Vaccines do not cause autism, but Russian bots cause measles

According to recent reporting from international health experts, Europe is currently experiencing a 20 year high in measles cases. Perhaps most disconcerting is that this trend has also been observed in many countries where it had been mostly eradicated. The primary reason, according to the World Health Organization (WHO), is “vaccine hesitancy.” This is listed as one of the WHO’s top 10 global health threats for 2019. According to WHO, “vaccine hesitancy” is defined as the reluctance or refusal to vaccinate despite the availability of vaccines.

The causes of vaccine hesitancy are multifaceted, but a major factor is the influence of news articles and social media which have become dissemination platform for bots and trolls determined in spreading disinformation about vaccines.

According to the recent study “Weaponized Health Communication: Twitter Bots and Russian Trolls Amplify the Vaccine Debate”, the same bots and trolls linked to Russia’s Internet Research Agency which spread discord in the 2016 US elections are the ones feeding disinformation and contributing to the current measles crisis in Europe. This same study attributes 93% of the anti-vaccine narrative being hawked on Twitter as originating or being amplified by Russian trolls and/or bots.

The goal of this disinformation campaign is to flood the discourse with anti-vaccine propaganda, creating a sense of ‘false equivalence’ in the ‘anti-vax vs pro-vax’ discourse. The bots assist by repeating and spreading the same narrative on various social media platforms in the languages of the countries they are targeting. The European countries most impacted by this hybrid threat include Ukraine, Greece, France, Italy, Romania, and Serbia.

In 2018, Ukraine saw the biggest surge in measles outbreaks of all European countries, with a 634% increase in cases. From 2017 to 2018, an astonishing 53,000 cases were reported in Ukraine. In 2018, Ukraine’s Minister of Health attributed the rapid increase of measles cases to the ongoing war, sub-standard vaccines imported from Russia and Russian anti-vaccination propaganda in social media and mainstream media.

At the same time, a newly-published study from Queen Mary University of London, found a positive association between the percentage of people in a country who voted for populist parties and the percentage who are sceptical of vaccinations. Indeed, populist parties in Europe are seen taking positions which feed into vaccine hesitancy.

For example, Italy’s Five Star Movement has raised concerns regarding vaccine safety and the alleged link between the measles, mumps, rubella (MMR) vaccines and autism. Similarly, Greece’s left-wing SYRIZA government similarly proposed that parents should be able to opt out of vaccinating their children. At the same time, since the beginning of 2019, there have been three posts by suspected trolls in Greece falsely stating the US Center for Disease Control and Prevention (CDC) ‘admitted’ that vaccines cause autism. The posts by this troll were subsequently amplified by suspected Russian bots. Currently, with 196 cases per million residents, Greece has the highest per-capita number of reported measles cases within the EU. Additionally, in France, the right-wing Front National also raised concerns about vaccine safety and laws that make childhood vaccinations mandatory. This rhetoric is even more concerning when paired with the fact that studies indicate French general practitioners are more sceptical of vaccines and 43% of them do not offer these potentially life-saving treatments to the parents of infants.

Concerned parents searching online for information about vaccines struggle to sort out truth from disinformation. One anthropological study at Canada’s McMaster University found among the top 10 Google search results using the keyword “vaccination”, 71% were anti-vaccination sites. Anna Kata, the study’s author, calls the internet a “postmodern Pandora’s box” in which scientific truth is rejected and misinformation is conflated with information.

So, what can be done to address the disinformation challenge which is feeding the measles surge in Europe?

On the surface, providing education and evidence-based responses to concerns would seem to be a reasonable place to start. However, according to some studies, education is not effective in convincing science-resistant anti-vaccination advocates. There is however evidence to support improving the parent-doctor trust relationship can help motivate and convince more parents to immunise their children.

That said, public health information campaigns combined with increased transparency about vaccines, more flexible vaccine schedules and better risk-benefit data can serve to better inform those parents who may not be resistant but may be ambivalent about vaccinating their children.

Some experts suggest mandatory vaccine schedules as an effective approach, but these can lead to even greater resistance among the most sceptical parents. One advantage of mandatory vaccinations, however, is that it signals a broader societal consensus that vaccines are an important aspect of public health. Just this week, Italy enacted a new law making a full schedule of vaccinations mandatory and banning young children from school unless they have completed the proscribed regiment.

Finally, the early identification and elimination of trolls and bots before their influence spreads too far is an important step in countering any disinformation campaign. To do so requires a detection system that is not simply automated but also augmented by human judgement to ensure adequate safeguards and provide feedback to better improve detection accuracy.

When false information is propelled into mainstream and social media, it is easily mistaken for science-based facts to the information seeker. 80% of internet users use search engines to seek information on health and 16% of those are searching for information on vaccines. One study indicates that at least 70% of those who do seek vaccine information report that information found online influenced their decision to vaccinate.

A resurgent measles is not the only disease that we need to be concerned about returning in force. Other more dangerous diseases are also included in Europe’s recommended childhood vaccination schedules: diphtheria, tetanus, polio, Haemophilis influenzae type b (Hib), meningitis, to name but a few.

When disinformation amplifies fears over vaccines, vaccine rates go down and illness returns. We’ve already seen how measles has returned but which more dangerous disease will be next if we do not act?