openpolitics.com

As the coronavirus began pushing the nation into lockdown in March 2020, Joshua Coleman, an anti-vaccine campaigner who organizes anti-vaccine rallies, went on Facebook Live to give his followers a rallying speech. He laid out what he thought the pandemic really was: an opportunity.

“This is the one time in human history where every single human being across this country, possibly across the planet, but especially in this country, are all going to have an interest in vaccination and vaccines,” he said. “So it’s time for us to educate.”

By “educate,” he meant to spread misinformation about vaccines.

The approach that Mr. Coleman displayed in his nearly 10-minute-long appearance — turning any negative event into a marketing opportunity — is characteristic of anti-vaccine activists. Their versatility and ability to read and assimilate the language and culture of different social groups have been key to their success. But Mr. Coleman’s speech also encapsulated a yearslong campaign during which the anti-vaccine movement has maneuvered itself to exploit what Mr. Coleman called “a very unique position in this moment in time.”

Over the last six years, anti-vaccine groups and leaders have begun to organize politically at a level like never before. They’ve founded state political action committees, formed coalitions with other constituencies, and built a vast network that is now the foundation of vaccination opposition by conservative groups and legislators across the country. They have taken common-sense concepts — that parents should be able to raise their children as they see fit, and that medical decisions should be autonomous and private — and warped them in ways that have set back decades of public health advances.

The power of anti-vaccine mobilization is particularly evident now in efforts to protect Americans against Covid-19. Only about 61 percent of eligible Americans are fully vaccinated — not enough to provide national protection — even though the vaccines are free and are the best tool for keeping people out of overcrowded hospitals. But those who are baffled by the outsize influence of the anti-vaccine movement must understand how carefully its leaders have navigated their way to this point.

Vaccine hesitancy has existed in some form since the development of the first vaccine over 200 years ago. But the 2014-2015 measles outbreak, which began among mostly unvaccinated visitors at Disneyland in California and led to more than 125 cases, woke up the nation to the threat of that hesitancy. The only reason measles had gained a foothold was that pockets of the country with low vaccination rates had led to the erosion of herd immunity in those places.

In years leading up to that outbreak, vaccines had not been a partisan issue in the United States. But something was changing. Politicians like Chris Christie and Rand Paul called for respecting parents’ choice to vaccinate their children or not (although Mr. Christie later backpedaled a bit).

Meanwhile, public outcry followed the discovery that the outbreak began with unvaccinated children, with everyone from soccer moms to late-night television hosts lambasting parents who refused to vaccinate their kids. A coalition of parents led by Leah Russin, co-founder of the nonprofit group Vaccinate California, worked with California legislators like Richard Pan, a state senator and pediatrician, to push for a bill that would remove all nonmedical exemptions for school vaccine requirements, which had grown in recent years to allow pockets of low vaccination coverage to spring up.

But the mockery of “anti-vaxxers” in that uproar also mobilized the movement.

Anti-vaccine activists of all political stripes pushed back — hard — against the bill. When they found that inaccurate claims about vaccines didn’t sway California legislators, they shifted gears and asserted that removing nonmedical exemptions impinged on their freedom to raise their children as they wanted. In the late-Tea Party era, that argument had traction.

Renée DiResta, a researcher at Stanford, found through Twitter analysis that there was “an evolution in messaging.” The movement discovered that a focus on freedom “was more resonant with legislators and would help them actually achieve their political goals,” Ms. DiResta said to me. Anti-vaccine Twitter accounts that had been posting for years about autism and toxins pivoted to Tea Party-esque ideas, leading to the emergence of a new cluster of accounts focused on “vaccine choice” messaging, Ms. DiResta said.

Anti-vaccine activists used the measles outbreak and others to claim public officials would force “harmful” vaccines on people. They also found new ways to court politicians, especially those who take pride in bucking the system.

Just a week after the California bill had been filed, a well-meaning Republican legislator in Texas, Jason Villalba, filed a similar bill in Austin. But Mr. Villalba didn’t realize that anti-vaccine sentiment had been growing in his state, and his bill unwittingly “kicked the hornet’s nest,” said Rekha Lakshmanan, director of advocacy and public policy for a Texas-based nonprofit group, the Immunization Partnership. “All of a sudden we saw a kind of new generation of the anti-vaccine movement in Texas emerge.”

Though Mr. Villalba’s bill never got to a vote, it helped drive the new guard to form Texans for Vaccine Choice, which would become a PAC, to lobby against the legislation. Other influential conservative state PACs took notice and may have joined forces with Texans for Vaccine Choice behind the scenes. The group’s emphasis on parents’ rights and medical freedom were a natural fit, aligning them with Tea Party-type Republicans like Jonathan Stickland, whose ringing cry for any issue was “freedom.”

Likely under the tutelage of conservative grass-roots groups, the fledgling anti-vaccine PAC learned effective political electioneering. It backed a champion for its cause to challenge Mr. Villalba in the Republican primary, a far-right politician named Lisa Luby Ryan. When Ms. Ryan defeated Mr. Villalba, Texans for Vaccine Choice cried victory. That Ms. Ryan eventually lost the general election was beside the point. Anti-vaccine activists had shown they were a formidable force, and Texas Republicans learned it was “politically expedient” to stay silent when, for example, Mr. Stickland attacked vaccine scientists, as The Houston Chronicle editorial board wrote.

With vaccine refusal reframed as “parent choice,” Republicans could no longer risk appearing to oppose “freedom of choice” on any issue. More state anti-vaccine PACs and nonprofit groups formed, and social media allowed greater collaboration. The “freedom” messaging united anti-vaccine groups, particularly those in Texas and California, and withstood social media platforms’ growing attempts to stanch false claims.

New anti-vaccine organizations also began fund-raising in earnest, bringing in millions of dollars, both from wealthy donors and by selling fear. They use this money to create slick propaganda for larger audiences, such as a spate of anti-vaccine films like “Vaxxed,” which provided a blueprint for pandemic denialism films like “Plandemic.” And they donate funds to the politicians they hope to win over.

At the anti-vaccine Health Freedom Summit in 2020, several anti-vaccine activists spoke. Jennifer Larson, who believes vaccination caused her child’s autism, described how she had worked to gain the trust of Minnesota legislators. She and another vaccine opponent, Mark Blaxill, had formed a political party in 2011 to run candidates who oppose vaccine mandates and “medical injury,” but the two-party system was too entrenched. So they pivoted to supporting major-party politicians who would champion their causes.

“If they say something that might be considered controversial, we have a community of people who will run to have their back and support them,” Ms. Larson said at the gathering. “If you can, get involved … Get to know them, get them to trust you.”

That became the anti-vaccine playbook across the nation. And in state after state, vaccine opponents have gradually leveraged their state and local Republican parties to their ends, riding the “freedom” wave that has become so central to party messaging today. Hence the seamless marriage between anti-vaccine activists and groups protesting mask mandates and lockdowns.

As one example, by 2020, anti-vaccine groups joined anti-mask groups in Ohio to support a Republican-sponsored bill to curtail the Department of Health’s ability to issue quarantine orders and allow legislators to rescind health department orders. Though that attempt failed, Republican legislators eventually succeeded in 2021 in barring public schools and colleges from requiring Covid-19 vaccination before the vaccines had full FDA approval. States like Texas and Florida are now trying to stop businesses from requiring Covid vaccines.

“The most dangerous thing that could happen,” Dr. Peter Hotez, co-director of the Texas Children’s Hospital Center for Vaccine Development, told me he had worried in recent years, “is the Republican Party adopts anti-vaccine anti-science to the major platform. … This is the nightmare situation I’d hoped to avoid.”

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Tennessee offers a glimpse of that nightmare.

Dr. Michelle Fiscus, Tennessee’s medical director in charge of vaccinations, was fired in mid-July after promoting vaccination to young people, an effort state legislators like Scott Cepicky, a Republican representative, found “reprehensible.” And then the state suspended vaccination outreach for all vaccines.

Dr. Fiscus says the anti-vaccine movement is partly to blame. “I think it’s been this insidious growth of their influence on susceptible legislators,” she said, “especially in Southern states where they have taken the ‘medical freedom’ kind of angle.”

Though Tennessee has since resumed most of those programs, the pause was a bellwether. Had widespread Republican opposition to Covid vaccination now apparently reached the point of interfering with routine childhood vaccinations?

Those of us who have followed the anti-vaccine movement for years know that’s been the plan all along. Although the movement’s leaders could not have known a pandemic was coming, they were more ready to take advantage of the moment with their messaging than public health experts and policymakers were to combat it.

The nature of the scientific process during a pandemic, with its unrelenting influx of new data and constantly evolving understanding of it, makes health communication incredibly challenging. That reality, combined with botched messaging from public health agencies, has emboldened vaccine opponents.

Americans hoping to fight the anti-vaccine movement must learn to use the same tools of political rhetoric and mobilization, to speak up against misinformation and to swarm lawmakers’ phone lines to oppose bills that harm public health. Republican legislators must defend the importance of public health more forcefully.

The Covid vaccine hesitancy running through the Republican Party threatens to do more than prolong this pandemic. It also threatens America’s ability to fight other diseases, of the past and the future.