I want to start off by stating the obvious. There is not yet a single vaccine approved for preventing COVID-19. There may not be any COVID-19 vaccines in commercial production yet, and it takes months to produce even an approved vaccine.
That's an example of "prebunking": "research that shows it can be more effective to give people information about how to identify conspiracy theories or misinformation before they are exposed to it. This is a fantastic idea, and I love the fact that this is being done in coordination with research to show if it is effective."
In this COVID-19 epidemic, we have learned that people can be infected at second, or third, or fourth hand. The same is true for anti-vaccine myths.Somebody doesn't have to read or here the original wild claim to believe it and repeat it.
This is a story about how a wild, completely unfactual story posted on Facebook started affecting what decisions people are making about getting the flu vaccine for themselves and their children.
Influenza is a virus, but like many infectious viruses, it's not just one strain. It's a particularly protean (or promiscuous) virus, swapping around bits with abandon (this video,Three types of flu, from Khan Academy Medicine is from 2013, but still accurate and very informative. The lecturer is Rishi Desai, MD, MPH. He also has one on how flu strains are named.)
So who decides which strains are included in each year's annual flu vaccine? Does somebody at CDC just sit down and guess? No. Back in 2018, Serese Marotta, Chief Operating Officer of Families Fighting Flu, wroe a great explainer on the complex, international process for identifying which strains to recommend for alternating "seasons" -- Northern Hemisphere, including the US, and the Southern Hemisphere. Marotta's explainer was posted at Vaccinate Your Family's blog, Shot of Prevention.
The very short version
- Throughout the year, dozens of flu monitoring centers around the world track and analyze virus samples. These are sent to the Collaborating Centers for Reference and Research on Influenza, which are part of the World Health Organization (W.H.O).
- In February of each year, W.H.O. issues recommendations for the strains to be included in Northern Hemisphere vaccines, and in September to recommend flu strains for the Southern Hemisphere.
- With respect to the US, an Food and Drug Administration's Vaccines and Related Biological Products Advisory Committee (VRBPAC) (a panel of experts) meets shortly after the W.H.O. recommendations are published, and makes the recommendations for the strains to included in that year's vaccine. This year the meeting was March 4, 2020.
- Once the selected strains are announced, all the manufacturers start growing them, either in egg or cell cultures. Growing enough virus for the nation takes months.
- The next regulatory step is the approval of the Advisory Committee on Immunization Practices (a volunteer panel of experts). ACIP does most of its work in subcommittees, called Work Groups, that meet virtually as needed. The Influenza Work Group is a permanent Work Group. The final report is typically issued in August.
People sometimes wonder why the annual flu vaccines can be approved so rapidly. Don't they change every year? The best analogy I have is cookies made with candy chips (you know, chocolate chips, butterscotch chips, peppermint chips...). You might have your favorite recipe for the dough (one brand of flu vaccine), which is a little different than your neighbor's (another brand), and so on. The dough recipes don't change, but you can slot in whatever kind of chip you want: milk chocolate, dark chocolate, butterscotch.... all that changes, year to year, in flu vaccines (after the initial approval) is three or four strains of flu.
Here are the various strains that Vaccines and Related Biological Products Advisory Committee recommended in March and the Advisory Committee on Immunization practices approved in August:
Image Source: https://www.fda.gov/vaccines-blood-biologics/lot-release/influenza-vaccine-2020-2021-season. Click to enlarge.
So what's different about this year? Well, since March (or January, if you are interested in epidemiology and emerging pandemic threats) it's been SARS Cov-2 (the virus) and COVID-19 (the disease) all the time. And the deep, deep desire for a vaccine, and and equally deep amount of anxiety about the safety and efficacy of the vaccine
Rumors and disinformation about COVID-19, and the many vaccines in development, have been swirling for months. This is not a surprise. People have lost beloveds to this disease, people have suffered economically, people with school-age children have had their lives upended, the US Federal government's response has been catastrophically bad -- in short, people are anxious. People are being flooded with information (good, bad, ambigous) that they lack the intellectual furniture to evaluate.
Even in a normal year, there's always a lot of flu vaccine hesitancy and refusal (why is a story for another time). This isn't a normal year, so I wasn't surpised to see this from a pediatrician I follow on social media
Image Source: https://twitter.com/greenhousemd/status/1316793539158835202
I got curious about this particular bit of misinformation, so I went looking. On September 18, 2020, Reuters published Fact-check: The flu vaccine is not an untested COVID-19 vaccine
A post shared over 6,600 times on Facebook claims the children’s influenza vaccine is actually an untested COVID-19 vaccine. This is false.
Oops. Reuters failed Lakoff's "truth sandwich" approach
- Start with the truth. The first frame gets the advantage.
- Indicate the lie. Avoid amplifying the specific language if possible.
- Return to the truth. Always repeat truths more than lies.
Sources: https://twitter.com/georgelakoff/status/1068891959882846208?lang=en and https://soundcloud.com/user-253479697/14-truth-sandwich-time
How Reuters might have more effectively have framed this story:
- The only antigens present in this year's flu vaccines are influenza antigens for four different named strains of flu. Flu vaccine production starts in the spring. The CDC may encourage flu vaccine uptake, but has no power to compel physicians to administer them.
- In a dramatic post on Facebook, a woman claimed that there were no flu antigens in this year's vaccine, just a "low strain of COVID", which the CDC is compelling doctors to give.
- There are no COVID vaccines available outside of clinical trials.
Reuters helpfully linked to the woman's Facebook post, so here is her dramatic (and totally imaginary) recounting of her recent conversation with her child's pediantrician.
Text version
COVID PARENT WARNING ALERT
I had to take my son to the doctor for a ear ache this morning ... when we were done this was my conversation with the Pediatrician, NO JOKE!
Doctor : would you like the kids to get the flu shot
Me: (I was curious) what strain of the flu is it
Doctor: Covid but a very low strain of it
Me: No thanks.
Doctor: they are really pushing us to push parents to get the flu shots for kids.
Me: I’m not a fan of what’s going on in the world and I’m not giving my children a untested Covid flu shot.
Doctor: I am sure if you and I sat and talked we would have similar beliefs on what’s going on.
Me: then why are you pushing a vaccine that’s not tested or Barely tested
Doctor: Because they tell us to.
Me: who tells you?
Doctor: CDC
Wake 👏UP👏and 👏for all the is Holy DO 👏NOT 👏GIVE 👏your 👏children 👏a 👏Covid 👏vaccine!!
Anybody who has been following the antivaccine movement will recognize the overall shape of this urban legend.
- Woke Mom visits the doctor
- Woke Mom discovers a terrible hidden truth about some vaccine
- Woke Mom's doctor confides in Woke Mom that physicians are bribed or forced into concealing THE TRUTH
- Woke Mom tells all her friends
- Woke Mom gets all kinds of accolades and social capital for her discovery, and her "bravery" in spreading the truth
These elements get shuffled and reassorted, but the overall arc is the same
(By the way, there's another anti-vaccine urban myth shape, the "everybody claps")
- Woke mom visits the doctor
- Woke mom spreads "truth bomb"
- doctor "wakes up"
- doctor ceases to vaccinate
- everybody claps
Here are a few examples of the genre
and
It became such a common trope in antivaccine circles there were even playing cards
But, why would somebody tell such a lie? And why did this woman's obviously false story get traction?
It probably has to do with her backstory, and the way that the Qanon narrative has taken hold among young suburban mothers.
Here is her backstory, from her Facebook page
Good morning Facebook! The Smart Sex Podcast I recorded with Leslie Newby Gustafson will be released this Friday! I talk about abuse as a child, how I was lured into being trafficked, and how I was rescued and where I’m at now! I hope you all will tune in. I of course will post on here once it’s released!
Intro to Podcast:
Madyson is a former porn star who's choice led to her freedom being taken away. She was trafficked for almost a decade. Madyson has bravely spoken out about her time in the porn industry and how it altered her life, her choices and how she gained her voice and took her freedom back. Madyson was owned by Derek Hays from LA Direct models but not anymore.
Here's her website
And here's her book, My Father's Daughter. Several reviews suggest that the details recounted are completely fabricated, and that the woman has a history of fabricating wild tales for attention or for money. If true, that would explain why she fabricated the vaccine story as well.
But she seems to have a large and enthusiast following, especially for her stories of being trafficked as a minor. This is part of a "moral panic" that gripped the US in the summer of 2020
In "HOW QANON CONSPIRACY THEORIES SPREAD IN MY COLORADO HOMETOWN, During the pandemic, some of the people I grew up with got sucked into QAnon and the Q-adjacent “Save the Children” movement.
During the pandemic, some of the people I grew up with in Colorado had gotten sucked into QAnon, the sprawling and baseless pro-Trump conspiracy theory that is deemed a domestic terror threat by the FBI. I remembered them as perfectly reasonable people: some liberal, some conservative, but all frozen in my memory as intellectually curious. Now, online and from a distance, I was watching them change. Young, white suburban women, in particular, were falling for a Q-adjacent movement, “Save the Children,” which raises false fears about child sex trafficking through fabricated stories, pastel infographics, and hashtag campaigns.
In How #SaveTheChildren is pulling American moms into QAnon The hashtag, its links to conspiracy theories, and its implications for the election, explained.
Another article, with more details
.....But all share the same message: Child sex trafficking is out of control in the US and around the world, and no one is paying attention. And they end with the hashtag #SaveTheChildren.The hashtag, which started to gain popularity this summer, seems hard to argue with. Ending human trafficking and protecting children, after all, are uncontroversial goals, barely even political.
But in reality, many say, QAnon adherents are trying, via the hashtag, to use the real issue of trafficking to spread their ideology — which includes the bizarre, untrue claim that liberals like Hillary Clinton, Barack Obama, and Chrissy Teigen are all part of a vast pedophile ring. While such outlandish theories may not be palatable for many, more general fears about child sex trafficking are easier to get behind. And so social media posts about saving the children have, for some, become a way “to launder QAnon into the mainstream,” as Whitney Phillips, a professor of communication and rhetorical studies and co-author of the book You Are Here: A Field Guide for Navigating Polarized Speech, Conspiracy Theories, and Our Polluted Media Landscape, put it to Vox.
So now you know the origin of this completely unplausible story, and how and why it spread.
Vince Iannelli writes Vaxopedia, a huge collection of facts about vaccines, and debunkings of persistent vaccine myths. Here's his article debunking "the flu vaccine is really "Covid but a very low strain of it" myth.
I hope this post gives pediatricians, family medicine physicians, and other flu vaccine providers the ammunition they need to turn flu vaccine refusers into flu vaccine accepters. If any of them reading this wants a handbook, may I suggest Gretchen LaSalle's "Let's Talk Vaccines: A Clinician's Guide to Vaccine Hesitancy and Saving Lives.
Edited to add, October 25, 2020
Here are a few representative samples of Madyson Marquette's tweets
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