Vaccine Rollout and Mis/Disinformation: Expectations and Action Plan for Health Communicators
Authors: Jennifer John, Kolina Koltai, Alex Zaheer, Carly Miller, Katie Jonsson, Isabella Garcia-Camargo, Matthew Masterson, Renee DiResta, Chase Small
Trends and Narratives About the COVID-19 Vaccine
As the U.S. vaccination campaign progresses, established pseudoscience and anti-vaccination communities will continue to create, spread, and iterate on narratives intended to dissuade the public from getting a COVID-19 vaccine. These actors have loyal audiences receptive to falsehoods about a myriad of topics and use sophisticated strategies to target audiences with vaccine disinformation.
The spread of online COVID-19 anti-vaccine misinformation has already impacted the vaccine rollout offline. For example, protestors that organized via a Facebook page that posts anti-vaccine misinformation managed to shut down a vaccination distribution center at Dodgers Stadium in Los Angeles, California. The small group’s disruption received widespread coverage and was just one of many anti-COVID-19 vaccine protests. This unrest is rooted in anti-vaccine sentiment, but also broader political reaction against COVID-19 public health measures. In November 2020, First Draft News found that COVID-19 vaccine related social media conversations center on two key topics: the political and economic motives of individuals and institutions involved in vaccine development, and vaccine safety, efficacy, and necessity.
As the rollout of COVID-19 vaccines continues, minimizing vaccine hesitancy in the general public will be critical to bring an end to the coronavirus pandemic. Following the three C’s model about vaccine hesitancy (Fig 1.), all three factors —complacency, confidence, and convenience—play a role in promoting vaccine uptake. Currently, issues of convenience (availability & access to the vaccine) are being addressed through the rollout, but as the supply of vaccines exceeds the demand, issues of confidence (trust in the vaccine) and complacency (the necessity or the value of the vaccine) will be our biggest hurdles.
This blog post first defines the categories of COVID-19 vaccine misinformation that the Virality Project expects to see. We then offer strategies for public health communicators to “pre-bunk” these narratives, preemptively informing the public about misinformation they will likely encounter. Finally outlines some specific narratives expected in each upcoming phase of vaccine rollout.
Evolving COVID-Specific Anti-Vaccination Narratives
Safety
Claims that COVID-19 vaccines cause widespread harm to recipients.
False and misleading information about the safety of COVID-19 vaccines will target newly eligible communities as vaccine availability grows. Anti-vaccine groups often distort mainstream news coverage and official statistics about adverse events like unexplained deaths and side effects caused from receiving the vaccine, omitting important context and reframing isolated incidents as evidence of widespread harm. Unverifiable personal stories of adverse reactions will proliferate; these stories have been leveraged for years in childhood vaccine misinformation, and have strong emotional appeal. These stories can have an additional impact if they involve a prominent figure, such as the case of Hank Aaron, a hall of fame baseball player, who passed away 2 weeks after receiving his first dose. Aaron’s death was the result of natural causes but some in the anti-vaccine community seized on this story to portray his death as part of a wave of suspicious deaths of people that were recently vaccinated.
Efficacy and Necessity
Claims about the efficacy of the vaccine, or whether it is necessary to receive the vaccine.
Anti-vaccine activists and vaccine-hesitant influencers seize on uncertainty about the COVID-19 vaccines’ effect on transmission by distorting pharmaceutical company statements to argue that the vaccine is ineffective. They leverage misleading reports of vaccinated individuals contracting COVID-19 anyway, attempting to increase skepticism about the vaccine’s efficacy. Additionally, they point to medical authorities’ prior predictions, including some that turned out to be incorrect, to argue that vaccination will fail to end the pandemic and that medical experts should not be treated as authorities.
Vaccine Development and Distribution
Claims about vaccine production, distribution, or mandates.
Anti-vaccine groups have long criticized the vaccine development and testing process even for well-established childhood immunizations, and have begun applying similar arguments to the new COVID-19 vaccines. Some have criticized the exclusion of pregnant women from vaccine trials, arguing that it compromises the safety of pregnant women now being vaccinated; others balk at the news that pharmaceutical companies are enrolling children in their trials. Misinformation and longstanding sensationalized claims regarding vaccine ingredients also persist, from religious fears about aborted fetal DNA (cell cultures) to concerns around newer mRNA technology. Exaggerated and false claims of public officials purportedly considering vaccine mandates have sparked fear and outrage. These narratives further spread through the fear of “vaccine passports”, which some European countries are considering to allow those who are vaccinated to travel for business or other purposes, and systems purportedly designed to surveil and restrict movement depending on vaccine status. Anti-vaccine groups have leveraged these concerns to exacerbate distrust in political and public health officials, aligning with libertarian political groups to advance arguments core to the growing “medical freedom” movement.
Conspiracy
Claims asserting that individuals or government institutions have malicious intent or ulterior motives behind creating or administering the vaccine.
Conspiracy community influencers, such as those primarily focused on QAnon, chemtrails, and claims that COVID-19 is a hoax, have engineered outlandish theories about COVID-19 vaccines’ creation and distribution. The theory that the vaccine contains microchips intended to mass surveil Americans persists despite debunking efforts. Other theories contend that mRNA vaccines will permanently alter DNA. Some influencers focus more on leading researchers, pharmaceutical company developers, or funders of vaccination programs, and allege that the virus and the vaccine constitute a money-making ploy. These leaders and their group members claim that Bill Gates, Dr. Anthony Fauci, and the NIAID are corrupt. Increasing vaccine availability leads more people to seek information online, and conspiratorial narratives returned in response to data voids (keywords for which there is nothing else to return) may confuse or misinform mainstream audiences. Supporters of these conspiracy theories have additionally taken drastic actions, like deliberately destroying vaccines or 5G towers.
Fig. 2. Vaccine Hesitancy Narratives. Graphics by Kolina Koltai.
Pre-bunk Strategies for Public Health Communicators
Public health communicators play a critical role in reducing vaccine misinformation by disseminating authoritative, fact-filled messaging about vaccination. According to recent misinformation research on “inoculation theory,” pre-bunking misleading narratives before they reach a large audience potentially offers an important tool for public health communicators. Building on past interventions into misinformation and emergent COVID-19 vaccine narratives so far, the Virality Project suggests the following pre-bunking efforts.
Pre-bunking Considerations
Focus on themes, not incidents. Individual incidents that gain widespread attention are able to do so because of the appeal of the larger narratives they support, not the particular details involved. Debunking efforts that focus on specific incidents, such as one type of rare side effect, will not prevent misinformation from other incidents within that theme from spreading. Additionally, increased attention to a particular incident could inadvertently amplify it. For example, a New York Times article that explained new findings about a rare blood disorder associated with the vaccine sparked fears in anti-vaccine groups. In contrast, pre-bunking efforts have the potential to proactively reduce the impact of misinformation by addressing larger themes, for example by explaining why side effects in general occur.
Be upfront about uncertainties. If the scientific evidence required to address a potential concern remains inconclusive, it is best to state that uncertainties remain and to explain why a definitive answer isn’t yet possible. Public trust is undermined when official results contradict strong initial statements that were based on incomplete information — the prior claim remains online and will be leveraged to claim that health authorities and the media are incompetent. For example, after public health officials recommended that pregnant women receive the vaccine without explaining why the science supported it, anti-vaccine influencers attacked them for allegedly putting pregnant women at risk given the lack of relevant data. Pre-bunking campaigns explaining that the best science shows the risks of COVID-19 infection outweigh the risks of the vaccine could have mitigated these narratives.
Data and statistics are not effective. A common tactic in anti-vaccine narratives involves undermining the credibility and conclusions of official data on vaccine safety and efficacy, a challenge that pre-bunking efforts based on statistics will likely face. Additionally, anti-vaccine narratives frequently rely on other sources of official data taken out of context, particularly vaccine injury databases such as the Vaccine Adverse Event Reporting System (VAERS) and the Vaccine Injury Compensation Program (VICP). These communities are unlikely to trust contradicting data. Instead, poor statistical literacy can be addressed by providing background information to the public on vaccine injury databases to contextualize the data.
Adapt to the contexts of communities. The beliefs and personal experiences underlying anti-vaccine misinformation, and the mechanisms through which it spreads, vary across communities of different backgrounds. In particular, vaccine hesitancy in Black communities is often rooted in historical medical exploitation and negative experiences with the healthcare system. Pre-bunking must account for the range of misinformation and that different communication strategies best reach certain groups. To that end, community members should be directly involved in analyzing misinformation narratives, developing pre-bunking content tailored to the intended community, and then disseminating the content.
Public Messaging Campaigns
More generally, public messaging campaigns that focus on a variety of aspects of vaccine development and distribution can increase confidence in the vaccine. The following are suggested components for effective campaigns.
Explain how the vaccine works. Misinformation about the effects of the vaccine has reached the spread that it has in part because of an underlying lack of knowledge and information about the science behind it. Educational campaigns should break down in basic terms how the mRNA vaccines were tested, how they generate an immune response, and why they are safe.
Detail what to expect from vaccination. Educational campaigns can explain the entire vaccination process, including vaccine allocation, the reason for and response to side effects, and the safety precautions to continue after immunity develops. The WHO has developed such a video that has received widespread attention online and can be a model for this strategy.
Streamline communication about vaccine updates. Provide centralized mechanisms through public service announcements and community partners to regularly issue updates on vaccine distribution, recommendations for certain groups, and scientific findings as soon as they are available. This communication channel should empower members of the public to find real facts from authoritative sources and approach misleading information from other sources with greater context.
Showcase the stories of community members. Directly involve community members in public messaging campaigns in which they share first-person stories about their reasons for receiving the vaccine, any hesitations they had and how they overcame them, and their vaccination experience. Community health workers can facilitate discussions about these stories to address individual vaccine concerns.
Challenges for Broader Vaccine Rollout
As additional communities become eligible for the vaccine, misinformation narratives may shift to target different audiences. Below, we have outlined four population groups drawn from CDC’s suggested vaccine rollout plan that are now or about to become eligible in most states, alongside examples of how these narratives may target them.
Public health communicators should pre-empt narrative evolutions by developing “inoculation” or “pre-bunking” messaging for each eligible population, prior to each rollout phase.
