. In fact, social media accounts held by anti-vaxxers have increased their following by at least 7.8 million since 2019. 

From Pakistan to Canada, anti-vaxxers are made up of multiple “mini-segments” - conspiracy theorists, far left natural healers, far right freedom fighters, revolutionary parents or celebrities. 

Their discourse and content lives mostly on Twitter and increasingly in Facebook Groups and private websites. We found people searching for concepts related to “anti-vaccination” steadily growing - close to 1.2 million searches a month. This includes search keywords linked to vaccine hesitancy, movies such as Vaxxed, and autism-vaccine links. 

Searches related to anti-vaccination

Warriors in the fight against vaccines

Supporters of the movement self perceive themselves as revolutionaries in the front line of a battle. Their messaging is framed around protecting their children from bureaucrats and hidden agendas. Using terms such as “persecuted minority”, they create empathy for themselves and provoke fellow believers into action. 

Many of the anti-vaxx groups call themselves “believe mothers” and “believe children”, stating that the suffering of families is dismissed by “pro vaxxers”. Consequently, they post intimate and painful images of how vaccines have impacted their families. 

Recruitment strategies for such groups include seeking out grieving family members who have a sick or lost child, and turning them into anti-vaxxers. 

In the online discourse, influencers advocate for “medical freedom” and the ability to be “pro-choice”, with regards to what they put into their bodies. This “pro-choice” and “medical freedom” nuance helps them recruit followers who might not have an issue with vaccinating. 

Rage against the Government

People in anti-vaxx groups argue that outbreaks and health scares happen intentionally, orchestrated by the government and big pharmaceutical companies. We hear narratives of bio weapons, population control, and money making schemes. 

As governmental bodies and agencies come out with legislatures on vaccination, people are gathering to protest against it. Contending against the law is one way to make their fight mainstream as anti-vaxxers come forward with expert opinions, endorsements and testimonials.

Up against Big Pharma

Big pharma is seen as the epitome of “negative capitalism” - the belief is that pharmaceutical companies prioritise profit-making to equitable product accessibility. Anti-vaxx content claims that the pharma industry engages in price fixing, or withholding money from the sick all over the world. 

Anti-vaxxers share pro-vaccine news/blogs in groups, claiming the following: 

• Someone was bribed 
• It is a conspiracy to sell more vaccines  
• Experimental vaccines are being tested on a live population.

Their distrust of big pharma extends to sensationalizing access issues, paranoia about ownership, and testing in developing countries. 

Anti-vaxxers are updated on the latest research and believe they are not being presented the full picture about vaccines. Blogs and forums frame scientific journalists, government regulators, insurance companies and big-pharma as being “in it together” and making profits. For example, when Bill Gates donated money during the pandemic, he was accused of engineering the epidemic. 

The anti-vaxx community also has its own scientists - professionals and academics who have stepped out to lend their voice to the movement. Heralded as “scientists” and “whistleblowers”, they make use of controversies and anti-vax content to make themselves more credible. 

Letting Nature Take Its Course

There are also emerging views around health and holistic ‘natural’ lifestyles that have shaped parents’ opinions on vaccination. As holistic lifestyles become increasingly popular, supporters use it to build faith in natural immunity, emphasizing that vaccination causes children to “lose immunity.” This narrative is especially popular in India, the country we chose for a deeper dive on the growing online anti-vaxx movement.

A Global Phenomenon Manifests in India

Our findings from a global search are relevant to our immunization studies in Uttar Pradesh, Bihar and 45 cities across India. 

In Uttar Pradesh and Bihar, we analyzed 5.7 million searches, 20,000 social media posts and 1,200 blogs/news posts to understand the immunization landscape. We found that search interests for immunization are gradually growing (+66%) with spikes in interest in child vaccination. 

With a high awareness of common illness, most Indians are searching for vaccines for specific diseases with concerns around polio and measles topping the list. This is followed by interest in Mission Indradhanush and learning more about the mechanics behind immunisation and the necessity for it. Across social media, videos and information about immunization dominates the platforms. However, Twitter shows more people criticizing the government’s immunization efforts. 

In another study, we expanded our analysis to 45 cities. Our team analyzed 286,490 searches over 4 years, 12 blogs/forums/news, 23,385 Twitter influencers, 42 YouTube uploads, and 250 Facebook pages/groups. 

Our study threw up concerning results: 

• Searches against vaccinations is growing at 23%
• Searches for Natural immunity is increasing steadily
• Pro-vaccine searches are decreasing by 36% even though there is a 61% growth in content on anti-vaccine defenses (e.g. movies, articles for vaccines) 

Searching to Challenge Vaccinations

People’s desire for information about vaccines are evident in their searches related to the following questions. 

1. WHAT HAPPENS IF I DO NOT VACCINATE?
   Searches on the “risks” and “effects” of vaccination have increased. People are caring less about reasons for vaccinating and more about the consequences of doing so. (“Is vaccination good or bad”, “Should I vaccinate”, “What are the risks”). Searches from people in this set contain open-ended questions that invite debate, suggesting their willingness to be given a fuller picture.
   
2. WHAT HAPPENS IF I DO VACCINATE?
   There is a rising number of searches surrounding the idea of natural immunity (searches in this category are +27% since 2018), suggesting a growing belief in vaccines being unnecessary.

The Anti-Vaxx Community Grows

People have also taken to social media to express sentiments around vaccines related to potency, protection, herd immunity, and political discourse (polio vaccine, cow milk). 

Word cloud of anti-vaxx sentiments

While it is easy to dismiss the anti-vaxx discourse in India as a fringe movement, it is clear that the discourse is becoming normalized. 

Some of the discourse we saw on social media: 

1. INFLUENCERS ARE ‘EXPERTS’ : The anti vaccine movement in India is increasing - it is supported by nationalists, ayurvedic doctors, politicians and students. Some influencers anchor their beliefs in ‘ancient wisdom’ as seen in YouTube videos for nature home remedies to cure chicken pox and measles. Others anchor on fear and belief in myths and superstitions to perpetuate the argument against vaccination in an attempt to sway others.
   
2. THE DEBATE HAS BECOME POLITICISED: The removal of anti-vaccine information from the various platforms has pushed the conversation ‘underground’ - into a series of interlinked Facebook Groups, WhatsApp groups and private group chats on Twitter.
   
3. THERE IS A REVOLUTIONARY ‘CHARGE’ TO THE DEBATE: By virtue of it being “silenced”, it attracts certain segments : revolutionaries, victims, eco-warriors, “true scientists”, etc. Within this discourse, resources released by organisations such as the Red Cross and Gates Foundation have been positioned as foreign intervention and genocide. 

What Can we Learn from India?

The growing anti-vaccination movement is worrying, but India’s history of successful public health campaigns can help push back. India leads the world’s largest immunization program and set an example for eradicating polio in 2014. Learnings from these campaigns can be used to scale up future vaccine programs - like when the COVID-19 vaccine rolls out. 

India was successful in eradicating polio due to multiple factors:

1. Strong government ownership and commitment helped coordination across ministries and ensured annual funds for immunization activities
2. Empowered state and district authorities to conduct immunization activities and hold monthly review sessions that ensured constant communication at state and national levels
3. Religious leaders are key in demystifying doubts around vaccines and must be brought on to help coordinate efforts. Celebrities also played a major role in endorsing and supporting efforts. 
4. Actively engaging the private sector ensured funds for immunization activities and access to vaccines and healthcare facilities. 

Between the inception and completion of the polio program (1995-2014), Internet penetration was still growing in India. But now, the country has seen a digital revolution - with access growing the fastest in rural areas - and anti-vaxxers’ voices growing louder on the Internet. The time to start developing an immunization plan for COVID-19 is now and must include digital interventions that can change discourses and end a pandemic.