Going viral in the online anti-vaccine wars

Fortunately, it looks like plans for a commission on vaccines have stalled, but Trump isn’t alone in believing – against all the available evidence – that vaccinations can cause autism. He’s part of a broader trend of vaccine refusal, one characterised in affluent Western countries by parents citing personal beliefs in order to exempt their children from vaccination programmes.

Despite generally high levels of vaccination in high-income countries, vaccine refusal has recently become a big enough concern to prompt state intervention.

In December 2014, 52 people caught measles after visiting Disneyland in California. Researchers investigating the cause of the outbreak concluded that it was fuelled by vaccine refusal. They calculated that the vaccination rate among people who were exposed was no higher than 86 per cent, and could have been as low as 50 per cent.

California has since passed new state legislation that removes personal belief exemptions from vaccination programmes for children entering kindergarten and the seventh grade.

This summer, Italy and France also announced measures to increase vaccine uptake, with French parents becoming legally obliged to vaccinate their children from 2018, and non-vaccinated children being banned from Italian state schools. This followed a 2016 study by Ipsos showing that only 52 per cent of French people believe the benefits of vaccination outweigh the risks.

This increasing resistance to vaccination has been attributed to the rise of a new movement and political identity: the self-styled ‘anti-vaxxer’, or active anti-vaccination campaigner.

Contemporary anti-vaccination campaigning started in earnest after the publication of Andrew Wakefield’s now infamous study suggesting that the combined measles, mumps and rubella (MMR) vaccine caused autism. The MMR scare snowballed to become the biggest science story of 2002, leading to demands in the British press for Tony Blair to disclose whether his son Leo had been given the vaccine.

In 2010 the study was retracted by its publisher, the Lancet, after an investigation discovered multiple conflicts of interest and manipulation of research data. Wakefield lost the right to practise medicine in the UK, but that didn’t stop him continuing his campaign against vaccines. In 2016 Wakefield released the documentary Vaxxed, which followed other anti-vaccination documentaries such as Trace Amounts and Calling the Shots. Vaxxed was pulled from the Tribeca Film Festival before its screening, following a public outcry about its message.

It’s pretty unlikely you’ll be seeing anti-vaccination documentaries at your local cinema. But anti-vaxxers are adept at using digital technology to sidestep what they see as official censorship, reaching new converts through ‘news’ articles, self-produced documentaries and memes. Despite this, anti-vaxxers aren’t a new digital phenomenon, but rather the latest incarnation of a social and political movement with a long history of resistance to large-scale vaccination programmes.

From mass demonstrations to Facebook and forums

Anti-vaccination movements have existed from the moment that national vaccination programmes were introduced. In the UK, widespread compulsory vaccination started with the Vaccination Act of 1853, which established mandatory vaccination for infants up to three months old, and the following Act of 1867, which extended this to children up to 14 years old. These parliamentary Acts were opposed immediately by members of the public, leading to the formation of the Anti Vaccination League and the Anti-Compulsory Vaccination League.

Scepticism towards vaccinations can be seen in satirical cartoons of the period. These were published in anti-vaccination pamphlets distributed by activists and also in periodicals such as Punch.

Opposition was often regionally organised or based in certain cities (read more about this in ‘The child whose town rejected vaccines’). Anti-vaccination protests took place in urban centres across Europe and North America throughout the 19th century, with the Leicester demonstration march of 1885 drawing over 20,000 people.

In Bodily Matters: The anti-vaccination movement in England, 1853–1907, Nadja Durbach argues that anti-vaccination protestors in the 19th century were largely working class, and that their protest was about feeling like second-class citizens without self-determination over their own bodies, as well as about a divide between an elite establishment and a community lacking trust in them.

We can follow this theme through to contemporary anti-vaccination movements around the world today. In Pakistan, India, East Africa and Afghanistan, suspicion of the motives of vaccination programmes – often seen as instruments of the West – has led to growing numbers of parents refusing to have their children vaccinated.

Whereas the anti-vaccination protests of the past once filled the streets of urban centres like Leicester, Ipswich, Milwaukee and Montreal, today they congregate online. Anti-vaxxers use websites like naturalnews.com, vaccineimpact.com and mercola.com and social media platforms like Facebook and Twitter to spread (mis)information and recruit new members to their cause.

Online groups and forums can provide invaluable support mechanisms for parents, but they are also spaces where the worried and vulnerable seek advice. This is particularly true of support groups for parents of autistic children, which are frequently targeted by anti-vaccination campaigners. In groups like these, one of the most important tools for spreading an anti-vaccination message is the meme.

The evolution of the in-joke

What exactly is a meme? The word ‘meme’ comes from Richard Dawkins’s 1976 book The Selfish Gene. Dawkins used it to describe a “unit of cultural transmission” – which might be anything from an idea to a piece of music – that is passed between people and subject to selection pressures in a way analogous to the transmission and selection of genes.

Memes on the web can take many forms, including animated GIFs, videos and images. They are often created using generators or templates, following or adapting a small number of existing forms. They bring colour, humour and entertainment to the web while also communicating ideas and concepts.

This comparison to evolution might be misleading: image memes are definitely a product of intelligent human design, even if the degree of intelligence behind them is sometimes questionable. It’s when memes are shared on social platforms that a form of selection comes into the mix. The most interesting, arresting or funny memes get shared more and the damp squibs drop away.

Professor Jean Burgess at the Queensland University of Technology describes this as “vernacular creativity”, home-grown creative production that has long been carried out in private but which has made its way into public culture through social media and web platforms.

The simplicity of memes, with their Microsoft Paint-style ‘cut and paste’ aesthetic and fondness for the font Impact, isn’t just evidence of a worldwide lack of design ability – it’s integral to how they work.

First up: the creation and consumption of memes is partly a performance of group belonging. Say what? A good parallel is the in-joke. An in-joke, like repeating a particular catchphrase or referencing a favourite film, protects access to group identity from outsiders: to get the joke you have to be part of the gang. It also rewards members of the group: being part of the gang means that you get the joke, and when you laugh about it together, you get a feeling of shared community and acceptance.

Visual memes do more than just facilitate membership of online groups. Using them ‘correctly’ might demonstrate an individual’s superior knowledge of a particular internet subculture, but memes are also often appropriated by groups and reused in ways that don’t match the original meaning or context at all.

The recent appropriation of Pepe the Frog by the alt-right, for example, piggybacks on the recognition and popularity of an existing meme to draw attention and grow a following. Good memes need to be simple and bold, using recognisable patterns and allowing easy understanding. They also need to be easily modified: the most reused memes are flexible enough to carry a wide range of meanings.

With their popularity, flexibility and ease of creation, it’s easy to see why image memes are attractive as campaign tools for anti-vaxxers. But like anti-vaccination campaigning itself, the history of hijacking images for a political cause is older than the internet. Anti-vaxxers see themselves as part of the rebel tradition of fighting authority. To understand how today’s anti-vaccination campaigners use memes, we need to think about their online activities as a form of countercultural resistance.

Anti-vaxxers as a counterculture

In 1956, French Marxist theorist Guy Debord and artist Gil J Wolman introduced the concept of détournement. Literally meaning ‘overturning’ or ‘hijacking’ in French, this is a technique of taking visuals from advertising and the mainstream press, and subverting or twisting their meaning as a form of political and cultural resistance.

Surrealist artists had previously reworked popular culture to make new meanings, but this new technique was linked to political subversion. Détournement was taken up by the Situationist International, an alliance of avant-garde artists and political theorists that influenced many artists from the late 1950s onwards.

Elements of their style can be seen in the DIY aesthetics of punk, the ‘culture jamming’ of the 1990s and in today’s memes. Along the way, the style has gathered broader associations of youthful energy, subcultural cool and an anti-authoritarian irreverence.

Anti-vaccination memes draw from this broad visual language of resistance by co-opting and subverting existing images to carry anti-vaxxer messages. While the anti-vaccination movement includes both left- and right-wing members, it’s generally strongly libertarian and anti-authority. Campaigners are highly suspicious of the ‘establishment’, resistant to state intervention and oppose what they believe to be a profit-driven collusion between science, government and Big Pharma.

Thinking about anti-vaccination as a social movement oriented around distrust of large companies and state institutions can help us understand not only anti-vaxxer graphic design choices, but also how they see themselves and their opponents.

Well-established meme formats are popular with anti-vaxxers. One common template is provided by someecards.com, which itself is a parody of a traditional style of greeting card illustration. The template has been widely used for memes across the web, and has been easily adapted to the anti-vaxxer cause through juxtaposition of an appropriate slogan.

Anti-vaxxers also subvert the visual language of science and education. One particularly interesting example of this is the adoption of the academic conference poster format to present anti-vaccination ‘research’.

Conference posters are normally used by researchers to present findings, but here the format is used to attack the “measles vaccine racket”. This isn’t a great meme: it’s not funny, it’s not easy to read and it’s certainly not entertaining. The hijacking of the visual language of science to lend authority to anti-vaxxer claims has overridden the simplicity and humour usually associated with memes.

This adoption of the form – if not the content – of science isn’t surprising. Establishing a sense of credibility is key to anti-vaccination arguments’ success.

One of the most popular anti-vaxxer meme forms is the ‘figure of authority’, where a quote from an ‘expert’ – preferably one with a medical degree or PhD – is used to confer respectability. For instance, this example also draws on institutional brands to support its argument: the logos of the British Library and Manchester Public Library are used as marks of quality.

Credibility, along with a sense of history and precedent, is also evoked by memes that reuse 19th-century satirical cartoons. This meme resurrects the vaccination monster of 1802, overlaying it with cropped images of book titles and quotes. The success of this image as a shareable meme is questionable, as it takes quite a bit of effort to work out what’s going on in it. This is often the case with anti-vaxxer memes; alongside snappier campaign images with clear messages, there are denser, text-rich images with more content to be used to bolster arguments.

This meme also makes use of a key anti-vaxxer symbol: the baby. Being recipients of vaccines, babies are often central to anti-vaccination concerns, but they are also used as symbols of innocence and vulnerability, and an as an emotional trigger to evoke sympathy and fear.

Anti-vaxxer memes can also take an uglier turn. Thug Health, a Facebook group, uses threatening and violent imagery, including pictures of guns, to oppose vaccination. Some anti-vaccination campaigners seek to align their beliefs and interests with other political identities, including (typically left-wing) anti-GMO and (typically right-wing) anti-abortion activists, who have a history of violent protest. The imagery in this example is evocative of memes circulated by libertarian, anti-state regulation and pro-gun groups in the USA.

Upping the anti-

Just as anti-vaccination groups form and communicate on Facebook, so do oppositional groups such as Informed Citizens Against Vaccination Misinformation and Refutations to Anti-Vaccine Memes. These groups post pro-vaccination memes, sometimes responding directly to anti-vaxxer memes. The most straightforward of the response forms is the ‘encapsulation’ of an anti-vaccination meme with a commentary that points out its problems, effectively making an anti-anti-vaxxer meme.

Many of the memes circulated in response to anti-vaccination arguments make identity-based attacks. It’s common to question the intelligence or education of the campaigner. The implied logic of this is clear: anti-vaxxers are unable to understand the evidence in favour of vaccines – it’s too difficult for them – and if they could understand it, they would change their positions.

The simplicity of this theory is attractive and suggests an easy solution to vaccine refusal, but unfortunately it’s false. Very few of us understand the statistics involved in clinical trials and even fewer have the time or inclination to scrutinise huge volumes of data. Instead we must trust that somebody with the appropriate knowledge has checked it. The difference for anti-vaxxers is that they don’t have that trust.

Other memes stereotype anti-vaxxers as over-privileged and over-indulged, and typically rich and white. Socioeconomic privilege does allow individuals greater agency to make choices around vaccination, and studies have found that in California school districts vaccination refusals tend to be geographically clustered and correlate with areas where there are higher proportions of white children in schools.

However, a 2015 Pew Research study in the USA found that people who distrust vaccines are more likely to be earning less than $25,000 a year, live in the Midwest rather than more affluent California, and lack college-level education.

After combing through thousands of memes while writing this article, one thing became readily apparent: anti-vaxxer campaigners are almost always depicted as women.

Perhaps this is because mothers are more likely to be making decisions about vaccine refusal. Alternatively, it might be based on a misogynist stereotype that women are more emotional and likely to buy into anti-vaccination beliefs, while men are more rational and ‘scientific’.

Either way this representation isn’t accurate. The same Pew Research study found that men are more likely to have anti-vaccine beliefs. Whatever the demographic makeup of anti-vaxxers, stereotyping them as a uniform group creates a dynamic of ‘us vs them’. It also obscures the fact that vaccine refusal is a global issue, not limited by gender, race or economic status.

Beyond the meme wars

As long as there has been wide-scale vaccination there has been an anti-vaccination movement. In the early days of the internet, it was hoped that open access to knowledge would lead to a more informed and rational public.

However, easier access to research on vaccines doesn’t seem to have helped at all – arguably it’s had the opposite effect. The reason for this may lie in how that research is communicated and how it is used in social exchanges online.

These exchanges are often overtly aggressive. Craig Egan is a particularly prominent online opponent to anti-vaxxers. Described as the “internet’s most prolific troll of anti-vaxxers”, he runs the Facebook page Embarrassed Cousins of Proud Parents of Unvaccinated Children, and stages counter-protests at anti-vaxxer events across the USA. Through his Facebook page, Egan creates and circulates pro-vaccine memes like the ones in this article. He also directly confronts anti-vaxxers in comment threads and forums, stating “I enjoy being, frankly, a pain in the ass to anti-vaxxers”.

While the evidence in favour of vaccination is undeniable, meme creators opposing anti-vaxxers don’t seem focused on communicating it.

As we have seen, pro-vaccine memes are often highly combative, using personal and identity-based insults, or pointing out flaws in the specifics of individual arguments. Taking an oppositional approach like this seems more likely to reinforce a sense of marginalisation and suspicion in anti-vaxxers than win them over.

In a recent blog post discussing the attendance of Egan at a Minneapolis event, the anti-vaxxer website ageofautism.com calls pro-vaccine campaigners like him “mockers and stalkers” and claims they are “empathy-challenged”. While anti-vaxxers are often not much better themselves, perhaps this time they might actually have a point.

Looking through the memes in this article, it’s clear that the current online discourse between pro- and anti-vaccination campaigners is not productive.

To change minds, we need to take a more empathetic approach, considering why people hold a belief and how they see themselves and their opponents. It is of course important to challenge false claims, but it’s just as important to consider how we make those challenges.

Anti-vaxxer memes show a movement strongly characterised by distrust of big business and the scientific claims that underpin vaccines, so we need to acknowledge where the research community has played a role in creating these concerns and address them. Ongoing controversies over ‘sponsorship bias’ in research relating to tobacco, antidepressants and sugar consumption reduce the credibility of research as a whole. Advocating for vaccination needs to be based on robust evidence free from perceptions of bias.

We may never persuade the hardcore anti-vaxxers, but we might have sway over those people that they influence. This requires honest communication and debate with the curious and unsure, which doesn’t begin with personal attacks and insults.

We need to ask ourselves: What would a truly persuasive pro-vaccine meme look like? And how could we get there?