The true cost of vaccine misinformation: A vulnerable nation

As a health communications researcher specializing in vaccine hesitancy, the last few years in my field have been paradoxical. Vaccinations played a large part in ushering us into the post-pandemic world, yet a “misinfodemic” against vaccines persists. Misinformation about vaccines has eroded confidence in vaccines’ prevention promise and has inflicted even our progressive state of California. As of August 2023, about 73% of Californians have received the initial series of COVID-19 vaccines, compared to only 38% of children between ages 5 to 11. In recognition of World Immunization Week – taking place annually during the last week of April – I want to highlight the collective action needed to improve vaccine uptake to protect people of all ages.

Our biggest threat to improving vaccine uptake is the rise in misinformation – mostly propagated on social media platforms. Having taken root during the 2016 U.S. presidential election, continuing during the COVID-19 pandemic, and the devastating aftermath of the 2020 U.S. Presidential election – misinformation is pervasive.

In my research scrubbing one of the more popular microblogging services, X (formerly Twitter), misinformation around the COVID-19 vaccine clocked in nearly 14.9 million tweets. Our research published in the Journal of Behavioral Medicine delineated the kinds of vaccine misinformation spread on social media. Falsehoods about vaccination ranged across nine categories that undermine vaccine confidence, including falsehoods about vaccine ingredients, safety, side effects, testing of the vaccine, alternatives to vaccinating, effects on the immune system, vaccine efficacy, vaccine information being concealed and doubts about the necessity of the vaccine. When users’ questions and concerns are not rapidly addressed and information voids ensue, such an environment is conducive to the adoption of pervasive misinformation being turned to and accepted. 

Now what we’re seeing is that the “misinfodemic” has slowly made its way off our phones and into pediatrician offices nationwide. During the 2022-23 school year, kindergarten vaccination rates did not return to pre-pandemic levels and our nation is now reporting the highest rate of vaccine exemptions, including medical and nonmedical, ever seen. Of the kindergartners with vaccine exemptions, over 93% had a nonmedical exemption. Parents are choosing to exempt their children from life-saving vaccines at the cost of our community’s safety. 

Higher rates of unvaccinated people in a community are associated with a greater incidence of vaccine-preventable diseases like measles, which has made a startling return. Take for example the 2014 measles outbreak that began at Disneyland, California, or in 2019, the largest measles outbreak in the U.S. that occurred in a New York City community with a cluster of unvaccinated children. And now, in the first three months of 2024, as reported by the Associated Press, the CDC shows that the number of measles cases is 17 times higher than in the previous three years of the same timeframe.

Why are parents hesitating in getting their children vaccinated or avoiding them altogether? Addressing the scourge of misinformation requires a multi-faceted approach to improve vaccine uptake across the nation. 

1. Stronger immunization requirements. Following California’s lead on Senate Bill 277, other states need to address the increase in vaccine exemptions by no longer allowing personal belief exemption to a currently required vaccine.

2. Policy interventions in the digital world. Social media platforms should be held accountable for helping to stop the spread of misinformation. Tactics like automated flagging of misleading content would be useful in the fight against misinformation.

3. Teach digital information literacy. Disseminating a curriculum not only to grade school students but also to their parents on misinformation discernment coupled with user accuracy nudges (a scalable solution) will help foster scientific thinking and equip them with the knowledge to protect themselves and their families. 

In a society where facts are distorted and falsehoods proliferate, individuals are robbed of the ability to make sound judgments based on reality. We cannot afford to be passive bystanders in the fight for the truth – our community’s health depends on it.

Suellen Hopfer is Associate Professor of Health, Society, and Behavior, with the UC Irvine Program in Public Health. She has affiliated appointments with the UCI School of Medicine’s Department of Pediatrics and the UCI School of Humanities’ Department of Asian American Studies.