key: cord-0807062-le81doz5
authors: Kalichman, Seth C; Eaton, Lisa A; Earnshaw, Valerie A; Brousseau, Natalie
title: Faster than warp speed: early attention to COVD-19 by anti-vaccine groups on Facebook
date: 2021-04-09
journal: J Public Health (Oxf)
DOI: 10.1093/pubmed/fdab093
sha: da5eec2a7a55fdf50ad1ad96de764de64fb9b60d
doc_id: 807062
cord_uid: le81doz5

BACKGROUND: The unprecedented rapid development of COVID-19 vaccines has faced SARS-CoV- (COVID-19) vaccine hesitancy, which is partially fueled by the misinformation and conspiracy theories propagated by anti-vaccine groups on social media. Research is needed to better understand the early COVID-19 anti-vaccine activities on social media. METHODS: This study chronicles the social media posts concerning COVID-19 and COVID-19 vaccines by leading anti-vaccine groups (Dr Tenpenny on Vaccines, the National Vaccine Information Center [NVIC] the Vaccination Information Network [VINE]) and Vaccine Machine in the early months of the COVID-19 pandemic (February–May 2020). RESULTS: Analysis of 2060 Facebook posts showed that anti-vaccine groups were discussing COVID-19 in the first week of February 2020 and were specifically discussing COVID-19 vaccines by mid-February 2020. COVID-19 posts by NVIC were more widely disseminated and showed greater influence than non-COVID-19 posts. Early COVID-19 posts concerned mistrust of vaccine safety and conspiracy theories. CONCLUSION: Major anti-vaccine groups were sowing seeds of doubt on Facebook weeks before the US government launched its vaccine development program ‘Operation Warp Speed’. Early anti-vaccine misinformation campaigns outpaced public health messaging and hampered the rollout of COVID-19 vaccines.

The rapid amplification of the SARS-CoV-2 pandemic, the cause of COVID-19, has brought unprecedented and interconnected crises. At a pace never before seen, dubbed by the US Government 'Operation Warp Speed', initial vaccine candidates were proposed within weeks of sequencing the SARS-CoV-2 genome and the first human trials of vaccine candidates soon followed, 1 with multiple safe and efficacious vaccines approved for use within 1 year. [2] [3] [4] However, the acceptance of COVID-19 vaccines has faced challenges, including public perceptions. 5, 6 One key factor threatening vaccination programs is a lack of public trust of vaccines, in general, and COVID-19 vaccines, in particular. A study of over 13 000 people in 19 countries showed that more than one in four (28%) were less than somewhat likely to accept a COVID-19 vaccine. 7 Research suggests the situation in the USA may be worse. Studies conducted near the time the first COVID-19 vaccines were approved showed that between 50 and 70% of Americans would not accept taking a COVID-19 vaccine, [8] [9] [10] including 23% of medical students being unwilling to be vaccinated immediately upon FDA approval, 11 with people of color expressing less intention to be vaccinated than their white counterparts. 12 Concern about the safety of vaccines, or vaccine hesitancy, is fueled by mistrust of pharmaceutical companies, misinformation and conspiracy theories. Decades of research shows that vaccine hesitancy has led to setbacks in polio eradication as well as outbreaks of previously controlled diseases such as The Vaccine Machine refers to the vested interests in medicine, industry and government dedicated to vaccinating our children by any means necessary. We stand in opposition to that machine. We examine the issue of vaccines, vaccination and immunization to uncover establishment lies and misinformation. Our goal is to end compulsory vaccination and immunization.

a Collected 1 December 2020.

measles and pertussis (whooping cough). 13 Vaccine hesitancy has also impeded the uptake of H1N1 and HPV vaccines and increased the avoidance of childhood immunizations. 14-16 A main source of vaccine misinformation and conspiracy theories are groups that explicitly oppose vaccinations, i.e. antivaccine groups. 17 Among the most accessible and influential channels of anti-vaccine messaging is social media, particularly Facebook. [18] [19] [20] Research examining public postings on anti-vaccine group Facebook pages has found that a majority of comments express caution against trusting vaccines, doubts regarding vaccine safety and a need for 'natural alternatives' to vaccination and conspiracy theories implicating the government, public health advocates and pharmaceutical companies in unethical practices. 18 The propagation of antivaccine sentiment across social media platforms is well established, and anti-vaccine groups are undermining the rollout of COVID-19 vaccines. [21] [22] [23] [24] [25] The purpose of this study was to examine early anti-vaccine group activity on Facebook in initial response to COVID-19. To chronicle early COVID-19 anti-vaccine activity, we tracked posts on Facebook in the first months of the COVID-19 pandemic. Our aim was to establish an early timeline of antivaccine Facebook activity, describe what leading anti-vaccine groups were posting and examine their dissemination and influence.

The methodology of the current study was grounded in previous research that monitored anti-vaccine communications online. 5, 26 In earlier research, we had identified the most active anti-vaccine groups on social media. In March 2020, we re-examined the current status of the previously identified anti-vaccine groups on Facebook and found that the most active and influential groups had not changed since 2013; Dr Tenpenny on Vaccines, the National Vaccine Information Center (NVIC) and the Vaccination Information Network (VINE) were then and remain still active and influential. In addition, a new popular group was identified, the Vaccine Machine. These four groups include explicit anti-vaccination mission statements (see Table 1 ) and typically post misinformation multiple times a week aimed to undermine trust in vaccines, offer alternatives typically promoted as 'natural immunity' and propagate conspiracy theories. 27

We collected all posts to the Facebook pages of the four anti-vaccine groups sampled at staggered time periods in the first months of the COVID-19 outbreak, specifically 1 February 2020 through 31 May 2020. We collected all Facebook posts retrospectively, from March back through February, and prospectively, through May 2020 representing a 4-month period for Dr Tenpenny on Vaccines (Tenpenny), a 3-month period (February-April) for the NVIC, and 2 months (April and May) for the Vaccine Information Network (VINE) and the Vaccine Machine. All posts were collected prior to Facebook taking actions in December 2020 to limit the activity of anti-COVID-19 vaccine messaging. 28 Posts were collected by copying and pasting verbatim entries into a text-searchable database. Reposts from other sources were treated the same as original posts. We calculated four numeric values characterizing the extent of dissemination (i.e. number of posts and times shared) and influence (i.e. number of positive reactions [i.e. 'Likes'] and number of comments).

To identify posts concerning COVID-19, we searched the text database for three key terms: 'Coronavirus', 'SARS' and 'COVID'. The use of any one term indicated posts concerning the COVID-19 pandemic. We calculated descriptive statistics for each of the dissemination and influence indicators aggregated at the month level. During the month of April, for which data were available for all four anti-vaccine groups, we conducted contingency table chi-square tests to compare the number of non-COVID-19 and COVID-19 posts. We also performed 2 (type of post: non-COVID-19 versus COVID-19) × 4 (source of post: Tenpenny, NVIC, VINE and Vaccine Machine) factorial analyses of variance with main effects and the interaction terms for the number of posts, number of shares, comments and reactions.

Analyses were further performed for two major antivaccine groups, Tenpenny and NVIC, for February, March and April. We examined each indicator of dissemination and influence across all months (i.e. overall) as well as within the months of February, March and April. Contingency table chisquare (χ 2 ) compared the number of non-COVID-19 and COVID-19 posts. In addition, we compared non-COVID-19 and COVID-19 Facebook posts from Tenpenny and NVIC on the dissemination and influence indicators. For these analyses, we used 2 (non-COVID-19 versus COVID-19) × 2 (Tenpenny versus NVIC) factorial analyses of variance. All statistical tests defined significance as P < 0.05.

We extracted a total of 2060 Facebook posts from four anti- Tenpenny and the NVIC were both posting reports concerning COVID-19 in the first days of the pandemic. Figure 1 shows a timeline of COVID-19 posts collected from the antivaccine groups in the context of milestones toward developing COVID-19 vaccines. A total of 49 COVID-19 posts from Tenpenny and the NVIC appeared in early February, most of which included the term coronavirus (n = 45), with early references also made to SARS (n = 7) and COVID (n = 11). COVID-19 posts for these two anti-vaccine groups increased each month, with 176 in March and 211 in April. In February, the month which saw the International Committee for the Classification of Viruses name SARS-CoV-2, 20% of Tenpenny's Facebook posts were already referencing COVID-19 as were 17% of NVIC posts. By March, the month that launched the first Phase-I safety trials for a COVID-19 vaccine, the proportion of COVID-19 posts increased to 61% for Tenpenny and 51% for the NVIC. In April, 78% of posts from NVIC were discussing COVID-19, as were 46% from Tenpenny, 57% from VINE and 44% from Vaccine Machine. Table 2 includes examples of posts from the anti-vaccine groups over the early months of COVID-19. Posts often framed the large financial investments necessary for COVID-19 vaccine development as part of a conspiracy for profit. Along with government and pharmaceutical companies, posts included frequent targets of anti-vaccine groups, including Dr Anthony Fauci of the National Institutes of Health (NIH), Bill Gates of the Bill and Melinda Gates Foundation and Dr Paul Offit of the Vaccine Education Center at the Children's Hospital of Philadelphia. Efforts to sow doubt and create distrust in vaccine safety also appeared early on, including discussions of shielding pharmaceutical companies developing vaccines from product liability and misrepresenting the long-term biologic actions of the vaccines themselves, such as falsely speculating about genetic alterations caused by messenger RNA (mRNA).

Results showed that the anti-vaccine groups were specifically discussing COVID-19 vaccines as early as February, prior to the US government launching its COVID-19 vaccine program, Operation Warp Speed, and months before the first COVID-19 vaccine trials. Initial posts that specifically concerned COVID-19 vaccines were found in the first 2 weeks of February: eight from NVIC and two from Tenpenny. In total, there were 25 COVID-19 posts concerning vaccines in February, 72 in March and 83 in April. Data from all four anti-vaccine groups in April indicated 153 of their 442 (34%) COVID-19 posts specifically concerned COVID-19 vaccines. Table 3 shows the number of shares, positive reactions and comments for the Facebook non-COVID-19 and COVID-19 posts from the four anti-vaccine groups in April. Among the 736 Facebook posts, 442 (60%) discussed COVID-19, which had been shared a total of 16 000 times, reacted to 33 645 times and had received 2602 comments. Analyses indicated that there were significant differences for non-COVID- 19 

Among the 928 Facebook posts examined for February, March and April from Tenpenny and the NVIC, there were no differences in their number of COVID-19 posts between February and April, χ 2 = 1.4, P = 0.23. At the month level, there were no differences in February, X 2 = 0.3, P = 0.55, or March, X 2 = 3.1, P = 0.07. However, in April, 78% of posts from NVIC concerned COVID-19 relative to 48% from Tenpenny, a significant difference, X 2 = 36.1, P < 0.001. Table 4 shows the dissemination and influence indicators for non-COVID and COVID-19 posts from Tenpenny and NVIC.

Across months, COVID-19 posts were shared significantly more than non-COVID posts. In addition, posts from Tenpenny were shared significantly more often than posts from NVIC. The interactions for type and source of post were not significant. In February, the main effects of type of posts and source of posts were both significant, and in February, the interaction was also significant; The first big mistake in the coronavirus pandemic emerged when the Chinese Communist Party (CCP) tried, but failed, to contain the outbreak in a cloak of silence. The second (and worst) mistake fell at the feet of the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), and other institutions that have long promoted the empty marketing point of "global health security". We are quickly learning there is no such thing. In the latter miscalculation, we now know their will not be enough time develop a vaccine in time to slow down, let alone contain, the novel 2019-nCoV virus. Leading vaccine experts, from Novartis' CEO Vas Narasimhan to Jeremy Farrar, the director of the Wellcome Trust, a UK-based health foundation with more than $34 billion in assets to support research, have stated as much in recent interviews with CNBC News and Der Spiegel International, respectively. How big pharma will profit from the coronavirus As the new coronavirus spreads illness, death and catastrophe around the world, virtually no economic sector has been spared from harm. Yet amid the mayhem from the global pandemic, one industry is not only surviving, it is profiting handsomely. 'Pharmaceutical companies view Covid-19 as a once-in-a-lifetime business opportunity', said Gerald Posner, author of 'Pharma: Greed, Lies, and the Poisoning of America'. The world needs pharmaceutical products, of course. For the new coronavirus outbreak, in particular, we need treatments and vaccines and, in the USA, tests. Dozens of companies are now vying to make them. 'They're all in that race', said Posner, who described the potential payoffs for winning the race as huge. The global crisis 'will potentially be a blockbuster for the industry in terms of sales and profits', he said, adding that 'the worse the pandemic gets, the higher their eventual profit'.

The national plan to vaccinate every American-national registry to record everyone's vaccination status Scientists at the NIH are working with a biotech company to quickly start clinical trials of an experimental mRNA vaccine and fast track it to licensure. The FDA has not yet licensed mRNA vaccines that use part of the RNA of a virus to manipulate the body's immune system into stimulating a potent immune response. 2,3 It looks like the coronavirus vaccine will be the first genetically engineered mRNA vaccine to be fast tracked to licensure, just like Gardasil was the first genetically engineered virus-like particle vaccine to be fast tracked to licensure. 4,5 There likely will be lots of questions about whether the fast-tracked coronavirus vaccine was studied long enough to adequately demonstrate safety, especially for people who have trouble resolving strong inflammatory responses in their bodies and may be at greater risk for vaccine reactions. 6-10 However, there is no question about what will happen if the CDC Advisory Committee on Immunization Practices (ACIP) 11,12 recommends that all Americans get the newly licensed coronavirus vaccine. The government has a national vaccine plan. It is a plan designed to make sure you, your child and everyone in America gets every dose of every vaccine that government officials recommend now and in the future.

(Continued) predicts that by 2030 (there is that date again) technological advances will allow tiny nano-bots to be injected into the bloodstream, pass through the blood-brain barrier and integrate into the brain. The human brains can then be connected to 'the cloud', achieving a level of brilliance never thought possible. So, essentially, biological beings will become 'non-biological entities'.

Tenpenny Safety/trust Yes any vaccine developed for covid19 will be liability free

The PREP Act provides complete immunity from liability for any loss relating to or resulting from, any product used to prevent or treat illness during a public health emergency. The immunity applies to entities and individuals involved in the development, manufacture, testing, distribution, administration and use of medical countermeasures described in a declaration. The only statutory exception to this immunity is for actions or failures to act that constitute 'willful misconduct'. And as we will see, even willful misconduct may not be punished. For a full explanation of the scope of the act, see below https://www.phe.gov/Preparedness/&#x2026;/prepact/Pages/pre pqa.aspx 'The Public Readiness and Emergency Preparedness Act (PREP Act) added new legal authorities to the Public Health Service (PHS) Act to provide liability immunity related to the manufacture, testing, development, distribution, administration and use of medical countermeasures against chemical, biological, radiological and nuclear agents of terrorism, epidemics, and pandemics. It also added authority to establish a program to compensate eligible individuals who suffer injuries from administration or use of products covered by the PREP Act's immunity provisions. The following is intended to address frequently asked questions from the manufacturing industry, the healthcare community, and state and local government officials about the PREP Act. It is not an exhaustive review of the PREP Act's provisions in all contexts or a protocol for the HHS's implementation of the PREP Act. In addition, other legal protections may be available at the federal, state, and local government level'. COVID-19 posts from Tenpenny were shared significantly more often. In March and April, Tenpenny's posts were shared more than NVIC's, and the main effect of type of posts and the type of posts by source interactions were not significant.

With respect to influence indicators, the overall differences between types of posts were not significant (see Table 4 ). However, both the number of reactions and comments did differ between sources; Tenpenny demonstrated greater numbers of reactions and comments. The interactions were also significant; for Tenpenny, the overall number of reactions and comments for non-COVID-19 posts were greater than COVID-19 posts, whereas reactions and comments on NVIC's COVID-19 posts were greater than their non-COVID-19 posts. In February, only the effects of source were significant; Tenpenny's posts received more reactions and comments. In March, the interaction for number of reactions was significant; Tenpenny received more reactions for non-COVID-19 posts, whereas NVIC received more reactions for COVID-19 posts. For comments in March, only the sources differed: Tenpenny's posts received more comments. Finally, in April, Tenpenny received more reactions and comments than NVIC. However, the interactions were significant; Tenpenny received more reactions and comments for non-COVID-19 posts, whereas NVIC received a greater number of reactions and comments for COVID-19 posts.

Our analysis of Facebook posts by anti-vaccine groups showed that by April 2020, more than 60% of their posts concerned COVID-19 and 20% specifically discussed COVID-19 vaccines. Two leading anti-vaccine groups, Tenpenny and NVIC, were discussing COVID-19 in early February, with increased activity as the pandemic emerged. Placed in the context of the effort to develop and test vaccines, the anti-vaccine groups examined in this study were sowing doubt about COVID-19 vaccines long before any such vaccine existed. While anti-vaccine groups are typically viewed as fringe and dangerous, 19, 23 they are well disguised as legitimate sources of medical information. Perhaps most concerningly and ironically, the US federal government gave NVIC $150 000 and Tenpenny $72 000 COVID-19 relief funds through the Paycheck Protection Program administered by the Trump Administration. 29 Regardless of how or why the US government could knowingly or unknowingly financially support anti-vaccine groups, their doing so legitimizes, supports and effectively underwrites the promotion of vaccine hesitancy that impedes COVID-19 vaccinations.

Previous research reported that public perceptions and concerns about vaccine safety stem from the mistrust of pharmaceutical companies, widespread misinformation and conspiracy theories often propagated by anti-vaccine groups. 27 COVID-19 anti-vaccine Facebook activity follows the same fundamental messaging that characterizes typical anti-vaccine rhetoric. Smith and Reiss 23 examined COVID-19 misinformation propagated on a popular anti-vaccine broadcast 'The Highwire with Del Bigtree' and found six common themes: (i) that government and pharmaceutical industry communications about COVID-19 are lying to exaggerate the severity of the new virus; (ii) government is imposing restrictions that infringe on civil liberties; (iii) scientists are 'so-called experts', and anyone can be an expert; (iv) science is not the answer to disease, rather herd immunity is; (v) selectively choosing, or cherry-picking science to support preconceived notions and (vi) vaccines are instruments of government and industry to control, track and harm people. Examining the early COVID-19 Facebook activity of anti-vaccine groups shows that COVID-19 posts fit these themes, with posts in February 2020 raising concerns about trusting vaccine safety months before there were any COVID-19 vaccines. Anti-vaccine groups emphasized natural immunity, corruption and conspiracies just as they have for past vaccines. 19, 27 What this study adds

Our findings extend previous research that reported early anti-vaccine COVID-19 messaging on Twitter. 8 These results suggest that anti-vaccine messaging, which has been widely shown to impact vaccine interest and uptake, 13 started in the earliest days of the COVID-19 pandemic and ramped up quickly. Facebook and other social media platforms have the capacity to disseminate accurate information, create influential public health messages and facilitate the rollout of vaccines. [30] [31] [32] The Centers for Disease Control and Prevention (CDC) and state departments of health are using Facebook for public health messaging in social networks, albeit with varying levels of success. A study of over 2500 CDC and health department Facebook posts found 7% concerned vaccines and immunization, and most states with lower childhood and influenza vaccination coverage are not utilizing Facebook to promote immunization. 33 A lack of accessible and accurate information fosters skepticism and reduces trust in vaccines, 34 and social media can be a tool to remedy information deficits.

We limited our study to four anti-vaccine groups and their activity on only one social media platform. While similar messaging and forms of persuasion have been found across various anti-science and denialism, 35 we cannot know if the Facebook activity for the groups included in this study mirrors the activity of other groups on other platforms. Also, because we collected the dissemination and influence indicators at a single point in time within a month of the postings, our data do not reflect the full extent of potential impact that anti-vaccine groups may have over followers and throughout followers' social networks. We also do not know whether the communications that occurred early in the pandemic had any impact on the subsequent vaccine acceptance or hesitancy. Future research is needed to replicate and clarify the study findings.

COVID-19 vaccine: a recent update in pipeline vaccines, their design and development strategies

Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine

Oxford-Astra Zeneca COVID-19 vaccine efficacy

The Johnson & Johnson Vaccine for COVID-19

Perceptions of public on the COVID-19 outbreak in Singapore: a qualitative content analysis

Covid-19: US cases surge but vaccine distribution is slow

A global survey of potential acceptance of a COVID-19 vaccine

Officials gird for a war on vaccine misinformation

Determinants of COVID-19 vaccine acceptance in the US

COVID-19 vaccination hesitancy in the United States: a rapid national assessment

COVID-19 vaccine hesitancy among medical students

Predictors of the intention to receive a SARS-CoV-2 vaccine

Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: a systematic review of published literature

Vaccine hesitancy: causes, consequences, and a call to action

Vaccine-preventable outbreaks: still with us after all these years

Racial disparities in exposure, susceptibility, and access to health care in the US H1N1 influenza pandemic

Vaccine hesitancy and anti-vaccination movements

It's not all about autism: the emerging landscape of anti-vaccination sentiment on Facebook

A comparison of language use in pro-and anti-vaccination comments in response to a high profile Facebook post

Pro-Vaxxers get out: antivaccination advocates influence undecided first-time, pregnant, and new mothers on Facebook

Even covid-19 can't kill the anti-vaccination movement

The online anti-vaccine movement in the age of COVID-19

Digging the rabbit hole, COVID-19 edition: antivaccine themes and the discourse around COVID-19

Acceptance of a COVID-19 vaccine and its related determinants among the general adult population in Kuwait

COVID-19 and vaccine hesitancy: a challenge the United States must overcome

Measles, social media and surveillance in Baltimore

Vaccine hesitancy, vaccine refusal and the anti-vaccine movement: influence, impact and implications

Facebook plans to remove false posts about COVID-19 vaccines

The trump administration bailed out prominent anti-vaccine groups during pandemic

The COVID-19 infodemic: a quantitative analysis through Facebook

Use of Facebook by academic medical centers in Taiwan during the COVID-19 pandemic: observational study

Closed Facebook groups and COVID-19: an evaluation of utilization prior to and during the pandemic

The use of social media by state health departments in the US: analyzing health communication through Facebook

The views of ethnic minority and vulnerable communities towards participation in COVID-19 vaccine trials

HIV denial in the Internet era

Supported by research infrastructure funding from the Office of the Vice President of Research University of Connecticut. This research received no other specific grant from any funding agency in the public, commercial or not-for-profit sectors.

No conflict of interest has been declared by the author(s).