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Santi Indra Astuti and colleagues argue that whole-of-society efforts are needed to build an internet ecosystem that helps communities be resilient to future health misinformation challenges
A local saying in Indonesia is that it is the most hoax filled country on Earth. As one of the world’s most diverse countries, with over 700 languages and people spread across 16 000 islands, it is challenging to reach its population with information that is credible and accurate. Misinformation has circulated in the country’s national media and affected discourse on everything from politics to natural disasters to immunisation for over a decade.12 Drawing from our experience with MAFINDO, a local civil society organisation dedicated to tackling misinformation and building health literacy within the community, we have learnt that promoting credible and compelling sources of health information benefits from taking a whole-of-society approach that helps to translate science for a general audie
### Key messages
Vaccine misinformation on social media has strong effects on behaviour, and the evidence base for interventions to reduce these effects is limited, but better approaches to evidence generation are possible, say Kai Ruggeri and colleagues
Effective population level vaccination campaigns are fundamental to public health.123 Counter campaigns, which are as old as the first vaccines,4 disrupt uptake and can threaten public health globally.4 In 2019, public health researchers linked increases in measles cases with the proliferation of global anti-vaccine campaigns.5 Some of these campaigns originated offline but were later amplified and expedited through social media, resulting in real world harms.6 Though crises and genuine safety concerns can also lower vaccine uptake,78 the return of measles after aggressive anti-vaccine campaigns prompted the World Health Organisation to list vaccine hesitancy among the greatest threats to global health (box 1).14
Box 1
### Vaccine
Sara Cooper and colleagues argue that a better understanding of the complex sociopolitical drivers of distrust in vaccination will increase the potential of social media to rebuild vaccine confidence
Vaccination experts have become increasingly alarmed about the continued waning of public confidence in vaccines.1 Social media are considered to be major contributors to this decline, facilitating the rapid and widespread sharing of misinformation, enabling vaccine anxieties and rumours to travel rapidly around the world.23 Social media are also seen to have enabled vocal anti-vaccination groups to self-organise and communicate well beyond their local areas.45 The covid-19 pandemic has only magnified these concerns,6 as Tedros Adhanom Ghebreyesus, director general of the World Health Organization put it, “We’re not just fighting a pandemic; we’re fighting an infodemic.”7
This dominant narrative on mistrust in vaccines assumes that it is primarily the result of a lack of informa