Information ecosystem disrupting health, Ex #6: A well-funded and well-organized “anti” movement counters health advice and politicizes health

Gone are the days when we thought that a focus on messages is sufficient to enable behavior change (RIP the “information deficit model”).

• Or, when we thought that if people just had the “right” information, they would make healthy decisions (RIP the “knowledge deficit model”).
• Or, when we thought that individual behavior change is sufficient to overcome systemic problems.
• Or, when we thought that behavioral nudges are sufficient to enact meaningful behavior change in health.
• Or, when we thought that people will trust health services and products as long as the science and evidence was well-communicated to them.

Achieving collective action is more complex than simple models that ignore this complexity.

The issue that health systems are also dealing with are the very well-funded “anti” movements, especially on certain health topics, like reproductive health and vaccines.

There’s an organized opposition to the health system, its mandate and tools.

The organized “anti” networks can be harmful because they exploit the “anti” sentiment of a wider group of individuals to either turn a profit, promote a political agenda, or both at the same time.

A byproduct of this “anti” activity is also further politicization of health and polarization of discussions by reinforcing mistrust in government and institutions.

“anti” beliefs in health are not monolithic and are socially reinforced

The share of people with hardened “anti” beliefs in our societies is small. But those whose world views may link up with the hard “anti” narratives is bigger.

• We tend to think about health advocacy and circulating narratives as topic-based – that people are vaccine sceptic or not, that they share misinformation or not, etc. In reality, people don’t think in topic-specific buckets on issues. For example, COVID-19 misinformation mixed with misinformation on GMOs, alternative treatments, wellness, and even astrology.
• People react to narratives that are compatible with their own beliefs, concerns, worldview and values. They’re also more likely to share and amplify such narratives.
• This means that narratives and beliefs are reinforced through a shared social linkage among members of a community, and even if some people exit the network or new ones come in over time.
• In communities, health topics mix and run parallel to other concerns and experiences in a community. A recent such example is the analysis of Hispanic community’s concerns in South Florida which showed that information needs span from health through elections.
• When we decide to trust, we draw upon a set of personal biases, experiences, interactions, and viewpoints, each influencing our judgment in its own distinct way. We understand any additional information we come across through the lens of past information and experiences.
• Coercive actions and confrontations against “anti” believers often harden the polarizations because “anti” believers experience them as proof of their world view. For example, banning “vaccine misinformation spreaders” in social media has not changed the misinformation narratives that circulate in communities.
• Because “anti” views are a social construct, we cannot diffuse them with solutions focused only on the individual (like improving critical thinking and literacy). Strategies that attempt to reduce polarization of views within a community (to open up discussion), and structural approaches (like regulation) are equally important.

The changing social and political environment for public health is challenging confidence in public health services and products

Health as a topic is increasingly intertwined with various political issues, reflecting broader societal debates and values. Health authority work becomes less effective and takes more effort to implement in such an environment.

• When it is accepted that health and well-being are more of a political topic than a matter of common good, then health-related narratives can be more easily misused for political, profiteering, and influencing motives.
• This politicization of health is taking place at the same time trust in institutions is eroding. This requires even more effort and partnerships from a health authority when it is providing services to people who have questions, concerns, information needs, or have low confidence in public health services and products.
• Public health efforts can also be eroded by the anti-science movement that links up different topics and reduces confidence in public health (or increased confidence in “alternatives”).

The organized “anti” networks in health leverage people’s questions, concerns and eroded confidence for their own profit and political gain.

The “anti” movements are not just about simple social media activity discussing particular topics or spreading mis- and disinformation. They have grown sophisticated and organized, and counter the work of health authorities and public health professionals.

Take the example of the antivaxx and anti-abortion movements.

Anti-vaccine and anti-abortion efforts consist of varied groups of people with different agendas. But the bottom line is that they advocate for systemic, political, economic, and legal changes that would erode use of vaccines, and make abortion and other politicized health products and services not only inaccessible and unsafe, but also illegal.

Motivations for promoting such activities vary.

• some see the financial opportunity in promoting vaccine fears, alternative treatments, and anti-abortion services and products. For example, a pastor in Nigeria has advocated anti-vaccination for decades and used it to build his businesses, which include print, TV and music media, hotels and real estate, a streaming service, a messaging app, and a microfinance bank. Here’s also an example of a similar business scheme in health misinformation and disinformation in the US and in Ireland.
• others, including politicians, use opposition to vaccine mandates and anti-abortion positions as a political tool. Like RFK JR, a presidential candidate in the 2024 US elections, who has turned his brand of speaking truth to corporate interests, protection against government totalitarian control and antivaxx sentiment into a political campaign. The other Presidential candidate in the same election, Donald Trump, has leveraged the antivax activities in his political campaigning as well.
• for some, embracing these positions within different conspiracy theories helps make sense of the world, despite leading to distorted beliefs. For example, the anti-abortion positions in the US are linked to the conspiracy theories warning of replacing whites with other races through immigration.

Similarly, the organized anti-science sentiment leverages the internet for advocacy, coordination and fundraising – especially focusing on public health and environmental science topics (GMOs, anti LGBTQ+ pseudoscience network, climate denial, etc). (As a side note, I think that the drivers behind the anti-science attitudes are the underlying shared mistrust of government and governmental regulations. They have spread from United States through conservative political networks to other countries.)

Additional problem with so devalued health advice, scientific evidence, or politicized health is that they are promoted by narratives that can be easily hijacked and leveraged by foreign disinformation campaigns by state actors to sow mistrust in institutions and cause confusion and conflict in targeted countries. Here’s an example of such a Russian anti-science campaign aimed at the US.

The “anti” movements are small in numbers but have large societal impacts.

I call these dynamics “movements” because localized groups and communities that blend different issues are complemented by organized, well-funded networks of “anti” advocates that push buttons in political, business, and legal systems.

1/ They have large funding – they either self-generate it online and/or get the funding from large politically motivated donors.

• Analysis of tax records and the payments to executive officers of NGOs that have peddled COVID-19 and antivaxx misinformation indicates that these NGOs have received increasing injections of donations since the end of the pandemic. With the money, they’ve increased public outreach, supported and built capacity to influence legislation and bring law suits to weaken vaccine requirements, and defend physicians accused of spreading misinformation.
• European anti-reproductive rights, anti-LGBTQ+, and antigender organizations have been funded significantly by donors from the US and Russia.
• Similarly, the funding of the anti-climate-change movement has been investigated for a long time.

2/ They use organic tactics that span online, systemic and in-person approaches.

• In the US and other countries, there has been an increase of the use of law suits and threats of law suits to harass supporters of health services and products away from advocacy, promotion, and work. Even more broadly, US congressman Jim Jordan and other Republicans in the US Congress have achieved a chilling of academic research that studies political disinformation and the quality of health information online.
• Reshaping legislation, legal precedents, and using threats of lawsuits against government and health offices has been well documented in the US. Take example of America First Legal, an organization that uses US Freedom of Information Act requests and lawsuits to publish misconstrued analyses of information, fueling further misinformation/disinformation and hate speech on topics such as gender and LGBTQI+ rights, vaccination, public health, social measures, and others. However, the legislative push is also taking place elsewhere.
• A recent investigation into the anti-abortion “Crisis Pregnancy Centers” in the US describes the CPC industry’s role in the anti-abortion, anti-LGBTQ+ movement. US CPCs are plugged into the global networks that leverage digital tools and data to expand, profile clients, and promote anti-disinformation disinformation.
• An analysis by Graphika aptly describes how anti-abortion social media influencers use three main tactics: spreading false information about abortion safety, methods, and necessity; supporting harassment of abortion providers, advocates, and seekers; and treating individual stories as universal truths. Typically, the more damaging acts, like real-world harassment, are committed by less influential, local supporters. Influencers with larger followings often highlight these actions, framing them as defending unborn children, which encourages similar behaviors among other smaller groups.
• In Europe, tactics against human rights include creating organizations funded by foreign sources, employing SLAPP lawsuits to intimidate critics, and laundering money and reputations. Other methods involve physical harassment, deploying paid groups to disrupt LGBTQ+ events, hacking journalists’ devices using software like Pegasus, and using troll farms to spread disinformation targeting LGBTQ+ activists.

3/ They link up through networks and aspire to have impact globally, not only in own countries.

• The ambition for a global impact is not new, but it is being done more effectively. In the anti-abortion space, the legislative and political limitations imposed on US foreign aid have impacted reproductive health programmes globally, especially in LMICs. But disinformation networks targeting reproductive health (and other topics) in LMICs has also been documented from Russia. And anti-abortion networks in Europe are trying to replicate US tactics in their own countries. The Swiss anti-abortion activists have learned from the US and from other countries.
• Similarly, the US far-right and the Russian Orthodox Church have funded attacks in Europe against sexual and reproductive health, women’s rights and LGBTQ+ people.
• Less organized, but similar impact disinformation patterns were seen during the pandemic on antivaxx topics, for example spreading to the Phillipines, and Japan.

Bottom line

The “anti” networks in health use a combination of tactics, and so should any efforts to counter them.

They also leverage the mistrust and low confidence in a wider set of communities, so any preventive measures must address the questions, concerns, and needs for information and services in a wider set of communities.

Here’s what we could do:

Address vocal science deniers, but be careful

• When speaking with people denying scientific evidence, there are refutation techniques that can be used in such conversation. However, public health professionals have historically been reluctant to directly confront vocal vaccine deniers or anti-abortion activists to reduce the opportunity for the organized anti-vaxxers or anti-abortion activists to use the experience or recordings of the conversations in their follow-up misinformation campaigns. WHO has a good resource on considerations on responding to vocal vaccine deniers in public, and I think this is easily adapted to other polarizing health topics.
• Strategies for addressing the “anti” viewpoints in health should be designed with the perspective of communities affected by the “anti” viewpoints, organizations serving people in the “anti” movement, and health professionals.

Analyze and understand the organized “anti” network legal, financial and social activity

• More research needs to be done and published in the online activities of “anti” social networks to identify the narratives and their underlying drivers in different communities, and international/organizational connections of the social networks.
• More research needs to be done on the legal tactics, arguments and cases that are being brought by the “anti” movements, either for purposes of intimidation or for changing legal precedents and practice.
• In addition to making knowledge resources available to health authorities who are being sued for their public health policies, there’s also a need for a network of legal experts that are familiar with “anti” movements’ legal practices who can be called as expert witnesses in support of public health or other science. (The antivax networks already have organized expert witnesses – see examples from Australia and the US.)
• More research needs to be done and published on how different “anti” initiatives are funded, both from institutional or large private donors or through organized fundraising campaigns and profit-making activities.

Go beyond organized “anti” groups, and work in communities that might share touch points with the “anti” campaigns

• Strategies to address “anti” beliefs need to focus not only on the communities that hold the specific beliefs but also on those who are “adjacent” and share similar interests and values and, therefore, may adopt the sentiment and beliefs over time.
• Community-based network analysis like this or this needs to become more routinized to identify which communities are mediating the spread of narratives on a particular topic, and what other topics or geographies are aligning with them. This should inform strategies and approaches to engage them.
• Addressing these issues in a country or community must be based on meeting community needs (for services, products, and information), addressing eventual grievances of the community against the health system or authorities, designing a supportive environment for health behaviors, and leveraging the social norms and behavioral approaches to drive social and behavior change.

Mitigate harm and protect people in the in real-world

• In instances where “anti” narratives translate into harassment and attacks, legal protections must be put in place and implemented to protect the most vulnerable from direct harm.

Leverage networks of cross-disciplinary practitioners and scientists that can develop a comprehensive multi-prong strategy to protect the communities, the health system and its partners from organized “anti” health movements

• To detect and understand the disinformation campaigns, work with disinformation researchers and law enforcement experts.
• Establish practitioner and expert network for the exchange of information, and collective troubleshooting. Any research, analysis, and intervention strategy development needs to include a multitude of expertise, from social and behavior change, disinformation research, political science, media science, law and ethics, communications, and others.
• Prioritize supporting the capacity of local organizations and authorities to address the impacts of the “anti” movements over planning one-size fits all global solutions.