With great power comes great responsibility

Jan 24, 2024

This week’s blog was written by our Scientific Projects Manager, Eve.

Eve discusses the topic of vaccine hesitancy and healthcare messaging, with a particular focus on the impact this has had due to the COVID-19 pandemic.

Photo of Eve Scott

This blog will focus on vaccination and vaccine hesitancy. The author has cited information that was correct at time of publication and aims to provide an unbiased assessment of the landscape.

The last time I wrote about vaccine hesitancy was 5 years ago, as part of a broader project looking at the interaction between the public and social media, mainstream media and scientific institutions (Wellcome in particular) when seeking information about medical and scientific topics. Since then a lot has changed, the gap in medical and scientific literacy has widened.

Access to social media has become increasingly easier while access to scientific institutions has become increasingly hard.

The discussion was primarily focused on the MMR (measles, mumps and rubella) vaccine given in childhood, often saved for a small group of people who felt very strongly one way or the other about vaccination.

But now, vaccine is an everyday word you might hear on your bus journey into work and since 2020 any Google search relating to ‘vaccine’ will focus almost entirely on COVID-19.

With more information than ever available on vaccine safety and efficacy, why have vaccination rates remained so low in the UK and how much impact does social media have on how we interact with healthcare?

In 2019, the World Health Organization (WHO) named vaccine hesitancy as one of the top 10 threats to global health. In the same year the WHO removed the UK’s ‘measles elimination’ status after a surge of 1000+ cases in 2018.

The WHO recommends a global coverage of 95% of eligible individuals being vaccinated to see eradication of measles. In 2021 MMR vaccine coverage sat at 87.4%, far from the target. These figures sit within the context of a global pandemic of both the SARS-COV-2 virus and a concurrent ‘infodemic’.

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The pandemic was a time of uncertainty.

This uncertainty trickled down from expert policy makers, scientists and virologists to the general public.

Not wanting to mis-inform, governments and global healthcare bodies were reluctant in creating easily accessible information as, they themselves, continued to learn more about this rapidly evolving situation. How can you disseminate evidence-based, robust information on a brand-new virus where there is no evidence?!

In addition to this, the power of misinformation, particularly in the area of vaccines, remains fresh in the minds of both the scientific community and the general public.

In 1998 a paper was published in highly respected and reputable medical journal, The Lancet. The paper, authored by a doctor practicing in the UK, implied a link between the MMR vaccine and cases of childhood autism. 12 years later, after a very intensive review of the science and methods behind the paper, it was retracted. The evidence was weak as well as the scientific and ethical basis of the research being poor and unregulated.

But 12 years is a long time for this information to sit under the umbrella of such a highly regarded source of medical and scientific information. Naturally, scepticism from the general public creeps in. If these outlets cannot fact check and disseminate accurate information, whom can we trust?!

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Enter social media.

Despite voices such as that of the US Surgeon General stating that vaccine misinformation via social media presents a “urgent threat to public health”, many individuals look to their like-minded connections on social media to understand their experiences, thoughts and feelings on the pandemic, fast-tracked vaccines and healthcare in general.

It is important to consider who are the ‘traditional’ care-givers of children in Western society, those who consequently also often make healthcare decisions for these children. These people are mothers.

Research into the psychology of motherhood has shown that social connection is absolutely crucial for both mother and child’s mental health. A social group, face to face or online, gives mothers a place to share concerns, to connect with those who have had similar experiences and gain valuable advice.

While many sources of information highlight the importance of the awareness of misinformation and ‘fake news’, many of the main ways that mothers connect to discuss the healthcare of their children, including Facebook, Twitter and other online forums, remain unregulated and unfiltered. The use of social media to connect became absolutely necessary during the pandemic and discussions around vaccination once again came to the forefront.

“Vaccine hesitancy to MMR and other childhood vaccines clustered in middle- to high-income areas among mothers with a college-level education or higher who preferred internet/social media narratives over physician-based vaccine information”.

Many social media users interested in information or experiences of vaccines are neither pro nor anti vaccine but are undecided and therefore are very susceptible to any messaging they should encounter.

While the anti-vaccination movement is relatively small in number, it is calculated in its targeting and uses loud voices within social media to specifically target and message these undecided and uncertain individuals, particularly within patient groups or forums, in the hope of swaying their opinion.

During the COVID-19 pandemic, many conspiracy theories and ‘fake news’ stories that started on social media within these small anti-vaccination groups gained tremendous momentum through this intelligent targeting.

One such story was that which reported that one of the first volunteers to receive the newly developed Oxford-AstraZeneca vaccine had died subsequent to receiving the vaccine.

This led to reputable news outlets, including the BBC, to report on this story – contacting the volunteer in question to indeed confirm she was alive and well.

The government also added their voice to confirm the volunteer had not suffered ill effects – issuing a tweet via the Department of Health and Social Care on the importance of checking facts before sharing information on social media.

Photo of Lucy smiling while running
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The mitigations by the BBC and the government were robust, with strong evidence to contradict the claims made on social media by the anti-vaccination movement however it shows the absolute power this small movement has in that its stories will be recognised even if it is a negative way.

Much like the MMR paper, the fact that the stories had broken and received such recognition means that damage had been done in terms of assigning a dark story to a vaccine.

The ripples of the MMR paper remain prevalent in attitudes to children receiving the COVID-19 vaccine which one 11% of parents in a study of 1549 stating that the risk of the vaccine causing autism was a contributing factor to their hesitancy, despite there being no evidence or reports of this within the COVID-19 vaccine trials.

The true knock-on effect of the messaging on social media that was hyper-prevalent has yet to be fully seen however, the data so far shows vaccination rates post-pandemic have not recovered to the levels of 2019 (pre-pandemic) and a continued recurrence of vaccine preventable diseases in Western society has been observed.

How do we combat vaccine hesitancy on social media in this low trust, high turnover landscape?

We have to recognise the power of social media for good and understand that, if this is the medium that mothers, caregivers and the general public want to use to receive medical and health information, that we must meet them there.

While there has been a fairly hard-line message in social media messaging relating to health being ‘fake news’ and not to be trusted, we should ensure that there are easily accessible, fact-checked resources available in these forums to counter the negative voice.

While it cannot entirely quiet the anti-vaccination movement, adding as much evidence-based information as possible can work to tip the scales little by little.

Where social media is succeeding where many medical practitioners and media outlets fail is by giving space for parents to raise their concerns in a ‘safe space’ where they will not be judged or ridiculed. We need to encourage active listening external to social media to rebuild the trust in science and medicine, a trust that has been severely impaired by the pandemic.

If societal models of healthcare reject the concerns of parents as ‘silly’ or inconsequential, they will surely turn elsewhere for advice where every voice is seemingly heard – social media.

A problem 25 years in the making will not be an easy fix but we must understand where the issues are being exacerbated and work harder to communicate accurate health messages to parents, caregivers and the public in the places they are most likely to receive them.

Thank you to Eve for writing this blog on vaccine hesitancy and healthcare messaging.

We hope you enjoyed reading!

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