Facebook Should Do More to Combat Vaccine Misinformation

Stephen Barrett, M.D.
May 18, 2020

In 2019, about two months after receiving a prod from Congressman Adam Schiff (D-CA), Facebook announced that it would tackle vaccine misinformation by reducing its distribution and steering Facebook users to authoritative information. Its strategies included (a) reducing its search and newsfeed ranking of pages that spread vaccine misinformation, (b) rejecting ads that include vaccine misinformation, (c) minimizing the spread of anti-vaccine content through Instagram (which Facebook owns), and (d) removing access to fundraising tools for pages that spread misinformation. The company is also exploring ways to share trustworthy information about vaccines when people come across misinformation on this topic [1]. Currently, cell-phone users looking for information about vaccination—even if they search for “vaccination risks”—get the message shown to the right which encourages them to visit the World Health Organization Web site.

Congressman Posey’s Responses

Congressman Bill Posey (R-FL), who is a member of the House Liberty Caucus, does not like what Facebook is doing. In March 2018, he expressed concern to Facebook CEO Mark Zuckerberg that “limiting the feee speech of Americans who present safety concerns about vaccinations” would be a form of “bullying.” Posey’s letter was headlined: “IF VACCINES DO NOT CAUSE INJURIES, WHY HAS THE VACCINE INJURY TRUST FUND PAID OUT $4,061,322,557.08 FOR VACCINE INJURIES?” [2] In October 2019, during Zuckerberg’s testimony at a hearing on an unrelated matter, Posey said:  “Over four billion has been paid out by the fund. For thousands of people. Shouldn’t people have information to make an informed choice?” [3,4]

The National Vaccine Injury Compensation Program (VICP) is a no-fault program enacted in 1986 to deal with an epidemic of lawsuits that threatened the continued availability of childhood vaccines. The U.S. Health Resources and Services Administration (HRSA) has reported that from 2006 to 2017, (a) over 3.4 billion doses of vaccines covered by the VICP were distributed in the United States, (b) 6,314 petitions were adjudicated by the Vaccine Court, and (c) of those, 4,328 were compensated. This means for every 1 million doses of vaccine that were distributed, approximately 1 individual was compensated. However, the HRSA also noted that about 70% of the total compensation awarded by the VICP came as result of a negotiated settlement between the parties in which HHS had not concluded, based upon review of the evidence, that vaccines caused the alleged injuries [5]. Those numbers are powerful evidence of safety.

Posey claims to support vaccination of young children. But the Orlando Sentinel has documented a steady flow of anti-vaccine sentiments and statements that include the idea that vaccines cause autism [6]. In 2013, he appeared as a panelist at the AutismOne Conference, which, for many years, has promoted the gamut of autism-related quackery.

In 2013, 2015, and 2017, Posey introduced the Vaccine Safety Study Act, which would  direct the the Secretary of Health and Human Services to conduct or support a comprehensive study to compare overall health outcomes, including risk of autism, in vaccinated populations and unvaccinated populations in the United States. In addition to being a waste of scarce research dollars, the study envisioned by the bill would not be possible to perform because the unvaccinated populations identified in the bill tend to avoid doctors, which means that their health status cannot be adequately documented.

That alleged link between autism and immunizations has been thoroughly debunked by scientific studies, including nine completed by 2012, that found no link between thimerosol-containing vaccines and autism as well as no link between the measles, mumps, rubella (MMR) vaccine and autism in children [7]. Nor has any link been demonstrated by court proceedings. In 2009. the Omnibus Autism Proceeding, which may have encompassed the most thorough health-related investigation in U.S. judicial history, found no link [8]. But in 2015, during an interview with a Sentinel reporter, Posey said he had spoken with mothers whose children stopped speaking after being vaccinated and his belief that “It can’t be coincidental.”

All of this makes me wonder whether Posey is willing to base his judgments on facts. Despite harping about possible vaccine-autism link for more than seven years, he doesn’t seem able to grasp the fact that the question has been scientifically settled—there is no link. It is also settled that the benefits of currently used vaccines vastly outweigh their risks.

The “Backfire Effect”

I believe that the best way to get health information is to identify and rely on trustworthy sources such as one’s own physician, government agencies, and major professional and voluntary organizations.

Many people form their beliefs about health matters by searching the Internet for different points of view and following what seems to be most sensible to them. However, without formal education, separating facts and misinformation can be difficult. Paul Offit, M.D., who heads the infectious disease department at Children’s Hospital of Philadelphia, has noted:

it’s hard to unscare people. I think once you’ve scared them, it’s hard to unscare them. . . . You can do all these studies and spend tens of millions of dollars looking at vaccinated or unvaccinated groups, that received MMR with thimerosal or didn’t. That’s certainly reassuring to look at these studies, but I think from a parent standpoint, they’re still thinking, “You know, maybe even if this is a possibility, I just want to avoid this vaccine. . . . It’s, frankly, hard as a scientist to watch these hypotheses like “MMR causes like autism” get raised, watch them be frankly refuted by the science, and watch the fear that was created just not go away. I think it’s been an enormous disservice to our children and it’s caused a lot of suffering that didn’t need to be caused [9]

A recent study found that four types of educational programs intended to debunk claims of a link between vaccines and autism actually increased parental misperceptions and reduced parental intention to vaccinate  [10]. This phenomenon—termed the “backfire effect”—has been shown to occur when beliefs are based on ideology rather than on facts. [11]. I have made similar observations while advocating for community water fluoridation. In many situations, limiting misinformation may be more effective than trying to counter it with logic. This can be accomplished by curbing the spread of scare statements through the mass media.

Steven Novella recently noted: “The antivaccine movement has proven immune to facts and reality. If someone insists on being so at odds with established medical facts, the best response is to marginalize them.” [12] I agree.

Why Facebook Deserves Our Thanks

I believe that Facebook has the right idea. False health-related ideas can cause serious harm. Freedom of speech does not give people an unlimited right to harm others. In the United States, freedom of speech means that the government cannot prosecute people for expressing their opinions. It does not give people the right to cause direct harm by falsely shouting “fire” in a crowded theater or making false and defamatory statements about people. Nor does it give people an unlimited right to spread false health claims.

In a democracy, there is very little regulation of non-commercial speech—and rightly so. However, it is clear that misinformation related to vaccination, fluoridation and other public health matters can cause harm and even death. (In fact, the World Health Organization included “vaccine hesitancy” in its list of ten threats to global health for 2019 [13].) So I believe that Facebook can ethically decide not to be a conduit for harmful health information. I doubt that it would be practical to try to censor statements or discussions made on “individual” Faccbook pages. But I believe it would be ethical as well as practical to remove the pages of groups whose purpose is to attack proven public health measures or promote quack cures. These groups can be judged not only by the content of their pages but by the extent to which they are organized for action that goes beyond mere discussion.

Will Facebook harm our society by restricting the flow of health misinformation? I don’t believe so. Facebook plays an extremely important role in helping people share ideas and experiences. That value will not diminish. People who want to share harmful ideas or organize campaigns will still have many other ways to do so. Facebook can perform a great public service by making it harder for anti-public health groups to mislead people and organize their noxious campaigns. In addition, marginalizing them will, by itself, send a powerful educational message. If I were running Facebook, I would remove the pages of all groups that oppose public health measures.

Alexis Madrigal believes that identifying Facebook’s most troublesome anti-vaccine pages is not difficult. Using repeated searches with the word “vaccine” between January 2016 and February 2019, he found that just seven pages generated nearly 20% of the anti-vaccine content that was widely shared: Natural News, Dr. Tenpenny on Vaccines and Current Events, Stop Mandatory Vaccination, March Against Monsanto, J.B. Handley, Erin at Health Nut News, and Revolution for Choice [14]. I would remove them also. If you know of other harmful pages, please send their URLs to me.

Additional Reading
  1. Combatting vaccine misinformation. Facebook, March 7, 2019, April 26, 2019, and Sept 4, 2019.
  2. Posey B. Letter to Mark Zuckerberg, March 4, 2019.
  3. Posey B. Questioning of Mark Zuckerberg at a hearing before the House Financial Services Committee, Oct 23, 2019.
  4. Merlan A. Mark Zuckerberg’s Congressional testimony got sidetracked by a weird exchange about vaccines. Vice, Oct 29, 2019.
  5. VICP data & statistics. Health Resources & Services Administration, June 6, 2019.
  6. Powers S. Rep. Posey at center of vaccine-autism fight. Orlando Sentinel Aug 21, 2015.
  7. Vaccines do not cause autism. CDC Web site, reviewed March 26, 2020.
  8. Barrett S. Omnibus Court rules against autism-vaccine link. Autism Watch, Oct 6, 2010
  9. Offit P. Sound advice. Interview recorded in April 2009.
  10. Nyhan B and others. Effective messages in vaccine promotion: A randomized trial. Pediatrics 133:e835-842, 2014.
  11. Nyhan B, Reifler J. When corrections Fail: The persistence of political misperceptions. Political Behavior 32:303-330, 2010.
  12. Novella S. MMR is safe and effective. Science-Based Medicine, May 6, 2020.
  13. Ten threats to global health in 2019. WHO Web site, accesses April 27, 2020.
  14. Madrigal AC: The small, small world of Facebook’s anti-vaxxers: Squelching vaccine misinformation might be easier than the platiorm makes it seem. The Atlantic, Feb 27, 2019.