On the 15 February 2021 a BBC TV Panorama documentary, Vaccines: The Disinformation War, investigated the rise of anti-vaccine content on social media platforms (https://www.bbc.co.uk/programmes/m000scy8). Ask the Experts is but one of many anti-vaccine videos that are currently being circulated on social media and messaging sites amid the COVID-19 pandemic.
People in many countries have sought to discredit the COVID-19 vaccines as being unsafe by fuelling myths that they can, for example, alter DNA and cause infertility. What was most concerning about the Panorama documentary is that among the so-called experts adding fuel to the fire of the anti-vaccine movement is a nurse who has been suspended from the Nursing and Midwifery Council (NMC) register and at least one doctor under suspension from the General Medical Council (GMC).
Anti-vaccination books are also being sold on well-known book websites, leading politicians to urge these companies to put warning tags on these books to combat the spread of misinformation.
Background
Following the launch of mass vaccination programmes against COVID-19 in a number of counties, after timely development of safe, effective vaccines, the conundrum now is how to tackle anti-vaxxers and their spread of propaganda that is boosted by social media (Boyd, 2021). Anti-vaxxers and COVID deniers are currently engaged in spreading malicious misinformation about vaccines generally, but especially those manufactured to tackle SARS-CoV-2. This is potentially putting the health of many people in society at risk, but especially those from BAME communities.
The development of vaccines to prevent infectious disease is one of the most significant achievements in the history of medicine. Vaccines are now one of the most important tools in preventive medicine to protect whole populations from diseases that, in the past, killed millions. In particular, vaccines are responsible for reducing mortality and morbidity rates from common childhood diseases and in some cases totally eradicating them. Some 6 years before the measles vaccine became available, author Roald Dahl's daughter Olivia died from measles encephalitis in 1962, something that would not happen in the UK today.
Despite the obvious success of vaccines, it is important to stress that public fear of vaccines is as old as the history of vaccination itself. Before the groundbreaking work in the 18th century of English physician Edward Jenner, who is now widely regarded as the father of immunisation, deaths from diseases such as smallpox were commonplace and affected all levels of society. Before the introduction of smallpox vaccination the virus killed some 400 000 people in Europe, and one third of survivors lost their sight.
Infectious disease viruses and pathogens are impervious and indifferent to the rank and status of those they infect. Famous people who have died or have been left with severe disabilities from what are now preventable diseases include Elizabeth I who was left badly scarred after developing severe smallpox in 1562, Albert, Prince Consort of Queen Victoria who died in 1861 from typhoid fever, Victoria and Albert's daughter Princess Alice who died in 1878 from diphtheria, and FD Roosevelt who was left partially paralysed after contracting polio when he was aged 39, 12 years before becoming US President, and actress Vivien Leigh famous for her role as Scarlett O'Hara in the film Gone with The Wind, who died of tuberculosis in 1967.
More recently, COVID-19 was implicated in the deaths of actor BJ Hogg, best known for playing Sir Addam Mabrand in the TV drama series Game of Thrones, and comedians Bobby Ball, Eddie Large and Tim Brooke-Taylor.
False claims
Jenner was able to prove that immunisation through vaccination was a successful method of preventing smallpox but objections to vaccination have periodically surfaced. Over the coming years and centuries many more vaccines would be developed with the latest being those that mollify or prevent infection from COVID-19.
However, even before the first of the COVID-19 vaccines began rolling off the production line, misinformation about the vaccines was rife. Among those espousing false claims have been celebrities who can have a strong influence on how people behave, and many have used media platforms to air their, often contentious, personal views on health care, but especially on vaccines. When powerful people overtly or covertly promote the anti-vaccination movement the harm they can potentially do is incalculable, but this can especially bring harm to young children.
Famous anti-vaxxers include Robert F Kennedy Jr, who was recently banned from Instagram for spreading misinformation about the coronavirus and vaccination (Burke, 2021).
The role of social media is one of the primary reasons for the recent strengthening of the anti-vaccination movement and its impact on public health generally. Anti-vaxxers believe, without any evidence, that vaccines bring more harm than benefit to those who receive them. Such views have led to a reduction in vaccination posing a threat to the herd immunity offered by widespread global immunisation (Hussain et al, 2018).
In 1998, British doctor and academic Andrew Wakefield claimed the existence of a relationship between bowel disease, autism and the MMR vaccine. After publication of his paper in The Lancet on the subject, there was a sharp decline in vaccination uptake, leading to a number of measles outbreaks around the world. The ensuing media coverage fanned the flames of pubic fear, leading to a dangerous fall in MMR immunisation, which fell to an all-time low of 79% by 2004 (Milward, 2019). The paper was subsequently retracted by The Lancet, which went some way to alleviating the drop in vaccination rates, and Wakefield was later was struck off the medical register for academic fraud, including dishonesty and abuse of children (Deer, 2011).
However, despite his pariah status in the world of medicine, Wakefield is still a prominent anti-vaccine campaigner now living in the USA, where he has acquired the support of ex-President Donald Trump (Boseley, 2018), who in the past has spoken about the link between the measles, mumps and rubella (MMR) vaccine and autism (Buncombe, 2018). For example, in 2012, Trump supported Wakefield's claims that the triple MMR vaccine increases children's chances of developing autism (Sharftstein, 2017), becoming the first US President to be on the record as having anti-vaccination views.
Given ex-President Trump's enormous influence in the world, it is worthwhile examining the extent to which allegiance to Trump is associated with scepticism about vaccine safety and efficacy. In a study reported by Hornsey et al (2020), Trump voters were significantly more concerned about vaccines than other Americans. When the head of state of the world's largest Western democracy invited Wakefield to attend one of his presidential inaugural balls many raised concerns that Wakefield discredited ideas would appear to be endorsed by the incoming administration.
Of note, is that the then President Trump and Melania Trump had a COVID vaccination just days before leaving the White House (Canon, 2021), but did not disclose this publicly, unlike many politicians who have had their ‘jabs’ on air to promote the safety of the vaccines.
It is important to stress that research conducted since the publication of Wakefield's paper has overwhelmingly rejected any links between MMR vaccination and autism in children and should have laid the ghost of vaccine related diseases to rest, but it did not.
Fuelling fears
Despite the obvious success of vaccines in immunising people from diseases that can kill, fear of vaccine side-effects remain among some swathes of society. In 2019, the New York Times reported that booklets distributed in some Jewish communities in New York contradicted the scientific consensus that vaccines are safe and highly effective. They gave false warnings that vaccines caused autism and contained cells from aborted human foetuses (Pager, 2019). Similarly, this year Roman Catholic leaders in several US states have instructed members of their flocks to avoid the Johnson & Johnson's single-shot COVID-19 vaccine, claiming that cells from aborted foetuses were used in its development (Glenza and Pengelly, 2021).
In many parts of the world vaccines against a range of diseases appear to engender similar fears, ranging from the utterly false link between MMR and autism in parts of North America and Europe to claims that tetanus vaccines are a vehicle to mask the administration of birth control agents in Kenya and Nigeria. In Afghanistan and Pakistan, the Taliban has been strident in opposing the administration of the polio vaccine by spreading fears that vaccination is a method used by the West to sterilise Muslim children (Farmer, 2021). Today, unfounded claims that Western countries are using COVID-19 vaccines to sterilise Muslims persist (Farmer, 2021).
The spread of inaccurate and irresponsible information by the anti-vaccination movement inflicts more harm than good on Muslim communities (Ahmed et al, 2017), with a recent resurgence of polio in Pakistan and Afghanistan, with repercussions for vaccination against SARS-CoV-2 in these countries (Shah and McKay, 2021).
In the USA, Muslims are also fearful of vaccination because some religious leaders are spreading misinformation. For example, well-known anti-vaxxer Louis Farrakhan, leader of the Nation of Islam, has been vociferous in warning fellow Muslims both in the USA and in African countries to be wary of coronavirus vaccines, describing it as ‘a free shot of toxic waste’ and urging his followers not to have it (Fruen, 2020).
The UK is not exempt from anti-vaxxers either. Leicester is famous as a past hotbed of anti-vaccine sentiment, associated especially with public fear of smallpox vaccination in the 19th century after vaccination became compulsory for children aged under 14 years. The Leicester Anti-Vaccination League was formed in 1867 and the city became the site of many anti-vaccine demonstrations. The 1885 demonstration was one of the most infamous anti-vaccination protests of the 19th century, with up to 100 000 people demonstrating against Jenner's work and vaccination (College of Physicians of Philadelphia, 2018; Glasper, 2019; Watson, 2019).
Today, the city is once again making headlines as a place of anti-COVID vaccine sentiment, but this time among NHS medical personal. An analysis of the University Hospitals of Leicester NHS Trust's nearly 20 000 staff, all of whom have been offered COVID vaccines, revealed that highest rates of vaccination uptake were among white healthcare workers and those in administrative and executive roles. However, the data reveal a much lower take-up among Pakistani and Bangladeshi healthcare staff including doctors and nurses (Martin et al, 2021).
Such significant disparities vaccination uptake between groups of healthcare workers might undermine the vaccination programme and our ability control the pandemic. However, it should be stressed that imams are speaking to their communities and rejecting suggestions that the vaccines contain pork, gelatin or alcohol, which are all banned by Islam.
Countering misinformation
So what can be done to reject unfounded claims about the new SARS-CoV-2 vaccines and should vaccination be compulsory for certain population groups such as health workers? Social media-fuelled misinformation about the vaccines include preposterous claims that vaccination is being used to implant microchips to track people or cause sterilisation.
The World Health Organization is concerned that, if not strongly countered, the consequences of unchecked anti-vaxxer misinformation will claim lives, especially among socially disadvantaged and BAME communities. At highest risk of contracting COVID-19 are people living in overcrowded housing, those who are obese and those in jobs that they do cannot from home, and these groups may also be more susceptible to the misinformation of anti-vaxxers and their illogical science (Cohen, 2021). According to a recent study by King's College London, people who gain most of their information about COVID-19 from social media are more likely to believe in conspiracy theories linked to the virus (Boyd, 2021).
As COVID-19 vaccination is being rolled out across many counties health professionals should take the threat posed by anti-vaxxers and their use of social media platforms to spread misinformation seriously (Wilson and Wiysonge, 2020). In recognition that social media platforms are being misused to promote anti-vaccine sentiments Facebook and Instagram have announced that it will ban negative posts that throw doubt on the safety and efficacy the vaccines against COVID-19. This follows calls by senior politicians across the world for social media companies to remove unfounded propaganda claims about the vaccines.
There has also been some discussion that deliberate intent to spread malicious vaccine disinformation that could result in preventable deaths should be considered a criminal act (Mills and Sivela, 2021).
Building confidence
After it was revealed that some 30% of care home staff have chosen not to have be vaccinated, England's Chief Medical Officer Professor Chris Whitty stated that all health professionals should be vaccinated, saying that it should be a professional responsibility for frontline health workers to take measures to safeguard patients.
However, the Royal College of Nursing (RCN) rejects the idea of compulsory vaccination and does not support staff being forced or coerced into having it. The RCN says that vaccination should not be a condition of employment or part of employment contracts because this could be seen as a breach of human rights. Instead, the RCN is encouraging members to take up offers of vaccination as soon as they can. It considers it vital that the healthcare workforce is equipped to build public confidence in vaccination and is clear that all healthcare staff should reject anti-vaxxer propaganda that disputes vaccine efficacy.
Likewise, the NMC does not support making COVID-19 vaccination mandatory for staff, but reminds nurses that the NMC (2018)Code requires registrants to ‘take all reasonable personal precautions necessary to avoid any potential health risks to colleagues, people receiving care and the public’.
The UK Government has stated that there will be no compulsory vaccination against COVID-19; however, some care home groups are considering making it part of the staff contract of employment. For example, Barchester Healthcare, one of the largest care home providers in the country with 17 000 staff has indicated that, if staff refuse vaccination there will no more shifts for them from the end of April 2021 (Boseley, 2021).
The most appropriate way for nurses and healthcare workers to show support for universal COVID-19 immunisation is to get vaccinated themselves. The Queen herself has led by example, encouraging people to ‘think about other people rather than themselves’ and take advantage of the vaccine just as she has done (Davies, 2021). I too had my vaccination recently from a community pharmacist and, apart from feeling tired for a couple of days, there were no side-effects.
Key Points
- Anti-vaxxers and COVID deniers are currently engaged in spreading malicious propaganda about vaccines, circulating anti-vaccine videos on social media and messaging sites
- Misinformation about the SARS-CoV-2 vaccines is potentially risking the health of many people, but especially those from BAME communities
- Healthcare workers should be prepared to counter the misinformation spread by anti-vaxxers and help build confidence in the efficacy of the vaccines
- The most appropriate way for healthcare workers to show support for universal vaccination against COVID-19 is to take up their offer of vaccination and lead by example