The Daily Telegraph - Saturday - The Telegraph Magazine
Inside the troll factories
Russian cybercriminals are working to discredit vaccinations that save millions of lives. Harry de Quetteville investigates this new online disease
At 11 minutes to six on the evening of 4 February 2015, a user called Judelambertusa wrote a message on Twitter. ‘Certainly, #vaccination is useful!’ it read. Within moments Jude was engaged in a fierce exchange with other users, and for the following 10 minutes staunchly defended the efficacy of vaccines. ‘No question, #vaccines work!’; ‘It’s proved that serious #vaccine side effects are extremely rare’; and ‘It’s a chance to get protected 4 free,’ she noted, always adding #Vaccinateus. The spelling of one message, however, was a little odd: ‘What will you fill [feel] when you get a disease that you could’ve been protected from?’
Judelambertusa wasn’t really writing from the USA. In fact, ‘she’ has subsequently been identified as one of hundreds of fake users created in 55 Savushkina Street, a modern four-storey office block in St Petersburg, as part of an ongoing disinformation campaign designed to fray the fabric of Western society.
The most recent example of the country’s cyber warfare was last week’s revelations about attempted hacking in The Hague by four Russians following the Salisbury Novichok attacks. The most significant, however, was the targeting of the US presidential election through the hacking of the Hillary Clinton campaign, a crime with which former FBI chief Robert Mueller charged 12 Russian intelligence officers on 13 July this year. Yet five months earlier, in February, Mueller had also indicted another 13 Russians for running the operation at Savushkina Street. Top of the wanted list was Yevgeny Prigozhin, a catering baron so close to the Russian president that he is known as ‘Putin’s chef ’. According to Mueller’s indictment, Prigozhin’s ‘organization sought to conduct what it called “information warfare against the United States of America” through fictitious US personas on social media platforms and other Internet-based media’. Officially that ‘organization’ was the Internet Research Agency. Unofficially, it was known as the troll factory.
‘Trolls’, people who deliberately start arguments online and throw vile abuse around, are a feature of the internet as widespread as they are widely deplored. Some pick fights just for the sheer hell of it. At Savushkina Street, however, the aim was nothing less than bringing down the US political system from within, starting fights and sowing discord that would turn American citizen upon American citizen.
To do so, the Russian trolls sought out issues they thought would be divisive: immigration, the Black Lives Matter campaign, Islam, gun control – they weren’t picky. In 12-hour shifts, they bashed out endless blogs, tweets and Facebook posts under assumed names, bombarding social media in an attempt to foster disharmony. Automated ‘bots’ repeated such messages incessantly. Analytics tools allowed the trolls to monitor precisely how widely their propaganda was shared, giving them an idea of which topics really stirred the pot. Some subjects they thought might become ‘wedge’ issues – such as Native American rights – didn’t work and were dropped. But others were hugely successful at inducing screaming matches and polarising audiences. Among these, it turned out, was vaccination.
To the man who identified this medical meddling – Prof David Broniatowski, of George Washington University, Washington, DC – the news came as a surprise. What he was actually trying to find out was why some people were reluctant to get themselves or their children vaccinated against infectious diseases. ‘The reasons can be very different,’ he says. ‘Some are libertarians: it’s not that they oppose vaccinations, it’s that they oppose being told by the government that they have to vaccinate. Others believe vaccines are not natural, or have religious objections.’ In fact, between 2014 and 2017 the World Health Organization (WHO) found 1,110 reasons given globally for so-called ‘vaccine hesitancy’, some form of which is reported in more than 90 per cent of countries.
As he delved into the subject, Prof Broniatowski found something odd. Gold-standard surveys by the Pew Research Center found that an overwhelming majority of Americans – some 88 per cent – supported vaccination, believing the benefits outweigh the risks. But on social media the situation was very different. So he began to investigate the disparity. It turned out that Russian trolls were stoking discord about immunisation. They were 22 times more likely to tweet about vaccination than average users. Moreover, the trolls were taking both sides of the debate, operating purely to heat up the argument. So it proved with the Judelambertusa account. Having vigorously defended vaccines in 2015, the fake Russian-run user was equally vigorously denouncing them in 2016. ‘The Truth About Mandatory Vaccines’, it blared in December that year, with a link to a video explaining why ‘vaccines are a violation of your human rights and how they are potentially dangerous to you or your child’s health’.
‘We certainly didn’t think of vaccination as a wedge issue when we started,’ Prof Broniatowski says. ‘But it turns out that those opposed to vaccines and those opposed to the anti-vaxxers are very vocal. If you egg them on, they fight.’
Or, as Ben Nimmo, information defence fellow at the US think tank Atlantic Council, puts it: ‘Someone in the troll factory identified vaccination as a contentious issue, an issue that would make people very angry, the theory being that doing so would divide the country and make it harder to govern.’
To many in medicine this is a cause for frustration and lamentation. Vaccinations, according to the WHO, are the second greatest promoter of human health in existence. ‘Only clean water, a basic human right, performs better,’ it notes. The WHO recently put the number of lives saved around the world thanks to vaccinations at five million. That’s five million each year. Yet despite this annually averted genocide, the Russian plot reveals that vaccination has today become a topic so sensitive and disputed that it can be pressed into service to undermine Western democracy.
How, medical professionals are asking, have things come to this?
‘Vaccine hesitancy has always been around,’ says Dr Heidi Larson, director of the Vaccine Confidence Project and professor at the London School of Hygiene & Tropical Medicine’s Department of Infectious Disease Epidemiology. ‘But it’s now moving way quicker and is itself spreading in a viral way. And a huge contributor to propagating the scepticism is social media.’
That digital communication, Dr Larson says, has helped turn vaccine scepticism into another wave in the current tide of anti-authoritarianism: ‘People have such low trust now in institutions, government, big business. This is not going to go away.’
To understand why is to understand both how social media works and how humans process data and analyse risk before making decisions. With its huge democratising power, the internet allows anyone to broadcast their message to the entire planet, something that has innumerable benefits. But social media is also vulnerable to what is known as an ‘asymmetry of passion’, where an overall picture of public sentiment is distorted because the vast majority remain silent while a vocal minority are dedicated to telling their side of the story. And online, it really is stories, personal tales – not data – that matter, and are most likely to get shared. ‘Many health organisations simply don’t understand how to communicate in the era of the internet,’ says Renée diresta, director of research at the cybersecurity firm New
‘Someone in the troll factory identified vaccination as an issue that would make people very angry, divide the country and make it harder to govern’
Knowledge. ‘Expert journals are important to establish facts but stories are what drives the internet. And of course it’s very rare for someone to share a positive vaccination story because that’s such a routine thing.’ Instead, she says, people broadcast, and audiences tune into, ‘those very rare outlier events where things go wrong. Like plane crashes, they stick in people’s minds.’
There is a term for this phenomenon. It’s called fuzzy-trace theory (FTT). It posits that humans take action based on both precise data and ‘gist’ messages. The former are generally complex and nuanced; the latter ‘fuzzy’ but simple. When it comes to our intuitions, which are notoriously hard to change, research suggests fuzzy, gist messages are formative. And when it comes to medical decision-making, such intuitions are crucial, even as hard and fast data are soon forgotten.
For example, who could remember that 3,153,876,236 vaccine shots were administered in America between 2006 and 2016, and that in that time there were only 3,749 payouts from the National Vaccine Injury Compensation Program – one for every 841,257 shots? According to the National Weather Service, the average American has a one in 14,600 chance of being struck by lightning – and thus as things stand Americans are 57.62 times more likely to be hit by lightning than be compensated for vaccine side effects. But it’s easy to remember a video diary posted online by parents of a child they are convinced has been harmed by a vaccine. That’s why simply plying sceptics with statistics is useless. ‘Emotional stories which make people anxious are way more powerful than numbers,’ says Dr Larson.
The result is writ large today in the rashy, feverish faces of children with measles. In August this year, the WHO revealed that Europe had seen more cases of measles in the first six months of 2018 than the 12-month total in each of the last five years. Dr Mary Ramsay, head of immunisation at Public Health England, blamed the ‘large outbreaks in Europe’ on ‘teenagers and young adults who missed out on their MMR vaccine when they were children’.
It is impossible to talk about MMR without mentioning the name Andrew Wakefield. He is usually referred to as the ‘discredited former doctor’ who wrote an infamous paper in 1998 that made a link between MMR and autism. Drummed out of the profession, he is widely blamed for a drop in vaccination rates.
It was a spectacular fall from grace for the gastroenterologist. But today, remarkably, Wakefield has reclaimed his reputation in America, where he has met and found a champion in Donald Trump, a president who seems to embody the instinct-first protocols of fuzzy-trace thinking. And this summer, Wakefield was photographed kissing his girlfriend – supermodel Elle Macpherson. Disgrace is no barrier to celebrity, it seems. And while his rehabilitation is in full swing, his influence endures.
‘Have you seen Vaxxed?’ says Rebecca Whitfield*, 39, who lives near London and is mother to three-year-old Rafi. ‘I liked what it had to say.’ Vaxxed is a film directed by Wakefield claiming a vaccine conspiracy in America. ‘For three of my friends, the day after vaccinations their children’s temperatures shot up so high. The way my brain works, I can’t put my child through that, whatever the long-term benefit.’
Whitfield says that, while some have been supportive, on the whole she has lost friends because she has not had Rafi vaccinated. ‘I had one friend who got very angry, who said, “You’re going to make all our children sick,”’ she recalls. ‘Another, who is a doctor, is simply baffled.’ But despite her critics, she is determined. ‘I’ve done a lot of research, but it’s just a feeling really, and until I know more, I can’t put my child through that.’
Whitfield’s story is in tune with the times: vaccine hesitancy is now a rich-world phenomenon. France and Italy, for example, have lower rates of child-vaccinations than Rwanda and Burundi. In a 2016 global survey of 67 nations, the UK ranked 40th on a scale of how important vaccines for children are considered to be. The number of Britons agreeing was 89 per cent – high, but not high enough to create ‘herd immunity’ (the level of immunisation required to suppress outbreaks of infectious diseases). For measles, this is thought to be around 93-95 per cent of the population. The top three nations where people considered immunisation most important were Bangladesh, Ecuador and Iran, where the figure was more than 99 per cent.
For Hugo Fry, UK managing director at Sanofi, one of the world’s largest manufacturers of vaccines, the underlying cause of this nascent richworld rejectionism is simple: the passage of time. ‘You see complacency. When you had lots of people dying of smallpox or thousands of polio victims, that focused the mind. But when you don’t see that any more, complacency can slip in, then lead to conspiracy. As with all prevention, people say, “Nothing is wrong, so why do we need this?” We have now got a generation who don’t remember polio.’ Occasionally he can’t help a note of frustration creeping into his voice: ‘There is no risk of autism, that is absolute rubbish. But there are genuine consequences you can measure. It starts with people spreading these stories, then parents don’t vaccinate, then children die.’
Fry points to a host of data, peer-reviewed studies, risk assessments, as evidence – as truth. But, in a fake-news era, where government power and the authority of experts are increasingly challenged, truth ain’t what it used to be. ‘There is this challenge of what is truth, the idea that anyone’s concept of what is truth is as acceptable as anyone
else’s,’ says Viren Swami, professor of social psychology at Anglia Ruskin University. ‘That is a big change in the last 10 years.’
Prof Swami is a specialist in the psychology of conspiracy theories. Until recently, it was thought that belief in such theories was a form of mental illness. ‘But 40-50 per cent of people believe in at least one conspiracy theory,’ he says. ‘So by that measure you are psychopathologising half the population. That doesn’t get you anywhere.’
These days, Prof Swami says, theories about conspiracies focus on power. ‘For people who feel powerless and voiceless, conspiracy theories clearly identify the bad people. With vaccines that is big pharma. Identification alleviates the sense of powerlessness. Paradoxically, conspiracies simplify the answers. Suddenly the world feels a lot more ordered, a lot more controllable.’
It is certainly true that those sceptical about vaccination feel belittled by an all-powerful medical establishment. ‘Many doctors just say, “It’s all in your head,”’ says Freda Birrell, chair of the UK Association of HPV Vaccine Injured Daughters (AHVID). It’s an attitude that amounts to ‘persecution’ she says.
Steve Hinks, AHVID vice-chair, relates his story with the methodical detail, and a measure of weariness, familiar to any parent who has repeatedly explained the symptoms of their child’s illness. His eldest daughter, Lucy, was 13 when, in May 2011, she had her third dose of the HPV vaccine, designed to prevent cervical cancer. Almost immediately, he says, she felt fatigued. By August, his once sporty child was sleeping 23 hours a day. And in September, he says, she entered a comalike sleep that lasted for 13 weeks. Lucy was subjected to a battery of tests and the family was twice investigated (and cleared) on suspicion of faking her illness, accused of Munchausen Syndrome by Proxy. As a result of his experience, he set up AHVID in 2015 with Birrell. Now the association has ‘550 or so members’, all convinced HPV is to blame for their daughters’ illnesses. And they are only the tip of the iceberg.
‘There is no risk of autism.
But people spread these stories, then parents don’t vaccinate, then children die’
‘It’s so totally obvious to parents who have lived with this,’ Hinks adds. ‘It is absolutely certain it is the vaccine that is causing this.’
His safety concerns are shared by Birrell. ‘We are not anti-vaccine. What we are is a group concerned about a vaccine that appears to be causing serious health issues to many of our girls.’ But Hinks goes further. ‘It’s bigger than HPV,’ he says. ‘It’s a global epidemic of pharmaceutical companies being paid huge sums of money from national health services. It’s all about money.’
That suspicion is only bolstered by the expansion in the number of vaccinations children are given. To the WHO and the medical establishment, a lengthening list of immunisations is something to celebrate – a triumph of science over disease, a barrage of preventative measures that are, in the words of Sanofi’s Hugo Fry, ‘the most cost-effective thing you can do. It’s good for the NHS and good for people. It’s good for the economy, keeping the workforce working.’ He is excited about a new raft of more effective flu vaccines and the possibility of immunisation against respiratory syncytial virus, which he describes as a ‘big childhood disease and killer of newborns’.
But to sceptics like John Stone, UK editor of the Age of Autism website, such broad ambitions are precisely what is wrong with the vaccination programme. ‘They are trying to target everyone with everything,’ he says. ‘It’s very dictatorial. It’s very serious. My own view is that we don’t know what we are doing to the population. The cost of autism is absolutely astronomical… I’m a risks and benefits man, but I’m much more wary of the risks.’
No one denies that, as with any medicine, very occasional adverse reactions can occur (unconfirmed reports of such reactions tend to be in the single figures per 100,000 vaccinations, and can range from a sore arm to chronic fatigue syndrome). And given the scale of national vaccination programmes, in which millions of doses are distributed (about 24 million people in England get the winter flu vaccine), the numbers can add up.
‘Vaccines do have these tiny risks and we haven’t been great about communicating them for fear of scaring people away,’ says Dr Larson, reasonably. ‘Then they go online and feel they have been lied to.’
The determination not to scare anyone away is partly because herd immunity thresholds require such high rates of immunisation. In a more paternalistic age, that could be achieved by health authorities simply informing people vaccines were safe and telling them to get on with it. Now, that may be changing.
‘There’s tremendous denial on the part of global and national health institutions, which thought scepticism was just fringe views of crazy people,’ says Dr Larson. ‘But we need to communicate so much better. We have so many more vaccines today than when they were introduced. We just keep adding them on, in our medical evangelism. Once we know they’re safe, we say, “Let just add them to the list.” We need to handle it better and stop calling people ignorant just because they ask questions. Public health institutions rarely make efforts to listen.’
New, more open dialogue is only one strand in the new strategy to counter vaccine hesitancy. Another is the pressure social media platforms are increasingly facing to hold stories about health shared online to greater scrutiny than those on other topics. Because they tend to highlight what people are interested in, recommendation and search algorithms have traditionally favoured what Renée Diresta calls the ‘most sensational, emotionally resonant and extreme content, not always taking facts into account’. Today, however, Google makes sure that quality, rather than ‘virality’, is the key metric for ranking websites in searches to do with health or finance. It calls such websites ‘Your Money or Your Life’ pages.
Diresta calls for other platforms, such as Facebook, to emulate Google in order to ensure that they do not promote any false equivalence between ‘crackpot blogs’ and ‘factual content from health authorities’. Meanwhile, she says, those health authorities are going to have to up their game to respond to the speed and quantity of adverse messaging online. ‘We don’t want a social media arms race, where the Center for Disease Control has to run a bot,’ says Diresta. ‘But we do have to recognise that one side is winning.’
That includes Russia and its trolls, despite the efforts of Robert Mueller. ‘There is no sense that the troll factory has stopped operating,’ says Ben Nimmo. ‘The accounts they were running have been stopped and taken down. But now they are just trying harder to cover their traces.’
The tangible effects of shifts in public opinion can, after all, be huge. ‘Nuclear power once had a fair amount of support in America,’ says Prof Broniatowski. ‘Then it became a political issue and that killed it off. People avoid things once they become politically sensitive in that way.’
Already the incentives to produce vaccines are diminishing, says Hugo Fry: ‘They are really complicated to manufacture and take massive investment. There are fewer and fewer companies in this space. It’s a fragile ecosystem.’
What would happen if they decide it’s not worth the aggravation? ‘We are absolutely dependent on pharmaceutical companies,’ says Dr Larson. ‘If they pull the plug, we’re stuffed.’
It is a stark warning. But the true danger today is a collapse in demand, not a collapse in supply. For a growing minority of people in the rich, educated world are turning against vaccines. And while doctors, scientists and pharmacologists are desperate to reverse that trend, they are relying on old weapons from the Age of Information: data, peer-reviewed studies, empirical analysis. They need to realise that a new era is at hand – the Age of Emotion – where stories matter as much as statistics; where feelings are as convincing as facts; and where perception is as valid as reality. And in this new age, the old arguments aren’t winning any more.
‘Vaccines have tiny risks and we haven’t been great about communicating them for fear of scaring people. Then they go online and feel they have been lied to’