Anti-Vaxxers and Vaccine Hesitancy: A Cottage Industry Gone Big Time

Scientific innovation is rapidly advancing in one direction; key elements of human behavioral response are going in the opposite direction. Old and now new segments of populations unwilling to get vaccinated are expanding. We used to have anti-vaxxers a.k.a. anti-vac protesters, now we have those who give into “vaccine hesitancy”. Together they are gaining momentum in many countries just as new formulations of vaccines emerge almost daily, vaccines that can reduce major infections, hospitalizations, and deaths.

The WHO mantra “Do No Harm” has been seen now by some as a weapon against vaccination.  The reality, of course, is that any vaccine, medicine, or substance introduced to a body will potentially do harm to some very few. Adding strength to vaccine hesitancy is the latest news about AstraZeneca and most recently the J&J vaccine put on temporary pause both in America and Europe because of minuscule numbers of blood clots after millions were vaccinated: less than one case per million vaccinated.

What is so troubling is that the momentum of those opposed to vaccination is gaining such speed, building on social media and unsupported claims. Citizens may well wonder why the public health institutions that are guarding them, the CDC and EMA, have moved to suspend the J&J vaccine rollout. For Europeans in particular, this is all the more puzzling that EMA had earlier decided to approve AstraZeneca which has a very similar structure to the J&J vaccine. 

WHO has been actively alerting the world on its website to an infodemic of false information about COVID-19 spreading online, but to no or little avail. Indeed, there is virtually a universal common theme across platforms: “Every anti-vaxx message can be boiled down to a master narrative of three parts: “COVID-19 isn’t dangerous; vaccines are dangerous; you can’t trust doctors or scientists.” This is all the more concerning that Nature Medicine reports that “investigations show that those spreading misinformation that undermines the rollout of vaccines against COVID-19 are well financed, determined and disciplined”. 

To understand this growing effort to undermine our common health, let’s look first at the broad picture, then sample countries.

The Broad Picture: Anti-vaccine movement Growth and Vaccine Hesitancy

A new report by the Centre for Countering Digital Hate (CCDH) noted that social media accounts held by so-called anti-vaxxers have increased their following by at least 7 to 8 million people since 2019, noting that: “The decision to continue hosting known misinformation content and actors left online anti-vaxxers ready to pounce on the opportunity presented by coronavirus”.  It further noted that 31 million people follow anti-vaccine groups on Facebook, with 17 million people subscribing to similar accounts on YouTube. The CCDH calculated that the anti-vaccine movement could generate US$1 billion in annual revenues for social media firms.

“Attention-grabbing headlines with sensationalist content can attract even the savviest internet users and studies have shown they tend to generate more user engagement”, warned CCDH. “As a result, content personalization algorithms can repeatedly expose people to the same or similar content and ads even on the basis of disinformation.”

The CCDH report divided the online anti-vaccine movement into four groups: 

(1) campaigners working full-time to foment distrust in vaccines; 

(2) entrepreneurs who expose their potential clients to advertisements for products purporting to have health benefits; 

(3) conspiracy theorists; and 

(4) communities with varied reasons to object. 

In a paper published in Nature earlier this year, the authors concluded that “although smaller in overall size, anti-vaccination clusters manage to become highly entangled with undecided clusters in the main online network, whereas pro-vaccination clusters are more peripheral”. They warned that in a decade the anti-vaccination movement – made up of determined anti-vaxxers and those who give into vaccine hesitancy – could overwhelm pro-vaccination voices online.

Anti-vaxxers are training each other in identifying potential targets online. They discuss their tactics for deepening people’s fears, creating doubt as to whether people should take a vaccine, deepening vaccine hesitancy, and converting the chosen few into fully-fledged anti-vaxxers—the people who further propagate the lies. 

Anti-vaxxers distribute themselves across social media, finding new and varied ways to inject misinformation into users’ news feeds. In that sense, they are far better equipped to reach people than are the national health services or WHO which relies on centralized digital communications through accounts with low engagement and little ‘personality’ or ‘authenticity’. Anti-vaxxers see COVID-19 as their opportunity to rapidly create widespread vaccine hesitancy, not just for the vaccine against COVID-19 but, indeed, for all vaccines.

The Country Sampler

The United States

According to a recent Pew survey, a comfortable majority of Americans intends to get a Covid-19 vaccine or has already been vaccinated: nearly 70% of the U.S. public. This represents an impressive 10% jump in vaccine receptiveness since the beginning of the pandemic. 

There is a political difference in vaccine receptiveness. A whopping 83% of registered Democrats are inclined to get vaccinated or have already received a coronavirus vaccine. Republicans have always been more hesitant, but even among registered Republicans, the numbers are improving, with a majority (56%) now saying they are willing to get vaccinated or have already obtained a coronavirus vaccine. Independents fall somewhere between the Democrats and Republicans in terms of their vaccine receptiveness. 

Notably, the difference in vaccine receptiveness between black and white Americans has diminished since November. Sixty-one percent of black Americans now say they plan to get a Covid-19 vaccine or have already received one, up dramatically from 42% in November.

There are other resistance factors at work in the U.S. (and elsewhere). Many holding anti-vaccine views, liberals, and conservatives like, focus specifically on health, religious, or other non-racist views. That said, the basic core of many white supremacist groups is to oppose all government, create fear of “white replacement” by others, a subject recently implicitly embraced by a major Fox opinion host, Tucker Carlson, and subsequently supported by Lachlan Murdoch, CEO of Fox Corporation.

These groups seek any opportunity to sow mistrust as a means to attract and recruit new adherents for their broader anti-government agenda. They know how to utilize social media platforms and take a seemingly unrelated issue like vaccines to draw in and progressively convert others to increasingly active disrupt-government support.

As Dr. Fauci says, statements like the one made by Tucker Carlson with millions of people listening are “certainly not helpful to the public health of this nation or even globally”.

The European Union

The U.S. is vaccinating at a faster pace than any member of the E.U., and three times the E.U. average: The latest numbers are 20 Europeans vaccinated vs. 59 Americans per 100 people.

After US regulators called for a pause in the J&J rollout, and the pharma giant has now suspended the deployment of its vaccine to Europe, the EU, relying on 200 million doses from J&J, is again left in the lurch and facing problems of public trust across the 27 nation bloc. Moreover, this is an additional blow to hopes of getting the whole world vaccinated as fast as possible, considering that the EU was more inclined to export vaccines than either the U.S. or the U.K. 

Here’s just a taste of Europe:


For much of the pandemic, nurses and doctors stood as national heroes who sacrificed their waking hours, safety and sometimes lives to protect their compatriots. It has shocked Italians that in some major hospitals up to 15 percent of those medical professionals — who were given preference in the vaccination rollout ahead of older people — have shunned inoculation.

“It’s really humiliating for the medical and health worker class that you have to force people to vaccinate themselves,” said Roberto Burioni, a virologist at San Raffaele University in Milan and a man who has been described as seeking to “fuse science with vulgar rhetoric to combat anti-vaxxers”. He added that while firing workers is exceedingly difficult in Italy, he hoped the government’s latest decree would bite into the salaries of any vaccine skeptics, especially considering the large amount of data demonstrating that the vaccines’ efficacy is worth the risk. 

Burroni is also worried that the high number of health professionals refusing to get vaccinated has troubling implications. “Unfortunately, there is a huge part of doctors who are deeply ignorant,” he said, suggesting that perhaps “the selection process for bringing people to gain a medical degree and then the medical license is not effective enough.” This may well be the case, but he is undoubtedly venturing into dangerous territory and could further weaken the standing of local public health authorities.


As I write, Germany is facing a dangerous, fast-rising third wave of COVID-19 that is seeing many more young patients in ICU, intubated and struggling for their lives than in past waves. The British variant, doctors believe, is the cause.

German health authorities are pleading with the government to tighten lockdown measures and expand vaccination. But despite repeated warnings from health workers about the urgency of the situation, German lawmakers are mired in a fierce political debate over restrictions imposed to fight the pandemic. A new law that would strengthen Federal control to fight COVID-19 is in the works, and a decision is due Friday.

But German doctors are frustrated, as this video shows.

Perhaps most troubling is that the anti-vax movement in Germany, Querdenken with links to the far right, has been targeting children, a group that is easy prey to vaccine hesitancy. What we see is a new crop of social media celebrities who push disinformation, sell branded merchandise and solicit donations from their followers. One of these is Samuel Eckert, a former evangelical preacher, who runs a public Telegram channel with more than 120,000 subscribers, targeting young people. According to computer scientist Josef Holnburger, who has studied the movement’s rise, this is one of the most popular Telegram channels in Germany.


A February 2021 survey by the independent pollster Levada Center showed that 62% of Russians did not want to be vaccinated with Sputnik V, and the numbers refusing, continue rising. 

Sociologist Denis Volkov thinks the slow pace of Russia’s vaccination campaign is due mainly to skepticism. “There is a lot of disbelief that [the coronavirus] is a serious illness. And that affects the number of people who are willing to get vaccinated.” The pollsters’ most recent survey also shows 56% of Russians say they aren’t afraid of COVID-19 while nearly two-thirds of Russians believe that “the virus was created artificially and is a new type of biological weapon.”

That said, roughly 60 countries have registered Sputnik V, with the Indian Government regulatory authority now approving its use. India is currently battling a second surge of COVID-19 positive cases, and it overtook Brazil to become the nation with the second-highest number of infections worldwide after the United States.

The People’s Republic of China

Two consecutive longitudinal surveys were conducted among Chinese adults in March 2020, during their severe epidemic phase, and then in November– December 2020, when COVID-19 was well contained in China (published on MDPI). The surveys trace the changing acceptance of vaccines between two epidemic phases, including attitude, acceptance, and preferences for future COVID-19 vaccinations.

In March 2020, over 58% wished to get vaccinated immediately, but that proportion declined to 20% in November–December, because more wanted to delay vaccination until the vaccine’s safety was confirmed.  The factors that impacted the intentions of the study participants to get vaccinated immediately are wide-ranging, from risk perception, attitude for the importance of vaccination against COVID-19, vaccination history, valuing doctor’s recommendations and vaccination convenience to vaccine price. “Information about vaccination safety from authoritative sources, doctor’s recommendations, and vaccination convenience were important in addressing vaccine hesitancy and promoting successful herd immunity for the general population in China.”

Unlikely to improve the uptake of vaccines in China is the April 10, 2021 statement by the head of the Chinese Center for Disease Control and Prevention, George Gao that the efficacy of Chinese vaccines is “not high and that they may require improvements”. 

This was a frank statement by a well-respected international leader.  The consequences of this remark will not be limited to China but will most certainly impact the more than 60 countries which have approved at least one of the Chinese vaccines. Unsurprisingly, a Chinese state-run newspaper quickly ran a piece that Gao’s statement had been misunderstood.

What Is to Be Done?

Anti-vax attitudes have been growing in part because the research community has been insufficiently investing in research to understand and formulate ways to get people on board and preempt human reluctance to vaccination and social distancing – in short, stop vaccine hesitancy. Innovations and supplying vaccines are absolutely wonderful and essential. But the demand for the vaccine and people’s acceptance are equally crucial. This requires as I have argued previously, much-heightened investment in the social sciences.

For now, the simple answer is that it will take all of us, the global village, acting in concert to turn this tide of misinformation. 

National and international public-health organizations must do common cause, use the tools at their disposal to strongly refute anti-vaxxers. Health professionals from all cadres and professional associations, scientists, academics, and politicians must engage on social media platforms with community groups and put forward information, reasons, and how to get vaccinated. And the main social media companies need to remove misinformation from their platforms.  It is likely that if all this is done, and enough people get vaccinated to achieve herd immunity, this will itself become a reverse tsunami.

Editor’s Note: The opinions expressed here by columnists are their own, not those of — In the Featured Photo: Anti-vaxxers, What Went Wrong Source: Video (screenshot)


About the Author /

Richard Seifman is a former World Bank Senior Health Advisor and U.S. Senior Foreign Service Officer. He is currently a Board Member of the United Nations Association-National Capital Area.

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