Rapid Response: Expanding COVID-19 Vaccines to Children
Authors & Contributors: Carly Miller, Renee DiResta, Chase Small, Ashwin Ramaswami, Jennifer John, Matthew Masterson, Pierce Lowary, Emma Dolan, (Stanford Internet Observatory); Kris Fortmann (University of Washington Center for an Informed Public); Erin McAweeney (Graphika)
Introduction — Pfizer is expanding vaccine access to children
On Monday May 10, the Food and Drug Administration (FDA) granted emergency use authorization of the Pfizer COVID-19 vaccine to children 12-to-15 years old. Despite clinical trials announced by the company - which suggested that the vaccine is 100 percent effective at preventing illness among children in this age group - we anticipate a significant amount of upcoming activity from anti-vaccine activists, who will leverage the expanded age range to extend their own false and misleading narrative campaigns about the vaccine. Many of the activists are longtime opponents of school vaccine requirements, and have experience operating within parenting communities to draw adherents. As more vaccines become available to children and manufacturers seek full FDA approval (which may make it easier for schools, hospitals, and other entities to require vaccination) the need to address misinformation narratives around children receiving COVID-19 vaccines will only become more pertinent.
While the vaccine in question is novel, most of the tropes used by anti-vaccine accounts are not. This blog post examines the claims emerging around the COVID-19 vaccine, and their similarity to those previously used in opposing routine childhood immunizations: some focus on false and misleading claims related to the shot itself, while others center around ideas of liberty. Healthcare professionals and communicators have the opportunity to address these refurbished narratives now, as they are emerging alongside approval for this new cohort, and to combat this potential subset of vaccine hesitancy as it emerges. We offer some recommendations on how to best engage in this pre-bunking.
Analysis of the narrative: Old tricks applied to a new vaccine
The anti-vaccine movement emerged alongside vaccines; for as long as there have been immunizations, there has been opposition. The modern movement has focused primarily on childhood vaccinations by falsely alleging that vaccines are dangerous, untested, or promoted for profit.
Longstanding anti-vaccine narratives specific to children have consistently focused on safety concerns, despite scientific studies from around the world repeatedly demonstrating that childhood immunizations are both safe and effective. The anti-vaccine narratives falsely claim that vaccine ingredients include harmful contents such as aluminum and mercury, or that the vaccine will overwhelm the immune systems of children and cause chronic health conditions, including autism. Statistics derived from the US Department of Health and Human Services’s Vaccine Adverse Event Reporting System (VAERS) and settlement amounts from the “vaccine court” (VICP) are also frequently incorporated into these claims, often misleadingly, to promote the false narrative that childhood vaccines are unsafe. Other narratives relating to the efficacy of vaccines claim that natural immunity is more protective than immunity through vaccination. And, of course, there are personal liberty objections: opposition to legislation related to school vaccine requirements has erupted into protests outside of state legislatures in numerous states.
In the early 2010s, social media platforms that offered an opportunity to share first-person narratives - with no fact-checking - became a primary focus of anti-vaccine leaders looking to grow their audiences. These influencers found an eager and susceptible audience in parents seeking facts to inform medical decisions for their children. For example, Robert F. Kennedy, Jr., who founded and frequently speaks on behalf of the anti-vaccine organization Children’s Health Defense, has been recognized by the Center for Countering Digital Hate as among the top twelve spreaders of anti-vaccine misinformation. The National Vaccine Information Center, which was considered a COVID-19 misinformation “super-spreader” before Facebook removed the organization from their platform, has long coordinated inter and intra-state efforts to oppose vaccination requirements for schools. The media operation linked to disgraced doctor Andrew Wakefield — the individual who falsely claimed that vaccines cause autism — is another longstanding presence. His film, Vaxxed, alleged a vast plot by the CDC to cover up purported harms caused by the MMR (measles, mumps, rubella) vaccine, ostensibly perpetuated against Black boys — a conspiracy theory that was picked up and amplified by Nation of Islam leaders. Although the platforms began to take action to limit the reach of these organizations following a resurgence of measles epidemics, the communities they have established around opposing childhood immunizations have been very active on the topic COVID-19.
Researchers at the Virality Project have observed anti-vaccine communities spreading misinformation about COVID-19 vaccines for children since the pandemic began. Now, as the age range approved for the Pfizer vaccine expands, the narratives specific to children will likely increase in prevalence. To date, we have observed narratives that fall into the following general categories:
False Narrative: Administering vaccines in clinical trials to children is unethical human experimentation. Discussion of adverse effects of the vaccine on children began prior to the announcement of trials for children. Much of the negative social media activity within this theme expresses horror and disgust around vaccination trials, claiming that they constitute “human experimentation” on children, especially infants. Such posts state that children should not be subjected to an experimental vaccine for which they are too young to meaningfully consent and for which long-term effects (i.e., the false claim that one could become sterile) are unknown.
Unfounded Narrative: Children who are in the vaccine trial are experiencing harmful side effects. In addition to assertions that children should not be included in the vaccine trials, there have been unfounded stories about children in COVID-19 vaccine trials experiencing side effects. For example, one high-engagement YouTube video claimed that a 12-year-old girl in the Moderna trial was hospitalized after receiving her second shot. Although the timeline in the video was inconsistent with Moderna’s children vaccine trial dates, the unverified video spread across social media platforms. Other similar stories have been debunked, such as a false story about a 2 year old who purportedly died after a Pfizer shot which originated from a false report in VAERS. However, these claims often offer few details, at times making them difficult to verify or fact-check.
Unfounded Narrative: The risk of COVID-19 in children is small enough to make a vaccine unnecessary and harmful. Posts in this category claim that because children tend to be less susceptible and have less severe reactions to COVID-19, the perceived risks of vaccination may outweigh its benefits. Some narratives hold that children contracting COVID-19 would gain longer-lasting natural immunity than that which is possible through vaccination, and that this natural immunity would contribute equally to herd immunity.
Recommendations for Health Officials
Government and health officials are paying close attention to vaccine hesitancy and are aware of the challenge of misinformation on social media. Given that past anti-vaccine activism has focused so strongly on children, and how resonant first-person claims of harm from childhood vaccines have proven to be over the years, being prepared to proactively counter false and misleading narratives around this new cohort eligible for COVID vaccines is key. Moreover, there is more at stake than confidence in the COVID-19 vaccine, as anti-vaccine activists see eroding confidence about COVID-19 vaccines as a way to erode confidence in vaccination programs for children overall.
Against this backdrop, government and health officials have the opportunity to get out in front of the narratives that we already know are, and have been, headed our way. Here are some concrete steps to help mitigate the harms from these online narratives:
Learn about how to effectively pre-bunk misleading narratives. In a previous blog post, we detailed 4 key considerations that should be factored in for an effective pre-bunk for misleading narratives: 1) focus on themes, not incidents; 2) be upfront about uncertainties; 3) data and statistics are not effective; and 4) adapt to the contests of communities. Read more about the strategy in our blog post here.
Set up a Rumor Control page. Local and state governments can set up Rumor Control websites that offer a centralized place where people can seek out trusted information and fact checking against common rumors or misleading narratives they’ve previously come across. Details on how to set up a Rumor Control page can be found on our blog post here.
Showcase positive experience stories from community members. As children begin to receive the vaccine, telling the stories of the kids and families benefiting from the vaccine provides a powerful counter-narrative that emphasizes the positives. For example, sharing one’s own family’s vaccination experience helps bring a personal narrative to members of the community.
Detail what parents should expect when their children receive vaccines. Parents will be very proactive about seeking information about the vaccine and its potential impact on their children. It’s important that they find reputable and honest information in those searches, particularly about potential side effects. Establishing regular channels to update parents in your community will help ensure that there is good information out there. As an example, Johns Hopkins has created a “What Parents Need to Know” page for parents to use to answer many of their primary questions.