As California state legislators consider a bill to crack down on suspect vaccine exemptions for schoolchildren, a vocal minority on social media is fostering opposition, often by spreading misinformation and sharing referrals to doctors who support their cause.
Senate Bill 276 would prevent doctors from providing medically unnecessary vaccine exemptions to students. But Facebook pages like Californians for Vaccine Choice, followed by over 22,000 people, have been a significant force for amplifying the relatively small minority of parents who oppose vaccine requirements, encouraging activism and posting dubious claims about the bill.
Recent posts have falsely claimed that medical exemptions would be allowed only for kids who had already experienced “severe anaphylaxis” to a specific vaccine and that children in comas would not be exempt.
“Scientific consensus is overwhelming on the issue of vaccines. So how do you foster doubt? One way is to use social media to create the appearance of controversy,” said David Magnus, a professor of pediatrics and director of the Stanford Center for Biomedical Ethics. “If you get a few crackpots on your side, you can make it seem like there’s a debate.”
The latest legislative showdown comes amid one of the worst measles outbreaks in the United States since 1994. Californians for Vaccine Choice was one of several social media groups that promoted chartered buses to bring anti-vaccine parents from Southern California to Sacramento for a rally last month. Hundreds of opponents of the bill gathered at the Capitol during a hearing by the Senate Committee on Health. The committee voted 6-2 in favor, despite the crowd.
“We do not believe in forced vaccines. A lot of people agree with us, including all the people who showed up at that hearing,” said Barbara Loe Fisher, president of the National Vaccine Information Center, an anti-vaccine nonprofit. “The people are making their voices heard.”
The overall rate of vaccinations among kindergartners increased after the Legislature passed a highly contentious bill in 2015 outlawing personal belief exemptions, but medical exemptions among kindergartners have tripled. The Centers for Disease Control and Prevention recommends medical exemptions for a small percentage of children, including those with weakened immune systems or severe allergies to vaccine ingredients.
But experts have linked the rise in medical exemptions in California to doctors who write them for reasons that fall far outside the CDC guidelines — and often for a fee.
SB 276 — co-sponsored by State Sen. Richard Pan, D-Sacramento, and State Assemblywoman Lorena Gonzalez, D-San Diego — would require the state Department of Public Health to review and approve doctors’ exemption recommendations. Currently, doctors have wide latitude to write exemptions with no routine oversight.
Shortly after the 2015 bill, SB 277, which Pan also wrote, the names of doctors willing to provide medical exemptions spread widely on social media.
“That’s how people look for a doctor and comparison shop,” said Renée DiResta, co-founder of the vaccine advocacy group Vaccinate California who is also a fellow at Mozilla researching the spread of conspiracy theories and disinformation on social media.
One group, Stop Mandatory Vaccination, used Facebook to promote the services of San Francisco physician Kenneth Stoller, whose practice of providing medical exemptions came under scrutiny last week by the San Francisco City Attorney’s Office.
“He fought against SB 277. He is in the San Francisco Bay area and he can take initial Skype appointments,” the group posted in 2015.
In an interview last week with the Bay Area News Group, Stoller’s attorney Rick Jaffe said many of Stoller’s patients come to him after other doctors rejected their requests for exemptions. “He does screen people out,” Jaffe said. “You can’t get an exemption just because you have a personal belief.”
Pan, who is a pediatrician, insists plenty of doctors cross the line. His office provided screenshots from closed Facebook groups in which parents discussed doctors willing to write medical exemptions: One doctor only required the child’s grandparent to have eczema; another granted temporary exemptions over the phone so kids could quickly enroll in school.
Loe Fisher, the vaccine opponent, said lawmakers who supported SB 277 promised opponents “that doctors would be able to exercise professional judgment and consideration when giving a child a medical exemption.
“If there are doctors doing things untruthfully, they should be looked at one on one.”
Vaccine opponents have also use closed Facebook groups to coordinate efforts to suppress and intimidate vaccine advocates. Physicians posting scientific information about the importance of vaccines, for instance, have had their Yelp and Healthgrades accounts bombarded with negative reviews.
“It’s not just one or two, it’s hundreds of people who go out and harass them,” Pan said. And doctors aren’t the only targets. “Families whose children have passed away from vaccine-preventable illnesses like the flu, they call them names, say the child never existed, just really horrible stuff.”Ethan Lindenberger, an 18-year-old whose parents refused to vaccinate him, has faced the wrath of anti-vaccine groups for speaking out against their tactics. When he went to Washington to testify before Congress, he had to reschedule his travel plans after a Facebook page called VaXism, with more than 100,000 followers, posted a screenshot of his flight and hotel information.
“I got some death threats,” the Ohio teen said in an interview with the Bay Area News Group. He also was harassed after speaking to Twitter executives about his experience. “People were calling me a Nazi, people calling me fascist, saying it was part of a government scheme.”
Facebook and other social media sites have pledged to crack down on the spread of misinformation about vaccines. On Thursday, Instagram said it would begin hiding search results for hashtags commonly used to spread anti-vaccine propaganda. However, on Friday, a search for “vaccine” on Instagram still returned primarily anti-vaccine content.
“Social media has created challenges for the medical system that we don’t know how to deal with yet,” said Magnus. “Free speech is obviously very cherished, but to say you can only put out good information instead of trying to create ignorance and foster controversy, I think there’s an argument for that.”