Key takeaways:

• The three most prominent U.S. anti-vaccination organizations -- National Vaccine Information Center, Children’s Health Defense, and Informed Consent Action Network -- are using Facebook and other major social media platforms to lay the groundwork for widespread coronavirus vaccine rejection.
• Facebook allows these groups to identify their organizations with descriptors like “Educational Research Center” and “Medical & Health” organization.
• Facebook’s current policies surrounding vaccine misinformation include de-ranking accounts and posting “educational units” to some anti-vaccine misinformation. But the Facebook pages for NVIC, CHD, and ICAN and those groups' leaders do not contain any warnings from Facebook about the organization’s purposes. 
• The groups' pages are rife with vaccine conspiracy theories and other coronavirus misinformation. For example, NVIC has promoted conspiracy theories about Bill Gates and vaccine development, CHD has promoted the falsehood that wearing masks does not reduce the likelihood of coronavirus spread, and ICAN’s leader has claimed even the “biggest vaccine advocates in the country” are “sounding the alarm” on coronavirus vaccine development.
• Facebook pages for NVIC, CHD, ICAN and their associated leaders and media projects have a combined more than 950,000 followers. This represents the tip of the iceberg; according to a recent report, anti-vaxxers have a combined Facebook following of 58 million people.
• Academic research on approaches similar to Facebook’s to counter anti-vaccine misinformation suggests Facebook’s current policies will not be effective in countering coronavirus vaccine misinformation.
• A growing share of Americans say they will refuse to receive a coronavirus vaccine, which could greatly harm efforts to get the disease under control in the U.S.

As novel coronavirus cases spike in the U.S. and numerous efforts are underway to develop a vaccine, the most prominent U.S. anti-vaccination organizations are using Facebook and other social media platforms to poison the well against a potential vaccine -- even though the consequence of widespread vaccination rejection in the U.S. would be an additional public health disaster.

In March 2019, Facebook said it “implemented new policies to de-rank accounts spreading vaccine misinformation in their search results,” according to ABC News. Later that year, Facebook and Instagram (which Facebook owns) announced they had partnered with the WHO and Centers for Disease Control and Prevention to “start posting educational units about vaccines on ‘vaccine-related searches on Facebook, Facebook Groups and Pages that discuss vaccines, and Invitations to join Facebook Groups that discuss vaccines.’” In theory, Facebook bans ads that include vaccine misinformation, but enforcement has been spotty. Anti-vaccine content on Facebook may be fact-checked by Facebook’s third-party fact-checking program. Additionally, Facebook has a policy to take action against coronavirus misinformation, though the methods Facebook uses have been criticized as ineffective and scattershot in their application. After Buzzfeed News identified anti-vaccine ads in January, a Facebook spokesperson paradoxically responded, “Facebook does not have a policy that bans advertising on the basis that it expresses opposition to vaccines. Our policy is to ban ads containing vaccine misinformation." 

There’s evidence that even brief exposure to anti-vaccination information changes attitudes. According to a 2010 study published in Health Psychology, “Accessing vaccine-critical websites for five to 10 minutes increases the perception of risk of vaccinating and decreases the perception of risk of omitting vaccinations as well as the intentions to vaccinate.” The phenomenon does not appear to work in reverse: A study that attempted to change attitudes with “direct pro-vaccination messages” found that those messages actually reinforced misguided beliefs. In fact, common ways that anti-vaccine information is countered are typically ineffective. A 2014 study published in Pediatrics tested the following four messaging strategies “designed to reduce vaccine misperceptions and increase vaccination rates for measles-mumps-rubella (MMR)”:

None of the four approaches “increased parental intent to vaccinate a future child” and the study warned that attempts to “correct false claims about vaccines may be especially likely to be counterproductive.” Based on these findings, it seems unlikely the “educational units” Facebook affixes to some vaccine misinformation would be sufficient in stopping the spread. Another negative factor in play at Facebook and other social media outlets is that research suggests that anti-vaccination content tends to be more popular than pro-vaccine content and anti-vaccine messages -- aided by the fact that their arguments need not be premised on scientific research -- tend to use stronger rhetorical devices compared to pro-vaccination efforts. 

Given the fraught conditions surrounding the effects of anti- and pro-vaccine messaging, one solution, of course, would be for social media platforms to root out and remove anti-vaccine misinformation rather than include a disclaimer or appeal to an authority that may actually reinforce anti-vaccine attitudes. 

There are growing concerns that vaccine rejection will prevent the United States from overcoming the novel coronavirus pandemic

Support in the U.S. for vaccination generally has been on a downward trend for the past two decades. A January 2020 poll released by Gallup found that 84% of Americans believe it is “important” to vaccinate children, down from 94% in 2001. The poll found that support for vaccination has declined “among almost all subgroups of the U.S. public.” Gallup attributed the decline in support for vaccination to the spread of false information about vaccines, in particular the debunked link between vaccines and autism, writing of false vaccination claims, “While they are not as pervasive and are being exposed as untrue, these counterarguments are still getting through, perhaps explaining why public support for vaccines remains lower than at the start of this century.”

Attitudes toward a coronavirus vaccine are worse. A May 20-21 survey from Yahoo News/YouGov found that just 50% of Americans say they will get the novel coronavirus vaccine, 23% say they will refuse the vaccine, and the rest are unsure. A previous Yahoo News/YouGov poll released on May 8 found that 55% of Americans said they will get the vaccine and 19% said they will refuse to get a vaccine, suggesting that anti-vaccine sentiment is building. Similarly, a May 27 Associated Press poll found that 49% of Americans say they would get a coronavirus vaccine, while 20% say they would not. Among people who say they would not get a vaccine, seven in 10 cited safety concerns. According to a report from Center for Countering Digital Hate, polling conducted in late June indicates that Americans who “use social media more than traditional media to access news and updates about Covid” say that they will get vaccinated against coronavirus at a rate 10 points lower compared to those who primarily consume traditional media.

Widespread vaccine refusal could have devastating consequences. In a June 26 interview, Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, said that the best cast scenario for an initial coronavirus vaccine was a 70-75% effectiveness rate. Fauci said that rate, paired with the fact that only two-thirds of the U.S. population might agree to receive a coronavirus vaccine, would make it “unlikely” that the herd immunity would develop in the U.S. through life-saving vaccine interventions; instead herd immunity would build as the disease runs rampant, sickening and killing Americans in the process. 

The major anti-vax players and their Facebook presence 

In a 2019 article about the reemergence of measles outbreaks in the United States, The Washington Post identified three anti-vaccination groups that have received significant funding in recent years: National Vaccine Information Center (NVIC), the Informed Consent Action Network (ICAN), and Children’s Health Defense (CHD). The most prominent public spokespeople for those organizations are NVIC co-founder Barbara Loe Fisher, ICAN founder Del Bigtree, and CHD chair Robert F. Kennedy Jr. According to the Post, “Though they are separately organized, the three groups reinforce one another’s efforts. Kennedy and Bigtree often appear together at public events, while ICAN’s website includes a link to Fisher’s group. Bigtree’s weekly live stream broadcast, which ICAN promotes, frequently features Kennedy.” Fisher, Kennedy, and Bigtree are now organizing against the coronavirus vaccine development and pushing other coronavirus misinformation with a major boost from the largest social media platforms.

National Vaccine Information Center

NVIC is a nonprofit organization that calls itself “the largest consumer-led organization advocating for the institution of vaccine safety and informed consent protections in U.S. public health policies.” Journalist Michael Specter has noted that NVIC “based on its name, certainly sounds like a federal agency.” But “actually, it’s just the opposite: the NVIC is the most powerful anti-vaccine organization in America, and its relationship with the U.S. government consists almost entirely of opposing federal efforts aimed at vaccinating children.” An academic qualitative analysis of NVIC’s website notes, “Although visitors to the NVIC website will find a great deal of governmental and scientific information on vaccines and vaccination, they are also faced with a vast number of resources that cast vaccines as dangerous.” In fact, the analysis found that, at the time, the layout of NVIC’s website contained “design choices typically employed on governmental and medical websites” and that its layout resembled the Department of Health and Human Services’ website vaccines.gov. 

Beginning in February, NVIC began publishing a multi-part “special report” on the novel coronavirus outbreak. The initial entry, authored by Fisher, included a mix of information from legitimate sources, such as the CDC, as well as right-wing sources such as The Washington Times.  

The first three installments of the “special report” adopt right-wing themes unrelated to vaccines, such as the claim that public health orders that promote social distancing result in a “loss of civil liberties” and subject Americans to “quarantine shaming.” 

The fourth installment, published on March 29, includes the first attacks on vaccine development in the series. Fisher writes about the prospect of challenge trials -- in which participants are deliberately infected with a disease -- being used to assist in developing a vaccine.  Fisher claims that the practice is “another unprecedented development regarding medical ethics.” In reality, challenge trials have been practiced for centuries. 

The fifth installment of the “special report,” published on April 1, frames the vaccine development efforts of pharmaceutical companies and other entities as a cash grab. It suggests without evidence that a vaccine could be approved without proper safety vetting that would result in “putting millions of people at risk for vaccine failures and reactions leading to chronic illness.” 

NVIC’s messaging against the development of a coronavirus vaccine is more explicit on major social media platforms. 

NVIC on Facebook and other social media platforms

NVIC maintains a Facebook page with more than 210,000 followers and is allowed to list itself as an “Educational Research Center.” The page contains no general disclaimer about vaccine misinformation, and a button that allows visitors to “learn more” about NVIC leads to a donation page. 

NVIC has been posting content about the coronavirus that echoes falsehoods commonly seen in right-wing media coverage of the outbreak, including claims that seek to downplay the severity of COVID-19, the disease caused by coronavirus, and that suggest coronavirus deaths are being overreported. (In fact, deaths are being undercounted.)

NVIC is also using its Facebook page to attack the development of a novel coronavirus vaccine. In a June 4 video, Fisher discussed NVIC’s latest “special report” on coronavirus and criticized lockdowns, fearmongered about incarcerated people being released from prison because of coronavirus, and downplayed the dangerousness of coronavirus. Fisher also attacked vaccine development as a government tracking plot, said vaccine development could have “devastating consequences for humans,” and complained critics of public health officials will be “branded a threat to global health and can be censored on the internet, or far worse.” A June 11 NVIC Facebook post opposing coronavirus vaccine developments tells supporters, “We need to start developing personal relationships with the legislators and officials we elect, including our county sheriff, who can intervene on our behalf to protect us from tyranny.” 

NVIC also uses its page to promote anti-vaccine information from other major anti-vaccine groups, such promoting anti-coronavirus vaccine material from Children’s Health Defense that argues “no ethical physician, parent, or politician should support their general use.”

On May 28, NVIC shared a link to a video by QAnon conspiracy theorist and YouTuber “Amazing Polly” that bizarrely attempts to draw a connection between U.S. officials supposedly involved in the the 1998 Kenya embassy bombing and 9/11 “bombings” (a reference to 9/11 truther conspiracy theories) and coronavirus vaccine development. NVIC is also promoting a video series that attacks Bill Gates’ involvement in vaccine efforts by claiming his goal is to gain “control over the global population itself.” The series is published by 9/11 conspiracy theorist James Corbett.

Other coronavirus vaccine misinformation shared by NVIC is more sophisticated, such as an effort by the group to portray as dangerous a vaccine developed by pharmaceutical company Moderna that has shown some promising results. On May 28, NVIC seized on Moderna’s routine disclosure that some subjects suffered side effects during an early trial and posted a link to an article at NVIC online publication The Vaccine Reaction.

To state the obvious, the purpose of the vaccine trial is to determine how a vaccine may be safely administered. One of the trial participants who suffered a reaction even spoke to medical news website Stat, expressing his hope that his experience wouldn’t be twisted by vaccine opponents. 

NVIC has a presence on other major social media platforms. Its Instagram account, where it posts similar material as it does on Facebook, has more than 43,000 followers, and it has smaller and less active accounts on YouTube and Twitter. Fisher maintains a Twitter account with over 17,000 followers where she pushes conspiracy theories about the novel coronavirus. 

NVIC’s podcast is carried on Spotify, Soundcloud, and Apple, where it is listed in the “Health & Fitness” category:

Children’s Health Defense

Children’s Health Defense is an anti-vaccine organization headed by Robert F. Kennedy Jr., who launched it in 2018. (In 2017, Kennedy claimed President Donald Trump asked him to chair a vaccine commission, but the plan appears to have not materialized.)

Kennedy and his organization have made multiple attacks on the development of the coronavirus vaccine. In an April interview with quack Dr. Joseph Mercola, Kennedy sought to sow doubts about coronavirus vaccine development, saying he doubts any coronavirus vaccine would ever be effective and falsely claiming that safety tests are not being conducted during vaccine development. (The New York Times tracks all potential coronavirus vaccines as they move through safety trials.) During the interview, Kennedy alleged without evidence that past SARs outbreaks have been traced to accidents in labs developing vaccines and pushed numerous other right-wing coronavirus conspiracy theories. 

CHD and Kennedy have echoed right-wing conspiracy theories in attacking Microsoft CEO Bill Gates’ involvement in vaccine development. Kennedy has pushed the conspiracy theory that Gates wants to help develop vaccines in order to track the world’s population and the conspiracy theory that the coronavirus outbreak is associated with the installation of 5G cell phone technology. Kennedy’s conspiracy theories about coronavirus vaccine development have been promoted by far-right conspiracy outlet Infowars. 

Children’s Health Defense on Facebook and other social media platforms

Children’s Health Defense has more than 125,000 followers on Facebook and is allowed to list itself as a “Medical & Health” organization. The page does not contain any general disclaimer about vaccine misinformation. CHD has previously run ads on Facebook, with the most recent ad run ending in November 2019. Kennedy also has a Facebook page, which is listed as a “Nonprofit Organization” and an “Environmental Conservation Organization,” with over 190,000 followers.

The CHD Facebook page routinely shares evidence-free information about coronavirus, such as the suggestion that the novel coronavirus emerged from a lab and the falsehood that wearing a facemask does not reduce the likelihood of coronavirus spread. CHD has shared attacks on coronavirus vaccine development on its page, as has Kennedy’s Facebook page.

CHD also maintains social media accounts that share similar information on Twitter (over 34,000 followers), YouTube (over 17,000 subscribers), and Instagram (more than 97,000 followers).

Informed Consent Action Network

ICAN is an anti-vaccine organization whose main focus is pushing the debunked claim that there is a link between vaccines and autism in children. ICAN was founded by Del Bigtree, who is the host of an anti-vaccine and conspiracy theory online show called The HighWire. Bigtree infamously interfered with efforts to control the 2019 measles outbreak and created the anti-vaccine film Vaxxed with the help of disgraced doctor Andrew Wakefield, who fabricated research linking vaccines to autism. A 2019 profile of Bigtree and his anti-vaccine efforts argued that he “may be the most connected node in the anti-vaccine activist network” and that “as the energetic and charismatic host of The HighWire on YouTube, Bigtree offers Alex Jones-ian revelations as he tracks the vaccine conspiracy back to its source.”

Informed Consent Action Network on Facebook and other social media platforms

ICAN’s and Bigtree’s presence on Facebook is split among a number of pages. ICAN maintains a Facebook page with more than 33,000 followers that is listed as a “charity” and “nonprofit” organization. Recent posts on the page focus on advancing the false claim of a link between vaccines and autism and have been affixed with a fact check containing research indicating there’s no link. The Facebook page for Bigtree’s show, The HighWire, is more tethered to current events and has been pushing numerous claims that deny the severity of the coronavirus outbreak, advancing the claim that getting a flu shot makes you more susceptible to have a severe COVID-19 case, as well as attacks on coronavirus vaccine development. According to The HighWire, even the “biggest vaccine advocates in the country” are “sounding the alarm” on coronavirus vaccine development. The page has more than 309,000 followers and is listed as a “TV Show” and “Media/News Company.”

Bigtree also maintains a personal Facebook page with more than 87,000 followers that is currently inactive. Beyond Facebook, The HighWire maintains a YouTube account with 195,000 subscribers that shares the same content that is posted to Facebook, and an Instagram account with more than 145,000 followers. 

NVIC, CHD, and ICAN, are of course just the most prominent and well-funded anti-vaccination groups using social media platforms to attack coronavirus vaccine development. According to a May analysis of hundreds of pro- and anti-vaccine pages that are “alarming public health professionals,” the anti-vaxxers “are winning” in “a battle for hearts and minds.” Overall, anti-vaxxers reportedly have a following of more than 58 million people on Facebook.