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With more than 250 cases of measles reported across the United States in 2019, doctors and lawmakers have increasingly scrutinized technology companies for their role in the spread of anti-vaccination rhetoric.

One month ago, Rep. Adam Schiff, Democrat of California, issued a letter to Mark Zuckerberg, Facebook, and Google addressing those concerns. In the weeks since then, many top tech companies, including Facebook and Google, have stepped up to address them as well.

Now, more medical organizations have issued their own warnings, including the American Academy of Pediatrics and the American Medical Association.

Earlier this month, the American Medical Association issued a public letter to the CEOs of Amazon, Facebook, Google, Pinterest, Twitter, and YouTube.

The central questions posed to tech companies: How are these platforms spreading anti-vaccination rhetoric and what, if anything, is being done to stop it?

“While misinformation is spread in many different ways, we know that social media is a leading source of how Americans are getting their information today,” AMA President Dr. Barbara L. McAneny, told Healthline.

McAneny explained why experts are worried that more and more parents than ever before get health information from social media.

“We are concerned that the proliferation of this type of health-related misinformation will undermine sound science, further decrease vaccinations, and persuade people to make medical decisions that could spark the spread of easily preventable diseases,” she said.

The American Academy of Pediatrics also sent out a similar letter to major tech companies on March 4 — an apparent about-face for the organization. When Healthline spoke to the AAP in mid-February they said they did not have a position on the role of technology companies and social media in spreading anti-vaccination messaging.

In regard to that change in position, Dr. David Hill, FAAP, chair of the AAP Council on Communications and Media, told Healthline, “The AAP has a very thorough and deliberate process for making any public statements to ensure that they reflect the best available evidence… [I]t resulted from AAP board members’ conviction that addressing how social media companies treat vaccine-related searches can make a real difference in children’s health worldwide.”

Still, the way tech companies address the issue — if in fact it is their responsibility — has yet to be resolved. It’s clear that there isn’t a simple answer, and a one-size-fits-all solution won’t work.

Facebook is designed as a completely different experience than, say, Twitter or Pinterest. Search algorithms and recommendations — the nuts and bolts of why some content appears for some users and some doesn’t; and why it appears at all — also varies.

For that reason, Healthline has investigated each of the six companies named in the AMA letter individually. Here is how they have responded:

Pinterest, a “visual search engine” and social media site with more than 250 million active users, was one of the first to take action against anti-vaccination messaging. The site has already taken steps to block vaccination-related searches.

The site’s health misinformation policy, which has been in place since 2017, doesn’t allow for advice which has “immediate and detrimental” effects on health and public safety, including anti-vaccination rhetoric.

A Pinterest spokesperson told Healthline the following:

“We want Pinterest to be an inspiring place for people, and there’s nothing inspiring about misinformation. That’s why we continue to work on new ways of keeping misleading content off our platform and out of our recommendations engine.”

The massive online marketplace has come under fire for allowing the sale of anti-vaccination books and products. The company has also been accused of accepting paid advertising money from anti-vaccination groups.

The company has subsequently removed some anti-vaccination books from retailers, as well as anti-vaccination documentaries from its video streaming service Amazon Prime.

An Amazon spokesperson told Healthline that they have received the AMA’s letter and are reviewing it.

The popular “microblogging” site has not received nearly as much heat on the issue of anti-vaccination rhetoric compared with Facebook and YouTube.

“Twitter’s open and real-time nature is a powerful antidote to the spreading of all types of false information. This is important because we cannot distinguish whether every single Tweet from every person is truthful or not. We, as a company, should not be the arbiter of truth. Journalists, experts and engaged citizens Tweet side-by-side correcting and challenging public discourse in seconds,” a Twitter spokesperson told Healthline.

The company doesn’t have a specific policy regarding specific tweets by individuals on vaccines and anti-vaccination. The spokesperson said that ads related to anti-vaccination could potentially violate their policies in several ways, including making claims about curing or preventing certain diseases or by being inflammatory and provocative.

YouTube, which is owned by Google, and is the most popular video-sharing site in the world, is demonetizing channels and videos that promote anti-vaccination rhetoric.

“Providing our users with trustworthy information is core to our mission, and anything discouraging parents from vaccinating their children against vaccine-preventable diseases is concerning. We’ve put a lot of effort into curbing misinformation in our products — from better search-ranking algorithms, to improving our ability to surface authoritative content, to tougher policies against monetization of harmful or dangerous content on YouTube. We know our work here isn’t done, and we’ll continue to evaluate our efforts to help improve our products,” a spokesperson told Healthline.

The company said it is taking to steps to ensure that the information that users get is accurate, in-context, and well-sourced. Those steps include modifying “suggested videos” recommendations to include authoritative sources and linking to informational websites such as Encyclopedia Britannica and Wikipedia.

Earlier this month, the popular social media site said that it will no longer show Pages and Groups that spread anti-vaccination rhetoric in search results. They will also stop showing up as “recommended” for some users.

The company will also crack down on ads from anti-vaccination groups.

Although Facebook did not respond at the time of writing, a spokesperson told Healthline last month, “We’ve taken steps to reduce the distribution of health-related misinformation on Facebook, but we know we have more to do. We’re currently working on additional changes that we’ll be announcing soon.”