Over the recent years, much has been made of the dangers of social media to mental health. However, a new threat is being created online: anti-vaccination propaganda that spreads as quickly as measles.
WHO data shows that measles cases in Europe will top 60,000 this year - more than double that of 2017 and the highest this century. There were 72 deaths in 218, twice as many as in 2017. While there are many factors behind this, many experts are increasingly looking to social media as one of the biggest causes.
Speaking at a health summit held by the Nuffield Trust think tank, Simon Stevens, chief executive of NHS England drew attention to the threat.‘Across the world, two to three million lives are saved each year by vaccination. But as part of the fake news movement, actually the vaccination deniers are getting some traction,’ said Stevens.
‘We are not being helped on this front by the fact that although nine in 10 parents support vaccination, half of them say they have seen fake messages about vaccination on social media.’
Early in 2019, The Royal Society for Public Health published a report called Moving the Needle1 revealing the extent to which social media propagates misinformation about vaccinations, and that the perceived risks of side effects are the key concern among those who choose not to vaccinate.
This found that two in five parents exposed to negative messages about vaccines on social media, this rises to one in two among parents of under 5s, and across a range of vaccines including MMR, HPV, and flu, fear of side effects was the most common reason for choosing not to vaccinate.
‘It is clear from our findings – including that two in five parents are exposed to negative messages on social media – that the online sphere is a breeding ground for misinformation around vaccination,’ says Toby Bell, senior policy executive at the Royal Society of Public Health.
‘While it is difficult to tie this to specific changes in measles rates, it is well established that outbreaks are a result of dips in vaccination rates, and in this context it’s incredibly important to maintain high levels of public trust in the safety and efficacy of vaccinations. Finding new and innovative ways to counteract ‘fake news’ about vaccines is likely to be a major battle to be fought in the coming years.’
In 1998, Andrew Wakefield published a now notorious case series in the Lancet, which suggested that the measles, mumps, and rubella vaccine may predispose a child to pervasive developmental disorder in children. Despite the small sample size, the uncontrolled design, and the speculative nature of the conclusions, the paper received wide publicity, and MMR vaccination rates began to drop because parents were concerned about the risk of autism after vaccination.
Immediately afterward, studies were conducted and published, refuting the posited link between MMR vaccination and autism. The logic that the MMR vaccine may trigger autism was also questioned because a temporal link between the two is almost predestined: both events, by design (MMR vaccine) or definition (autism), occur in early childhood.
While in the UK, Mr Wakefield was largely discredited, his theories found a new life across the Atlantic, where antivax advocates use enormous platforms to spread mistruths. Jenny McCarthy, former wife of Hollywood star Jim Carrey has used her Twitter account, followed by 1.34 million, to propagate the link between autism and vaccination. Mr Wakefield has even received sympathy from the highest levels of government, being invited to Donald Trump’s inauguration in 2017.
‘With the rise of social media, we must guard against the spread of ‘fake news’ about vaccinations. We have found worrying levels of exposure to negative messages about vaccinations on social media, and the spread of misinformation – if it impacts uptake of vaccines – could severely damage the public’s health,’ says Shirley Cramer, Chief Executive of the RSPH.
‘It is 21 years since Andrew Wakefield published his infamous and now widely discredited paper on an alleged link between the MMR vaccine and autism, and Europe is still living with the consequences – as we have seen with the resurgence in measles rates in recent years.
‘In the 21st Century it would be unacceptable to allow vaccine-preventable diseases to make a comeback, and it is vital we do all we can to ensure the UK maintains its status as a global leader in vaccination,’ says Cramer.
The result of the MMR scare was a fall uptake of the vaccine, with a low of 79.9% of children in England receiving their first dose of the MMR vaccine by their second birthday in 2003-04, and low uptake rates elsewhere in the UK.
The return of measles
The World Health Organization (WHO)has confirmed that the UK eliminated rubella in 2015 and measles in 2016. Elimination means that measles and rubella are no longer native to the UK. It does not mean that these diseases have been completely wiped out. Measles and rubella remain endemic in many countries around the world and with recent large measles outbreaks across Europe, imported infections pose a very real threat to the UK.
Additionally, analysis conducted by PHE shows that immunity levels within some age groups across the UK - especially young people aged 15 to 20 years – are well below the levels needed to prevent measles from returning. Measles is one of the most infectious known diseases, so it can take only one infected person in an area with lower vaccination rates to cause an outbreak. Anyone who has not received 2 doses of MMR vaccine is at risk.
‘Our research found a consistently higher exposure to negative messaging about vaccinations on social media and online forums than to positive messaging – a trend that held true across all demographics we surveyed,’ says Toby Bell, of the RSPH. ‘Add to this the worry that – as a range of new studies have revealed – negative messages on social media are more likely to spread rapidly and elicit longer viewing times than positive messages, and it suggests that the effects of social media are negative on balance.’
‘It’s a tricky thing, social media is a bit of a double edged sword, it can spread misinformation but also spread information very quickly. We as nurses should use social media to make sure we get the correct messages out there rather than the avoidable scare stuff,’ says Teresa Chinn, a nurse and founder of the social media network #wenurses.
Mistrust of vaccines has been stoked by the rise of populist parties. In France, Marine Le Pen, who leads the far-right National Rally, has opposed an expansion of the list of mandatory vaccinations, while in Italy, members of the Five Star Movement have previously suggested vaccines were unsafe. Last year they entered the Italian government.
What can you do
Nurses are capable of combatting much of this, according to the RSPH. The RSPH is calling for a multi-pronged approach to improving and maintaining uptake of vaccinations in the UK, including efforts to limit ‘fake news’ about vaccinations online and via social media should be stepped up, especially by social media platforms themselves
‘The good news is that health professionals are in prime position to lead the fight against vaccine misinformation, as they remain highly trusted by the UK public,’ says Toby Bell.
‘Among all the groups we surveyed, the most valued sources of vaccine information were doctors and nurses, scientific experts, and pharmacy teams. It’s vital therefore that these professionals continue to deliver evidence-based vaccine advice, and make patients aware that there are more trustworthy information sources than what they may encounter on social media.’
Additionally, nurses can use face to face meetings with parents to advise on vaccines. According to research by Public Health England, health professionals are seen as the most trusted source of information (63% strongly agreed in 2017). Over 70% of parents had a discussion with
a health professional before their child was immunised. Although prior to these discussions 86% of parents intended to fully immunise their child, 52% said they felt more confident following the discussion.
Among parents of 0-2 year olds, 13% who had not intended to immunise changed their mind following discussion. The impact of discussions with a health professional was even greater in parents of 3-4 year olds with 22% changing their mind and deciding to go ahead and immunise, this proportion was even higher among parents from Black and Minority ethnic groups (29%) and among first time parents (38%).
‘It’s part of our role moving forward as nurses to take on this digital professionalism challengeto ensure that not only do we use our real world to spread informationand teach but actually we need to mind that an awful lot of the general public are using social media. There are a high percentage of people using social media in the UK, so we need to start communicating with people in the ways they communicate,’ says Teresa Chinn.
‘If so many people are using social media, then we need to be out there as nurses to engage with people and make sure that the right info is out there when people need it.
‘It’s about being an active participant in social media, and it’s about sharing evidence, research and being visible out there. If all that is visible on social media is the misinformation that does the public a huge disservice. So we need to be visible as nurses online and spread the correct information, which is backed up with research.’
Since the introduction of the measles vaccine, an estimated 20 million cases and 4,500 deaths have been prevented in the UK. If the ‘fake news’ spreading across social media is allowed unchecked, we may see a return to Victorian epidemics. As Steve Silberman, author of the acclaimed history of autism Neurotribes, tweeted recently: ‘No, vaccines do not cause autism, part gazillion. Vaccines cause adults.’
1. Royal Society of Public Health. Moving the Needle. 2019