The Risks of Misinformation and Vaccine Hesitancy within the Covid-19 Crisis

Combating misinformation about Covid-19 and strengthening the U.S. population’s confidence in vaccines, particularly once a safe and effective Covid-19 vaccine becomes available, is an urgent national security matter. A prolonged Covid-19 outbreak, with recurring cycles of lockdown and reopening, threatens millions of American lives; U.S. economic competitiveness, research, and innovation capabilities; and the health security of the nation. It is increasingly clear that ill-intentioned political elements are also disseminating misinformation about Covid-19 vaccines to foment discord and exacerbate political divisions within U.S. society. Amid persistent Covid-19 transmission in the United States, with more than 6 million Americans infected and 180,000 dead, the protection of U.S. national interests requires addressing the circulation of misinformation about the pandemic—far more systematically and effectively than is the case today—to interrupt the erosion of confidence in vaccines.

Shortly after the World Health Organization (WHO) reported the outbreak of the novel coronavirus—now known as Covid-19—in January 2020, misinformation about the virus, its causes, and its treatments began to circulate and propagate through social media channels. Messages purporting to confirm the laboratory origins of the virus, rumors that claim 5G technology was a risk factor, and beliefs that consuming large quantities of raw garlic was a certain cure were shared, retweeted, and debated on such platforms as Twitter, Facebook, and LinkedIn. As early as February, the WHO declared the dissemination of misinformation about Covid-19 to be an “infodemic.”

In the United States, recent polls have shown that just 50 percent of respondents plan to get a Covid-19 vaccine, assuming one becomes available. Statements by President Donald Trump that a vaccine will be available by the end of 2020, backed by nearly $11 billion in investments in select industry partners’ vaccine candidates, have stirred online rumors over the safety of any product developed as rapidly as “Operation Warp Speed” aspires to. Older narratives that vaccines can be used to sterilize young women have resurfaced alongside messaging that claims that the motives of those who invest in new vaccine research include inserting microchips into people’s bodies to control their behavior.

Even before the Covid-19 pandemic, vaccine hesitancy had led to decreased immunization coverage in the United States—and in other parts of the world—across several vaccine-preventable diseases, including measles, polio, and diphtheria. The United States eliminated measles in 2000, but in 2019 more than 1,280 cases were reported in 31 states, concentrated in communities where immunization coverage had been persistently low or had declined in recent years. Within the context of the coronavirus pandemic, stay-at-home orders have further led to parents’ reluctance to take children to the pediatrician for routine immunizations and contributing to even greater declines in coverage overall. In one recent study of data from the Michigan Department of Health and Human Services, fewer than 50 percent of children were up to date on required immunizations this past May, a drop from the 66 percent who were up to date at the same time during the previous four years.

Given that the prospect of returning to a stable economic and social life in the United States rests, to a great extent, on the successful introduction and dissemination of a Covid-19 vaccine(s), the connection between vaccines and U.S. national security has never been so starkly revealed. 

In the age of Covid-19, the interconnection between vaccines and U.S. national security plays out along four critical dimensions:

First, at a time when jobless numbers are at a historic high and economic growth for 2020 is expected to remain negative, Covid-19 disproportionately impacts Blacks, Latinos, and immigrants, including workers in the “gig” economy—both in terms of the risk of falling ill and dying and of experiencing negative economic impacts. That has immediate destabilizing consequences. It aggravates deep preexisting social inequities and amplifies a larger set of political tensions around racial justice, manifested most recently in the cycle of protests sparked by the killing of George Floyd in Minneapolis in late May and fueled by other episodes of violence and conflicts over police funding since then.

Second, a wave of vaccine-preventable disease, combined with an uncontrolled pandemic across much of the country, is undermining U.S. competitiveness and the ability to conduct foreign policy. As the countries within the European Union began reopening to air travel and tourism on July 1, the European Union barred travelers from the United States due to the lack of control over the outbreak within the nation’s borders. Should such limits on the ability of U.S. citizens remain in the medium term, this will seriously erode effective engagement in trade, security, humanitarian, and diplomatic missions.

Third, the longer the outbreak persists, and schools and universities remain closed (or partially closed, or in an on-again/off-again cycle), the greater the damage to U.S.-based education, cutting-edge research, and innovation. The United States is falling behind those advanced economies that have mounted a more effective outbreak response, setting the stage for the long-term erosion of U.S. economic competitiveness and emergency preparedness.

Last, the risk of outbreaks of vaccine-preventable disease increases when coverage drops for highly infectious diseases like measles. At the same time, many children—and adults—who become seriously ill with a vaccine-preventable disease face challenges getting care, as clinics and hospitals in many states remain overwhelmed by Covid-19 and as health resources continue to be diverted for Covid-19 response. Nationwide economic contractions are hitting state and local governments especially hard, driving up the cost of all health services, including immunizations. These stresses are compounded by the rising demand for additional protective gear, handwashing stations, and distancing requirements in doctors’ offices and health clinics. The net result is that communities at all levels are left ill-equipped to deal with new infections.

At the same time, measures that can help prevent transmission of the virus, such as wearing a mask or practicing social distancing, have become politicized, leading to further risk-taking and intensifying social tensions in public settings.

Vaccine hesitancy is not a new phenomenon, nor is it confined to the United States. It is a phenomenon that is steadily globalizing, accelerating through rapidly evolving technological changes. Concerns about immunizations surfaced soon after the first smallpox vaccines were introduced in the eighteenth century. But these concerns have intensified over the period during which global immunization programs have expanded, particularly in the last 25 years. The factors associated with vaccine hesitancy are highly context-specific. In places where vaccine-preventable diseases are no longer common, some individuals and health care providers have become complacent about the need for vaccination, leading to lower coverage. There is also a newer dynamic in which immunization efforts are disrupted by digital wildfires—social media assaults that occur at moments of high political tension or the start of national vaccination campaigns.

While vaccine hesitancy may manifest in context-specific ways, there are common overarching themes that drive it. One set of perceptions focuses on the science of immunization, itself, given its language being deemed as elite and inaccessible, hiding truths around the real safety risks of vaccines and provoking public concerns that the real risks of vaccines outweigh their benefits. The rush to introduce a vaccine for swine flu in 1976 backfired when more than 400 people became ill with Guillain-Barré syndrome after being vaccinated, leading to decades of concerns about immunization safety. A 1998 Lancet article suggesting that the measles, mumps, and rubella (MMR) vaccine led to higher rates of developmental disorders in young children triggered a significant wave of vaccine hesitancy that persists, even though the research was afterward discredited and the article retracted

A second set of issues relates to the compulsory nature of immunization policies, with some parents rejecting government or school requirements that they have their children vaccinated or rejecting the idea of a vaccine schedule. In the United States, a campaign in the state of Maine to repeal laws requiring school-aged children to be immunized gained traction, under the slogan “Reject Big Pharma,” suggesting that popular concerns over profits accruing to vaccine manufacturers also play a role in undermining vaccine confidence.

Some new research also suggests that digital misinformation campaigns around vaccines are initiated by divisive political actors motivated more by the goal of exacerbating social divisions and encouraging mistrust of government than by health or vaccine concerns.

Amid persistent Covid-19 transmission in the United States, the protection of U.S. national interests requires addressing—far more systematically and more effectively than is true today—the circulation of misinformation about the pandemic and the erosion of confidence in vaccines.

  • We need to confront the reality that vaccine hesitancy—and social media misinformation campaigns about vaccines—are urgent national security matters. Yet they are most frequently understood as predominantly health issues. That narrow interpretation is a mistake. The drivers and consequences of misinformation campaigns about vaccines, specifically; the erosion of confidence in science and medicine, more generally; and the politicized, polarizing, and anti-government sentiments driving some of the misinformation have grave security implications that reach far beyond the health sector. The challenge is to look beyond a narrow public health perspective to understand what those security risks are and how to mitigate those risks with concrete policies and actions.
  • Vaccine hesitancy and misinformation in health serve the broader interests of actors seeking to stoke discord in U.S. society. The universe of people transmitting—and receptive to—misinformation about vaccines within social media channels is complex and diverse. While some groups seek to protect the health of their children, others have historic reasons to mistrust government. Others are skeptical of the motives of pharmaceutical companies, reject Western biomedical approaches, or are advocates of natural health. At the same time, there is evidence that many impactful efforts to amplify misinformation about vaccines are networked with domestic and international groups seeking to undermine confidence and take advantage of fears to deepen social divisions and fuel discord and political polarization.
  • The public health world is losing the battle against far more sophisticated and nimble actors. Social media misinformation campaigns related to vaccines and vaccine safety make highly skilled use of social media tools to reach and amplify their messages to large populations. Public health is an important voice in responding to, and in countering, these messages, but the health sector is relying largely on old, often centralized, and sluggish approaches that are not very effective within the new digital communications environment. New innovative approaches and new expertise that draws on the fields ofbehavioral and social science, anthropology, psychology, intelligence, polling, communications and messaging, cybersecurity, and digital media analytics are needed. There is a historic tension between the health and security sectors, yet in the context of the Covid-19 pandemic and misinformation, the two fields are inextricably linked. It is fruitless to relitigate the debate over the “securitization” of global health when it comes to vaccines for such a debilitating and disruptive pandemic. 

Most experts agree that success in returning to some form of normal economic and social life depends to a high degree, though not exclusively, on the introduction and dissemination of a safe and effective Covid-19 vaccine, or more likely, a combination of vaccines. Making that strategic goal possible does not rest simply on field trials and the financing, manufacturing, and distribution of vaccines. It will rely on mobilizing expertise from diverse disciplines, including but also outside of public health, that are essential to understanding and combating misinformation and restoring public trust and confidence. It requires understanding the deep national security implications of misinformation and declining popular confidence and mapping out a coherent, innovative national action plan.

This work is supported by a grant from the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the foundation.

Katherine E. Bliss is a senior fellow with the Global Health Policy Center at the Center for Strategic and International Studies (CSIS) in Washington, D.C. J. Stephen Morrison is a senior vice president and the director of the CSIS Global Health Policy Center. Heidi J. Larson is professor of anthropology, risk, and decision science and the director of the Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine.

Commentary is produced by the Center for Strategic and International Studies (CSIS), a private, tax-exempt institution focusing on international public policy issues. Its research is nonpartisan and nonproprietary. CSIS does not take specific policy positions. Accordingly, all views, positions, and conclusions expressed in this publication should be understood to be solely those of the author(s).

© 2020 by the Center for Strategic and International Studies. All rights reserved.

Katherine E. Bliss
Senior Fellow and Director, Immunizations and Health Systems Resilience, Global Health Policy Center

Heidi J. Larson

Professor of Anthropology, Risk, and Decision Science and Director of the Vaccine Confidence Project, London School of Hygiene and Tropical Medicine