Social media as breeding ground for vaccine refusal

Vaccine hesitancy is largely a decision making problem and can as such, at least at the individual level, be described by psychological and cognitive models233. While decision making on vaccination generally would require the consideration and incorporation of information concerning vaccination, the availability, sources and reliability of such information is diverse and rapidly changing234. In particular, people are increasingly moving from “controlled” forms of mass media (for example, newspapers) towards uncontrolled social media like Facebook and Twitter235,236. On social media, so-called “opinion leaders” or “influencers” with a significant following affect the way information (even incidental) is consumed and incorporated237. Moreover, highly active users of social media are more likely to consider themselves opinion leaders and show increased efforts to try and persuade the opinions of others238. Also, social media has immense influence when certain posts are going “viral”, an exponential sharing of a single article/post among social media users that reaches millions within a timespan of hours. For example, a parent intended to travel with their child posted on social media that certain airline companies secretly vaccinate passengers through the air conditioning system, which was widely shared by others239. While the sharing may not necessarily be in agreement with the content of the post, fictitious information is allowed to thrive and likely affects the opinion of many. One study in Italy found an inverse correlation between MMR vaccine coverage and internet search activity, Facebook posts and tweets (posts of Twitter)240. In the US, negative representation of vaccines by over 250.000 tweets sent over two years concerning HPV vaccine-related information affected the acceptance and coverage of vaccines241. Finally, an analysis of 153 YouTube videos on immunization showed that videos disapproving vaccines were more viewed, liked and shared242. Negative vaccine sentiment on social media is framed around skepticism and distrust of government organizations that communicate scientific evidence supporting positive vaccine benefits243,244. These studies show that social media can act as a breeding ground and echo chamber for misinformation and conspiracy theory, but also provides health professionals with a unique platform to reduce vaccine hesitancy245–248. Indeed, traditional educational tools like information pamphlets appear to have little or no effect on vaccine hesitancy, or in some instances even reinforced vaccine hesitancy249. For example, pregnant women presented with a website containing vaccine information and interactive social media components positively influenced vaccination rates of their infants, compared to usual care250. Pro-vaccination messaging, however, needs to be carefully approached, as a study reported that parents receiving images of sick children increased expressed belief in a vaccine/autism link and a dramatic narrative about an infant in danger increased self-reported belief in serious vaccine side effects251. As societies are becoming increasingly connected and influenced by social media, vaccination sentiments need to be carefully monitored and addressed252,253, in order to rightfully gain public credibility and trust254,255.

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