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How to beat anti-vaxxers at their own game

Emily Pursino, of Amityville, a school teacher who

Emily Pursino, of Amityville, a school teacher who quit her job over the new vaccine law to home school her children, center, chants with protestors outside an event with Gov. Andrew M. Cuomo at Farmingdale State College on Sept. 18, 2019. Credit: Newsday/Steve Pfost

November saw the release of "Vaxxed II: The People's Truth." The film is a sequel to 2016's "Vaxxed: From Coverup to Catastrophe," a documentary directed by Andrew Wakefield, the disgraced physician who fabricated a connection between the MMR vaccine and autism. This new film advances another falsehood about vaccines: that public health organizations and pharmaceutical companies are conspiring to conceal "vaccine injuries."

The film features interviews with parents who believe vaccines have harmed their children. These interviews were collected during the nationwide "Vaxxed Bus" tour that accompanied the 2016 film. Recently, news broke that the "Vaxxed Bus" will hit the road again, on a tour funded through Facebook crowdsourcing.

This tactic should not be surprising given that Robert F. Kennedy Jr. served as a producer on "Vaxxed II." A recent study found Kennedy's anti-vaccination organization, the World Mercury Project, was one of two groups responsible for 54 percent of anti-vaccine advertisements on Facebook. Anti-vaxxers, far from being a grass-roots fringe group, are now a powerful and well-funded lobby, one that is increasingly successful at peddling falsehoods on social media.

The social media savvy of anti-vaxxers, and their opponents' relative lack of it, gives anti-vaxxers an advantage. But this could change. In the past, physicians and vaccine producers were remarkably flexible and politically astute when making claims about vaccine safety or responding to anti-vaccinationists. To defeat anti-vaxxers' campaign of misinformation, the same thing must happen today.

The story of vaccination begins in 1796, when English physician Edward Jenner learned that exposure to cowpox - a harmless bovine virus - could make a person immune to smallpox. Jenner had often performed a common technique called "inoculation" by giving his patients a mild case of smallpox to generate lasting immunity. But dairy maids sometimes refused the procedure, insisting their occupational exposure to cowpox was protection enough. Jenner decided to conduct experiments to test these claims. He found they were correct.

Vaccination began to proliferate around the world and replace inoculation as the favored technique to prevent smallpox.

However, obstacles quickly appeared. Cowpox was a rare virus, and it proved to be difficult to transport. Doctors tried mailing one another scabs they scraped from vaccinated patients or pus from cowpox lesions dried onto threads. These methods sometimes failed, so doctors increasingly turned to arm-to-arm vaccination, which involved removing pus from a cowpox lesion on one patient and depositing it directly into an incision on the arm of another patient.

This technique made some people viscerally uncomfortable, because they were concerned about exposing themselves to the bodily material of someone from a lower class. Beyond classism, patients also had more legitimate concerns: It became clear that arm-to-arm vaccination could transmit syphilis and other blood-borne diseases. Stories of such incidents circulated in the press.

Physicians found a solution to this problem by establishing what became known as "vaccine farms." Enterprising doctors bought plots of good farmland and herds of cattle. Then, to begin production, they intentionally infected their cattle with one or more newly discovered strains of cowpox to secure a steady supply. Once they'd collected the pus necessary to transmit cowpox to human patients, they sold it to other physicians.

Doctors and the general public alike came to believe vaccinating with cowpox that had only been transmitted between animal hosts, without ever entering another human body, was the safest method available.

With this in mind, vaccine farm owners went to great lengths to publicize the quality of their product and reassure potential customers it was genuine. Often, they accomplished this by advertising that their virus had a particular pedigree, a concept they borrowed from stockbreeding. In the world of stockbreeding, a pedigree traced an animal's lineage, indicated the qualities it was likely to possess and determined its value.

Because cowpox came from animal bodies, it was a perfect candidate for this form of branding. Vaccine farm owners would announce in newspapers or medical journals that they were "propagating" a virus that was a "lineal descendant" of the Beaugency, Esneux or Cohasset strains, named for the places they were discovered. The stakes of claims about pedigree were high. The reputations of vaccine farms, as well as public trust in vaccine safety, depended on them.

But by the 1890s, the business of vaccine production was changing. The development of germ theory and the science of bacteriology fueled the creation of new public health laboratories and brought vaccine farms under scrutiny from health departments. Vaccine farm owners adopted new technologies, like germicides and aseptic syringes, and emphasized that vaccines were produced in pastoral settings, far from the pollution that plagued urban centers.

As vaccine farms transformed into laboratories, they began competing to appear more scientifically advanced than their rivals. This meant a shift in advertising: Out went boasts about pedigree, and in came images of technicians in white lab coats and clean metallic spaces that implied sterility.

This was an important change. At the turn of the 20th century, an anti-vaccination movement rose up in protest over compulsory vaccination laws and stirred public anxiety surrounding vaccination by publishing cartoons of humans transforming into cows, referencing the technique's agricultural roots. Then, in both 1901 and 1919, contaminated batches of diphtheria antitoxin killed and sickened a number of children. Changes in vaccine production had not been merely aesthetic, but they also hadn't made vaccines entirely safe.

Vaccine producers and public health officials were able to respond to these incidents and to the claims of anti-vaccinationists by playing to the public's faith in scientific progress and emphasizing the new safety measures involved in vaccine production. By wielding a savvy communications strategy, much as vaccine farm owners had, they were able to establish and maintain public faith in vaccines.

Over the next half-century, public confidence in vaccination remained relatively high. Vaccines were credited with helping American forces triumph in military conflicts, and on the domestic front, undergoing vaccination was framed as a patriotic duty. The reputation of vaccination was further buoyed by the success of highly visible campaigns to eliminate polio in the United States and smallpox worldwide. Meanwhile, public health officials crafted advertisements that targeted parents, reminding them that even seemingly "mild" illnesses like measles could kill their children.

However, in the late 20th century, a new anti-vaccination movement - characterized by a mistrust of governmental and medical authority - began to gain traction. Unlike at the turn of the 20th century, scientific evidence and exhortations to trust experts no longer seem to be effective strategies for combating vaccine skepticism. And the anti-vaccine movement has taken advantage of social media to spread their claims, which include attempts to discredit scientific evidence.

Facebook has been criticized repeatedly for allowing anti-vaccine organizations to run advertisements, because doing so, in effect, legitimizes their position and the notion that there is a genuine controversy over the safety of vaccination. De-platforming anti-vaxxers would be ideal. But in the meantime, pro-vaccine forces must learn from the savvy media strategies that sold the public on vaccines in the 19th and 20th centuries, even during periods when vaccination came with far greater attendant risks than it does today.

Pro-vaccine advertisements are more likely than anti-vaccine advertisements to be removed from Facebook, often because they fail to meet the requirements for "political" advertising. This probably occurs because pro-vaccine advertisers believe their messages convey scientific truth, rather than a political position. This failure, however, also reflects a broader mistake by pro-vaccine forces: They have assumed the scientific merits of vaccination are self-evident and sufficient to convince a skeptical public.

But they need to stop assuming and start organizing as a political movement that employs calculated marketing, applies political pressure to de-platform anti-vaxxers, strengthens legislation surrounding vaccination and maintains social pressure to undergo vaccination. This set of strategies could potentially calm anxiety among parents, which has been fueled by misinformation online, and beat anti-vaxxers at their own game.

Lanzarotta is a historian of medicine, science, and technology currently based at the Dalla Lana School of Public Health at the University of Toronto. She wrote this for The Washington Post.

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