Composition Essay Contest

The English Department at Western Kentucky University is pleased to announce our fourth annual Composition Essay Contest. Students should visit https://www.wku.edu/english/essay-contests.php to complete an application and submit a 500-750-word essay (MLA style; pdf format) based on the prompt below. The English Department will invite finalists, their teachers, and family to campus for a reception and ceremony on February 15th where they will be recognized. The winners will receive scholarships if they choose to major or minor in English at WKU and cash prizes whether or not they attend WKU. First Place: $500 Scholarship and $200 cash; Second Place: $300 Scholarship and $100 cash; Third Place: $200 Scholarship and $50 cash. Applications and Essays are due January 5.

Question: One of the most discussed elements of the COVID-19 pandemic has been the efforts to develop a vaccine. But several aspects of the search for this vaccine have faced debate or controversy, ranging from the safety of this specific vaccine to how it will be distributed to questions about vaccines in general.

Carefully read the sources found in the contest flyer. Then synthesize material from at least three of the sources and incorporate it into a coherent, well-developed essay in which you take a clear stance on a specific issue surrounding the search for a COVID-19 vaccine. The issue you select should be one in which there is room for reasonable debate and disagreement. Because this is an ongoing issue that will have new developments as you work on your essay you may, in consultation with your teacher and with his or her approval, include an additional source. Any additional source must be from a legitimate journalistic or scholarly outlet and must be properly cited.

Your argument should be the focus of your essay. Use the sources included in the essay contest flyer to develop your argument and explain the reasoning for it. Avoid merely summarizing your sources. Indicate clearly which sources you are drawing from whether through direct quotation, paraphrase, or summary. You may cite the sources by using the descriptions in parentheses below.

Source A (Ojikutu, et al.) Source B (Stanley-Becker) Source C (Conis, et al.) Source D (Knowles) Source E (Johnson, et al.)

Source A: Ojikutu, et al. “A covid-19 vaccine can ensure better outcomes for communities of color. Let’s work to earn their trust.” https://www.washingtonpost.com/opinions/2020/07/26/covid-19-vaccine-can-ensure-better-outcomes-communities-color-lets-work-earn-their-trust/ The following is an Opinion by Bisola O. Ojikutu, Julie H. Levison and Kathryn E. Stephenson The New England Journal of Medicine reported this month that the covid-19 vaccine candidate mRNA-1273 induced robust antibody responses among participants in a clinical trial sponsored by the National Institutes of Health. With multiple potential vaccines in the pipeline, cautious optimism is emerging that a safe and effective covid-19 vaccine is within reach. However, as physician-scientists who are invested in improving health among vulnerable populations, we fear that the glimmer of hope ignited by these findings may be short-lived. Even if a safe and effective vaccine is developed, serious problems loom. Surveys indicate that many Americans would not obtain a coronavirus vaccination were it available. The consequences of low participation are all but certain to be grave among people of color, whose vulnerability to the novel coronavirus is high — and whose interest in vaccination is likely to be low. The covid-19 fatality rate among black Americans is more than twice that of whites. Latinx individuals are hospitalized at more than four times the rate of whites. The Pew Research Center reported last month that 44 percent of black Americans say they would not obtain a covid-19 vaccine (54 percent of black survey respondents said they “would definitely or probably get a coronavirus vaccine if one were available today," as would 74 percent of Latinx respondents). Associated Press polling in May found that only 25 percent of black Americans and 37 percent of Latinx individuals would be willing to be vaccinated. These data are not surprising. Like covid-19, H1N1 “swine flu” resulted in more severe cases among black and Latinx individuals than among whites. Still, anticipated acceptability of the H1N1 vaccine was low, as was actual vaccination, particularly among people of color. Similar disparities have been noted with established vaccines. While 71 percent of white individuals 65 or older obtained pneumococcal vaccine, only 56 percent of black and 49 percent of Latinx individuals have done so in recent years. Vaccination rates for seasonal influenza and human papillomavirus are also disproportionately lower among black and Latinx individuals, who are in high-risk demographic groups. Reasons for low vaccination rates among people of color include underestimated perceptions of infection risk, general anti-vaccine sentiments and lack of access to health care. For many patients of color, including immigrants, financial concerns are paramount. Out-of-pocket costs, transportation expenses and inability to take time off work are likely to be significant deterrents. Stigma may also thwart vaccination efforts. Any vaccination rollout is likely to prioritize “highest-risk” populations, a characterization that carries baggage. There are widespread, racist assumptions that black and Latinx people living with diabetes and obesity — two conditions that predict severe covid-19 infection — are “poor” and “lazy.” In some communities, “high risk” is code for being less hygienic. Mistrust is the most insidious challenge. Anti-vaccine sentiments specific to covid-19 are evident among many black Americans, and calls for people of color to have priority access to a new vaccine have been met with suspicion. Vaccine conspiracy theories — such as the now-debunked belief that HIV was spread throughout sub-Saharan Africa via polio vaccine campaigns — have gained footholds in some areas. Beyond conspiracy theories, many people of color can recount stories of how they or someone they know were treated unjustly in a health-care setting. Evidence of structural racism in black and Latinx neighborhoods, including poor-quality hospitals and suboptimal schools, adds to suspicions about interventions promoted by the pharmaceutical industry, researchers or the U.S. government. Mistrust contributes to underutilization of health-care services in communities where health outcomes are

already poor. Without trust, covid-19 vaccines will go unused. Trust must be earned. Here are six steps to begin that process:

Include people of color in all phases of vaccine development, from the scientific team to vaccine administrators. Efforts to distribute a covid-19 vaccine among black and Latinx populations should be led by people from those communities.

Be transparent about the vaccine development process and safety data. All studies should be published in peer-reviewed journals before the vaccine is widely distributed.

Articulate clear messages. A vaccine campaign needs to be widely implemented now. Trusted sources should be engaged in this effort. The messenger is as important as the message.

Protect people from potential harm. If a vaccine licensed for “emergency use” causes more harm than anticipated, people need assurances that they won’t shoulder undue medical costs.

Dismantle all financial barriers to vaccination. This includes not just fees but also flexible clinic hours. Most important, address health inequities and structural racism that have led to the gross racial and

ethnic disparities in covid-19 infection and beyond.

Covid-19 caught the world off-guard. But learning from the past can ensure better outcomes. Starting now is the best way to make sure that those who most need a covid-19 vaccine can trust it, afford it, acquire it and be protected by it.

Source B: Stanley-Becker. “Trump’s promise of ‘Warp Speed’ fuels anti-vaccine movement in fertile corners of the Web”

The question was posed bluntly to the nearly 100,000 members of a Facebook group devoted to ending Pennsylvania’s stay-at-home orders, with a user writing, “if there was a vaccine for coronavirus would you be likely to take it.” “Absolutely not.” “No.” “Never.” The resoundingly negative answers streamed forth, generating 1,700 comments and providing a window into brewing resistance to a potential coronavirus vaccine that experts say offers the surest path back to normal life. Some of the same online activists who have clamored to resume economic activity, echoing President Trump’s call to “liberate” their states from sweeping restrictions, are now aligning themselves with a cause on the political fringe — preemptively forswearing a vaccine. To further their baseless claims about the dangers of vaccines and to portray the scientific process as reckless, they have seized on the brisk pace promised for the project, which the Trump administration has branded “Operation Warp Speed.” “We’re looking to get it by the end of the year if we can,” the president said Friday Both movements represent the views of a small minority of Americans. But leading medical experts fear that the ability of their adherents to spread misinformation online could plant seeds of confusion and distrust in the broader public — and undermine future efforts to distribute a vaccine.

How to spot misinformation amid the coronavirus outbreak As misinformation about the novel coronavirus continues to spread, here are some important tips to keep in mind when consuming news about the outbreak. (Elyse Samuels/The Washington Post) Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, said he has grown increasingly concerned that the name of the initiative has led to misconceptions about what is being put at risk by speeding up the effort — only financial investments, not safety or efficacy. “People don’t understand that, because when they hear ‘Operation Warp Speed,’ they think, ‘Oh, my God, they’re jumping over all these steps and they’re going to put us at risk,’ ” Fauci said in an interview Wednesday with The Washington Post.

No steps would be eliminated, he vowed. Rather, multiple steps — from collecting data to preparing to scale up the number of potential doses — would be pursued at once, creating “risk for the investment” but not for the patient or the “integrity of the study.” “You’re doing things in a totally unprecedented way, and you’re going really fast but not compromising safety because you haven’t cut out any of the steps you would have done had you done it the traditional way,” Fauci said. But such guardrails have gone unmentioned on some of the most active platforms for coordinating opposition to measures designed to slow the spread of the virus. One participant in a 2,000-member reopening group on Facebook suggested Trump was “pandering to the left” by speeding a vaccine to market. Another, addressing more than 26,000 fellow users, called the effort “mad,” linking to a video outlining a conspiracy theory about Bill Gates. The views, though they reflect an extreme position, are a sign of looming obstacles to public trust for the Trump administration and governments around the world rushing to complete a process in a matter of months that typically takes years. In a Yahoo News-YouGov poll this month, nearly 1 in 5 Americans said they would not take a coronavirus vaccine. The online activity illustrates how anti-vaccine stalwarts have found common cause with those protesting stay-at-home measures, flocking to their demonstrations and staging their own. The two movements are also drawing on a common online organizing infrastructure, increasingly merging in the fluid corners of Facebook. Their groups and pages, which frequently boast followings in the six figures, easily swap out one target of perceived government overreach for another, in an early sign of how misinformation could thwart efforts to immunize the public from a disease that has killed 90,000 Americans. Matthew Ferrari, an epidemiologist at Pennsylvania State University, said there were already indications that anti-science sentiment flaring in the early days of the pandemic could be “eroding confidence in existing vaccines.” A study released by the Centers for Disease Control and Prevention found that vaccination rates for children in Michigan fell steeply in May, including to fewer than half of infants 5 months or younger. Reduced access to immunizations could have been a result of the stay-at-home order designed to contain the outbreak, the report noted, though the state order halting elective procedures did not specifically include vaccinations. The decline in up-to-date status for recommended vaccines threatens herd immunity against highly contagious infectious diseases such as measles, the CDC warned. Ensuring the interruption does not become permanent is a priority, Ferrari said, requiring clear science communication. Peter J. Hotez, a professor of pediatrics and dean of the National School of Tropical Medicine at the Baylor College of Medicine in Houston, said his initial modeling suggests “a significant number of Americans” will need to be vaccinated against the coronavirus to interrupt transmission. “I’m worried that the anti-vaccine movement is going to be so strengthened to the point where we won’t have those numbers, and part of this may just be people opting out because of mixed messaging,” he said. “You’d think the anti-vaccine movement would go into retreat with everyone wanting a vaccine, but it’s been energized over ‘Operation Warp Speed’ and over biotech and pharma companies sending out irresponsible press releases.” The central tenets of the anti-vaccine movement, Hotez said, are that vaccines cause autism, which they do not, and, “second, that vaccines are rushed, third that they’re not adequately tested for safety and fourth that there’s an alliance between the federal government and the pharmaceutical companies.” “This ‘Operation Warp Speed’ plays right into three of those four things, and there’s been no attempt to refute that messaging,” he said. Michael Caputo, a longtime Trump adviser tapped to lead communications for the initiative as the freshly minted head of public affairs at the Department of Health and Human Services, said he was responsible for the branding. He drew the name “Operation Warp Speed” from the terminology scientists were already using internally to describe their efforts, he said, after initially toying with names from Greek and Roman mythology but struggling to find a fitting title. Of efforts to paint the process as overly hasty, Caputo said, “This is a concern that everyone in the operation is

taking to heart.” A White House spokesman declined to comment. The protests against a possible vaccine extend far beyond the group focused on Pennsylvania. A similar question appeared in a Facebook group dedicated to reopening Arizona, where a user suggested that resisting a vaccine was a reason “to keep this Facebook group strong and going,” even as states begin to lift their stay-at-home orders. “Will you take it?” she asked. Among answers spouting debunked theories about the dangers of vaccines, one user weighed in to say she was newly skeptical, in light of how the development process was proceeding. “Although I have been vaccinated myself and vaccinated my kids for the typical childhood diseases (and have no issue with that) the thought of a vaccine being rushed through trial and forced on us makes me very nervous,” she wrote. On Twitter, more than three-quarters of posts since Monday using the hashtag #OperationWarpSpeed have pushed conspiracy theories about the effort. Others suggested hydroxychloroquine was a more suitable option, even though the Food and Drug Administration has warned of the antimalarial drug’s possible side effects. Trump on Monday said he was taking the drug as a preventive measure, prompting some of his supporters to double down on the unproven drug, which has been linked to increased risk of death for certain patients. “I would take Trump’s hydroxychloroquine . . . before I would be vaccinated by the left’s new covid-19 vaccine!” read a meme posted Tuesday in a pro-Trump Facebook group with more than 82,000 members. Brad Parscale, who is managing the president’s reelection campaign, also touted the drug after the president’s revelation about taking it. On Twitter, he shared a news release from the Association of American Physicians and Surgeons, a right-wing group that has lobbied in favor of broader exemptions from inoculation requirements for religious and other beliefs. Its periodical has published reports falsely tying child vaccination to autism and advancing a discredited link between abortion and breast cancer. A spokesman for the Trump campaign did not respond to a request for comment. Jane M. Orient, the group’s executive director, said AAPS contends that “vaccines should be fully tested and voluntary.” Similar views animate an online petition against a mandatory coronavirus vaccine sponsored by LifeSiteNews, a right-wing website that the fact-checking website Snopes calls a “known purveyor of misleading information.” The petition, which has racked up nearly half a million signatures, has been posted in some of the largest “reopen” groups on Facebook. Hotez said the activity showed Facebook is not doing enough to weed out dangerous misinformation putting public health at risk. Changes introduced by the technology giant last year were aimed at surfacing authoritative content about vaccines, including by altering what sort of pages and groups appear in the News Feed and search features. Andrea Vallone, a Facebook spokeswoman, pointed to a March news release from Nick Clegg, the company’s vice president for global affairs and communications, saying, “We remove COVID-19 related misinformation that could contribute to imminent physical harm.” Misinformation about vaccines is still rampant on the platform, said Kolina Koltai, a postdoctoral scholar at the Center for an Informed Public at the University of Washington who has been studying anti-vaccine groups on Facebook for five years. She first learned about the coronavirus in January, she said, because the online communities she tracks were already portraying the outbreak as a tool of government control. The conspiracy theories that sow distrust of immunization rely on some well-founded concerns about profit and the role of industry, she said. Moncef Slaoui, a former Moderna executive tapped to lead the White House’s vaccine initiative, on Tuesday divested his stock options in the Massachusetts biotechnology company, which a day earlier had announced promising early results from its first human safety tests. Moderna did not respond to a request for comment. “The anti-vaccine movement is really good at drawing people in,” Koltai said. “They’ll use whatever half-truth or slogan they can to convince people of their conspiracy beliefs.” Carolyn Y. Johnson contributed to this report.

Source C: Conis, et al. “What to Expect When a Coronavirus Vaccine Finally Arrives”

By Elena Conis, Michael McCoyd and Jessie A. Moravek On a spring morning in 1955, a pair of press officers greeted a mob of reporters in a stately hall on the University of Michigan campus. The officers had hot news: A clinical trial of the long-awaited polio vaccine had proved it to be safe and effective. The reporters nearly rioted in their scramble to spread the word. Once they did, church bells rang, and people ran into the streets to cheer. In the midst of our current pandemic, collective hope for a vaccine is just as palpable and regularly reinforced — as it was with this week’s news of promising results from a small coronavirus vaccine test. The federal government’s top infectious-disease expert, Dr. Anthony Fauci, said that “the ultimate game changer in this will be a vaccine.” President Trump assured us that a vaccine is not far off. Television hosts and pundits claim that this goal is within reach because we’ve beaten infectious killers, such as polio, with vaccines in the past. But America’s experience with polio should give us pause, not hope. The first effective polio vaccine followed decades of research and testing. Once fully tested, it was approved with record speed. Then there were life-threatening manufacturing problems. Distribution problems followed. Political fights broke out. After several years, enough Americans were vaccinated that cases plummeted — but they persisted in poor communities for over a decade. Polio’s full story should make us wary of promises that we will soon have the coronavirus under control with a vaccine. The first polio epidemic in the United States hit Vermont in 1894, killing 18 and leaving 58 permanently paralyzed. It was only the beginning. Over the next several decades, warm-weather outbreaks became common, striking communities one year and sparing them the next, sometimes only to return later with added force. A New York City outbreak killed more than 100 people in 1907. In 1916, polio returned and killed 6,000. The disease primarily struck children. It could kill up to 25 percent of the stricken. And it left many paralyzed, consigning some to life in an iron lung. Scientists knew polio was caused by a virus but did not know how it spread. (We know now that it was spread by consumption of food or water contaminated by the virus in fecal matter.) Then, as now, the only way to stay safe was not to be infected. Towns with cases closed movie theaters, pools, amusement parks and summer camps. They canceled long-planned fairs and festivals. Parents kept children close to home. Those who could afford to do so fled to the country. Still, cases mounted. Among three early polio vaccines developed in the 1930s, two proved ineffective, another deadly. Image Finally, in April 1954, a promising vaccine, developed by Jonas Salk’s laboratory at the University of Pittsburgh, entered a large, yearlong clinical trial. On the day in 1955 when the press officers greeted the reporters in Ann Arbor, they shared the results: The vaccine, containing inactivated polio virus, was safe. It was also 80 percent to 90 percent effective in preventing polio. The federal government licensed the vaccine within hours. Manufacturers hastened into production. A foundation promised to buy the first $9 million worth and provide it to the nation’s first and second graders. A national campaign got underway. But less than a month later, the effort ground to a halt. Officials reported six polio cases linked to a vaccine manufactured by Cutter Laboratories in Berkeley, Calif. The surgeon general asked Cutter to recall its lots. The National Institutes of Health asked all manufacturers to suspend production until they met new safety standards. Federal investigators found that Cutter had failed to completely kill the virus in some vaccine batches. The flawed vaccines caused more than 200 polio cases and 11 deaths. The vaccine program partly restarted two months later, but more mayhem followed. With the vaccine in short supply, rumors spread of black markets and unscrupulous doctors charging exorbitant fees. One vaccine manufacturer planned to vaccinate its employees’ children first, and then sent a letter to shareholders promising their children and grandchildren priority access, too.

States asked the federal government to create a program to ensure fair distribution. A Senate bill proposed making the vaccine free to all minors. A House bill proposed free vaccines only for children in need; according to newspaper accounts from the time, discussion of the bill triggered an “angry row” that forced the speaker to call a “cooling off” recess. The $30 million Polio Vaccination Assistance Act that President Dwight Eisenhower signed that August was a compromise that essentially let states decide for themselves. Polio cases fell sharply over the next few years. Then in 1958, as national attention began to flag, cases ticked back up — among the unvaccinated. Polio cases clustered in urban areas, largely among poor people of color with limited health care access. States’ “pattern of polio,” government epidemiologists noted, had become “quite different from that generally seen in the past.” Three years later, the federal government approved an oral polio vaccine, developed by Albert Sabin’s laboratory in Cincinnati, containing weakened, not inactivated, virus. By the end of that year, polio infections were down 90 percent from 1955 levels. In 1979, the country recorded its last community-transmitted case. Today, decades into a global vaccination campaign, polio persists in just three countries. The battle against the disease has been a century-long march. And it has required a sustained commitment to continuing polio vaccination — a commitment now compromised as global polio vaccination efforts have been put on hold to slow the coronavirus’s spread. Granted, there are countless differences between the fight against the coronavirus and the long-ago fight against polio. The global capacity for vaccine research and development is far greater than it was in the 1950s. Drug approval and manufacturing safety protocols have been refined since then, too. Already, just months into the current pandemic, there are far more vaccines in development against the coronavirus than there ever were against polio.

But the regulatory thresholds we’ve spent decades putting into place are being swept aside to speed that development. And some of the coronavirus vaccines now in “lightning fast” development — by new biotech firms, university labs and familiar pharmaceutical giants — are as novel as the first polio vaccine was in 1955.

If one does prove safe and effective, we will face the same challenges we faced then — of making enough to protect the population, without causing harm, and distributing it without exacerbating existing inequities in our society.

Elena Conis is a historian and a professor in the Graduate School of Journalism at the University of California, Berkeley, where Michael McCoyd is a doctoral candidate in computer science and Jessie A. Moravek is a doctoral student in environmental science, policy and management.

Source D: Knowles, Hannah. “A med-school staffer dived into online groups to debunk coronavirus conspiracy theories. Would anyone listen? https://www.washingtonpost.com/nation/2020/07/18/coronavirus-online-groups-misinformation Armed with Centers for Disease Control and Prevention reports, C-SPAN testimonies and a former Lincoln-Douglas debater’s penchant for arguing, Phil Cochetti has spent months wading into Facebook groups created to oppose covid-19 shutdowns and mask mandates. To many, he’s a “troll” with too much free time. He posts links and keeps comment chains going until others peel off — or until he gets kicked out by admins, which tends to happen swiftly. He pleads: “Do me the honor of hearing me out, and I will listen to you all day.” He’s a 36-year-old research coordinator at the University of Pennsylvania’s School of Medicine — department of biostatistics, epidemiology and informatics — who’s made a stay-at-home hobby out of defending states’ pandemic-era restrictions and combating coronavirus misinformation on social media. Posting resources for his

friends and diving into the online communities where misinformation thrives, he’s part of an everyday line of defense against the deluge that’s overwhelmed even professional fact-checkers — comments from family, friends or total strangers on the lookout. The efforts can feel futile, even as research suggests that average citizens of the Internet are a real force in correcting misperceptions. One person’s trusted source in the crisis is another’s political hack. “My biggest thing is, there is this outright rejection of science and what our best scientific knowledge is able to impart,” Cochetti said in an interview. ‘No politics’ Lots of people have been using social media during the pandemic to provide “observational correction,” where others are watching and potentially benefiting, said Emily Vraga, an associate professor in health communication at the University of Minnesota. She co-led a March survey in which more than 1 in 5 Americans reported having told someone during the previous week that they shared misinformation on the coronavirus. That’s slightly higher than other research has found for corrections in general, according to Vraga — maybe because there’s simply so much to debunk with covid-19, or maybe because “any decision you make is inherently about your community.” “Any choice you make has implications for everyone you might come into contact with,” Vraga said. “And so that could be motivating people to engage in more correction than they might on other issues or topics.” Those kinds of fact checks have an impact, she said — along with social media platforms’ efforts to debunk and remove falsehoods — and are usually most effective when people point to a credible expert. However, she notes her latest data is from early on in the pandemic. The politicization of the country’s main tools against virus, from face masks to mass testing, was just getting started. “I don’t know how well the CDC, for example — which has long been that gold standard, trusted-across-party-lines organization — I don’t know if that’s still the case with how political this has become,” she said. There are so many coronavirus myths that even Snopes can’t keep up Some people are trying to create online bubbles where “NO POLITICS” is the explicit rule. Discussion in a roughly 2,700-member public Facebook group called “COVID-19: Scientific Sources and Reputable News” is filled with Nature articles, trackers and a pinned “hoax post” thread. Comments below a Sunday post promoting a “fireside chat” with infectious-diseases expert Anthony S. Fauci made no mention of the drama unfolding as the White House moved to discredit its own adviser. Creator Elizabeth Lilly, a 56-year-old Santa Cruz-area resident, said she wanted to attract and benefit people “across the aisle,” though admins say they’re reevaluating whether “NO POLITICS” is possible when scientists are under political attack. She says she made the group with two friends after watching another online group — despite a similar mission — struggle to weed out posts about unproven miracle cures. She’s given up trying to convince the few anti-vaxxers on her timeline, and one of her fellow admins has had people in an environmental Facebook group dismiss news articles from a variety of countries as “corporate media” with an agenda. “You always have to consider that you’re talking to the people who are listening quietly,” Lilly said. She explains her ideal approach to a fact check: “If you can be diplomatic and reasonable — ” then pauses. She’s a newly laid-off library worker with extra health concerns, a history enthusiast who’s read extensively about pandemics. “It’s sometimes hard to be diplomatic when you’re really frustrated, when you really feel that there is a lot riding on this.”

Into unfamiliar territory Phil Cochetti is a research coordinator at the University of Pennsylvania’s School of Medicine. (Phil Cochetti) Cochetti, the medical school employee — he works on clinical trials, sometimes interacting with patients and other times analyzing the data — quickly became a member of “Scientific Sources and Reputable News” in March. The coronavirus had been on his radar early, he said, thanks to an epidemiologist friend who posted Jan. 3 on Facebook about a mysterious respiratory disease emerging in the Chinese city of Wuhan. In April, he ventured into a much more political online space that sprung up around covid-19. He read about the pro-gun activist siblings behind some of the biggest Facebook groups calling for protests of stay-at-home orders in the United States, including “Pennsylvanians Against Excessive Quarantine” in his home state. Cochetti started Googling, joined the Pennsylvania group and recalls he was eventually kicked out after posting articles about rising infection rates in Kentucky and about the siblings. (Administrators did not respond to inquiries from The Post.) That was the start of a crusade to bring the quarantine-critical crowd around to his views — maybe an exercise in “self-flagellation,” as he admits, all while he worried: about his mom, his dad, his stepmom whose elementary school-aged niece told her she valued her life too much to come visit. It was “a way to vent my own anxiety about what’s going on and hopefully to change some minds about the root of what we need to do next,” Cochetti said as he worked from home. Perspective: Conspiracy theories run rampant when people feel helpless. Like now. Next came Delaware, New Jersey and Maryland, where he has family, friends or work connections. In “Marylanders Against Excessive Quarantine,” instead of being barred, he found members willing to engage. Much of Cochetti’s disagreement with members came down to policy and the right course of action. How much risk justified shutting down society? How serious was this? “I feel like we have, you know, no voice, no advocacy, no lobbying,” Mike Stewart Jr., a 36-year-old martial arts teacher who co-founded the Facebook group, said in an interview when his academies were still suffering under closure orders. “I think some of the shutdown protocols have been pretty heavy-handed and unfair to small businesses while allowing the bigger businesses to stay operational.” But Stewart’s group was also, like many of its counterparts in other states, a freewheeling forum containing falsehoods and distortions: conspiracy theories about vaccines; a video about “murder” at a hospital that YouTube took down; accusations that a federal health official’s statements are just meant to distract from the woman behind a viral, debunked film called “Plandemic.” “This is chock-full of half truths, fraud, bad medical advice, and just poor quality,” Cochetti wrote below the hospital “murder” post. It was the start of a four-paragraph response, but if it swayed anyone, it’s not clear. Victory, to Cochetti, looked like someone saying they watched the video he posted, or having a polite back-and-forth in the comments (“I agree to a point … ”) or messaging privately and eventually agreeing they’d be fine to one day “have a beer” together. Stewart affirmed that virtually no content would be removed, saying he’s not there to police viewpoints or determine accuracy: If you’re an adult on the Internet who drinks Lysol because someone told you to, he said, “I don’t have a terrible amount of sympathy for you.” Asked about Cochetti, Stewart said he was unimpressed with someone “reposting any article you have" and “just repeating everything that you’ve been hearing.” He’s not sure he’d trust even a scientific study, though he’d listen to an infectious-disease specialist friend of his at Johns Hopkins. “I do not trust the police. I don’t trust the media. I don’t trust doctors. And I don’t trust the government,” Stewart said. “I trust my friends and my family.” It’s a common sentiment in “Marylanders Against Excessive Quarantine” — no longer publicly visible because it was archived a few weeks ago, after restrictions lifted — and in other groups that have persisted as states with

spiking cases tighten back up, in some cases swelling to more than 100,000 members. It’s also an outlook that’s stymied Cochetti again and again. Once, in the Maryland group, Cochetti shared a link to a report about a “superspreader” choir practice in Washington state. One person went with coronavirus symptoms; 87 percent of the other 60 people in attendance ended up as confirmed or “probable” covid-19 patients, the report stated. Two died. “Median age was 69,” someone commented, directing some profanity at Cochetti. “This was in Washington state what exactly does it have to do with Maryland?” said another further down. “Also i don’t believe this is a true article more propaganda BS by the snowflakes.” “Trump’s CDC released it … ” Cochetti wrote below. There was no reply.

Nature | www.nature.com | 1

Source E: Johnson, et al. “The Online Competition between Pro- and Anti-Vaccination Views”

Distrust in scientific expertise1–14 is dangerous. Opposition tovaccination with a

vaccine against SARS-CoV-2, the causal agent of COVID-19, for example, could amplify outbreaks2–4, as happened for measles in

20195,6. Homemade remedies7,8 and falsehoods are being shared widely on the Internet, as well as dismissals ofexpert advice9–

11. There is a lack of understanding about how this distrust evolves at the system level13,14. Here we provide a map of the

contention surrounding vaccines that has emerged from the global pool of around three billion Facebook users. Its core reveals a

multi-sided landscape of unprecedented intricacy that involves nearly

100 million individuals partitioned into highly dynamic, interconnected clusters across cities, countries, continents and

languages. Although smaller in overall size, anti-vaccination clusters manage to become highly entangled with undecided

clusters in the main online network, whereas pro-vaccination clusters are more peripheral. Our theoretical framework

reproduces the recent explosive growth in anti-vaccination views, and predicts that these views will dominate in a decade.

Insights provided by this framework can inform new policies and approaches to interrupt this shift to negative views. Our

results challenge the conventional thinking about undecided individuals in issues ofcontention surrounding health, shed light on

other issues ofcontention such as climate change11, and highlight the keyrole of network cluster dynamics in multi-species

ecologies15.

Social media companies are struggling to control online health dis-

and misinformation, for example, during the COVID-19 pandemic in

20208. Online narratives tend to be nurtured in in-built community

spaces that are a specific feature of platforms such as Facebook (for

example, fanpages) butnot Twitter3,16–18. Previousstudieshavepointed

outthat what ismissingisa system-level understandingat the level of

millions of people13, whereas another study14 has highlighted the need

to understand the role of algorithms and bots in the amplification of

risk among unwitting crowds.

Here we provide a system-level analysis of the multi-sided ecology

of nearly 100 million individuals expressing views regarding vaccina-

tion, which are emerging from the approximately 3 billion users of

Facebook from across countries, continents and languages (Figs. 1,

2). The segregation in Fig. 1a arises spontaneously. Individuals come

together into interlinked clusters. Each cluster is a Facebook page and

its members (that is, fans) who subscribe to, share and interact with the

content and narratives of that Facebook page. A link from cluster A to

B exists when A recommends B to all its members at the page level, as

opposed toapage member simply mentioning a cluster. Each red node

isaclusteroffansofapagewithanti-vaccinationcontent. Clustersize is

given by the number of fans, for example, the page ‘RAGE Against the

Vaccines’ has a size of approximately 40,000 members. Blue nodes are

clusters that support vaccinations, for example, the page ‘The Gates

Foundation’ has a size (that is, number of fans) of more than 1 million.

Eachgreen nodeisa page focused aroundvaccinesoranother topic—

for example, a school parent association—that has become linked to

the vaccine debate but for which the stance is still undecided. Support

and potential recruitment of these green clusters (crowds) is akin to

a battle for the ‘hearts and minds’ of individuals in insurgent warfare.

Seven unexpected features of this cluster network (Fig. 1) and its

evolution (Fig. 2) together explain why negative views have become so

robust and resilient, despite aconsiderable number of news stories that

supported vaccination and were against anti-vaccination views during

the measles outbreak of 2019 and recent efforts against anti-vaccination

views from pro-vaccination clusters and Facebook.

First, although anti-vaccination clusters are smaller numerically

(that is, have a minority total size, Fig. 1d) and have ideologically fringe

opinions, anti-vaccination clusters have become central in terms of

the positioning within the network (Fig. 1a). Specifically, whereas

pro-vaccination clusters are confined to the smallest two of the three

network patches (Fig. 2a), anti-vaccination clusters dominate the main

network patch in which they are heavily entangled with a very large

presence of undecided clusters (more than 50 million undecided indi-

viduals). This means that the pro-vaccination clusters in the smaller

1Physics Department, George Washington University, Washington, DC, USA. 2Institute for Data, Democracy and Politics, George Washington University, Washington, DC, USA. 3Institute for

Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI, USA. 4Theoretical Biology and Biophysics Group, Los Alamos National Laboratory, Los Alamos, NM,

USA. 5Department of Computer Science, University of Miami, Coral Gables, FL, USA. 6Department of Political Science, George Washington University, Washington, DC, USA. ✉e-mail:

neiljohnson@gwu.edu

b Global ether a

c

600

400

200

0

600

400

200

0

600

400

200

0

d Number of Number of individuals clusters

Anti-vaccination 4.2 million 317

Article

101 103 105 107

101 103 105 107 101 103 105 107 Pro-vaccination 6.9 million 124

Initial cluster size Initial cluster size Initial cluster size Undecided 74.1 million 885

Fig. 1 | Online ecology ofvaccine views. a, Snapshot from 15 October 2019 of

the connected component in the complex ecology of undecided (green),

anti-vaccination (red) and pro-vaccination (blue) views comprising nearly

100 million individuals in clusters (pages) associated with the vaccine topic on

Facebook. The colour segregation is an emergent effect (that is, not imposed).

Cluster sizes are determined by the number of members of the Facebook page.

Black rings show clusters with more than 50% out-link growth. Each link

between nodes has the colour of the source node. b, Global spread of Fig. 1a for

a small number of clusters. The ‘global ether’ represents clusters that remain

global (grey). c, Anti-vaccination clusters have a stronger growth in cluster

size. Each coloured dot is a node; data are from February–October 2019.

d, Anti-vaccination individuals are an overall numerical minority compared

with pro-vaccination individuals; however, anti-vaccination individuals form

more separate clusters.

network patches may remain ignorant of the main conflict and have

the wrong impression that they are winning.

Second, instead of the undecided population being passively per-

suadedbytheanti- orpro-vaccinationpopulations, undecidedindividu-

als are highly active: the undecided clusters have the highest growth of

new out-links (Fig. 1a), followed by anti-vaccination clusters. Moreover,

it isthe undecided clusters whoareentangled with the anti-vaccination

clustersinthemainnetworkpatchthattendtoshowthishighout-link

growth. These findings challenge our current thinking that undecided

individuals are apassive background population in the battle for ‘hearts

and minds’.

Third, anti-vaccination individuals form more than twice as many

clusterscomparedwithpro-vaccinationindividualsbyhavingamuch

smaller average cluster size. This means that the anti-vaccination pop-

ulation provides a larger number of sites for engagement than the

pro-vaccination population. This enables anti-vaccination clusters

to entangle themselves in the network in a way that pro-vaccination

clusterscannot. Asaresult, manyanti-vaccinationclustersmanageto

increase their network centrality (Fig. 2b) more than pro-vaccination

clusters despite the media ambience that was against anti-vaccination

views during 2019, and manage to reach better across the entire net-

work (Fig. 2a).

Fourth, our qualitative analysis of cluster content shows that

anti-vaccination clusters offer a wide range of potentially attractive

narrativesthatblendtopicssuchassafetyconcerns, conspiracytheo-

ries and alternative health and medicine, and also now the cause and

cure of the COVID-19 virus. This diversity in the anti-vaccination nar-

ratives is consistent with other reports in the literature4. By contrast,

pro-vaccination views are far more monothematic. Using aggregation

mathematics and a multi-agent model, we have reproduced the ability

of anti-vaccination support to form into an array of many smaller-sized

clusters, each with its own nuanced opinion, from a population of

individuals with diverse characteristics (Fig. 3b and Supplementary

Information).

Fifth, anti-vaccination clusters show the highest growth duringthe

measles outbreak of 2019, whereas pro-vaccinationclusters show the

lowest growth (Fig. 1c). Some anti-vaccination clusters grow by more

than 300%, whereas no pro-vaccination cluster grows by more than

100% andmostclustersgrow bylessthan 50%. Thisisagainconsistent

withtheanti-vaccinationpopulationbeingabletoattractmoreunde-

cided individuals byoffering manydifferenttypesofcluster, each with

its own type of negative narrative regarding vaccines.

Sixth, medium-sized anti-vaccination clusters grow most.

Whereas larger anti-vaccination clusters take up the attention of the

pro-vaccination population, these smaller clusters can expand without

beingnoticed. Thisfindingchallengesabroadertheoreticalnotionof

population dynamics that claims that groups grow though preferential

attachment (that is, a larger size attracts more recruits). Therefore, a

different theory is needed that generalizes the notion of size-dependent

growth to include heterogeneity (Fig. 3b).

Seventh, geography (Fig. 1b) is a favourable factor for the

anti-vaccination population. Anti-vaccination clusters either self-locate

within cities, states or countries, or remain global. Figure 1b shows a

small sample of the connectivity between localized and global clus-

ters. Any two local clusters (for example, two US states) are typically

interconnected through an ether of global clusters and so feel part of

both a local and global campaign.

The complex cluster dynamics between undecided, anti-

vaccination and pro-vaccination individuals (Figs. 1, 2) mean that

traditional mass-action modelling19 cannot be used reliably for

Incre

ase in

clu

ste

r siz

e (

%)

Nature | www.nature.com | 3

4

a

11

9

7

5

Jan Jul Jan Jul 2020 2025 2030 2035

b

Jan Jul

2040 2045

b

4,000

Individual clusters

Individual networks Across all networks

2,000

0

102 104 106 102 104 106 102 104 106

Time

0.5

Fraction of

1.0

Rate of existing Initial cluster size Initial cluster size Initial cluster size B/(B + X) link inactivation

Fig. 2 | Temporal evolution ofonline ecology. a, Link growth during

February–October 2019 for anti-vaccination (red; left) and pro-vaccination

(blue; right) clusters. Anti-vaccination clusters successfully added many new

links within the largest network patch and between network patches, despite

the media ambience against anti-vaccination views during the measles

outbreak in 2019. The underlying clusters are identical to Fig. 1a, that is, each

network patch is a clustered region of clusters from Fig. 1a. b, Anti-vaccination

clusters have a stronger growth in node eigencentrality—which indicates the

influence of a node in a network—than pro-vaccination clusters. Data are from

February–October 2019.

predictions or policies. Mass-action models suggest that given the large

pro-vaccination majority (Fig. 1d), the anti-vaccination clusters should

shrink relative to pro-vaccination clusters under attrition, which is the

opposite of what happened in 2019. Figure 3a shows the importance of

these missing cluster dynamics using a simple computer simulation

with mass-action interactions only between clusters, not populations.

The simulation reproduces the increase in anti-vaccination support in

2019, and predicts that anti-vaccination views will dominate in approx-

imately 10 years (Fig. 3a). These findings suggest a new theoretical

framework to describe this ecology, and inform new policies that allow

pro-vaccination entities, or the platform itself, to choose their preferred

scale at which to intervene.

If the preferred intervention scale is at the scale of individual clus-

ters (Fig. 3b), then Fig. 1a can identify and target the most central and potentially influential anti-vaccination clusters. Our clustering theory

Fig. 3 | Predictions and interventions. a, Theoretical prediction for the future

total size of anti-vaccination and pro-vaccination support without new

interventions (coloured lines with 2σ bands from the simulation). Under the

present conditions, it predicts that total anti-vaccination support reaches

dominance in around 10 years. b, Top left, our theoretical model predicts that,

as observed empirically, many smaller-sized anti-vaccination clusters form,

with each cluster having its own nuanced type of narrative (for example, X, Y, Z)

that surrounds a generaltopic(vaccines in this case). Bottom left, the predicted

growth profile of individual clusters can be manipulated by altering the

heterogeneity to delay the onset and decrease the growth. Bottom middle,

pro-vaccination population B is predicted to overcome the anti-vaccination

population, or persuade the undecided population, X, within a given network

patch in time T by using Fig. 1a to identify and then engage with all the clusters.

Bottom right, the link dynamics can be manipulated to prevent the spread of

negative narratives. See Supplementary Information for all mathematical

details.

delayed onset time for a future nascent anti-vaccination (or connected

undecided) clusteris tonset= N/2F. Ifinsteadthepreferredintervention

scale is at the scale of network patches (single or connected; Fig. 3b),

our theoretical framework predicts that the pro-vaccination population

(B) can beat the anti-vaccination population or persuade the undecided

population (X) within a given network patch S over time T by using

Fig. 1a to identify and then proactively engage with the other clusters

in S, irrespective of whether they are linked or not:

(see Supplementary Information) predicts that the growth rate of an

influential anti-vaccination cluster can be reduced, and the onset time

for future anti-vaccination (or connected undecided) clusters delayed,

T = 1

X + (B − X)ln xc(2 − dB− dX)

X(B − X + xc)

xcB (1)

by increasing the heterogeneity within the cluster. This reduces param-

eter F of our theory, which captures the similarity of pairs of engaged

individuals N in a particular narrative. The anti-vaccination (or con-

nected undecided) cluster size C(t) is reduced to C(t)=N(1 − W([−2Ft/N]

exp[−2Ft/N])/[−2Ft/N]) where W is the Lambert function20, and the

where dB and dX are rates at which the activity of an average cluster

becomes inactive (for example, no more posts in the cluster), and B and

X are the current total sizes of the respective populations21. If instead

the preferred intervention scale is the entire global ecology (Fig. 1a),

this framework predicts the condition rlinkp/rinactiveq < 1 to prevent the

a

X

Z

Y

rlink

p

r inactive

q = 1

Spreading

No spreading

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alit

y (

%)

Tota

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um

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r o

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sup

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(m

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e

Tim

e T

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r B

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om

e X

Rate

of

new

link fo

rmatio

n

Article

spreading of negative narratives22 (Fig. 3b), where rlink and rinactive are

the rates at which links are formed and become inactive between sets

ofclusters; p istheaveragerateatwhichaclustersharesmaterialwith

another cluster and q is the average rate at which a cluster becomes inac-

tive. Conversely, rlinkp/rinactiveq > 1 predicts the condition for system-wide

spreading of intentional counter-messaging. As p and q are proper-

ties related to a singleaverage cluster and are probably more difficult

to manipulate, the best intervention at this system-wide scale is to

manipulate the rate at which links are created (rlink) and/or the rate at

which links become inactive (rinactive).

Finally, wenotethatouranalysisisincompleteandthatotherchan-

nels of influence should be explored. However, similar behaviours

should arise in any online setting in which clusters can form. Our mathe-

matical formulae are approximations. Wecould define links differently,

for example, as numbers of members that clusters have in common.

However, suchinformationisnotpubliclyavailableon Facebook. Fur-

thermore, our previous study of a Facebook-like platform for which

such information was available showed that the absence or presence

of such a link between pages acts as a proxy for low or high numbers

of common members. How people react to intervention is ultimately

an empirical question23,24. One may also wonder about external agents

or entities—however, clusters tend to police themselves for bot-like or

trollbehaviour. Thecrudelypower law-like distributionofthe cluster

sizesofanti-vaccinationclusterssuggeststhatanytop-downpresence

is not dominant.

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acknowledgements, peer review information; details of author con-

tributions and competing interests; and statements of data and code

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© The Author(s), under exclusive licence to Springer Nature Limited 2020

Methods

We used clusters (Facebook pages) as the unitforouranalysis17,18. Our clusterapproachdoesnotrequire

anyprivateinformationofindividu- als. The ForceAtlas2 layout of Gephi (Fig. 1a) simulates a physical system inwhich nodes

(clusters) repel each other while linksact as springs. It is colour-agnostic, that is, the colour segregation in Fig. 1a

emerges spontaneously and is not in-built. Nodes that appear closer to each other have local environments that are

more highly interconnected, whereas nodes that are far apart do not. Our data collection uses the same cluster

snowballing methodology as described previously17,18, that is, a combination of automated processes and human subject-

matter analysis. Each cluster (Facebook page) directly receives the feed of narratives and other material from that

page and all members (fans) can engage in the discussions and posting activity. Figure 1b uses the declared location of

each cluster. Derivations of the equations are provided in the Supplementary Information; they build on published

results20–22 and our approach complements other studies25–33. Equa- tion (1) is easily generalizable, but for simplicity

we assume here a minimal model in which each pro-vaccination cluster has a narrative that persuades on average

xcmembers of each cluster X in each engage- ment, and the pro-vaccination cluster B picks a cluster X randomly within

S. Equation (1) also applies to the full anti-vaccination–unde- cided ecology if we take the X-related quantities in

equation (1) as weighted anti-vaccination–undecided values from Fig. 1a. The formula rlinkp/rinactiveq < 1, to prevent

spreading, accounts for the key feature of cluster interconnections that change over time and can be applied to

spreading between anti-vaccination clusters, between undecided clusters, or between both anti-vaccination and

undecided clusters using weighted values. For the model in Fig. 3a, rates of cluster inter- action are given to the first

order by the relative number of links of each type with Y-undecided interactions that yield more recruits for Y when Y

is anti-vaccination than when Y is pro-vaccination (see Sup- plementary Information). Thefidelityofthese

predictionsisaffected by the approximations of the model. For Fig. 3b, all parameters can be extracted from data or

estimated from simulations. In the top left graph of Fig. 3b, two dimensions are shown for simplicity, for example, the

degree of belief in government conspiracy and the degree of belief in alternative health, but similar plots emerge for

other numbers of dimensions. In the bottom middle graph of Fig. 3b, the total initial size B (pro-vaccination population)

plus size X (for example, anti-vaccination population) is kept constant. Although this leaves open the details of the

conversion process for each X cluster, a previous study30 has shown

thatsuchconversionwithinanonlineclusteroccursandcanberapid. T for mass-action theory would tend to decrease

monotonically as B

increases; however, our theory in equation (1) shows a counterintui- tive dependence because smaller but

finite numbers of X clusters take the pro-vaccination clusters longer to find. Only functional forms are shown

(that is, no numbers) as the underlying formulae and models are not restricted by specific numerical choices

of parameter values.