Viral spread: Peter Hotez on the increase of anti-science aggression on social media

Last November, Twitter announced it will no longer enforce “the COVID-19 misleading information policy.” The platform also allowed previously banned users to rejoin the site. Since then, anti-vaccination messaging has gained renewed energy, distressing scientists and researchers who have been combatting misinformation and disinformation on social media. According to research, there’s a strong relationship between anti-vaccination efforts on social media and vaccine hesitancy, and while millions of people were saved by having taken the COVID-19 vaccines, hundreds of thousands of Americans died after refusing it.

Peter Hotez, a physician-scientist, dean of the National School of Tropical Medicine, and a professor in the departments of Pediatrics and Molecular Virology and Microbiology at Baylor College of Medicine, is no stranger to anti-vaccination attitudes. He has fought against misleading medical information for years. But now, he says, anti-science sentiments have been weaponized by businessmen and politicians seeking profits and power.

In the 1940s and 1950s, the House Un-American Activities Committee (HUAC) investigated and discredited several scientists who worked on the Manhattan Project. Hotez expects congressional committees under Republican control to engage in a similar targeting of scientists in an attempt to accumulate influence and foster a sense of belonging—a signature of authoritarian regimes—among their constituents. In his view, this anti-vaccine, anti-science movement, versions of which are spreading to other countries, could destabilize the global vaccine ecosystem.

I spoke with Hotez about the role of social media in spreading misleading information on vaccines and stoking anti-science aggression in many dimensions. The resulting discussion has been edited for length and clarity.

Sara Goudarzi: You’ve been on Twitter for more than a decade and often use it as a tool to communicate health and science facts, such as the importance of vaccinations. How in your experience has the social media platform changed during this time?

Peter Hotez: Well, it’s become a lot more adversarial as the anti-vaccine movement has shifted. The anti-vaccine movement began in earnest around 20 years ago in the United States around false assertions that vaccines cause autism. The way I got involved was because I have a daughter with autism, and I wrote the book Vaccines Did Not Cause Rachel’s Autism: My Journey as a Vaccine Scientist, Pediatrician, and Autism Dad, and that made me public enemy number one or two with the anti-vaccine activists.

What I would do at that time of social media was use their statements in their attacks against me as a teachable moment, to expose what the anti-vaccine movement was all about and how they were monetizing the internet with books on Amazon and nutritional supplements and the phony autism cures. So, rather than simply block people who were attacking me, I would retweet them with a little description of what they were doing. People found it very interesting because it was teaching them how an anti-science movement works, and they started coming to my Twitter for that purpose.

The game changer was about nine years ago, when [vaccine disinformation] became a political movement around health and medical freedom. You saw a different set of actors come into this, and it became a lot more aggressive; people’s political allegiance became tied to not giving their kids vaccinations, and that has just come off the rails with COVID-19. And I’d like to point out that 200,000 Americans now have needlessly lost their lives because they refused the COVID vaccine.

The hardest thing yet is really trying to describe the anti-vaccine ecosystem, because too often it’s still couched in the old autism thing that they call infodemic or give it euphemisms like misinformation or disinformation. That is, as though it’s some random stuff appearing on social media, when in fact, it’s organized, politically motivated, and deliberate. It has a system in place, and what I do now is use that to actually describe who the actors that comprise that ecosystem are—elected leaders in the House Freedom Caucus, certain senators, and local leaders amplified in Fox News with designated contrarians from the far right think tanks.

All our training to be a scientist says you’re not supposed to talk about Republicans, Democrats, liberals, or conservatives; you’re supposed to be politically neutral. But what do you do when the anti-science, anti-vaccine aggression is predominantly coming along the partisan lines from the far right? How do you articulate that without basically saying, “the reason I’m doing this is to save lives?” It’s no longer a theoretical discussion; Americans have lost their lives because they believed the politics, and to be able to articulate that is really threading a needle there.

Goudarzi:  With Twitter’s moderators practically gone, the platform’s announcement that it will no longer enforce measures to combat misleading information regarding COVID-19 and will give amnesty to previously banned users, there seems to be a rise in anti-vaccination sentiment.

Hotez: It’s blown up. It’s gotten much tougher: Anything I put out there gets immediately pounced on, and I can trace the origins to four or five either elected leaders or these contrarians from far right think tanks and elsewhere who blow dog whistles. They will put out a (typically false or exaggerated) statement against me, and then I’ll receive hundreds and hundreds of tweets or emails specifically targeting me. About half of them look like bots because the person sending it is an empty face with a gazillion numbers attached to the Twitter handle. But others are real people tuning into Fox News every night who totally fall into the rabbit hole because they seem to worship these contrarians. The other piece to this is a lot of Nazi imagery and fantasies, a lot of antisemitism, because they know I’m a Jewish scientist. And that’s yet another dimension to all of this.

Goudarzi: How do you think this affects patients in healthcare settings? Have you had personal experience with those who decided not to get vaccinated because of information on the internet or social media indicating the shots are dangerous?

Hotez: I’ve had sort of the opposite experience, where patients were in the rabbit hole, had seen my postings, see me as credible, and because of me are taking the vaccine, which is kind of nice and spurs me on to keep going at this. But more and more I’ve also had the other extreme as well, which is based on what they see on social media: People will take the time to write me a threatening email or make a call to the lab or to the office. Then I have to bring in law enforcement through the Texas Medical Center Police or the Houston Police Department and the Anti-Defamation League (because they have a list of individuals who are known to make these types of threats). It’s taken this very, very dark turn as a consequence.

Goudarzi: Anti-vaccination movements are nothing new and go back to the late 1700s, even before the development of the smallpox vaccine and then the 1800s and again in the 1990s and 2000s. Do you think social media has allowed the latest movement to gain even more steam than previous movements?

Hotez: I wrote an article about the whole history of [anti-vax movements] in Journal of Clinical Investigation. I think it really accelerated in the early 2000s with autism, in part aided by social media—it was new then but was starting up. Now, I think social media has really been an enabler. It’s not only social media; I think amazon.com was a big contributor. If you search for books on vaccinations, what’s out there is a horror show. My books are among the top-rated on vaccines, and they’re probably ranked about number 30 or 40, because it’s all preceded by the phony-baloney, anti-vaccine COVID conspiracy books. So, it’s Amazon and social media. And Fox News is having a huge impact. This has been documented by Media Matters, the watchdog group, as well as this very interesting paper that came out of ETH Zurich, which is like the MIT of Central Europe.

Goudarzi: Do you think Amazon is purposefully placing these books higher up in search results, or are search results just a reflection of how much steam the movement has gained?

Hotez: I don’t know. Amazon is probably amoral. I don’t think they think about this one way or the other, but whatever sells. So, it’s whatever people are buying—that’s how they’re ranking it.

Goudarzi: Are you seeing a difference in the attitudes towards COVID-19 vaccines versus say the flu or MMR vaccines?

Hotez: Yeah, because remember, MMR came out of autism; that was the [original] assertion that the MMR vaccine causes autism. That was [The Lancet] paper from 1998. But then around 2014, 2015 (I like to think because I was helping to take some of the wind out of the sails around autism), you started to see the anti-vaccine movement pivot around this concept of health and medical freedom, that you can’t tell us what to do about our kids. And that was the first link to the Republican Tea Party here in Texas. In fact, they started getting PAC [political action committee] money… It really took off in Texas and Oklahoma and that’s what you see came off the rails with COVID-19.

It has been documented now by Charles Gaba, a health analyst whose work has been mentioned in the New York Times, National Public Radio, Pew Research Center and Peterson Academic Center, that the lowest vaccination rates were where health freedom propaganda was the strongest, and among those who are in red states like Texas, the redder the county, the lower the vaccination rate, the higher the numbers of deaths. It’s a really tight correlation, so much so that David Leonhardt in the New York Times has called it red COVID. My forthcoming book, The Deadly Rise of Antiscience: A Scientist’s Warning and it’s full on linked to far-right politics and it’s been embraced by the House Freedom Caucus.

After vaccines became widely available, the statements from the 2021 CPAC conference of conservatives in Dallas was first along the lines of: “they’re going to vaccinate you, and then they’re going to take away your guns and your bibles.” It’s ridiculous. A quarter of the country accepted it—mostly in Texas and the Southern states, and then [Georgia US Rep.] Marjorie Taylor Greene called people like me “medical brownshirts,” using Nazi paramilitary analogy. Then, those in the Senate GOP, such as Senator Johnson from Wisconsin, held anti-vaccine roundtables, amplified by Fox News. Every night, during the last half of 2021, nighttime anchors Tucker Carlson and Laura Ingraham filled their airwaves with very strong anti-vaccine rhetoric, discrediting the effectiveness and safety of vaccines. And then contrarians from the far right think tanks piled on.

As I said, if it were just a theoretical construct, I wouldn’t get so exercised, but 40,000 Texans died during the delta wave in the last half of 2021 and early Omicron BA1 wave in 2022 because they refused the COVID vaccine and were victims of this targeted aggression towards them. The number that I put out in the new book is 200,000 Americans across the country. The Kaiser Family Foundation and the health analyst Charles Gaba come up with similar numbers.  On that basis, anti-vaccine activism, anti-science aggression, if you look at it as a societal killing force, is killing more Americans than gun violence, terrorism, nuclear proliferation, or cyber-attacks.

Goudarzi: And the interesting thing is that COVID-19 vaccines have been tremendously successful.

Hotez: Alison Galvani at Yale has just done a modeling exercise with the Commonwealth Fund, indicating that COVID vaccines have saved 3.1 million Americans.

Goudarzi: Yet the messaging against these vaccines seems to be just as successful and as you mentioned hundreds of thousands of deaths could have been prevented here in the United States. So, it begs the question, why are we having such an anti-science moment?

Hotez: It’s because it’s fully ensconced in the political landscape of the country that became part of the far right, and people refused the vaccine out of allegiance. Part of showing your allegiance to the far right is not getting vaccinated. Then, you saw the Proud Boys march in anti-vaccine rallies, and an early arrest in the January 6 insurrection included a prominent anti-vaccine activist.

The question that I get is: “Hey doc, what should we do about this?” And I say I don’t know, because this goes outside the health sector. This is a political problem right now. How do you uncouple the anti-science from the politics? It’s been really, really challenging, and the Biden administration has not been willing to take this on. Vivek Murthy, who is a very good Surgeon General, issued an advisory in July of 2021 about social media and said we have to work with Meta and Facebook and Twitter to prevent this stuff from going viral. That’s fine, but it doesn’t get to those who are generating the content. This is where we’re starting to see breakdowns, in my view, among our scientific and professional societies, and even the National Academies, because this idea that we have to remain politically neutral is so strong that no one will talk about it the way I’m talking about it with you. You have to be politically neutral; it’s silly.

To paraphrase Desmond Tutu and Elie Wiesel, neutrality favors the aggressor.

Goudarzi: What do you think the end goal is for those generating the content and spearheading these movements? There are certain people who truly believe that vaccines could cause x, whatever x is, but there are others like Gov. DeSantis who himself was vaccinated yet promotes anti-vaccination sentiments.

Hotez: Early on when vaccines first came out, he was actually pro-vaccines. So, what caused the change? When it was pre-health freedom, it was fairly straightforward: It was people monetizing the internet, selling nutritional supplements and books on phony autism cures. When I wrote the book, trying to look at other examples of this, I found what’s going on now in Stalin’s Russia in the 1930s 1940s. This is part of the signature of an authoritarian regime: to target the science and scientists. When you read Hannah Arendt’s The Origins of Totalitarianism, you see this is part of the playbook. Even though it’s self-defeating, it still fosters allegiance and belonging. I think what happened is with the anti-vaccine groups for whom the wind was let out of their sails around autism, they needed a new thing. They found money and power and relevance by tying themselves to the far right, and the far right created a whole new cadre of people that they wouldn’t have otherwise.

Goudarzi: Just add adding to that: Do you think vaccine disinformation is propagated or reinforced purposely by other governments to cause division within the United States, similar to the 2016 election?

Hotez: No question about that, and I think Russia is probably the most egregious [perpetrator], and this has been documented. David Broniatowski, a computer scientist at the George Washington University, has written about this and the Russian bots’ roles. In some cases, they’re using both anti-vaccine and pro-vaccine rhetoric. They are specifically using this as a wedge issue to divide the country and destabilize our democracy. And it’s not only the Russians—the Chinese, North Koreans and Iranians are doing this. But I think Russia is probably the biggest state actor.

What I’ve recommended to the Biden administration is they create an inter-governmental agency, because the United States Department of Health and Human Services (HHS) doesn’t know what to do at this point. Because of the foreign actors involved, you have to bring in Homeland Security, the Commerce Department, the Justice Department and the State Department as well. There are people smart enough who know about these big dangerous societal forces, and we need their advice on what levers we can pull and push. But they haven’t wanted to take it on.

Similarly, at the level of the UN agencies, the World Health Organization doesn’t know what to do at this point. So, you’re starting to see that same US-style anti-vaccine activity moving to Canada, the United Kingdom and Western Europe—and I wrote about this in a paper in Nature Reviews Immunology. You’re even seeing it now in low- and middle- income countries, including those in Africa. So, it’s going to destabilize the global vaccine ecosystem, even around childhood vaccination.

Goudarzi: Scientific debate around new treatment or preventive measure used to happen more or less behind closed doors. But given the nature of a real time pandemic, some of those debates are taking place on social media, and sometimes that leads to the lay audience misunderstanding certain aspects of the discussion and spreading misinformation. How valuable, and how harmful, do you think it is to have scientific debates between researchers on social media?

Hotez: It’s often not between researchers. For instance, one of the most common things when they target me on social media is they say I should be in a public debate with the lead anti-vaccine activist. And I say, “No, that’s not how science is done. I’ve written a scientific paper and if somebody has an issue with that, they can either refute it in a scientific journal, or publish their own finding.” Of course, they can’t get it published because there’s no science behind it. So, what they want to do instead is they want a public debate.

And I say, “Look, you can debate 18^th-century enlightenment philosophy, but science is not typically something that’s debated in that kind of forum; we have a mechanism for doing that through scientific publication and peer review.” And they don’t want to play that way. They just want to put out their propaganda because that’s all they have behind it. An example is ivermectin or hydroxychloroquine, which the scientific community has clearly shown has no effect on COVID-19. Hydroxychloroquine is even harmful. But the problem is the anti-vaccine force has dominated the internet, and they say, “Hey, scientists don’t want to debate us, what are they hiding?”

And that’s, again, how they weaponize communication.

Goudarzi: I was actually thinking of earlier during the pandemic. Because there was so little time, some researchers were putting their papers up on open access preprint servers, which didn’t require a peer review, and then others were weighing in on social media platforms. At times, you would see non-scientists take one aspect of that discussion and spread something that wasn’t necessarily true.

Hotez: I think with the whole preprint server mechanism, ultimately the benefits outweighed the downside. I can’t tell you how many times I had to depend on data from bioRxiv, medRxiv in order to make sense of what was going on. If I had to wait a few weeks for it to air in New England Journal of Medicine or Nature and Science—and by the way, they did a pretty good job too; they were able to turn that around in record time—[it would have been too late.] If you’re looking for any silver lining in this pandemic, it’s the journal editors, the whole preprint server mechanism, and the willingness of the scientific community to share information. And I think for most of the public understood that they were seeing this play out in real time and that there wasn’t always going to be consistency. The problem was those who were who were weaponizing it for their own personal or political gain.

Goudarzi: But you still think the advantages outweighed the disadvantages?

Hotez: I think so. It’s hard to imagine how I could’ve really talked about everything going on knowledgeably on CNN, NBC, or wherever without having access to the information. The preprints were so important.

Goudarzi: Some researchers have either left Twitter or are thinking of leaving. What will this do to scientific discourse? Would it make sense to stay on the platform to counter misinformation and disinformation and increase public awareness, or should researchers seek a more balanced platform?

Hotez: I don’t have the answer. I struggle with this every day. I mean, the aggression against me and the threats would continue even if I wasn’t on Twitter, because more often than not, it’s not against anything that I tweeted. Ninety percent of the time, it’s people who see me as a threat to undermine their politics or their business line and are just making up things about me and would still continue even if I wasn’t on Twitter. So that’s the reason I stay on it, because at least I’m getting out important and timely information. But it is really painful and awful to see what’s going on there.

Goudarzi: Is the amount of aggression you face tied to the changing ownership of Twitter and political shifts?

Hotez: The politics around the anti-science, anti-vaccine and phony baloney about COVID origins had started with the pandemic in 2020. But now with all the contrarians back at once it reminds me of the old Batman series when they brought back Catwoman, Joker, Penguin, and Riddler all at once to do away with Batman. That seems to be going on, so it’s been their superstars who are super energized by being invited back to Twitter, and they are using the platform very aggressively.

Goudarzi: What are some of the lessons we’ve learned about disinformation and misinformation over the last few years regarding social media that we should consider moving forward?

Hotez: I would say social media is a major weapon of choice for spreading disinformation. But remember, we have to get to those who are generating content. Social media is an important vehicle, but it’s not the only one. I think we probably should stop calling it misinformation, disinformation or infodemic. We should call it for what it is, which is anti-science aggression, because it is a killing force. What we realized is that the science aggression is taking lives in the United States on an unprecedented scale.

For that reason, it needs to be addressed, and that’s the part the scientific community has not come to terms with. When I call myself a scientist, it’s not just co-heading a team of scientists making a COVID vaccine for the world that has reached a 100 million people. That’s a very noble activity, but from my perspective, even that’s still insufficient. Now being a scientist means, to some extent, being willing to combat the anti-science. It’s nothing that any of us signed up for. I never dreamed when I got my MD-PhD in New York in the 1980s that this was something I’d be doing, but this is what’s in front of us.

And I don’t really feel that the scientific community—the professional societies, scientific bodies, even the academy—fully understand the impact. Hopefully it’ll be clear when my book comes out, but it may become even clearer when we see the House GOP hearings. I predict the oversight committee and the judiciary committee or select subcommittees will become an anti-science witch hunt and will target prominent American scientists. And then we’ll get a better picture.