It’s funny how certain sorts of news about the antivaccine movement seem to come in waves. For instance, just the other day, I wrote about news stories describing how antivaxers use social media to swarm and harass anyone whom they perceive as a threat. That includes doctors, scientists, and, most despicable of all, even mothers grieving over the deaths of their children from vaccine-preventable disease. I put this into the context of what I’ve observed over the years, particularly the violent, apocalyptic rhetoric I often observed antivaxers invoke. So, even though a really interesting story on what’s become of Generation Rescue and how it is enriching its board members by selling rank quackery was published the other day, this story, basically a continuation of the stories about how antivaxers are harassing their perceived enemies, in this case doctors, starting with Chad Hermann of Kids Plus Pediatrics of Pittsburgh.
Just before school started in the summer of 2017, Kids Plus Pediatrics of Pittsburgh posted a video on its Facebook page urging parents to vaccinate their children against human papillomavirus, or HPV, which can cause a variety of cancers. Three weeks later, communications director Chad Hermann noticed “something new happening” online.
First, someone posted the claim that “the vaccine kills.” Within minutes, more anti-vaccine comments came pouring in. The next day, someone inside a closed Facebook group started sending private messages with “screen shots so we could see them coordinating the attacks,” Hermann recalled.
Hermann would later discover that a woman in Australia was particularly active, directing people to give the practice negative reviews on various social media platforms. “She would say, ‘Let’s move on to Yelp reviews,’ then change tactics and say, ‘Let’s go after the Facebook reviews,’ ” Hermann recalled.
Of course, on the surface, this is nothing new. Antivaxers have been using email, closed discussion forums, and even comments in blog posts to coordinate attacks on whoever opposes them. I’ve been on the receiving end more than once, the most memorable example being in 2010 when, egged on by Jake Crosby, the antivaccine crank blog Age of Autism was the nexus of a campaign to try to get me fired from my job. My university’s board of governors was inundated with emails and phone calls from antivaxers accusing me of an undisclosed conflict of interest. It got to the point where the dean of my medical school called me and asked me if I felt threatened. Hell yes, I felt threatened, but not physically. Maybe I should have felt physically threatened.
Of course, back then Facebook was nowhere near as ubiquitous and powerful as it is now, and cranks had not yet figured out how powerful a tool it is to serve their purposes. Closed and secret discussion forums are the perfect tool to link antivaxers from all over the world for purposes of discussion, organizing, and coordinating, and discuss, organize, and coordinate they do. Here’s what Hermann and his crew found:
Instead of enduring the abuse, Kids Plus fought back, tracking comments and turning its Facebook page data to researchers at the University of Pittsburgh.
What they found, in a study released Thursday in the journal Vaccine, is that most commenters weren’t from Pittsburgh at all but were from across the United States and around the world. Only five were from Pennsylvania. Within eight days, the page was flooded with 10,000 negative comments from about 800 commenters. Some messages were threatening, such as “You’ll burn in hell for killing babies.” Others were conspiratorial, such as “You have been brainwashed,” the doctors said.
Having seen this part of the story, I was intrigued. So, as is my wont, I wondered over to Vaccine to get it straight from the horse’s mouth, so to speak, by reading the study itself. Basically, Chad Hermann and Todd Wolynn, , chief executive officer of Kids Plus Pediatrics, teamed up with researchers at the University of Pittsburgh to analyze the Facebook profiles and postings of the various people who left derogatory antivaccine comments on the Kids Plus Pediatrics video. The dataset consisted of 197 individuals who posted anti-vaccination comments in response to a the Kids Plus message promoting vaccination against HPV. Authors systematically analyzed publicly-available content using quantitative coding, descriptive analysis, social network analysis, and an in-depth qualitative assessment. Because the comments weren’t just restricted to HPV vaccines, the authors decided to examine all antivaccine comments, rather than restrit themselve to anti-Gardasil comments.
Their codebook divided looked at various variables: e.g., activism (as in complaints about SB 277, the California law that eliminated personal belief exemptions), Media, censorship, and “cover up,” vaccination as genocide, vaccines as a cause of autism, fetal “tissue” in vaccines, and several others that are familiar to regular readers here. A descriptive analysis of all sociodemographic and anti-vaccination variables was carried out using this codebook. Also:
Second, we conducted social network analysis to determine if people discussing different anti-vaccination topics led to certain sub-groups organically clustering together. While traditional social networks tend to only assess relationships between people, we used a 2-mode network (also called an “affiliation network”) to describe relationships between not only people but also non-person artefacts (e.g. anti-vaccination topics) . In other words, we studied the connections between people as mediated by discussion topics. We then used modularity to identify potential clusters that could demonstrate how discussion topics were inter-connected . Clusters were compared to the five topics of vaccine denial (threat of disease, trust, alternatives, effectiveness, and safety) proposed by the World Health Organization (WHO) regional office for Europe . Visualizations and network descriptive metrics were generated using the Gephi software package .
The authors’ findings were interesting, although they were not particularly novel. For instance, the majority of individuals (89%) identified as female and/or as parents (78%). This is very similar to a study from a little over a year ago that I discussed when it came out that also found that the vast majority of antivaxers on Facebook are women. One difference between the current study and the study from 2018 is that the older study, instead of examining individuals, examined six of the largest antivaccine Facebook groups and asked two questions: 1.) What are the networked properties of anti-vaccination communities on Facebook, including their size, shape, and connectedness? and 2.) What types of anti-vaccination discourses are present within these communities?
In any event, the authors of the current study made a rather unsurprising observation as well:
The majority of individuals for whom political affiliation could be determined (28%, n = 55) identified as supporters of Donald Trump (56%, n = 31), a conservative and the 2016 Republican nominee for President. This was followed by supporters of Bernie Sanders (11%, n = 6), a contender in the 2016 Democratic primary and a self-described democratic socialist.
Given that Donald Trump has a long, sordid history of spewing antivaccine conspiracy theories dating back at least to 2007. Also, although the prevalence of antivaccine beliefs is roughly the same on the left and the right, of late the Republican Party of late has become the favored home of antivaxers, which is why this finding did not surprise me in the least. At its core, antivaccine beliefs are based on conspiracy theories; so it’s almost a “well, duh” finding that Donald Trump supporters would be overrepresented in Facebook antivaxers.
Of more interest to me was the network analysis:
A 2-mode network was constructed with 133 nodes, representing 115 people and 18 topics (Fig. 1). There were 1068 edges, or connections, between people and topics. The network had a density of 0.122 and average degree of 8.03. Modularity analysis found 4 distinct sub-groups. Based on the overarching themes represented in these sub-groups and the topics of vaccine denial provided by the WHO , we named these sub-groups (1) trust, (2) alternatives, (3) safety, and (4) conspiracy.
Of course, none of this is unexpected either. Anyone who’s very familiar with the antivaccine movement could have predicted at least some of these, as one could fairly easily predict this:
We also assessed betweenness , a measure that identifies all of the shortest paths found between any 2 nodes in the network. In this network, “vaccination policy is a violation of civil liberties” had the highest betweenness centrality (b = 0.135); it was the topic most discussed by people who discussed only one topic.
Indeed, this is likely the reason why the antivaccine movement has become so cozy with right wingers. Antivaxers routinely portray their opposition to vaccine mandates as manifestations of their belief in freedom and parental rights and opposition to government mandates.
Amusingly, to me, the authors appear to have rediscovered the principle of crank magnetism, as well:
In addition to the similarities surrounding anti-vaccination sentiment, qualitative analysis revealed other commonalities in public posts by these individuals. For example, many individuals consistently posted content related to “naturalness,” including attitudes against genetically modified food (anti-GMO), circumcision, and water fluoridation. Some of these individuals also expressed vegan activism.
Other individuals expressed views against water fluoridation and GMO in a way that focused on liberty and potential government interference. Many of these individuals posted about government conspiracy related to “chemtrails,” which is a theory that long-lasting condensation trails left by high-flying aircrafts contain chemical/biological agents. They also tended to express anti-abortion and pro-gun sentiments.
Recall that Mark Hoofnagle and I were blogging about crank magnetism over a decade ago. I do, however, have to give credit is due. It was Mark who coined the term “crank magnetism” almost 12 years ago. Basically, crank magnetism is the tendency of cranks to subscribe to more than one form of crank beliefs. It is rare for a person to believe in just one form of pseudoscience, conspiracy theory, or quackery. Usually they believe in more than one, ane frequently in many. Watching antivaxers, I’ve seen that they often believe in alternative medicine and even more frequently in anti-GMO pseudoscience. Those, however, are only the most frequent other ludicrous beliefs to which they subscribe other than antivaccine views. Often the subscribe to many more, including the ones listed above. Still, it’s useful to have a degree of empirical support that the phenomenon of crank magnetism is real. As I’ve been saying about the antivaccine movement for years, it truly isn’t just about autism. It is, however, always about the vaccines, whatever other pseudoscience and conspiracy theories antivaxers layer on top of their antivax views.
The authors also note:
Qualitative analysis found that posts related to safety concerns often distorted reputable epidemiological data, consistent with known characteristics of science denialism . For example, many posts included data showing parallels between rates of vaccination and cancer mortality rates to support the claim that vaccines cause cancer. However, the scientifically-established consensus is that immunization against vaccine-preventable diseases, which led to a 29-year increase in life-expectancy, shifted leading causes of death from infectious causes to chronic diseases such as cancer . Therefore, dialogue from health professionals about vaccination may need to be updated to reflect the ways in which those against vaccination use science denialism.
Actually, health professionals need to continually update their dialogue based on what the antivaccine conspiracy theories du jour are if they expect to be effective in this sphere.
One thing very much disappointed me about this study, and it relates to Tweets I saw by one of the authors, Chad Hermann, two and a half weeks ago:
Anti-vaxx harassment isn’t new, but this tactic — real-time coordination of a global attack from a virtual war room inside a closed Facebook group — is. It first appeared about 18 months ago, and has continued apace on providers, practices, hospitals, and whole health systems.
— Chad Hermann (@ChadTRM) March 3, 2019
And, in response to a criticism that this was nothing new:
A letter-writing campaign is nothing like what’s happening now. We’re talking real-time, minute-by-minute, war-room-style attacks, moving from Facebook page to Yelp reviews to Google reviews to DOS attacks, in response to whatever defense the provider or practice mounts.
— Chad Hermann (@ChadTRM) March 3, 2019
Absolutely. The outlines, and elements, were all there. And sadly time-tested. But again: these attacks are occurring faster, and more nimbly, than ever before. They’re now unleashed in breadth, and speed, and volume unseen until the past year and a half.
— Chad Hermann (@ChadTRM) March 3, 2019
And finally, from Todd Wolynn:
Yep. And the international access and coordination make the attacks Global 24/7 with the ability in real-time to redirect effort(s).
Weaponized Social Media provides:
– access to 100,000’s+ allies
– amplification by foreign entities
– multi-platform avenues
… and more
— Dr. Todd Wolynn (@DrToddWo) March 4, 2019
So why was I disappointed? I was hoping that there would be evidence in this paper to back up these claims that what we’re seeing is not just qualitatively, but quantitatively different from what antivaxers have been doing online at least a decade to coordinate their attacks on science advocates. Maybe it’ll be in another article. Or maybe Hermann and Wolynn don’t want to let antivaxers know what they know. Still, I haven’t been convinced that this is some sort of new technique that only emerged 18 months ago. Although I don’t do it, I’m in contact with a fair number of people who lurk in these closed antivaccine Facebook groups—and have been doing so for a long time. I don’t mean to be too hard on them, as they’re new to a fight that I’ve been involved with for nearly 20 years and intensely for 14 of those years. This is all relatively new to them. I’ve seen this phenomenon before, and, damn, does it make me feel old and cynical—but not cynical enough not to enthusiastically welcome Hermann and Wolynn and anyone else who wants to join in the effort to counter the spread of misinformation about vaccines online.
My doubts aside about their characterization of the novel methods of online harassment by antivaxers, I definitely do like what Hermann and Wolynn are working on to help anyone who is targeted by the antivaccine horde, because it is definitely needed, particularly for those who haven’t been targeted before. I, for instance, have been targeted so many times that antivaxers rarely bother any more because they’ve learned that their attacks no longer faze me and that I consider them a badge of honor:
“The idea that we can have counter-speech when [Facebook] groups become brigade mobs is ludicrous,” said Renee DiResta, an expert in online misinformation and co-founder of Vaccinate California. “It makes just participating as an everyday citizen a high-stakes ordeal.”
“We are at the point where doctors are creating their own anti-vaxx social media attack response teams to help other doctors,” DiResta added.
One such rapid response team is being organized by Dr Todd Wolynn and Chad Hermann, the CEO and communications director of Kids Plus Pediatrics (KPP) in Pittsburgh, Pennsylvania.
“If you’re being attacked, we’ll light the signal fires of Gondor, and you’ll have pro-science, pro-vaccine cavalry come to your aid,” Hermann said of the nascent project, called “Shots Heard Round the World”.
I, of course, immediately volunteered. Those of you among my readers who routinely combat antivaccine misinformation should join too. This is something that should have been done a long time ago, and I kick myself for not having done it. (I guess I’m a bit too much of a loan wolf.) Whether or not what antivaxers are doing on Facebook is qualitatively different than what they did 18 months ago is more or less a quibble. What they’re doing to silence science advocates is intimidation, and there needs to be a resource—multiple resources—to which targeted physicians and lay people can turn to call in the cavalry.