An article in BMJ in January 2024 explores the role of misinformation in undermining effective population level vaccination campaigns. Although counter campaigns are “as old as the first vaccines”, they continue to present a disruption and threat to public health. The authors reflect that prolific anti-vaccine campaigns had “undeniable effects” during the COVID-19 pandemic, with social media emerging as “the epicentre of misinformation leading to hesitancy”. Thus, interventions to tackle this hesitancy have focused on social media delivery. However, while vaccine access and communication reached “unprecedented levels”, public health officials were unable to match the pace of “misleading or inaccurate content online”.
“Social media dynamics exacerbated the sharing of misinformation, reduced vaccination rates, undermined trust in reliable information, magnified polarisation, and damaged the perceived credibility of institutions.”
Vaccine hesitancy and disinformation
The term “vaccine hesitancy” is used throughout the paper with the original WHO definition: a “delay in acceptance or refusal of vaccination despite availability of vaccination services.” The authors state that this definition facilitates a distinction between vaccination behaviour and the “underpinning psychological, environmental, and structural aspects influencing behaviour”.
Disinformation is understood as a “form of misinformation” that “deliberately seeks to mislead or otherwise disrupt understanding”. However, both are covered “broadly” under misinformation throughout the paper.
Encouraging vaccination
The authors describe as “standard behavioural approaches” to encourage vaccination measures such as mandatory vaccination and regulation for specific subgroups, incentives, and communication campaigns. Contemporary methods have included a shift to social media implementation, including “debunking” and “pre-bunking”; the latter is a behavioural approach that teaches users about ‘fake news’ before exposure.
“Such behavioural approaches to misinformation on social media have shown promise in reducing the sharing of disinformation and misinformation and in changing people’s beliefs, but less clear is their effect on vaccination uptake.”
The paper highlights the importance of investigation the success of these interventions because of the “established link between social media exposure and offline beliefs that vaccines are unsafe.” What is clear, is that “providing fact based probabilistic information alone” is insufficient to “meaningfully increase uptake”, and indeed “might even backfire”.
“Multiple drivers and barriers to vaccine uptake must therefore be considered when developing effective tools.”
The study
The authors found 30 studies that evaluate interventions to tackle misinformation on social media that “explicitly captured real world behavioural outcomes”. After 19 studies were excluded for “lack of external validation”, 11 published interventions remained.
“There is clearly insufficient evidence from field studies on social media interventions.”
Recognising the “major challenge” of linking online campaigns to true behaviours in field studies, the authors state that, to justify investment in developing interventions, there must be evidence of success in increasing uptake. Therefore, researchers of vaccine behaviours and associated campaigns must “engage directly with clinics and public health agencies” to improve the “ecological and external validity” of interventions.
10 insights from existing evidence
As “few” interventions that were evaluated captured evidence on real world behaviours, the authors cannot provide a “gold standard toolkit”. However, they draw on available evidence to inform future tool development with 10 insights to provide a “clearer and more specific, evidence driven toolkit”.
- Negative sentiments on social media might increase vaccine hesitancy faster than interventions reduce it.
- Messaging seems to work best when it is tailored to what groups know and care about.
- Simple messaging about benefits and risk based on probabilities is not enough.
- Correct misinformation to both parents and their children.
- Trust matters: the message, the messenger, and the (vaccinated) provider.
- Debunking efforts have shown mixed effects on social media.
- Raising the quality and visibility of reliable health information can counter misinformation.
- Framing of vaccine messages matters.
- Blanket bans can drive groups and activities underground.
- Social media platforms need to be part of the solution.
High stakes
“Misinformation is not new, and its noxious consequences are not insurmountable, but its effect on vaccine hesitancy through social media is an urgent global threat to public health.”
The paper highlights the importance of “close monitoring” of public perceptions of vaccination and services. Thanks to digital technologies, it is possible to analyse swathes of “social listening data” in real time. This insight would improve the design of “new, robust, and appropriately targeted interventions”.
“There remains an urgent need for direct partnerships between behavioural researchers with healthcare clinics and public health agencies.”
Study author Professor Kai Ruggeri added a comment on social media when sharing the link to the article:
“People that don’t care about you & want to divide communities push cheap, lazy lies about vaccines, then say misinformation is fake. Solution: Build trust. Engage real concerns. Keep debates public”
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