The “anti-vax” movement: a quantitative report on vaccine beliefs and knowledge across social media

Fear of vaccines dates as far back as vaccines themselves as evident by Edmund Massey's [29] Sermon titled “A sermon against the dangerous and sinful practice of inoculation.” This appears to be the first objection to any forms of inoculation to prevent disease with Massey stating “Let us not sinfully endeavour to alter the Course of Nature” [29]. Next in notable vaccine objections was when the smallpox vaccine was introduced, “many skeptics […] found it counterintuitive that deliberately infecting a person with a disease” [38]. This is when the world began to see a group of people who not only refused vaccination but made an effort to inform others of the “dangers” through propaganda. However this propaganda largely consisted of arguments of infringement of rights and anti-socialism [15].

Since the infamous 1998 paper by Andrew Wakefield, this was later retracted because it incorrectly related the MMR vaccine to autism, a group of people known as vaccine deniers or more commonly known as anti-vaxxers have been exponentially growing. A vaccine denier or anti-vaxxer will be defined in this study as someone who believes vaccines do not work, are not safe or refuse vaccines for themselves and their children if applicable. Claims about vaccine safety, efficacy, and adverse effects have been evolving and have now spread to almost every vaccine available. Surveys from the American Academy of Pediatrics found that the rate of parents who refused one or more recommended vaccines increased from 9.1% in 2006 to a staggering 16.7% in 2013 [30]. The problem being faced today is the wealth of information that is not only accessible but easily spread across social media platforms regardless of veracity. It is clear that the internet is now patching a significant time in health literacy and decision making. A survey by Fox [18] found "(72%) [Of] adult internet users say they have searched online for information about a range of health issues[...] (26%) adult internet users say they have read or watched someone else’s health experience about health or medical issues in the past 12 months. And 16% of adult internet users in the U.S. have gone online in the past 12 months to find others who share the same health concerns. There are an estimated 58 milion followers on anti-vaccination pages across socialmedia ]1]. This study uses Social media propagation, to reach the study population.

The purpose of this study is to evaluate the current knowledge and beliefs about vaccines in people who use social media and the differences between scores and demographics. Past research has found that the strongest influence for positive vaccine views is having factual knowledge [11]. This study hopes to determine how much factual information is known and what differentiates social media users who have adequate and inadequate knowledge. This cross sectional study hypothesizes that there are correlations between each of the individual demographic questions and the respondent’s knowledge of vaccines. Knowing what differentiates people who have adequate and inadequate knowledge can be beneficial for determining how to reach people in future vaccine campaigns. This information could also be used in an attempt to better educate or correct misinformation by means of social media in those who classify under this study as having insufficient knowledge. Additionally this research will investigate the individual’s beliefs about vaccinations in people who use social media, whether positive or negative. Uncovering individual characteristics in the respondents with their different beliefs can be helpful for deciding how to correctly reach each person group in the future in regards to vaccinations. We can use this information for educational purposes through social media to help those who were found to have negative or lower beliefs toward vaccinations.

Knowledge about vaccines, both true and false, can be easily accessible but also easily confused. The internet has become a huge influence on vaccine knowledge [26] and the emergence of social media has created a vast community that allows multi-person discussion to happen instantaneously and with little supervision [9]. “Anti-vaccination activists use [social media] to disseminate messages, facts and beliefs that oppose some or all recommended vaccinations” [6]. Brunson [8] found that the most significant factor influencing parents online is the percent of parents within a parents online network that are nonconforming. Because of these factors refusal to vaccinate is becoming a concern of public safety.

Regardless of vaccination rates, legitimate information about vaccine safety is “not reaching parents in an effective or convincing manner” [19]. This study seeks to assess whether factual knowledge is reaching social media users. This is because it has been found that the strongest predictor of positive attitudes towards vaccines is better knowledge [11]. In a study of Serbian University students it was found that 47.9% of participants thought that giving multiple vaccines at one time overloads the immune system [11]. Further research will determine if views such as the one above are perceived across all social media users and not just students.

Investigations of the dissemination of vaccine knowledge across social media have been substantially less studied until recent years, especially with the development of the COVID-19 vaccine. In a study of vaccine attitudes in Twitter users Mitra et al. found that anti-vaccination tweets had a wider reach (seen by more people) than pro-vaccine tweets [31]. In a study of HPV vaccine tweets it was found that there was “an association between prior exposure to negative tweets about HPV vaccines and the subsequent posting of negative tweets about HPV vaccines” which allowed for the sharing of negative opinions to more susceptible people [14]. From the information aforementioned it can be predicted that the majority of information about vaccines on social media has a negative connotation. What is still unclear is the ability of the general population to distinguish between fact and fiction, and whether this information has an influence on their knowledge and eventually decisions.

To determine what questions would be used and what is to be expected by demographic results this study looked at Duggan and Brenner's [13] journal article on social media users. This study found several useful social media user characteristics. Firstly, women are statistically significantly more likely to be social media users compared to men. This study also shows that with age, there is a statistically significant progressive decline in social media use. In terms of education they found that social media use was approximately equal across all levels of education. Equity across races was also seen. This demographic data is important for determining what questions should be asked, but also what can be expected in the results.

It is important to determine what factors influence people to not vaccinate. Yaqub et al. found that “‘distrust of doctors’, ‘distrust of government sources’, and ‘distrust of pharmaceutical companies’ as reason for hesitancy” [40]. In that same study they found that very few people reported that they did not have access to adequate information. While this is important, it does not elaborate on the quality of information these people are using. A cross sectional study in Australia in 2012 found that although 92% of 452 parents reported that their children were adequately vaccinated, 52% reported concerns including but not limited to vaccine safety and source of vaccine knowledge [10]. However due to discrepancies in defining anti-vaxxers or people who are vaccine hesitant, this study will focus on what knowledge people have and not ask their vaccine practices. Rather, it will look into how far the anti-vax messages have reached and the characteristics of those participants that have or have not been swayed by these messages.

Since the collection of the data related to this research the world has faced the COVID-19 pandemic. Social media and vaccine hesitancy has become a huge topic of discussion and research relating to combating COVID-19. Several studies worldwide have indicated that older individuals, females, those with higher incomes and those with higher education levels were more likely to accept a vaccine [34]. Research in this area has exploded due to fast paced development and deployment of the COVID 19 vaccine. Globally there has been varying intention to get the COVID-19 vaccine ranging from 41 and 89% [17]. A survey conducted in the United States of America showed only 57.6% of respondents intended to be vaccinated but also that “(62%) [of respondents] believed that sociopolitical factors and pressures may lead to a rushed approval for the COVID vaccine without the assurances of safety and efficacy” [27].

Of the 2517 respondents, 2417 were included in the analysis based on the inclusion/exclusion criteria. The age of participants showed 446 (18.5%) people aged 18–24, 715 (29.6%) people aged 25–34, 591 (24.5%) people aged 35–44, 394 (16.3%) people aged 45–54, 189 (7.8%) people aged 55–64 and 82 (3.4%) people over the age of 65. Females accounted for 80.1% of the respondents (n = 1937 people) and males accounted for 18.8% (n = 454 people). Respondents were predominantly North American with 70.3% (n = 1700) from the USA and 12.9% (n = 312) from other North American Countries. The remaining were divided into 7.4% (n = 180) Australia/Oceanic, 7.3% (n = 176) European, 0.9% (n = 22) Asian, 0.6% (n = 15) African, 0.5% (n = 11) South American, and 1 respondent from Antarctica. The education levels showed that 0.1% (n = 2) had no formal schooling, 0.4% (n = 10) completed elementary school (grade level 1–8), 21.2% (n = 509) completed high school (grade level 9–12/13), 22.3% (n = 540) completed an Associates (2 year) degree, 34.5% (n = 833) completed a Bachelor (4 year) degree, 13.9% (n = 336) completed a Master’s degree, and 7.7% (n = 187) completed a Professional degree (PhD, MD, DC, DO, etc.). Individuals identified themselves as Lower class socioeconomic status (SES) comprised 9.8% (n = 238) of the population, 82.2% (n = 1987) as Middle class SES, and 7.9% (n = 192) as Upper class SES.

Facebook is the most commonly used social media type in the population with 69.8% (n = 1688), followed by Twitter 15.6% (n = 378), Instagram 12.9% (n = 311), then other forms of social media 1.7% (n = 40). Other forms of social media were identified as Snapchat, Tumblr, Reddit, Pinterest, or using all platforms equally. Most people 47.9% (n = 1158) claimed to only spend 0–2 h on social media daily, followed by 40.9% (n = 989) using 3–4 h, 8.4% (n = 204) using 5–6 h, 1.5% (n = 36) using 7–8 h, and 1.2% (n = 30) using social media for over 9 h. Most respondents 92.7% (n = 2240) have seen posts on social media about vaccines and only 7.3% (n = 177) have not. These posts influence 5.4% (n = 130) of users to think vaccines are worse than previously thought, 13.6% (n = 328) to think vaccines are better than previous thought, 76.4% (n = 1846) claim to not have been influenced by the posts, and 4.7% (n = 113) had not seen any posts. Lastly, people claimed to trust doctors 89.4% (n = 2160) the most with their immunization related information/decisions. The remaining people trust the internet 4.1% (n = 100), family 2.0% (n = 48), peers and friends 2.3% (n = 55), social media 0.2% (n = 5) and the government 2.0% (n = 49) with their information and decisions.

The significance found in this study can help us understand who is being influenced by posts about vaccines on social media. It is important to note that the sample in this study was originally started in North America; hence the vast majority of respondents reported residing on this continent. Beyond that, significant values from the statistics should be examined to determine what it means for this research and for further implications.

As social media continues to grow exponentially, it can be expected that anti-vaxxers will further spread their messages across these platforms. While this research does not delve into the totality and extent of the anti-vax movement on social media it does provide some insightful information. As mentioned previously, it is possible for governments and doctors to use this information to intervene and correct false information about vaccines and their safety. Given that trust in doctors resulted in significantly higher knowledge and belief scores, it is imperative that physicians create a trusting environment and relationship with their patients and guardians of pediatric patients. This also tells us that the information patients are getting from their doctors and the conversations they are having are influencing vaccine decision making in a positive way. What was not studied, and would be beneficial to investigate going forward, is whether doctors have the ability to change a patient’s perspective on vaccines once they have been exposed to negatively skewed vaccine information. It is also evident that those who trust the internet with their vaccine information are exposed to more misinformation. There may be an avenue for addressing misinformation on the internet through this trusted source and that could be via physician social media influencers. We have started to see the importance of this avenue with the prevalence of COVID-19. Social media has create an easily accessibly way to reach credible sources such as CDC and WHO, who made their presence known during the height of the pandemic through social media campaigns [7]. This appears to be especially important for direct intervention on Facebook, where the majority of social media use is, and unfortunately lower rates of knowledge and more negatively skewed beliefs. In North America, actions should be taken to combat the misinformation and myths that are reaching its population more than anywhere else in the world.

Further research is recommended to understand why some countries, age groups, social network users, etc. are not getting adequate information on vaccines. Future research would benefit from using a structured interviewer based approach to allow for expansion and clarification of answers. Further evaluation of the data collected here could yield more in-depth understanding of demographics. As mentioned before this research did not cross analyze demographics.