Not just conspiracy theories: Vaccine opponents and proponents add to the COVID-19 'infodemic' on Twitter

Decoding the Discourse: Analyzing the Linguistic Features and Strategies Behind the Querdenken Movement's COVID-19 Narrative

This study analyzes the linguistic rhetorical strategies utilized by the German-speaking Querdenken movement's alternative media during the COVID-19 pandemic. Employing a critical discourse analysis (CDA) framework, we examine articles from alternative media sources frequently used by the movement's members in comparison with broadsheet and tabloid newspapers, utilizing dictionary-based linguistic analyses with linear mixed models to investigate the emotional tone, health-related language, and scientific terminology used in COVID-19 coverage. Our research reveals that Querdenken outlets use more scientific language and exhibit a more negative emotional tone, emphasizing health-related issues more strongly than other media sources. Additionally, a manual content analysis inspected the relationship between articles and cited sources, including their interpretative congruence and originality, uncovering a notable mismatch between sources cited and their representation in Querdenken outlets. These findings illuminate alternative media's important role in shaping discourse, especially in critical public health contexts. Our research contributes to a better understanding of how alternative media narratives operate and, in our study, co-opt the language of science. This study underscores the need for adequate science literacy and communication strategies to counteract misinformation and enhance public understanding of complex health issues.

Conspiracy narratives and vaccine hesitancy: a scoping review of prevalence, impact, and interventions

Believing conspiracy narratives is frequently assumed to be a major cause of vaccine hesitancy, i.e., the tendency to forgo vaccination despite its availability. In this scoping review, we synthesise and critically evaluate studies that assess i) the occurrence of vaccine-related conspiracy narratives on the internet, ii) the prevalence of belief in vaccine-related conspiracy narratives, iii) the relationship between belief in conspiracy narratives and vaccination intention or vaccination uptake, and iv) interventions that reduce the impact of conspiracy narratives on vaccination intention.In July 2022, we conducted a literature search using three databases: PubMed, PsychInfo, and Web of Science. Following the PRISMA approach, of the 500 initially identified articles, 205 were eligible and analysed.The majority of identified studies were conducted in Europe and North America, were published in 2021 and 2022, and investigated conspiracy narratives around the COVID-19 vaccination. The prevalence of belief in various vaccine-related conspiracy narratives varied greatly across studies, from 2 to 77%. We identified seven experimental studies investigating the effect of exposure to conspiracy narratives on vaccination intentions, of which six indicated a small negative effect. These findings are complemented by the evidence from over 100 correlative studies showing a significant negative relationship between conspiracy beliefs and vaccination intention or uptake. Additionally, the review identified interventions (e.g., social norm feedback, fact-checking labels, or prebunking) that decreased beliefs in vaccine-related conspiracy narratives and, in some cases, also increased vaccination intentions. Yet, these interventions had only small effects.In summary, the review revealed that vaccine-related conspiracy narratives have spread to varying degrees and can influence vaccination decisions. Causal relationships between conspiracy beliefs and vaccination intentions remain underexplored. Further, the review identified a need for more research on interventions that can reduce the impact of conspiracy narratives.

Leveraging artificial intelligence to identify the psychological factors associated with conspiracy theory beliefs online

Given the profound societal impact of conspiracy theories, probing the psychological factors associated with their spread is paramount. Most research lacks large-scale behavioral outcomes, leaving factors related to actual online support for conspiracy theories uncertain. We bridge this gap by combining the psychological self-reports of 2506 Twitter (currently X) users with machine-learning classification of whether the textual data from their 7.7 million social media engagements throughout the pandemic supported six common COVID-19 conspiracy theories. We assess demographic factors, political alignment, factors derived from theory of reasoned action, and individual psychological differences. Here, we show that being older, self-identifying as very left or right on the political spectrum, and believing in false information constitute the most consistent risk factors; denialist tendencies, confidence in one's ability to spot misinformation, and political conservativism are positively associated with support for one conspiracy theory. Combining artificial intelligence analyses of big behavioral data with self-report surveys can effectively identify and validate risk factors for phenomena evident in large-scale online behaviors.

Analysis of Pharmaceutical Companies' Social Media Activity during the COVID-19 Pandemic and Its Impact on the Public

The COVID-19 pandemic, a period of great turmoil, was coupled with the emergence of an "infodemic", a state when the public was bombarded with vast amounts of unverified information from dubious sources that led to a chaotic information landscape. The excessive flow of messages to citizens, combined with the justified fear and uncertainty imposed by the unknown virus, cast a shadow on the credibility of even well-intentioned sources and affected the emotional state of the public. Several studies highlighted the mental toll this environment took on citizens by analyzing their discourse on online social networks (OSNs). In this study, we focus on the activity of prominent pharmaceutical companies on Twitter, currently known as X, as well as the public's response during the COVID-19 pandemic. Communication between companies and users is examined and compared in two discrete channels, the COVID-19 and the non-COVID-19 channel, based on the content of the posts circulated in them in the period between March 2020 and September 2022, while the emotional profile of the content is outlined through a state-of-the-art emotion analysis model. Our findings indicate significantly increased activity in the COVID-19 channel compared to the non-COVID-19 channel while the predominant emotion in both channels is joy. However, the COVID-19 channel exhibited an upward trend in the circulation of fear by the public. The quotes and replies produced by the users, with a stark presence of negative charge and diffusion indicators, reveal the public's preference for promoting tweets conveying an emotional charge, such as fear, surprise, and joy. The findings of this research study can inform the development of communication strategies based on emotion-aware messages in future crises.

Perceived experts are prevalent and influential within an antivaccine community on Twitter

Perceived experts (i.e. medical professionals and biomedical scientists) are trusted sources of medical information who are especially effective at encouraging vaccine uptake. The role of perceived experts acting as potential antivaccine influencers has not been characterized systematically. We describe the prevalence and importance of antivaccine perceived experts by constructing a coengagement network of 7,720 accounts based on a Twitter data set containing over 4.2 million posts from April 2021. The coengagement network primarily broke into two large communities that differed in their stance toward COVID-19 vaccines, and misinformation was predominantly shared by the antivaccine community. Perceived experts had a sizable presence across the coengagement network, including within the antivaccine community where they were 9.8% of individual, English-language users. Perceived experts within the antivaccine community shared low-quality (misinformation) sources at similar rates and academic sources at higher rates compared to perceived nonexperts in that community. Perceived experts occupied important network positions as central antivaccine users and bridges between the antivaccine and provaccine communities. Using propensity score matching, we found that perceived expertise brought an influence boost, as perceived experts were significantly more likely to receive likes and retweets in both the antivaccine and provaccine communities. There was no significant difference in the magnitude of the influence boost for perceived experts between the two communities. Social media platforms, scientific communications, and biomedical organizations may focus on more systemic interventions to reduce the impact of perceived experts in spreading antivaccine misinformation.

COVID-19 infodemic and health-related quality of life in patients with chronic respiratory diseases: A multicentre, observational study

Background

The explosion of information, misinformation and disinformation (the "infodemic") related to the coronavirus disease 2019 (COVID-19) pandemic on digital and social media is reported to affect mental health and quality of life. However, reports assessing the COVID-19 infodemic on health-related quality of life (HRQL) in patients with chronic diseases are scarce. In this study, we investigated the associations between the infodemic and HRQL in uninfected individuals with pre-existing chronic respiratory diseases (CRDs) such as asthma, chronic obstructive pulmonary disease (COPD) and other CRDs.

Methods

We conducted a multi-national, cross-sectional, observational study in Canada, India, New Zealand and the United Kingdom where we distributed a set of digitised questionnaires among 1018 participants with chronic respiratory diseases who were not infected with the SARS-CoV-2 virus at least three months prior to the study. We collected information about the infodemic such as news watching or social media use more than usual during the pandemic. HRQL was assessed using the short form of the chronic respiratory questionnaire (SF-CRQ). Demographic information, comorbidities, compliance, mental health, behavioural function, and social support were also recorded. We analysed the direct and indirect relationships between infodemic and HRQL using structural equation models (SEM).

Results

Of all participants, 54% were females and had a mean (standard deviation (SD)) age of 53 (17) years. We found that higher infodemic was associated with worse emotional function (regression coefficient β = -0.08; 95% confidence interval (CI) = -0.14 to -0.01), which means a one SD change of the higher infodemic latent variable was associated with a 0.08 SD change of emotional function level. The association between higher infodemic and worse emotional function was mediated by worse mental health and behavioural functions but is marginally ameliorated by improved social support. In stratification analysis, we found significant disease and country-wise variations in the associations between infodemic and SF-CRQ domain scores.

Conclusions

These results provide new evidence that the COVID-19 infodemic significantly influences the HRQL in patients with CRDs through a complex interplay between mental health, behavioural function, and social support. This new dimension of research also opens avenues for further research on infodemic-related health effects in other chronic diseases.

The Role of Social Media in Health Misinformation and Disinformation During the COVID-19 Pandemic: Bibliometric Analysis

BACKGROUND

The use of social media platforms to seek information continues to increase. Social media platforms can be used to disseminate important information to people worldwide instantaneously. However, their viral nature also makes it easy to share misinformation, disinformation, unverified information, and fake news. The unprecedented reliance on social media platforms to seek information during the COVID-19 pandemic was accompanied by increased incidents of misinformation and disinformation. Consequently, there was an increase in the number of scientific publications related to the role of social media in disseminating health misinformation and disinformation at the height of the COVID-19 pandemic. Health misinformation and disinformation, especially in periods of global public health disasters, can lead to the erosion of trust in policy makers at best and fatal consequences at worst.

OBJECTIVE

This paper reports a bibliometric analysis aimed at investigating the evolution of research publications related to the role of social media as a driver of health misinformation and disinformation since the start of the COVID-19 pandemic. Additionally, this study aimed to identify the top trending keywords, niche topics, authors, and publishers for publishing papers related to the current research, as well as the global collaboration between authors on topics related to the role of social media in health misinformation and disinformation since the start of the COVID-19 pandemic.

METHODS

The Scopus database was accessed on June 8, 2023, using a combination of Medical Subject Heading and author-defined terms to create the following search phrases that targeted the title, abstract, and keyword fields: ("Health*" OR "Medical") AND ("Misinformation" OR "Disinformation" OR "Fake News") AND ("Social media" OR "Twitter" OR "Facebook" OR "YouTube" OR "WhatsApp" OR "Instagram" OR "TikTok") AND ("Pandemic*" OR "Corona*" OR "Covid*"). A total of 943 research papers published between 2020 and June 2023 were analyzed using Microsoft Excel (Microsoft Corporation), VOSviewer (Centre for Science and Technology Studies, Leiden University), and the Biblioshiny package in Bibliometrix (K-Synth Srl) for RStudio (Posit, PBC).

RESULTS

The highest number of publications was from 2022 (387/943, 41%). Most publications (725/943, 76.9%) were articles. JMIR published the most research papers (54/943, 5.7%). Authors from the United States collaborated the most, with 311 coauthored research papers. The keywords "Covid-19," "social media," and "misinformation" were the top 3 trending keywords, whereas "learning systems," "learning models," and "learning algorithms" were revealed as the niche topics on the role of social media in health misinformation and disinformation during the COVID-19 outbreak.

CONCLUSIONS

Collaborations between authors can increase their productivity and citation counts. Niche topics such as "learning systems," "learning models," and "learning algorithms" could be exploited by researchers in future studies to analyze the influence of social media on health misinformation and disinformation during periods of global public health emergencies.

Complementary, alternative, and integrative medicine-specific COVID-19 misinformation on social media: A scoping review

Background

The sharing of health-related information has become increasingly popular on social media. Unregulated information sharing has led to the spread of misinformation, especially regarding complementary, alternative, and integrative medicine (CAIM). This scoping review synthesized evidence surrounding the spread of CAIM-related misinformation on social media during the COVID-19 pandemic.

Methods

This review was informed by a modified version of the Arksey and O'Malley scoping review framework. AMED, EMBASE, PsycINFO and MEDLINE databases were searched systematically from inception to January 2022. Eligible articles explored COVID-19 misinformation on social media and contained sufficient information on CAIM therapies. Common themes were identified using an inductive thematic analysis approach.

Results

Twenty-eight articles were included. The following themes were synthesized: 1) misinformation prompts unsafe and harmful behaviours, 2) misinformation can be separated into different categories, 3) individuals are capable of identifying and refuting CAIM misinformation, and 4) studies argue governments and social media companies have a responsibility to resolve the spread of COVID-19 misinformation.

Conclusions

Misinformation can spread more easily when shared on social media. Our review suggests that misinformation about COVID-19 related to CAIM that is disseminated online contributes to unsafe health behaviours, however, this may be remedied via public education initiatives and stricter media guidelines. The results of this scoping review are crucial to understanding the behavioural impacts of the spread of COVID-19 misinformation about CAIM therapies, and can inform the development of public health policies to mitigate these issues.

Validating a German Version of the Conspiracy Mentality Scale (CMS)

Increased scientific interest in conspiracy beliefs raises the need for validated individual difference measures in the general tendency to believe in conspiracy theories, otherwise referred to as conspiracy mentality. In this article, we present a German language version of the Conspiracy Mentality Scale (CMS). A representative sample of German-speaking Swiss residents (N = 468) filled in the scale, along with measures of trust in several sources of information, need for social validation, compliance with Covid-19 preventive measures, perceived severity of the pandemic, loneliness, functional literacy and interpersonal conflict. Confirmatory factor analysis supported the two-dimensional structure of the original scale. Positive correlations between conspiracy theory ideation and trust in friends and the need for social validation on the one hand, and negative correlations with trust in scientific publications and scientific experts, perceived severity of the pandemic and functional literacy on the other hand supported construct validity. We conclude that our German language version of the scale is a valid measure of conspiracy theory ideation and skepticism.

The role and influence of perceived experts in an anti-vaccine misinformation community

The role of perceived experts (i.e., medical professionals and biomedical scientists) as potential anti-vaccine influencers has not been characterized systematically. We describe the prevalence and importance of anti-vaccine perceived experts by constructing a coengagement network based on a Twitter data set containing over 4.2 million posts from April 2021. The coengagement network primarily broke into two large communities that differed in their stance toward COVID-19 vaccines, and misinformation was predominantly shared by the anti-vaccine community. Perceived experts had a sizable presence within the anti-vaccine community and shared academic sources at higher rates compared to others in that community. Perceived experts occupied important network positions as central anti-vaccine nodes and bridges between the anti- and pro-vaccine communities. Perceived experts received significantly more engagements than other individuals within the anti- and pro-vaccine communities and there was no significant difference in the influence boost for perceived experts between the two communities. Interventions designed to reduce the impact of perceived experts who spread anti-vaccine misinformation may be warranted.

Examining the Negative Sentiments Related to Influenza Vaccination from 2017 to 2022: An Unsupervised Deep Learning Analysis of 261,613 Twitter Posts

Several countries are witnessing significant increases in influenza cases and severity. Despite the availability, effectiveness and safety of influenza vaccination, vaccination coverage remains suboptimal globally. In this study, we examined the prevailing negative sentiments related to influenza vaccination via a deep learning analysis of public Twitter posts over the past five years. We extracted original tweets containing the terms 'flu jab', '#flujab', 'flu vaccine', '#fluvaccine', 'influenza vaccine', '#influenzavaccine', 'influenza jab', or '#influenzajab', and posted in English from 1 January 2017 to 1 November 2022. We then identified tweets with negative sentiment from individuals, and this was followed by topic modelling using machine learning models and qualitative thematic analysis performed independently by the study investigators. A total of 261,613 tweets were analyzed. Topic modelling and thematic analysis produced five topics grouped under two major themes: (1) criticisms of governmental policies related to influenza vaccination and (2) misinformation related to influenza vaccination. A significant majority of the tweets were centered around perceived influenza vaccine mandates or coercion to vaccinate. Our analysis of temporal trends also showed an increase in the prevalence of negative sentiments related to influenza vaccination from the year 2020 onwards, which possibly coincides with misinformation related to COVID-19 policies and vaccination. There was a typology of misperceptions and misinformation underlying the negative sentiments related to influenza vaccination. Public health communications should be mindful of these findings.

The Roles of Information Valence, Media Literacy and Perceived Information Quality on the Association Between Frequent Social Media Exposure and COVID-19 Vaccination Intention

PURPOSE

This study aimed to examine the associations between frequent exposure to positive/negative information about vaccine efficacy/safety on social media and intention of COVID-19 vaccination, and to test if media literacy and perceived information quality would moderate such associations.

DESIGN

A multi-city cross-sectional survey.

SETTING

At five universities in different regions of China.

SUBJECTS

6922 university students (a response rate of 72.3%).

MEASURES

frequency of exposure to social media information about COVID-19 vaccination, media literacy, perceived information quality, intention of COVID-19 vaccination, and sociodemographic characteristics.

ANALYSIS

Logistic regression analysis was conducted to test main and interaction effects.

RESULTS

Higher exposure to positive information about vaccine efficacy (adjusted odds ratio [AOR] = 1.30, P < .001) and vaccine safety (AOR = 1.27, P < .001) were positively associated with vaccination intention. No significant associations were shown between exposure to negative information about vaccine efficacy/safety and vaccination intention. Higher net exposure to negative vs positive information was negatively associated with vaccination intention (AOR = .82, P < .001). High media literacy was further found to attenuate the effect of negative information exposure and strengthen that of positive information exposure. Perceived information quality was not a significant moderator.

CONCLUSION

The valence of social media information regarding the efficacy and safety of COVID-19 vaccines and individuals' media literacy jointly shaped COVID-19 vaccination intention. The findings can inform the development of effective health promotion strategies for enhancing COVID-19 vaccination.

Parents' Willingness to Vaccinate Children for COVID-19: Conspiracy Theories, Information Sources, and Perceived Responsibility

Understanding parental decision-making about vaccinating their children for COVID-19 is essential to promoting uptake. We conducted an online survey between April 23-May 3, 2021, among a national sample of U.S. adults to assess parental willingness to vaccinate their child(ren). We also examined associations between parental intentions to VACCINATE their children for COVID-19 and conspiracy theory beliefs, trusted information sources, trust in public authorities, and perceptions regarding the responsibility to be vaccinated. Of 257 parents of children under 18 years that responded, 48.2% reported that they would vaccinate their children, 25.7% were unsure, and 26.1% said they would not vaccinate. After adjusting for covariates, each one-point increase in the Vaccine Conspiracy Beliefs Scale was associated with 25% lower odds of parents intending to vaccinate their children compared to those who did not intend to (adjusted odds ratio (AOR) = 0.75, 95% confidence interval (CI): 0.64-0.88). Parents that perceived an individual and societal responsibility to be vaccinated were more likely to report that they intended to vaccinate their children compared to those that did not intend to vaccinate their children (AOR = 5.65, 95% CI: 2.37-13.44). Findings suggest that interventions should focus on combatting conspiracy beliefs, promoting accurate and trusted information sources, and creating social norms emphasizing shared responsibility for vaccination.

Information propagation on cyber, relational and physical spaces about covid-19 vaccine: Using social media and splatial framework

With the advent of social media, human dynamics studied in purely physical space have been extended to that of a cyber and relational context. However, connections and interactions between these hybrid spaces have not been sufficiently investigated. The "space-place (Splatial)" framework proposed in recent years allows capturing human activities in the hybrid of spaces. This study applies the Splatial framework to examine the information propagation between cyber, relational, and physical spaces through a case study of Covid-19 vaccine debates in New York State (NYS). Whereby the physical space represents the regional boundaries and locations of social media (i.e., Twitter) users in NYS, the relational space indicates the social networks of these NYS users, and the cyber space captures the larger conversational context of the vaccination debate. Our results suggest that the Covid-19 vaccine debate is not polarized across all three spaces as compared to that of other vaccines. However, the rate of users with a pro-vaccine stance decreases from physical to relational and cyber spaces. We also found that while users from different spaces interact with each other, they also engage in local communications with users from the same region or same space, and distance-based and boundary-confined clusters exist in cyber and relational space communities. These results based on the Splatial framework not only shed light on the vaccination debates but also help to define and elucidate the relationships between the three spaces. The intense interactions between spaces suggest incorporating people's relational network and cyber presence in physical place-making.

Public attitudes on social media toward vaccination before and during the COVID-19 pandemic

With the success of COVID-19 vaccines in clinical trials, vaccination programs are being administered for the population with the hopes of herd immunity. However, the success of any vaccination program depends on the percentage of people willing to get vaccination which is influenced by social, economic, demographic, and vaccine-specific factors. Thus, it is important to understand public attitudes and perceptions toward vaccination. This study aims to measure public attitude toward vaccines and vaccinations before and during the COVID-19 pandemic, using public data from Twitter. A total of 880,586 tweets for 57,529 unique users were included in the study. Most of the tweets were posted in five languages: French, English, Swedish, Dutch, and Italian. These tweets were divided into two time periods: before COVID-19 (T1) and during COVID-19 (T2). This study observed the shift in the sentiments of the public attitude toward vaccines before and during COVID-19 pandemic. Both positive and negative shifts in sentiments were observed for the users of various languages but shifts toward positive sentiments were more prominent during the COVID-19 pandemic.

On the relationship between conspiracy theory beliefs, misinformation, and vaccine hesitancy

At the time of writing, nearly one hundred published studies demonstrate that beliefs in COVID-19 conspiracy theories and misinformation are negatively associated with COVID-19 preventive behaviors. These correlational findings are often interpreted as evidence that beliefs in conspiracy theories and misinformation are exogenous factors that shape human behavior, such as forgoing vaccination. This interpretation has motivated researchers to develop methods for "prebunking," "debunking," or otherwise limiting the spread of conspiracy theories and misinformation online. However, the robust literatures on conspiracy theory beliefs, health behaviors, and media effects lead us to question whether beliefs in conspiracy theories and misinformation should be treated as exogenous to vaccine hesitancy and refusal. Employing U.S. survey data (n = 2,065) from July 2021, we show that beliefs in COVID-19 conspiracy theories and misinformation are not only related to COVID-19 vaccine hesitancy and refusal, but also strongly associated with the same psychological, social, and political motivations theorized to drive COVID-19 vaccine hesitancy and refusal. These findings suggest that beliefs in conspiracy theories and misinformation might not always be an exogenous cause, but rather a manifestation of the same factors that lead to vaccine hesitancy and refusal. We conclude by encouraging researchers to carefully consider modeling choices and imploring practitioners to refocus on the worldviews, personality traits, and political orientations that underlie both health-related behaviors and beliefs in conspiracy theories and misinformation.

Impact of Media Use on Chinese Public Behavior towards Vaccination with the COVID-19 Vaccine: A Latent Profile Analysis

(1) Background: research on vaccines has received extensive attention during epidemics. However, few studies have focused on the impact of media use on vaccination behavior and the factors influencing vaccination in groups with different media use degrees; (2) Method: Based on seven items related to media use, a total of 11,031 respondents were categorized by the frequency of media use by using latent profile analysis (LPA). Binary regression analysis was used to study the factors that influence the vaccination behaviors of people with different media use frequencies; (3) Results: All respondents were classified into the following three groups: media use low frequency (9.7%), media use general (67.1%), and media use high frequency (23.2%). Media use low frequency (β = −0.608, p < 0.001) was negatively associated with COVID-19 vaccination behavior. In the media use low frequency, analysis showed that “aged 41 years or older” β = 1.784, p < 0.001), had religious belief (β = 0.075, p < 0.05), were ethnic minorities (β = 0.936, p < 0.01) and had friends support (β = 0.923, p < 0.05) were associated with a preference to accept the COVID-19 vaccine. In the media use general, those who aged 41 years old and older (β = 1.682, p < 0.001), had major depression (β = 0.951, p < 0.05), had friends support (β = 0.048, p < 0.001) would be more likely to receive COVID-19 vaccination. However, respondents who live in towns (β = −0.300, p < 0.01) had lower behaviors to receive vaccination for COVID-19. In the media use high frequency, the respondents who aged 41 or older (β = 1.010, p < 0.001), were ethnic minorities (β = 0.741, p < 0.001), had moderate depression (β = 1.003, p < 0.05) would receive the vaccination for COVID-19 positively; (4) Conclusions: The more occluded the media use is, the less likely the respondents are to get vaccinated against COVID-19. Vaccination behavior is influenced by different factors in groups with different frequencies of media use. Therefore, the government and appropriate departments should make individualized and targeted strategies about COVID-19 vaccination and disseminate the vaccination information to different media use groups.

COVID-19 Conspiracy Theories Discussion on Twitter

The coronavirus disease 2019 (COVID-19) pandemic was an unexpected event and resulted in catastrophic consequences with long-lasting behavioral effects. People began to seek explanations for different aspects of COVID-19 and resorted to conspiracy narratives. The objective of this article is to analyze the changes on the discussion of different COVID-19 conspiracy theories throughout the pandemic on Twitter. We have collected a data set of 1.269 million tweets associated with the discussion on conspiracy theories between January 2020 and November 2021. The data set includes tweets related to eight conspiracy theories: the 5G, Big Pharma, Bill Gates, biological weapon, exaggeration, FilmYourHospital, genetically modified organism (GMO), and the vaccines conspiracy. The analysis highlights several behaviors in the discussion of conspiracy theories and allows categorizing them into four groups. The first group are conspiracy theories that peaked at the beginning of the pandemic and sharply declined afterwards, including the 5G and FilmYourHospital conspiracies. The second group associated with the Big Pharma and vaccination-related conspiracy whose role increased as the pandemic progressed. The third are conspiracies that remained persistent throughout the pandemic such as exaggeration and Bill Gates conspiracies. The fourth are those that had multiple peaks at different times of the pandemic including the GMO and biological weapon conspiracies. In addition, the number of COVID-19 new cases was found to be a significant predictor for the next week tweet frequency for most of the conspiracies.

A comparative analysis of anti-vax discourse on twitter before and after COVID-19 onset

This study aimed to identify and assess the prevalence of vaccine-hesitancy-related topics on Twitter in the periods before and after the Coronavirus Disease 2019 (COVID-19) outbreak. Using a search query, 272,780 tweets associated with anti-vaccine topics and posted between 1 January 2011, and 15 January 2021, were collected. The tweets were classified into a list of 11 topics and analyzed for trends during the periods before and after the onset of COVID-19. Since the beginning of COVID-19, the percentage of anti-vaccine tweets has increased for two topics, “government and politics” and “conspiracy theories,” and decreased for “developmental disabilities.” Compared to tweets regarding flu and measles, mumps, and rubella vaccines, those concerning COVID-19 vaccines showed larger percentages for the topics of conspiracy theories and alternative treatments, and a lower percentage for developmental disabilities. The results support existing anti-vaccine literature and the assertion that anti-vaccine sentiments are an important public-health issue.

Partisan asymmetries in exposure to misinformation

Online misinformation is believed to have contributed to vaccine hesitancy during the Covid-19 pandemic, highlighting concerns about social media's destabilizing role in public life. Previous research identified a link between political conservatism and sharing misinformation; however, it is not clear how partisanship affects how much misinformation people see online. As a result, we do not know whether partisanship drives exposure to misinformation or people selectively share misinformation despite being exposed to factual content. To address this question, we study Twitter discussions about the Covid-19 pandemic, classifying users along the political and factual spectrum based on the information sources they share. In addition, we quantify exposure through retweet interactions. We uncover partisan asymmetries in the exposure to misinformation: conservatives are more likely to see and share misinformation, and while users' connections expose them to ideologically congruent content, the interactions between political and factual dimensions create conditions for the highly polarized users-hardline conservatives and liberals-to amplify misinformation. Overall, however, misinformation receives less attention than factual content and political moderates, the bulk of users in our sample, help filter out misinformation. Identifying the extent of polarization and how political ideology exacerbates misinformation can help public health experts and policy makers improve their messaging.

Sentinel node approach to monitoring online COVID-19 misinformation

Understanding how different online communities engage with COVID-19 misinformation is critical for public health response. For example, misinformation confined to a small, isolated community of users poses a different public health risk than misinformation being consumed by a large population spanning many diverse communities. Here we take a longitudinal approach that leverages tools from network science to study COVID-19 misinformation on Twitter. Our approach provides a means to examine the breadth of misinformation engagement using modest data needs and computational resources. We identify a subset of accounts from different Twitter communities discussing COVID-19, and follow these 'sentinel nodes' longitudinally from July 2020 to January 2021. We characterize sentinel nodes in terms of a linked domain preference score, and use a standardized similarity score to examine alignment of tweets within and between communities. We find that media preference is strongly correlated with the amount of misinformation propagated by sentinel nodes. Engagement with sensationalist misinformation topics is largely confined to a cluster of sentinel nodes that includes influential conspiracy theorist accounts. By contrast, misinformation relating to COVID-19 severity generated widespread engagement across multiple communities. Our findings indicate that misinformation downplaying COVID-19 severity is of particular concern for public health response. We conclude that the sentinel node approach can be an effective way to assess breadth and depth of online misinformation penetration.

Ideology and COVID-19 Vaccination Intention: Perceptual Mediators and Communication Moderators

Widespread COVID-19 vaccination is critical to slow the spread of the illness. This study investigates how political ideology is associated with COVID-19 vaccine intention via perceived effectiveness of the vaccine, perceived side effects, and perceived severity of the illness, three key aspects of the Health Belief Model (HBM). This study also examines how partisan information flow moderates the effects of ideology on these three HBM components. Using survey data collected from two battleground states in the 2020 election (N = 1849), regression, mediation and moderation analyses revealed that conservatives were less likely to intend to get vaccinated against COVID-19, and this association was significantly mediated by perceived effectiveness and perceived side effects of vaccination, as well as perceived severity of COVID-19. In addition, partisanship of news sources and discussion partners were significant moderators of ideology's association with perceived vaccine effectiveness, with conservatives viewing COVID-19 vaccination as less effective if they were frequently exposed to liberal news, and if they had frequent conversations with fellow conservatives. This suggests boomerang effects for cross-cutting mass media exposure, and reinforcement effect for interpersonal communication. Implications for efforts to promote COVID-19 vaccine uptake are discussed, including tailored and targeted campaign strategies.

Social media and attitudes towards a COVID-19 vaccination: A systematic review of the literature

Background

Vaccine hesitancy continues to limit global efforts in combatting the COVID-19 pandemic. Emerging research demonstrates the role of social media in disseminating information and potentially influencing people's attitudes towards public health campaigns. This systematic review sought to synthesize the current evidence regarding the potential role of social media in shaping COVID-19 vaccination attitudes, and to explore its potential for shaping public health interventions to address the issue of vaccine hesitancy.

Methods

We performed a systematic review of the studies published from inception to 13 of March2022 by searching PubMed, Web of Science, Embase, PsychNET, Scopus, CINAHL, and MEDLINE. Studies that reported outcomes related to coronavirus disease 2019 (COVID-19) vaccine (attitudes, opinion, etc.) gathered from the social media platforms, and those analyzing the relationship between social media use and COVID-19 hesitancy/acceptance were included. Studies that reported no outcome of interest or analyzed data from sources other than social media (websites, newspapers, etc.) will be excluded. The Newcastle Ottawa Scale (NOS) was used to assess the quality of all cross-sectional studies included in this review. This study is registered with PROSPERO (CRD42021283219).

Findings

Of the 2539 records identified, a total of 156 articles fully met the inclusion criteria. Overall, the quality of the cross-sectional studies was moderate - 2 studies received 10 stars, 5 studies received 9 stars, 9 studies were evaluated with 8, 12 studies with 7,16 studies with 6, 11 studies with 5, and 6 studies with 4 stars. The included studies were categorized into four categories. Cross-sectional studies reporting the association between reliance on social media and vaccine intentions mainly observed a negative relationship. Studies that performed thematic analyses of extracted social media data, mainly observed a domination of vaccine hesitant topics. Studies that explored the degree of polarization of specific social media contents related to COVID-19 vaccines observed a similar degree of content for both positive and negative tone posted on different social media platforms. Finally, studies that explored the fluctuations of vaccination attitudes/opinions gathered from social media identified specific events as significant cofactors that affect and shape vaccination intentions of individuals.

Interpretation

This thorough examination of the various roles social media can play in disseminating information to the public, as well as how individuals behave on social media in the context of public health events, articulates the potential of social media as a platform of public health intervention to address vaccine hesitancy.

Funding

None.

Digital Marketing: A Unique Multidisciplinary Approach towards the Elimination of Viral Hepatitis

New technologies are supported by the global implementation of the internet. These improvements have deeply affected various disciplines of sciences and consequently changed services such as daily business, particularly health sectors. Innovative digital marketing strategies utilize the channels of social media and retrieved user data to analyze and improve relevant services. These multidisciplinary innovations can assist specialists, physicians and researchers in diagnostic, prophylaxis and treatment issues in the health sector. Accordingly, compared to recent decades, health decision makers are more accurate and trustful in defining new strategies. Interestingly, using social media and mobile health apps in current pandemics of SARS-CoV-2 could be an important instance of the key role of these platforms at the local and global level of health policies. These digital technologies provide platforms to connect public health sectors and health politicians for communicating and spreading relevant information. Adding influencers and campaigns to this toolbox strengthens the implementation of public health programs. In 2016, the WHO adopted a global program to eliminate viral hepatitis by 2030. Recent constructive measures that have been used in the battle against COVID-19 could be adopted for the elimination of viral hepatitis program. The presented evidence in our narrative review demonstrates that the application of digital marketing tools to create campaigns on social media, armed with professional influencers, can efficiently consolidate this program. The application of different strategies in using these popular tools will raise the public awareness about viral hepatitis. Subsequently, the availability of an effective vaccine for HBV and antiviral medication for HCV can motivate the audience to take steps towards prophylaxis and screening methods against these infectious illnesses. The encouragement of health policy makers to apply digital communication technologies and comprehensive roadmaps to implement this global program will certainly decrease the burden of viral hepatitis worldwide.

Effects of trust, risk perception, and health behavior on COVID-19 disease burden: Evidence from a multi-state US survey

Early public health strategies to prevent the spread of COVID-19 in the United States relied on non-pharmaceutical interventions (NPIs) as vaccines and therapeutic treatments were not yet available. Implementation of NPIs, primarily social distancing and mask wearing, varied widely between communities within the US due to variable government mandates, as well as differences in attitudes and opinions. To understand the interplay of trust, risk perception, behavioral intention, and disease burden, we developed a survey instrument to study attitudes concerning COVID-19 and pandemic behavioral change in three states: Idaho, Texas, and Vermont. We designed our survey (n = 1034) to detect whether these relationships were significantly different in rural populations. The best fitting structural equation models show that trust indirectly affects protective pandemic behaviors via health and economic risk perception. We explore two different variations of this social cognitive model: the first assumes behavioral intention affects future disease burden while the second assumes that observed disease burden affects behavioral intention. In our models we include several exogenous variables to control for demographic and geographic effects. Notably, political ideology is the only exogenous variable which significantly affects all aspects of the social cognitive model (trust, risk perception, and behavioral intention). While there is a direct negative effect associated with rurality on disease burden, likely due to the protective effect of low population density in the early pandemic waves, we found a marginally significant, positive, indirect effect of rurality on disease burden via decreased trust (p = 0.095). This trust deficit creates additional vulnerabilities to COVID-19 in rural communities which also have reduced healthcare capacity. Increasing trust by methods such as in-group messaging could potentially remove some of the disparities inferred by our models and increase NPI effectiveness.

Could Social Bots’ Sentiment Engagement Shape Humans’ Sentiment on COVID-19 Vaccine Discussion on Twitter?

During the COVID-19 pandemic, social media has become an emerging platform for the public to find information, share opinions, and seek coping strategies. Vaccination, one of the most effective public health interventions to control the COVID-19 pandemic, has become the focus of public online discussions. Several studies have demonstrated that social bots actively involved in topic discussions on social media and expressed their sentiments and emotions, which affected human users. However, it is unclear whether social bots’ sentiments affect human users’ sentiments of COVID-19 vaccines. This study seeks to scrutinize whether the sentiments of social bots affect human users’ sentiments of COVID-19 vaccines. The work identified social bots and built an innovative computational framework, i.e., the BERT-CNN sentiment analysis framework, to classify tweet sentiments at the three most discussed stages of COVID-19 vaccines on Twitter from December 2020 to August 2021, thus exploring the impacts of social bots on online vaccine sentiments of humans. Then, the Granger causality test was used to analyze whether there was a time-series causality between the sentiments of social bots and humans. The findings revealed that social bots can influence human sentiments about COVID-19 vaccines. Their ability to transmit the sentiments on social media, whether in the spread of positive or negative tweets, will have a corresponding impact on human sentiments.

COVID-19 vaccine perceptions in the initial phases of US vaccine roll-out: an observational study on reddit

BACKGROUND

Open online forums like Reddit provide an opportunity to quantitatively examine COVID-19 vaccine perceptions early in the vaccine timeline. We examine COVID-19 misinformation on Reddit following vaccine scientific announcements, in the initial phases of the vaccine timeline.

METHODS

We collected all posts on Reddit (reddit.com) from January 1 2020 - December 14 2020 (n=266,840) that contained both COVID-19 and vaccine-related keywords. We used topic modeling to understand changes in word prevalence within topics after the release of vaccine trial data. Social network analysis was also conducted to determine the relationship between Reddit communities (subreddits) that shared COVID-19 vaccine posts, and the movement of posts between subreddits.

RESULTS

There was an association between a Pfizer press release reporting 90% efficacy and increased discussion on vaccine misinformation. We observed an association between Johnson and Johnson temporarily halting its vaccine trials and reduced misinformation. We found that information skeptical of vaccination was first posted in a subreddit (r/Coronavirus) which favored accurate information and then reposted in subreddits associated with antivaccine beliefs and conspiracy theories (e.g. conspiracy, NoNewNormal).

CONCLUSIONS

Our findings can inform the development of interventions where individuals determine the accuracy of vaccine information, and communications campaigns to improve COVID-19 vaccine perceptions, early in the vaccine timeline. Such efforts can increase individual- and population-level awareness of accurate and scientifically sound information regarding vaccines and thereby improve attitudes about vaccines, especially in the early phases of vaccine roll-out. Further research is needed to understand how social media can contribute to COVID-19 vaccination services.

Azithromycin Misuse During the COVID-19 Pandemic: A Cross-Sectional Study from Jordan

Objective

Since coronavirus disease 2019 (COVID-19) became a global pandemic, repurposing known drugs was the quickest way to combat the disease. The initial screening revealed that azithromycin (AZM) might have potential against COVID-19. Although clinical trials did not prove such efficacy, many countries have put AZM within their guidelines for treating COVID-19. Therefore, the present study was designed to assess the misuse of AZM in Jordan during the COVID-19 pandemic.

Methods and Results

A cross-sectional study was conducted among community pharmacies in Jordan from March 27 to May 8, 2021, and 184 pharmacies data were collected from the Google forms. During COVID-19, 42.9% of pharmacies sold more than 20 packs of prescribed AZM per month compared to 46.7% of pharmacies used to sell 0-5 packs AZM prescriptions per month before the pandemic. During COVID-19, pharmacists significantly dispensed AZM with and without prescriptions 107% and 127%, respectively, more than before the pandemic (p < 0.0001). Overall, pharmacists stocked 121% more AZM packs during COVID-19 than before the pandemic (p < 0.0001). Additionally, most pharmacists (59.7%) believed that AZM could cure COVID-19 patients. However, using multinomial logistic regression analysis, low-experienced pharmacists were unsure if AZM could positively affect COVID-19 patients (p < 0.05, OR = 3.76, 95% CI = 1.23-11.52). Furthermore, low-experienced pharmacists believed that increased use of AZM for the treatment of viral infections could lead to negative consequences (p < 0.001, OR = 0.161, 95% CI 0.063-0.414).

Conclusion

This study demonstrated that AZM is misused by physicians, pharmacists, and the public in Jordan. Since AZM efficacy on SARS-CoV-2 is scarce, there is a need for new guidelines by governmental health authorities to implement strict enforcement of AZM dispensing during COVID-19 to avoid negative consequences of bacterial resistance.

Building global capacity for COVID-19 vaccination through interactive virtual learning

BACKGROUND

To support the introduction of the COVID-19 vaccine, the World Health Organization and its partners developed an interactive virtual learning initiative through which vaccination stakeholders could receive the latest guidance, ask questions, and share their experiences. This initiative, implemented between 9 February 2021 and 15 June 2021, included virtual engagement between technical experts and participants during a 15-session interactive webinar series as well as web and text-messaging discussions in English and French.

METHODS

This article uses a mixed-methods approach to analyze survey data collected following each webinar and a post-series survey conducted after the series had concluded. Participant data were tracked for each session, and feedback surveys were conducted after each session to gauge experience quality and content usability. Chi-square tests were used to compare results across professions (health workers, public health practitioners, and others).

RESULTS

The COVID-19 Vaccination: Building Global Capacity webinar series reached participants in 179 countries or 93% of the WHO Member States; 75% of participants were from low- and middle-income countries. More than 60% of participants reported using the resources provided during the sessions, and 47% reported sharing these resources with colleagues. More than 79% of participants stated that this initiative significantly improved their confidence in preparing for and rolling out COVID-19 vaccinations; an additional 20% stated that the initiative "somewhat" improved their confidence. In the post-series survey, 70% of participants reported that they will "definitely use" the knowledge derived from this learning series in their work; an additional 20% will "probably use" and 9% would "possibly use" this knowledge in their work.

CONCLUSION

The COVID-19 Vaccination: Building Global Capacity learning initiative used a digital model of dynamic, interactive learning at scale. The initiative enhanced WHO's ability to disseminate knowledge, provide normative guidance, and share best practices to COVID-19 vaccination stakeholders in real time. This approach allowed WHO to hear the information needs of stakeholders and respond by developing guidance, tools, and training to support COVID-19 vaccine introduction. WHO and its partners can learn from this capacity-building experience and apply best practices for digital interactive learning to other health programs moving forward.

Message framing and COVID-19 vaccination intention: Moderating roles of partisan media use and pre-attitudes about vaccination

One of the ways to overcome the sheer devastation of the COVID-19 pandemic is to get vaccinated. However, vaccine hesitancy could be a significant barrier. The main purposes of the current study are to examine the impact of four types of theory-driven messages on COVID-19 vaccination intention and to understand the moderating role of partisan media use and vaccination attitudes. The study used a between-subject randomized online experiment with four conditions. The manipulation messages were presented as screenshots from the CDC's Facebook page. The total number of participants were 387 (female 43%, mean age 37 years). The participants were from the U.S. and older than 18 years. The findings show that loss vs. gain message frames did not have any impact on COVID-19 vaccine intention. The moderating effects of conservative media and attitudes show that in general, those who consumed lower conservative media and held positive attitudes were higher on vaccine intention, and individual vs. collective frames did not have a strong impact. However, among those participants who scored high on conservative media use, and held negative vaccination attitudes, the individual frame had a higher impact on vaccine intention. The current study experimentally tested the intertwined relationships among message frames, partisan media use, and attitudes on vaccine intention. These relationships are critical considering the political nature of the pandemic.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s12144-022-02851-3.

Social Bots' Involvement in the COVID-19 Vaccine Discussions on Twitter

During the COVID-19 pandemic, social media served as an important channel for the public to obtain health information and disseminate opinions when offline communication was severely hindered. Yet the emergence of social bots influencing social media conversations about public health threats will require researchers and practitioners to develop new communication strategies considering their influence. So far, little is known as to what extent social bots have been involved in COVID-19 vaccine-related discussions and debates on social media. This work selected a period of nearly 9 months after the approval of the first COVID-19 vaccines to detect social bots and performed high-frequency word analysis for both social bot-generated and human-generated tweets, thus working out the extent to which social bots participated in the discussion on the COVID-19 vaccine on Twitter and their participation features. Then, a textual analysis was performed on the content of tweets. The findings revealed that 8.87% of the users were social bots, with 11% of tweets in the corpus. Besides, social bots remained active over three periods. High-frequency words in the discussions of social bots and human users on vaccine topics were similar within the three peaks of discourse.

Perspectives on Mass Media and Governmental Measures during the 2020 COVID-19 Pandemic in a Romanian Sample of Healthcare Practitioners

OBJECTIVE

Along with the rapid spread of the COVID-19 pandemic around the globe, a proliferation of mass media information exposed the population to an infodemic with various implications documented worldwide. The present study analyzed Romanian healthcare practitioners' (HCPs) appraisal of COVID-19 mass media information and governmental measures throughout 2020, ranking vaccination priorities and moral values.

METHODS

97 HCP completed a cross-sectional survey with items referring to the COVID-19 pandemic in 2020.

RESULTS

Findings were consistent with other studies, indicating an overall negative appraisal of mass media information, which predicted anxiety and relaxation difficulties. Unlike other studies, our sample reported a moderate level of satisfaction with official measures in 2020, which was not related to their view on mass media information. The ranking of population categories in the vaccination order showed similarities with the governmental vaccination program in 2021. Despite placing freedom third after health and love in the hierarchy of values, HCPs showed a high tendency of limiting individual liberty for the common good.

CONCLUSIONS

Results showed a dissociation between the overall negative appraisal of mass media information and the satisfaction with governmental measures in 2020. Romanian HCPs shared a secular perspective on moral values and assumed an authoritarian position.

Social-Cyber Maneuvers Analysis During the COVID-19 Vaccine Initial Rollout

BACKGROUND

During the time surrounding the approval and initial distribution of Pfizer-BioNTech's COVID-19 vaccine, large numbers of social media users took to used their platforms to voice opinions on the vaccine. They formed pro- and anti-vaccination groups towards the purpose of influencing behaviors to vaccinate or not to vaccinate. The methods of persuasion and manipulation for convincing audiences online can be characterized under a framework for social-cyber maneuvers known as the BEND maneuvers. Previous studies have been conducted on the spread of COVID-19 vaccine disinformation. However, these previous studies lacked comparative analyses over time on both community stances and the competing techniques of manipulating both the narrative and network structure to persuade target audiences.

OBJECTIVE

This study aimed to understand community response to vaccination by dividing Twitter data from the initial Pfizer-BioNTech COVID-19 vaccine rollout into pro-vaccine and anti-vaccine stances, identifying key actors and groups, and evaluating how the different communities use social-cyber maneuvers, or BEND maneuvers, to influence their target audiences and the network as a whole.

METHODS

COVID-19 Twitter vaccine data was collected using the Twitter API for one-week periods before, during, and six weeks after the initial Pfizer-BioNTech rollout (December 2020-January 2021). Bot identifications and linguistic cues were derived for users and tweets, respectively, to use as metrics for evaluating social-cyber maneuvers. ORA-PRO software was then used to separate the vaccine data into pro-vaccine and anti-vaccine communities and to facilitate identification of key actors, groups, and BEND maneuvers for a comparative analysis between each community and the entire network.

RESULTS

Both the pro-vaccine and anti-vaccine communities used combinations of the 16 BEND maneuvers to persuade their target audiences of their particular stances. Our analysis showed how each side attempted to build its own community while simultaneously narrowing and neglecting the opposing community. Pro-vaccine users primarily used positive maneuvers such as excite and explain messages to encourage vaccination and backed leaders within their group. In contrast, anti-vaccine users relied on negative maneuvers to dismay and distort messages with narratives on side effects and death and attempted to neutralize the effectiveness of the leaders within the pro-vaccine community. Furthermore, nuking through platform policies showed to be effective in reducing the size of the anti-vaccine online community and the quantity of anti-vaccine messages.

CONCLUSIONS

Social media continues to be a domain for manipulating beliefs and ideas. These conversations can ultimately lead to real-world actions such as to vaccinate or not to vaccinate against COVID-19. Moreover, social media policies should be further explored as an effective means for curbing disinformation and misinformation online.

CLINICALTRIAL

Not applicable.

Determinants of Hesitancy Towards COVID-19 Vaccines in State of Kuwait: An Exploratory Internet-Based Survey

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has wrought havoc upon healthcare and economic systems worldwide. COVID-19 vaccines considered a beacon of hope for normal life to return. We wished to understand the willingness of people in Kuwait to be vaccinated against COVID-19.

METHODS

An online, exploratory, cross-sectional study was conducted on 16-18 January 2021 using a validated structured questionnaire to collect data from adults aged 18 years or older living in Kuwait by applying a "snowball sampling" method.

RESULTS

A total of 7274 people received an online link of the survey on their smartphone or computer, and 6943 people enrolled in this study (95.4%). Kuwaiti nationals represented 79.7% of the study cohort, 54.8% were aged ≥40 years, and 66.7% were females. Hesitancy against a COVID-19 vaccine was remarkably high (74.3%), with 50.8% not planning to take it and 23.5% not sure about taking it. The overall mean perception score was 3.4 ± 2.8, with 66.8% having a negative attitude towards a COVID-19 vaccine. Multiple logistic regression analysis of the factors affecting the decision to take a COVID-19 vaccine was done. The decision to take a COVID-19 vaccine was significantly positively associated with younger age (OR = 1.219), being male (2.169), having a higher education level (1.362), vaccinated against seasonal influenza previously (2.706), being a non-Kuwaiti (1.329), being a healthcare worker (1.366), and working in the private sector (1.228). Options to encourage future COVID-19 vaccination were more studies showing the vaccine to be safe and efficacious (68.6%), physician recommendation (41.8%), mandatory travel requirements (39.8%), if a family or friend vaccinated (34.9%) and compulsory by government (33.1%) or for employment (29.8%).

CONCLUSION

Our data suggest that considerable vaccine hesitancy persists despite the widespread availability of highly efficacious and safe COVID-19 vaccines.

Content and Dynamics of Websites Shared Over Vaccine-Related Tweets in COVID-19 Conversations: Computational Analysis

BACKGROUND

The onset of the COVID-19 pandemic and the consequent "infodemic" increased concerns about Twitter's role in advancing antivaccination messages, even before a vaccine became available to the public. New computational methods allow for analysis of cross-platform use by tracking links to websites shared over Twitter, which, in turn, can uncover some of the content and dynamics of information sources and agenda-setting processes. Such understanding can advance theory and efforts to reduce misinformation.

OBJECTIVE

Informed by agenda-setting theory, this study aimed to identify the content and temporal patterns of websites shared in vaccine-related tweets posted to COVID-19 conversations on Twitter between February and June 2020.

METHODS

We used triangulation of data analysis methods. Data mining consisted of the screening of around 5 million tweets posted to COVID-19 conversations to identify tweets that related to vaccination and including links to websites shared within these tweets. We further analyzed the content the 20 most-shared external websites using a mixed methods approach.

RESULTS

Of 841,896 vaccination-related tweets identified, 185,994 (22.1%) contained links to specific websites. A wide range of websites were shared, with the 20 most-tweeted websites constituting 14.5% (27,060/185,994) of the shared websites and typically being shared for only 2 to 3 days. Traditional media constituted the majority of these 20 websites, along with other social media and governmental sources. We identified markers of inauthentic propagation for some of these links.

CONCLUSIONS

The topic of vaccination was prevalent in tweets about COVID-19 early in the pandemic. Sharing websites was a common communication strategy, and its "bursty" pattern and inauthentic propagation strategies pose challenges for health promotion efforts. Future studies should consider cross-platform use in dissemination of health information and in counteracting misinformation.

Motivating Seasonal Influenza Vaccination and Cross-Promoting COVID-19 Vaccination: An Audience Segmentation Study among University Students

In the response to the coronavirus pandemic, much attention has been invested in promoting COVID-19 vaccination. However, the impact of seasonal influenza should not be neglected, particularly during the winter influenza surge. Currently, most influenza vaccination campaigns target at healthcare workers or high-risk population groups, while COVID-19 vaccination programmes are targeting the whole population as a single homogeneous group. There is limited research on the promotion of influenza vaccination for university students who study, live, and socialise in close contact with a large variety of people on campus, resulting in a low vaccination rate among this underserved group. Thus, a vaccination programme tailored for university students should be developed to increase protection against influenza-like illnesses and complications, and to help achieve herd immunity across populations who spread viruses. WHO has advocated the potential value of social marketing in vaccination campaigns and highlighted the need for audience segmentation as a major prerequisite component of intervention design. This study aims to identify distinct and homogeneous groups of university students based on sociodemographic, psychographic, and behavioural attributes to inform interventions. Two-step cluster analysis was applied in a sample size of 530 university students and revealed four segments that demonstrate statistically significant differences in their attitudes, behaviours, intentions, and responses to promotion messages about seasonal influenza and COVID-19 vaccination. The findings provide a detailed understanding of segment characteristics among university students that can be applied to develop an effective social marketing campaign that can motivate influenza vaccination and cross-promote uptake of the COVID-19 vaccine.

Online Intergroup Polarization Across Political Fault Lines: An Integrative Review

We revisit the construct of political polarization and current distinctions between issue-driven and affective polarization. Based on our review of recent research on polarization from psychology, political science, and communication, we propose to treat polarization as a process that integrates the concepts of social identification (collective self-definition) with ideologically opposed camps - that is, psychological groups based on support or opposition to specific socio-political issues and policies (related to issue-driven polarization), and that of ideological and psychological distancing between groups (related to affective polarization). Furthermore, we discuss the foundations of polarizing groups – and more specifically, the role of conflicting collective narratives about social reality in providing an initial platform for polarization in a technologically networked world. In particular, we highlight the importance of online media in facilitating and enhancing polarization between ideologically opposed camps. As a theoretical contribution, the review provides a more functional conceptualization of polarization that can explain how polarization may occur across partisan fault lines and in domains outside of politics. We conclude with a discussion of new pathways to the study of polarization which this integrative conceptualization opens.

Identification of affective valence of Twitter generated sentiments during the COVID-19 outbreak

This study aims to conduct text mining of affective valence of the sentiments generated on social media during the COVID-19 and measure their association with different outcomes of the disease. 50,000 tweets per day over 23 days during the pandemic were extracted using the VADER sentiment analysis tool. Overall, tweets could effectively be classified in terms of polarity, i.e., “positive,” “negative” and “neutral” sentiments. Furthermore, on a day-to-day basis, the study identified a positive and significant relationship between COVID-19-related (a) global infections and negative tweets, (b) global deaths and negative tweets, (c) recoveries and negative tweets, and (d) recoveries and positive tweets. No significant association could be found between (e) infections and positive tweets and (f) deaths and positive tweets. Furthermore, the statistical analysis also indicated that the daily distribution of tweets based on polarity generates three distinct and significantly different numbers of tweets per category, i.e., positive, negative and neutral. As per the results generated through sentiment analysis of tweets in this study, the emergence of “positive” tweets in such a gloomy pandemic scenario shows the inherent resilience of humans. The significant association between news of COVID-19 recoveries and positive tweets seems to hint at a more optimistic scenario whenever the pandemic finally comes to an end or is controlled. Such public reactions—for good—have the potential to go viral and influence several others, especially those who are classified as “neutral” or fence-sitters.

Public perception of COVID-19 vaccines from the digital footprints left on Twitter: analyzing positive, neutral and negative sentiments of Twitterati

Purpose

Twitter is gaining popularity as a microblogging and social networking service to discuss various social issues. Coronavirus disease 2019 (COVID-19) has become a global pandemic and is discussed worldwide. Social media is an instant platform to deliberate various dimensions of COVID-19. The purpose of the study is to explore and analyze the public sentiments related to COVID-19 vaccines across the Twitter messages (positive, neutral, and negative) and the impact tweets make across digital social circles.

Design/methodology/approach

To fetch the vaccine-related posts, a manual examination of randomly selected 500 tweets was carried out to identify the popular hashtags relevant to the vaccine conversation. It was found that the hashtags “covid19vaccine” and “coronavirusvaccine” were the two popular hashtags used to discuss the communications related to COVID-19 vaccines. 23,575 global tweets available in public domain were retrieved through “Twitter Application Programming Interface” (API), using “Orange Software”, an open-source machine learning, data visualization and data mining toolkit. The study was confined to the tweets posted in English language only. The default data cleaning and preprocessing techniques available in the “Orange Software” were applied to the dataset, which include “transformation”, “tokenization” and “filtering”. The “Valence Aware Dictionary for sEntiment Reasoning” (VADER) tool was used for classification of tweets to determine the tweet sentiments (positive, neutral and negative) as well as the degree of sentiments (compound score also known as sentiment score). To assess the influence/impact of tweets account wise (verified and unverified) and sentiment wise (positive, neutral, and negative), the retweets and likes, which offer a sort of reward or acknowledgment of tweets, were used.

Findings

A gradual decline in the number of tweets over the time is observed. Majority (11,205; 47.52%) of tweets express positive sentiments, followed by neutral (7,948; 33.71%) and negative sentiments (4,422; 18.75%), respectively. The study also signifies a substantial difference between the impact of tweets tweeted by verified and unverified users. The tweets related to verified users have a higher impact both in terms of retweets (65.91%) and likes (84.62%) compared to the tweets tweeted by unverified users. Tweets expressing positive sentiments have the highest impact both in terms of likes (mean = 10.48) and retweets (mean = 3.07) compared to those that express neutral or negative sentiments.

Research limitations/implications

The main limitation of the study is that the sentiments of the people expressed over one single social platform, that is, Twitter have been studied which cannot generalize the global public perceptions. There can be a variation in the results when the datasets from other social media platforms will be studied.

Practical implications

The study will help to know the people's sentiments and beliefs toward the COVID-19 vaccines. Sentiments that people hold about the COVID-19 vaccines are studied, which will help health policymakers understand the polarity (positive, negative, and neutral) of the tweets and thus see the public reaction and reflect the types of information people are exposed to about vaccines. The study can aid the health sectors to intensify positive messages and eliminate negative messages for an enhanced vaccination uptake. The research can also help design more operative vaccine-advocating communication by customizing messages using the obtained knowledge from the sentiments and opinions about the vaccines.

Originality/value

The paper focuses on an essential aspect of COVID-19 vaccines and how people express themselves (positively, neutrally and negatively) on Twitter.

Factors associated with SARS-CoV2 infection and care pathways among the most vulnerable populations living in Marseille: a case control study

BACKGROUND

The Covid-19 pandemic has led to substantial and unexpected increases in morbidity and mortality in France. Vulnerable populations housed in accommodation centres have a greater risk of infection because collective housing and their dependence on social support services mean it is more difficult to apply preventive measures. They are also at greater risk of developing severe forms of Covid-19 and waiting longer before seeking healthcare (for Covid-19 or other) treatment. We aimed to identify the factors associated with SARS-CoV2 infection in the most vulnerable populations in the city of Marseille.

METHODS

The study sample comprised users of various services provided by the association AAJT in Marseille, France, some presenting symptoms suggestive of Covid-19 and others not. All had routine health surveillance provided by AAJT's dedicated healthcare team between March 2020 and May 2020. Using univariate and multivariate analyses, we studied the influence of several variables on morbidity associated with Covid-19.

RESULTS

The study included 64 participants, 29 of whom tested positive for Covid-19 and 35 control subjects. Median age was 21.16 years old. Individuals in the 'Covid-19 case' group (p < 0.005) - which included persons testing positive and those suspected of being infected - were younger. The study sample's male/female ratio was seven. In our multivariate analyses, living in a shared apartment and poor adherence to social distancing measures were factors associated with Covid-19 infection. Furthermore, mental health problems - such as anxiety disorder - were very frequent in the study sample.

CONCLUSIONS

Allocating more and specific housing units to structures providing accommodation services to the most vulnerable people would seem to be a decisive factor in controlling the spread of SARS-CoV2, and deserves more attention from public authorities.

Characterizing Discourse about COVID-19 Vaccines: A Reddit Version of the Pandemic Story

It has been one year since the outbreak of the COVID-19 pandemic. The good news is that vaccines developed by several manufacturers are being actively distributed worldwide. However, as more and more vaccines become available to the public, various concerns related to vaccines become the primary barriers that may hinder the public from getting vaccinated. Considering the complexities of these concerns and their potential hazards, this study is aimed at offering a clear understanding about different population groups' underlying concerns when they talk about COVID-19 vaccines-particularly those active on Reddit. The goal is achieved by applying LDA and LIWC to characterize the pertaining discourse with insights generated through a combination of quantitative and qualitative comparisons. Findings include the following: (1) during the pandemic, the proportion of Reddit comments predominated by conspiracy theories outweighed that of any other topics; (2) each subreddit has its own user bases, so information posted in one subreddit may not reach that from other subreddits; and (3) since users' concerns vary across time and subreddits, communication strategies must be adjusted according to specific needs. The results of this study manifest challenges as well as opportunities in the process of designing effective communication and immunization programs.

Agent Based Model of Anti-Vaccination Movements: Simulations and Comparison with Empirical Data

Background: A realistic description of the social processes leading to the increasing reluctance to various forms of vaccination is a very challenging task. This is due to the complexity of the psychological and social mechanisms determining the positioning of individuals and groups against vaccination and associated activities. Understanding the role played by social media and the Internet in the current spread of the anti-vaccination (AV) movement is of crucial importance. Methods: We present novel, long-term Big Data analyses of Internet activity connected with the AV movement for such different societies as the US and Poland. The datasets we analyzed cover multiyear periods preceding the COVID-19 pandemic, documenting the behavior of vaccine related Internet activity with high temporal resolution. To understand the empirical observations, in particular the mechanism driving the peaks of AV activity, we propose an Agent Based Model (ABM) of the AV movement. The model includes the interplay between multiple driving factors: contacts with medical practitioners and public vaccination campaigns, interpersonal communication, and the influence of the infosphere (social networks, WEB pages, user comments, etc.). The model takes into account the difference between the rational approach of the pro-vaccination information providers and the largely emotional appeal of anti-vaccination propaganda. Results: The datasets studied show the presence of short-lived, high intensity activity peaks, much higher than the low activity background. The peaks are seemingly random in size and time separation. Such behavior strongly suggests a nonlinear nature for the social interactions driving the AV movement instead of the slow, gradual growth typical of linear processes. The ABM simulations reproduce the observed temporal behavior of the AV interest very closely. For a range of parameters, the simulations result in a relatively small fraction of people refusing vaccination, but a slight change in critical parameters (such as willingness to post anti-vaccination information) may lead to a catastrophic breakdown of vaccination support in the model society, due to nonlinear feedback effects. The model allows the effectiveness of strategies combating the anti-vaccination movement to be studied. An increase in intensity of standard pro-vaccination communications by government agencies and medical personnel is found to have little effect. On the other hand, focused campaigns using the Internet and social media and copying the highly emotional and narrative-focused format used by the anti-vaccination activists can diminish the AV influence. Similar effects result from censoring and taking down anti-vaccination communications by social media platforms. The benefit of such tactics might, however, be offset by their social cost, for example, the increased polarization and potential to exploit it for political goals, or increased 'persecution' and 'martyrdom' tropes.

A National Survey to Assess the COVID-19 Vaccine-Related Conspiracy Beliefs, Acceptability, Preference, and Willingness to Pay among the General Population of Pakistan

The current study aims to assess the beliefs of the general public in Pakistan towards conspiracy theories, acceptance, willingness to pay, and preference for the COVID-19 vaccine. A cross-sectional study was conducted through an online self-administered questionnaire during January 2021. The Chi-square test or Fisher exact test was utilized for statistical data analysis. A total of 2158 respondents completed the questionnaire, among them 1192 (55.2%) were male with 23.87 (SD: ±6.23) years as mean age. The conspiracy beliefs circulating regarding the COVID-19 vaccine were believed by 9.3% to 28.4% of the study participants. Among them, 1040 (48.2%) agreed to vaccinate on its availability while 934 (43.3%) reported the Chinese vaccine as their preference. The conspiracy beliefs of the participants were significantly associated with acceptance of the COVID-19 vaccine. The existence of conspiracy beliefs and low vaccine acceptance among the general population is a serious threat to successful COVID-19 vaccination.

Advocacy, Hesitancy, and Equity: Exploring U.S. Race-Related Discussions of the COVID-19 Vaccine on Twitter

BACKGROUND

Our study aimed to describe themes of tweets related to COVID-19 vaccines, race, and ethnicity to explore the context of the intersection of these topics on Twitter.

METHODS

We utilized Twitter's Streaming Application Programming Interface (API) to collect a random 1% sample of publicly available tweets from October 2020 to January 2021. The study team conducted a qualitative content analysis from the full data set of 1110 tweets.

RESULTS

The tweets revealed vaccine support through vaccine affirmation, advocacy through reproach, a need for a vaccine, COVID-19 and racism, vaccine development and efficacy, racist vaccine humor, and news updates. Vaccine opposition was demonstrated through direct opposition, vaccine hesitancy, and adverse reactions. Conspiracy and misinformation included scientific misinformation, political misinformation, beliefs about immunity and protective behaviors, and race extermination conspiracy. Equity and access focused on overcoming history of medical racism, pointing out health disparities, and facilitators to vaccine access. Representation touted pride in development and role models, and politics discussed the role of politics in vaccines and international politics.

CONCLUSION

Our analysis demonstrates that Twitter can provide nuances about multiple viewpoints on the vaccine related to race and ethnicity and can be beneficial in contributing to insights for public health messaging.

Acceptance of COVID-19 Vaccination among Front-Line Health Care Workers: A Nationwide Survey of Emergency Medical Services Personnel from Germany

INTRODUCTION

The aim of this study was to evaluate the COVID-19 vaccination acceptance of emergency medical services (EMS) personnel as front-line health care workers (HCW) in Germany. Several studies have shown low willingness for vaccination (e.g., seasonal influenza) among HCWs and EMS personnel.

METHODS

We created a web-based survey. The questions were closed and standardized. Demographic data were collected (age, sex, federal state, profession). Experience with own COVID-19 infection, or infection in personal environment (family, friends) as well as willingness to vaccinate was queried.

RESULTS

The sample includes n = 1296 participants. A willingness to be vaccinated exists in 57%, 27.6% participants were undecided. Our results show a higher propensity to vaccinate among the following groups: male gender, higher medical education level, older age, own burden caused by the pandemic (p < 0.001).

CONCLUSIONS

Due to the low overall acceptance of vaccination by HCWs, we recommend that the groups with vaccination hesitancy, in particular, be recruited for vaccination through interventions such as continuing education and awareness campaigns.

#Scamdemic, #Plandemic, or #Scaredemic: What Parler Social Media Platform Tells Us about COVID-19 Vaccine

This study aims to understand public discussions regarding COVID-19 vaccine on Parler, a newer social media platform that recently gained in popularity. Through analyzing a random sample (n = 400) of Parler posts using the hashtags #COVID19Vaccine and #NoCovidVaccine, we use the concept of echo chambers to understand users' discussions through a text analytics approach. Thematic analysis reveals five key themes: reasons to refuse the COVID-19 vaccine (40%), side effects of the COVID-19 vaccine (28%), population control through the COVID-19 vaccine (23%), children getting vaccinated without parental consent (5%), and comparison of other health issues with COVID-19 (2%). Textual analysis shows that the most frequently used words in the corpus were: nocovidvaccine (348); vaccine (264); covid (184); covid19 (157); and vaccines (128). These findings suggest that users adopted different terms and hashtags to express their beliefs regarding the COVID-19 vaccine. Further, findings revealed that users used certain hashtags such as "echo" to encourage like-minded people to reinforce their existing beliefs on COVID-19 vaccine efficacy and vaccine acceptance. These findings have implications for public health communication in attempts to correct false narratives on social media platforms. Through widely sharing the scientific findings of COVID-19 vaccine-related studies can help individuals understand the COVID-19 vaccines efficacy accurately.

An exploratory study of social media users' engagement with COVID-19 vaccine-related content

Background: Facebook, as the world's most popular social media platform, has been playing various important roles throughout the COVID-19 pandemic, allowing users to produce and share health-related information that both eases and complicates public health communication. However, the characteristics of vaccine-related Facebook content and users' reaction to the vaccine issue has been an unexplored area to date. Methods: To fill the previous knowledge-gap, this exploratory study wants to understand the communication climate of Facebook on the COVID-19 vaccine issue, including the nature of dominant content and users' engagement patterns with them. Therefore, the study analyzes the 10,000 most popular Facebook posts with the highest interactions on the vaccine issue. Results: The results show that Facebook users prioritize more vaccine-related news links (71.22%) over other content. The declining interactions on the issue suggests that interaction growth mainly depends on positive news on the vaccine. Finally, users' reaction to the vaccine issue is dominantly positive, though they may show a highly negative attitude toward vaccine misinformation. Conclusions: A few limitations and strengths of this study are discussed along with values and implications. This study for the first time analyzes Bangla language-based Facebook content related to the COVID-19 vaccine issue, which is largely overlooked in global academic research.

An exploratory study of social media users' engagement with COVID-19 vaccine-related content

Background: Facebook, as the world's most popular social media platform, has been playing various important roles throughout the COVID-19 pandemic, allowing users to produce and share health-related information that both eases and complicates public health communication. However, the characteristics of vaccine-related Facebook content and users' reaction to the vaccine issue has been an unexplored area to date. Methods: To fill the previous knowledge-gap, this exploratory study wants to understand the communication climate of Facebook on the COVID-19 vaccine issue, including the nature of dominant content and users' engagement patterns with them. Therefore, the study analyzes the 10,000 most popular Facebook posts with the highest interactions on the vaccine issue. Results: The results show that Facebook users prioritize more vaccine-related news links (71.22%) over other content. The declining interactions on the issue suggests that interaction growth mainly depends on positive news on the vaccine. Finally, users' reaction to the vaccine issue is dominantly positive, though they may show a highly negative attitude toward vaccine misinformation. Conclusions: A few limitations and strengths of this study are discussed along with values and implications. This study for the first time analyzes Bangla language-based Facebook content related to the COVID-19 vaccine issue, which is largely overlooked in global academic research.

An exploratory study of social media users' engagement with COVID-19 vaccine-related content

Background: Facebook, as the world's most popular social media platform, has been playing various important roles throughout the COVID-19 pandemic, allowing users to produce and share health-related information that both eases and complicates public health communication. However, the characteristics of vaccine-related Facebook content and users' reaction to the vaccine issue has been an unexplored area to date. Methods: To fill the previous knowledge-gap, this exploratory study wants to understand the communication climate of Facebook on the COVID-19 vaccine issue, including the nature of dominant content and users' engagement patterns with them. Therefore, the study analyzes the 10,000 most popular Facebook posts with the highest interactions on the vaccine issue. Results: The results show that Facebook users prioritize more vaccine-related news links (71.22%) over other content. The declining interactions on the issue suggests that interaction growth mainly depends on positive news on the vaccine. Finally, users' reaction to the vaccine issue is dominantly positive, though they may show a highly negative attitude toward vaccine misinformation. Conclusions: A few limitations and strengths of this study are discussed along with values and implications. This study for the first time analyzes Bangla language-based Facebook content related to the COVID-19 vaccine issue, which is largely overlooked in global academic research.

Characterization of Vaccine Tweets During the Early Stage of the COVID-19 Outbreak in the United States: Topic Modeling Analysis

BACKGROUND

During the early stages of the COVID-19 pandemic, developing safe and effective coronavirus vaccines was considered critical to arresting the spread of the disease. News and social media discussions have extensively covered the issue of coronavirus vaccines, with a mixture of vaccine advocacies, concerns, and oppositions.

OBJECTIVE

This study aimed to uncover the emerging themes in Twitter users' perceptions and attitudes toward vaccines during the early stages of the COVID-19 outbreak.

METHODS

This study employed topic modeling to analyze tweets related to coronavirus vaccines at the start of the COVID-19 outbreak in the United States (February 21 to March 20, 2020). We created a predefined query (eg, "COVID" AND "vaccine") to extract the tweet text and metadata (number of followers of the Twitter account and engagement metrics based on likes, comments, and retweeting) from the Meltwater database. After preprocessing the data, we tested Latent Dirichlet Allocation models to identify topics associated with these tweets. The model specifying 20 topics provided the best overall coherence, and each topic was interpreted based on its top associated terms.

RESULTS

In total, we analyzed 100,209 tweets containing keywords related to coronavirus and vaccines. The 20 topics were further collapsed based on shared similarities, thereby generating 7 major themes. Our analysis characterized 26.3% (26,234/100,209) of the tweets as News Related to Coronavirus and Vaccine Development, 25.4% (25,425/100,209) as General Discussion and Seeking of Information on Coronavirus, 12.9% (12,882/100,209) as Financial Concerns, 12.7% (12,696/100,209) as Venting Negative Emotions, 9.9% (9908/100,209) as Prayers and Calls for Positivity, 8.1% (8155/100,209) as Efficacy of Vaccine and Treatment, and 4.9% (4909/100,209) as Conspiracies about Coronavirus and Its Vaccines. Different themes demonstrated some changes over time, mostly in close association with news or events related to vaccine developments. Twitter users who discussed conspiracy theories, the efficacy of vaccines and treatments, and financial concerns had more followers than those focused on other vaccine themes. The engagement level-the extent to which a tweet being retweeted, quoted, liked, or replied by other users-was similar among different themes, but tweets venting negative emotions yielded the lowest engagement.

CONCLUSIONS

This study enriches our understanding of public concerns over new vaccines or vaccine development at early stages of the outbreak, bearing implications for influencing vaccine attitudes and guiding public health efforts to cope with infectious disease outbreaks in the future. This study concluded that public concerns centered on general policy issues related to coronavirus vaccines and that the discussions were considerably mixed with political views when vaccines were not made available. Only a small proportion of tweets focused on conspiracy theories, but these tweets demonstrated high engagement levels and were often contributed by Twitter users with more influence.