A measles outbreak in Washington has left at least 70 people infected with the virus. How is social media involved?

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Officials worry that pockets of unvaccinated children could put people at risk. Getty Images

With recent outbreaks of preventable diseases in the United States and Europe, lawmakers are increasing the pressure on technology companies like Google and Facebook for hosting or spreading anti-vaccination (anti-vaxx) rhetoric on their platforms.

Nearly two decades ago, the Centers for Disease Control and Prevention proclaimed measles eliminated in the United States, but now health officials in Washington state are battling an outbreak of measles.

With 66 confirmed cases in Washington and four in Oregon, they’ve dubbed the ongoing incident a public health emergency.

A major factor of the outbreak: An anti-vaccination “hotspot” near Portland where nearly seven percent of children were exempted from required vaccines for personal or religious reasons.

Once a fringe belief, anti-vaccination rhetoric initially pushed its way into the national debate on individual liberties and federal oversight. Now, through its proliferation online on social media platforms, the rise of anti-vaxx content has become a legitimate public health concern unto itself.

The World Health Organization lists “vaccine hesitancy,” defined as “the reluctance or refusal to vaccinate despite the availability of vaccines,” alongside the deadly Ebola virus as one of the ten biggest threats to global health in 2019.

In response to the Washington measles outbreak and its links to the anti-vaxx movement, Rep. Adam Schiff of California issued a letter to Mark Zuckerberg and Facebook pressuring them about their policies on how they manage the spread of medically inaccurate information.

“I am writing out of my concern that Facebook and Instagram are surfacing and recommending messages that discourage parents from vaccinating their children, a direct threat to public health, and reversing progress made in tackling vaccine-preventable diseases,” begins the letter.

Schiff concludes with several pointed questions about Facebook’s policies including:

  • whether medically inaccurate information violates Facebook’s terms of service
  • if Facebook accepts paid advertising money from anti-vaccination groups and activists
  • what steps are being taken to prevent anti-vaccine video content from appearing as “recommended” to users algorithmically or through suggested search results

In a response sent to Healthline a Facebook spokesperson said they are working on addressing misinformation.

“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,” a Facebook spokesperson said in an email.

In an earlier response shared with Bloomberg, Facebook said it is “exploring additional measures to best combat the problem,” which could include “reducing or removing this type of content from recommendations, including ‘Groups You Should Join,’ and demoting it in search results, while also ensuring that higher quality and more authoritative information is available.”

Schiff issued a letter to Google addressing similar concerns, but the company did not immediately respond to an emailed request for comment from Healthline, and it has not publicly addressed the letter.

One social media company Pinterest took action by temporarily disabling search function for vaccines in an effort to keep people away from misleading posts.

Facebook has previously taken more serious action against issues such as hate speech and the propagation of various conspiracy theories (and those who spread them), but anti-vaccination is a more sensitive issue.

“Anti-vaccination sentiment, while causing social harm, is not unlawful in the way that hate speech is,” Naomi Smith, PhD, digital sociologist at Federation University Australia who has researched the growth of the anti-vaxx movement on Facebook, told Healthline.

“Anti-vaccination pages often have a lot of natural health advice mixed in with anti-vaccination sentiment so on the surface they can look quite harmless,” she said.

With more vaccine-preventable outbreaks occurring, some lawmakers are now keen to pressure tech companies into taking action against the spread of misinformation as it pertains to public health, even if its actual harm is harder to pinpoint.

“Internet companies like Facebook and Google are slowly coming to terms with the fact that they do bear some responsibility for information that causes social harm,” Smith told Healthline. “Facebook has accepted that it needs to regulate gun sales, hate speech, and other causes of social harm on its platform, so Facebook needs to seriously consider how it can help users access high-quality information in their news feeds.”

Fighting back against misinformation has become a goal of public health organizations, but, mediating free speech — even if medically inaccurate — is often beyond the scope of these groups.

The American Academy of Pediatrics (AAP) has firm policies on vaccines and vaccine scheduling — namely that they are safe, effective, and necessary — but doesn’t have a specific recommendation on how social media platforms should handle anti-vaccination rhetoric.

“Our first job is to listen. To hear parents’ concerns and make sure that we have reliable information to share with them and that we’re very transparent about where this information comes from and what the quality of it is,” said Dr. David Hill, FAAP, chair of the AAP Council on Communications and Media.

“Where the conversation is happening online, that’s where we need to be,” he said.

Today, he says, the AAP has plenty of pediatricians — or “tweetiatricians,” as he calls them — that are active on social media.

And they’re taking initiatives online to make sure that they’re spreading accurate, transparent information for parents all over the world. Although, he admits, they’ve had to play catchup to the speed at which anti-vaccination rhetoric has proliferated on social media.

The larger question for the medical community is whether they think limiting anti-vaccination rhetoric on Facebook (and beyond) would have real-world consequences like saving lives.

“I don’t know that I have enough data to answer that question,” Hill said. “I’d need to see another case where changing the virtual conversation changed what people actually did.”

Smith was more outspoken: “A high rate of community vaccination coverage absolutely saves lives… Clearly communicating the benefits of vaccination, and combating the misinformation that makes people reluctant to vaccinate is really important.”

With outbreaks of vaccine-preventable diseases popping up in New York, Washington, and Texas in the last year, it is increasingly likely there will be a push to address the public health effects of the anti-vaccination movement, either from technology companies, government agencies, or both.

This month the U.S. Food and Drug Administration (FDA) also appears to be mulling action to clamp down states’ rights to allow vaccine exemptions for personal and religious reasons after the outbreak in Washington.

“Some states are engaging in such wide exemptions that they’re creating the opportunity for outbreaks on a scale that is going to have national implications,” said FDA Commissioner Dr. Scott Gottlieb, MD, in an interview with CNN.

If “certain states continue down the path that they’re on, I think they’re going to force the hand of the federal health agencies,” Gottlieb said.

The debate over anti-vaccination is one that has grown to a profound philosophical degree, weighing the freedoms of individuals and the sovereignty of parents against the mandates of public health.

But bringing that conversation back down to earth has become much easier to do as measles currently ravages a community in Washington.

No deaths have been reported yet, but as Hill puts it, “One person is too many when you have a completely preventable disease.”