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Abstract and Figures

Background: Vaccine hesitancy has been recognized as a major global health threat. Having access to any type of information in social media has been suggested as a potential influence on the growth of anti-vaccination groups. Recent studies w.r.t. other topics than vaccination show that access to a wide amount of content through the Internet without intermediaries resolved into major segregation of the users in polarized groups. Users select information adhering to theirs system of beliefs and tend to ignore dissenting information. Objectives: The goal was to assess whether users' attitudes are polarized on the topic of vaccination on Facebook and how this polarization develops over time. Methods: We perform a thorough quantitative analysis by studying the interaction of 2.6 M users with 298,018 Facebook posts over a time span of seven years and 5 months. We applied community detection algorithms to automatically detect the emergence of communities accounting for the users' activity on the pages. Also, we quantified the cohesiveness of these communities over time. Results: Our findings show that the consumption of content about vaccines is dominated by the echo chamber effect and that polarization increased over the years. Well-segregated communities emerge from the users' consumption habits i.e., the majority of users consume information in favor or against vaccines, not both. Conclusion: The existence of echo chambers may explain why social-media campaigns that provide accurate information have limited reach and be effective only in sub-groups, even fomenting further opinion polarization. The introduction of dissenting information into a sub-group is disregarded and can produce a backfire effect, thus reinforcing the pre-existing opinions within the sub-group. Public health professionals should try to understand the contents of these echo chambers, for example by getting passively involved in such groups. Only then it will be possible to find effective ways of countering anti-vaccination thinking.
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Polarization of the Vaccination
Debate on Facebook
!
Ana!Lucía!Schmidt1,!Fabiana!Zollo2,!Antonio!Scala3!,Cornelia!Betsch3,!Walter!Quattrociocchi2!
1IMT!Alti!Studi!Lucca!
2Ca'!Foscari!University!of!Venice!
3ISC-CNR,!Rome!Italy!
4University!of!Erfurt!
Abstract(
Background+
Vaccine! hesitancy! has! been! recognized! as! a! major! global! health! threat.! Having! access! to! any! type! of!
information! in! social! media! has!been!suggested!as!a!potential!powerful!influence!factor! to! hesitancy.! Recent!
studies! in! other! fields! than! vaccin ation! show! that! access! to! a! wide! amount! of! content! through! the! Internet!
without! intermediaries! resolved!into! major! segregation! of! the! users! in! polarized! groups.! Users! select! the!
information!adhering!to!theirs!system!of!beliefs!and!tend!to!ignore!dissenting!information.!!
Objectives+
In!this!paper!we!assess!whether!there!is!polarization!in!Social!Media!use!in!the!field!of!vaccination.!!!
Methods+
We!perform!a!thorough!quantitative!analysis!on!Facebook!analyzing!2.6M!users!interacting!with!298.018!posts!
over! a! time! span! of! seven! years! and! 5! months.! We! used! community! detection! algorithms!to! automatically!
detect!the!emergent!communities!from! the! users’! activity!and!to!quantify!the! cohesiveness! over! time! of!the!
communities.!
Results+
Our!findings!show!that!content!consumption!about!vaccines!is!dominated!by!the!echo-chamber!effect!and!that!
polarization!increased!over!years.!Communities!emerge!from!the!users’!consumption!habits,!i.e.!the!majority!of!
users!only!consumes!information!in!favor!or!against!vaccines,!not!both.!!
Conclusion+
The!existence!of!echo-chambers!may!explain!why!social-media!campaigns!providing!accurate!information!may!
have!limited!reach,!may!be!effective!only!in!sub-groups!and!might!even!foment!further!polarization!of!opinions.!
The! introduction! of! dissenting! information! into! a! sub-group! is! disregarded! and! can! have! a! backfire! effect,!
further!reinforcing!the!existing!opinions!within!the!sub-group.!
Keywords+
Social!media,!vaccine!hesitancy,!network!analysis,!computational!social!science,!misinformation!
!
Introduction(
Undeterred!by!the!scientific!consensus! that! vaccines! are! safe! and! effective,! unsubstantiated!claims!doubting!
their!safety!still! occur! to! this!day.!Perhaps!the!most! famous!case!is!the! multiple!times!disproved! [1,2,3]!myth!
that! the! MMR! vaccine! causes! au tism.!However,! outbreaks! and! deaths!resulting! from! objections! to! vaccines!
continue!to!happen![4,5],!with!the! anti-vaccination!movement!gaining!media!attention!as!a!result.!Mandatory!
vaccination!policies!only!seem!to!foment!the!controversy![6].!
Since! 2013,! the! World! Economic! Forum! lists! massive! digital! misinformation! among!the! main! threats! to! our!
societies![7].!Recent!studies!outline!that!misinformation!spreading!is!a!consequence!of!the!shift!of!paradigm!in!
the! consumption! of! content! induced! by! the!advent! of! social!media.! Social! media! platforms!like! Facebook!or!
Twitter!have!created! a! direct!path!for!users!to! produce! and! consume! content,!reshaping!the!way!people!get!
informed![8-13].!
Like! for! other! misinformation! campaigns,! Facebook!provides! an! ideal! medium! for! the!diffusion! of! anti-
vaccination! ideas.!Users! can! access! a! wide! amount! of! information! and! narratives! and! selection! criteria! are!
biased! toward! personal! viewpoints! [14,15,16].! Online! users! select! information! adhering! to! their! system! of!
beliefs!and!tend!to!ignore!dissenting!information!and!to!join!polarized!groups!that!cooperated!to!reinforce!and!
frame! a! shared! narrative! [17,18,19].! The! interaction! with! content! dissenting! the! shared! narrative! is! mainly!
ignored!or!might!even!foment!segregation!of!users,!heated!debating!and!thus!bursting!polarization!of!opinions!
[20].!Such!a!scenario!is!not!limited!just!to!conspiracy!theories,!but!it!is!related!to!all!issues!that!are!perceived!as!
critical! by! the! users! such! as! geopolitics! and! health! [21].! This! effect! allows! for! the! emergence! of! polarized!
groups![12],!i.e.!clusters!of!users!with!opposing!views!that!rarely!interact!with!one!another.!!
In! this! paper!we! use! quantitative! analysis! to! understand! the! evolution! of! the! debate! about!vaccines! on!
Facebook,!taking!into! account!two!opposing!views:!anti-vaccines!and!pro-vaccines.!Considering!the!liking!and!
commenting! behavior! of! 2.6M!users! we! study! the! evolution! of! the! two! communities! over! time,! taking!into!
account!the! number! of! users,!the!number! of! pages,! and! the! cohesiveness! of! the! communities.!The! analyses!
confirm! the! existence! of! two! polarized! com munities.!Additionally,! we! find! evidence! that! selective! exposure!
plays!an!pivotal!role!in!the!way!users!consume! content!online.!The!two!communities!display!different!rates!at!
which! the! variety! of! news! sources!consu med! diminishes!for! increasing! levels! of! u ser! activity,! with! the! anti-
vaccines!community!being!more!engaged.!!
Data(Description(
Ethics(Statement(
The!data!collection!process!was!carried!out!using!the!Facebook!Graph!API![22],!which!is!publicly!available.!The!
pages!from! which! we! downloaded!data! are! public! Facebook! entities! and! can! be! accessed! by! anyone.!Users'!
content!contributing! to! such! pages! is!also!public! unless! users'! privacy! settings!specify!otherwise,!and!in!that!
case!their!activity!is!not!available!to!us.!
Data(Collection(
The!dataset!was!generated!through!requests!to!Facebook!for!pages!containing!the!keywords!!"##$%&,!!"##$%&'!
or!!"##$%"($)%!in!their!name!or!description.!We!then!filtered!the!raw!Facebook!data!in!order!to!include!only!the!
ones!relevant!for!the!study.!Inclusion!criteria!were!language!(English),!a!minimum!level!of!activity!(at!least!10!
posts),!date!of!the!posts!(between!1st!January!2010!to!31st!May!2017),!and!relation!of!the!page!to!vaccination.!
This!last!step!was!essential,!as!having!one!of!the!keywords!in!the!description!does!not!necessarily!mean! the!
page's!topic!is!about!vaccines.!Some!examples!of!those!false!positive!search!results!are!the!pages!*+&,-"##$%&'!
(an!UK!music!band),!and!./(+0/,12!"##$%&!(a!comedian).!
From!the!resulting!set!of! Facebook!pages!we!downloaded!all!posts!as!well!as!all!likes!and!comments!made!on!
those! posts.!Considering! the! content! of!the!posts!made! on! the! pages,! all! the! Facebook! pages! were! also!
manually!classified!by!two!raters!into!two!groups:!145!3/)4!"##$%&'!with!1,388,677!users!and!98!"%($4!"##$%&',
5$(+,1,277,170!users.!The!Cohen’s!kappa!inter-agreement!between!both!raters!is!0.966,!showing!nearly!perfect!
agreement.!
A!list!of!Facebook!pages!with!their!respective!community!label!and!a!breakdown!of!the!dataset!in!numbers!of!
posts,!likes,!likers,!comments,!commenters!and!users!can!be!found!in!the!Appendix.!
Preliminaries(and(Definitions(
The!likes!(or!comments)!given!by!users!to!the!posts!of!different!Facebook!pages!form!a!6$3"/($(&,%&(5)/7.!The!
6$3"/($(&,%&(5)/7!is! formed!by!a!set!of! users! and! a! set!of!pages!where! links! only! exist!between!a! user! and! a!
page!if!the!user!liked!(or!commented)!anything!on!that!page.!!
We!can!represent!the!bipartite!network!with!a!matrix!where!each!column!is!a!user!and!each!row!is!a!page,!and!
the!content!of!each!cell!equals!1!if!the!user!liked!at!least!one!post!of!that!page.!If!we!multiply!the!matrix!by!its!
transpose,!we!get!the!3/)8&#($)%,)9,(+&,6$3"/($(&,%&(5)/7.!This!new!matrix!will!have!a!row!and!column!for!each!
page,!and!the!content!of!each!cell!will!represent!the!number!of!common!users!between!the!2!pages!that!define!
that!cell,!that!is,!the!number!of!users!who!liked!any!post!on!both!pages.!The!same!method!can!also!be!applied!
considering!the!matrix!formed!by!the!users’!comments.!
For!illustration,!Figure!1!visualizes!a!simplified!example!of!a!bipartite!network!with!5!users!and!4!pages!and!the!
corresponding!projection.!
(
,
:$;0/&,<,=,>"?,@$3"/($(&,%&(5)/7,5$(+,A,0'&/',"%B,C,3";&'D,(+&,E$%7',6&(5&&%,(+&F,$%B$#"(&,(+"(,",0'&/,E$7&B,",3";&G,>6?,*+&,3/)8&#($)%,)9,
(+&,6$3"/($(&, %&(5)/7D,(+&,5&$;+(',)%,(+&, E$%7',6&(5&&%,(+&,3";&','+)5, (+&,%0F6&/,)9,0'&/',(+&H, +"!&,$%, #)FF)%G,>#?, *+&,#)FF0%$(H,
'(/0#(0/&,"',B&(&#(&B,5$(+,(+&,"E;)/$(+F,:"'(I/&&BHG,J)B&','+"/$%;,(+&,'"F&,#)E)/,6&E)%;,(),(+&,'"F&,#)FF0%$(HG,
Once! we! have! the! network! of! pages! linked! by! their! common! users! (Figure! 1b),! we! can! apply! different!
community!detection!algorithms!to!detect!group!of!pages!that!are!strongly!connected!(Figure!1c).!To!do!this!
we! apply! five! well! known! community! detection! algorithms:! FastGreedy1[23],! WalkTrap2[24],! MultiLevel3[25]!
and! LabelPropagation4[26].!Different! algorithms! are! used! as! they! allow! for! unsupervised! clustering,! i.e.,! no!
human!intervention,!and!they!each!have!different!approaches!to!detecting!of!communities!in!the!networks.!To!
compare!the! communities! detected! with! the! various!algorithms!we! use! standard! methods! that!compute!the!
similarity!between!different!community!partitions!by!considering!how!the!algorithms!assign!the!nodes!to!each!
community![27].!Due!to!its!speed!and!its!lack!of!parameters!in!need!of!tuning,!the!FastGreedy!algorithm!will!be!
the! main! reference! to! compare! against! the! partitions! resulting! from! the! application! of! other! community!
detection!algorithms.!
Results(and(Discussion(
Validation(of(the(Community(Partition(
In!order!to!validate!the!manual! partition! of! the! pages! into!two!communities! we!generated!the!projections!of!
the! bipartite! networks! considering! the! user! likes!and! the! user! comments.!We! then! applied!the! community!
detection!algorithms!to!extract!the!communities!of!pages!according!to!the!users'!behavior!and!compared!those!
to!the!expert-based!partitioning.!
Table! 2! shows! the! comparison! between! a! random! partition! of! the! pages,! the! manual! partition,! and! the!
FastGreedy! partition! against! those! resulting! from! the! different! algorithms.!We! can! see! that! the! manual!
classification!matches!well! against! the!unsupervised! approaches!and! that! the! FastGreedy! results! have! a! high!
agreement! with! the! other! algorithms.!This! indicates! that! the! users'! behavior! generates! well! defined!
communities! of! pages! and! that! these! communities! are! similar! to! the! anti-vaccines! and! pro-vaccines! as!
manually!tagged.!
*"6E&,<,=,-"E$B"($)%,)9,(+&,#)FF0%$(H,3"/($($)%G,
Graph&
Communities&
FastGreedy&
WalkTrap&
MultiLevel&
LabelProp.&
Likes&
Random&
0.496!
0.497!
0.495!
0.497!
Manual&
0.774!
0.721!
0.738!
0.714!
FastGreedy&
1!
0.935!
0.950!
0.901!
Comments&
Random&
0.497!
0.499!
0.495!
0.496!
Manual&
0.590!
0.610!
0.567!
0.570!
FastGreedy&
1!
0.909!
0.876!
0.824!
Note:! We! compared! a! random! partition!of! the! pages! into! communities,! the! manual! classification,!and ! the!FastGreedy!
classification!against!the!community!partitions!detected!with!the!different!community!detection!algorithms.!The!values!of!
the!comparison!range!from!0!to!1,!where!1!is!an!exact!match!and!0!is!no!match.!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
1!It!optimizes! the!modularity!score! in!a! greedy!manner!to!calculate!the!communities.!The!modularity!is! a!benefit!function!
that!measures!the!quality!of!a!particular!division!of!a!network!into!communities.!A!high!modularity!score!corresponds!to!a!
dense! connectivity! between! nodes! inside! a! cluster! and! sparse! connections! between! clusters.! This! algorithm! takes! an!
agglomerative! bottom-up! approach:! initially! each! vertex! belongs! to! a! separate! community! and,! at! each! iteration,! the!
communities!are!merged!in!a!way!that!yields!the!largest!increase!in!the!current!value!of!modularity.!!
2!It!exploits!the!fact!that!a!random!walker!tends!to!become!trapped!in!the!denser!parts!of!a!graph,!i.e.,!in!communities.!
3!It!uses! a!multi-level!optimization!procedure!for! the!modularity!score.!It!takes!a!bottom-up!approach!where!each!vertex!
initially!belongs!to!a!separate!community!and!in!each!step,!unlike!FastGreedy,!vertices!are!reassigned!to!a!new!community.!
4!It!uses!a!simple!approach!where!each!vertex!is!assigned!a!unique!label,!which!is!updated!according!to!majority!voting!in!
the!neighboring!vertices.!Dense!node!groups!quickly!reach!a!consensus!on!a!common!label.!
Thus,!the!pages!cluster!together!according!to!the!users'!activity.!In!a!next!step,!we!analyzed!the!polarization!of!
the!users.!
Polarization(
Assuming!that!a!user!u!has!performed!x!likes!on!community!C1!and!y!likes!on!community!C2,!we!calculate!the!
users’!polarization!as!ρ(u)!=!(x!−!y)/(x!+!y).!Thus,!a!user!u!for!whom!ρ(u)!=!−1!is!polarized!towards!C2,!whereas!a!
user! whose! ρ(u)! =! 1! is! polarized! towards!C1.! We! then! measure!the! pola rization! of! all! users! considering! the!
communities!they!commented!and!liked!content!on.!We!examine!two!partitions:!the!manual!classification!of!
pages,!pro-vaccine!and!anti-vaccine,!and!the!two!biggest!communities!as!detected!with!FastGreedy,!C1!and!C2.!
Figure!2!shows!the!Probability!Density!Function!(PDF)!of!ρ(u)!for!all!users!who! have! given! at! least! 10! likes! in!
their!lifetime.!The!PDF!for!the!polarization!of!all!users!is!sharply!bi-modal,!that!is,!the!majority!of!the!users!are!
either! at! -1!or! at! 1.!This! indicates! a!strong! polarization! among! the! communities,! that! is,! the! majority!of! the!
users!are!active!either!in!the!pro-vaccines!or!anti-vaccines!community,!not!both.!
!
:$;0/&,K,4, L/)6"6$E$(H,1&%'$(H,:0%#($)%,>L1:?,)9,(+&,0'&/'M,E$7$%;,>E&9(?,"%B,#)FF&%($%;,>/$;+(?,6&+"!$)/,$%,(+&,F"%0"E,#)FF0%$($&',>()3?,
"%B,(+&,K,E"/;&'(,#)FF0%$($&',B&(&#(&B,5$(+,:"'(I/&&BH,>6)(()F?G,*+&,B$'(/$60($)%,)9,(+&,0'&/',$',6$F)B"E,9)/,"EE,#"'&'D,5+$#+,$%B$#"(&',",
'(/)%;,3)E"/$N"($)%,"F)%;,(+&,#)FF0%$($&'D,(+"(,$'D,(+&,F"8)/$(H,)9,(+&,0'&/',"/&,"#($!&,$%,)%EH,)%&,#)FF0%$(HG,
Selective(Exposure(
Facebook!users!differ!in!the!time!they!spend!with!the!pages!and!in!how!frequently!they!interact!with!the!pages.!
The!E$9&($F&!of!a!user!is!defined!as!the!period!of!time!where!the!user!started!and!stopped!interacting!with!the!
included!set!of!pages.!It!can!be!approximated!by!the!time!difference!between!a!user’s!latest!and!earliest!liked!
post.!The! total!number!of!likes! per!user!is!a! good!proxy!for!the! user’s!"#($!$(H,!i.e.,!their!level!of!engagement!
with!the!Facebook!pages.!These!two!measures!provide!important!insights!on!how!users!consume!information!
in!each!echo!chamber!as!demonstrated!in!the!following!analyses.!
Figure!3! shows!the!number!of! unique!pages!users!from! the!anti-vaccines!(red)!and!pro-vaccines!communities!
(blue)!interact!with,!considering!increasing!levels!of!lifetime!and!activity!for!different!time!windows!(yearly!left,!
monthly!middle!and!weekly!right!panel).!For!a!comparative!analysis,!we!standardized!lifetime!and!activity!to!
range!between!0!and!1,!both!over!the!entire!user!set!of!each!community,!and!the!number!of!pages.!
Note!that!for!both!communities,!users!usually!interact!with!a!small!number!of!Facebook!pages.!Longer!lifetime!
and!higher! levels! of! activity!correspond! with!less! number!of!pages!being!consumed.!This!suggests!that!more!
time! on! Facebook! corresponds! to ! a! smaller! variety! of! sources! being! consumed.! This! is! consistent! with! [12]!
showing!that! content! consumption! on! Facebook! is! dominated! by! selective! exposure!and,! over! time,! users!
personalize!their!information!sources!accordingly!with!their!tastes!which!results!in!a!smaller!number!of!sources.!
Pro-vaccine! users! interact! with! M! =! 1.42! pages! (SD! =! 0.79),! anti-vaccine! users! with! 2.45! (SD! =! 2.13).! This!
difference!is!displayed!in!Figure!3:!users!in!the!anti-vaccines!community!(red!line)!consume!information!from!a!
more! diverse! set! of! pages! than! those! in! the! pro-vaccines!community,! regardless! of! the! time! window!
considered.!Grey! shades! are! 95%! CI!of! the! local! regression! of! the! data,! indicating! significant! differences!
between! the! groups! at! any! time.! So! while! there! is! a! natural!tendency! of! users! to! confine! their! activity! to! a!
limited!set! of! pages! [12],! the!two!communities!display!different! rates! of!selective! exposure.!The!anti-vaccine!
community!shows!more!commitment!to!the!consumption!of!their!posts.!
!
:$;0/&, O, 4, P"Q$F0F, %0F6&/,)9, 0%$R0&, 3";&', (+"(, 0'&/',5$(+, $%#/&"'$%;, E&!&E',)9, '("%B"/B$N&B, E$9&($F&,>()3?, )/, '("%B"/B$N&B,"#($!$(H,
>6)(()F?, $%(&/"#(, 5$(+, H&"/EH, >E&9(?D, F)%(+EH, >F$BBE&?, "%B, 5&&7EH, >/$;+(?, 9)/, &"#+, #)FF0%$(HG, S'&/'M, E$9&($F&, #)//&'3)%B', (), (+&,
'("%B"/B$N&B,($F&,B$99&/&%#&,6&(5&&%,(+&$/,E"(&'(,"%B,&"/E$&'(,E$7&B,3)'(G,S'&/'M,"#($!$(H,#)//&'3)%B',(),(+&,'("%B"/B$N&B,%0F6&/,)9,E$7&',
;$!&%,$%,(+&$/,E$9&($F&G,S'&/',B$'3E"H,",(&%B&%#H,(),E$7&,E&'',3";&',5+&%,(+&$/,E$9&($F&,"%B,"#($!$(H,$%#/&"'&'G,*+&,0'&/',5+),$%(&/"#(,5$(+,
(+&,"%($4!"##$%&',#)FF0%$(H, "E'), #)%'0F&, ",E"/;&/,!"/$&(H, )9,3";&',(+"%,(+&, 3/)4!"##$%&', 0'&/'G,I/&H,'+"B&', "/&,TAU,VW,)9, (+&,9$((&B,
#0/!&D,$%B$#"($%;,'$;%$9$#"%(,B$99&/&%#&',6&(5&&%,(+&,;/)03',"(,"%H,($F&G,
Growth(of(the(Communities(over(Time(
We! also! analyzed! the! growth! of! the! two! communities! over! time,! considering! the! variety! of! pages! and! the!
number!of! users!that!interact!with!them.!Figures!4!shows!the!evolution!of!the!communities!over!the! years! in!
quarterly!increments.!
The!left!panel!plots!the!number! of! active!pages! in! each! community.!We!define!a!page! as! active! in! a! specific!
quarter! if! it! made! a! post! (bottom! panel),! received! a! like! (middle)! or! comment! in! that! period!(upper! panel).!
Overall,!the!number!of!active!pages!in!both!communities!increases!at!similar!rates,!with!slight!variations!when!
we!consider!the!different! types!of!action!that! marks! a!page!as!active.!If!we!use!the!pages'!posting! activity! or!
the!likes!they!received!to!determine!whether!they!were!active!in!a!given!quarter,!we!can!see!that,!from!2013,!
the!pro-vaccine!community!consistently! tends! to!show!a!higher!number!of! active!pages!than!the!anti-vaccine!
community!(interaction!effect!in!a!MANOVA!with!sentiment!(pro,!anti)!and!time!(until!2012Q4!vs.!following)!as!
factors!and!posts!and!likes!as!dependent!variables!F(2,55)!=!2.708,!p!=!0.076;!eta2!=!0.09;!both!main!effects!are!
highly! significant).! On! the! other! hand,! if! we! focus!on! the! comments,! the! anti-vaccines!community! shows! a!
boost! in! activity! starting! in! 2015!(interaction! effect! in! an! ANOVA! with! sentiment! (pro,! anti)! and! time! (until!
2014Q4!vs.! following)!as!factors!and!comments!as!dependent!variable!F(1,56)! =!5.053,! p!=!0.029;! eta2!=! 0.08;!
both!main!effects!are!significant).!!
The!right! panel!plots!the!number!of! active! users! in!each!community.!We!define!users!as!active!if!they!gave!a!
like! (or! comment)! to! any! page! of! that! community! in! the! given! quarter.! The! plot! shows! that! while! both!
communities!gain!users!throughout!the!entire! period,!the!anti-vaccines!community!has,!until!the!end!of!2015!
and!beginning!of!2016,! more! active! users! than!the!pro-vaccines!community.!After!that,!this! relation!reverses!
(interaction!effect!in!a!MANOVA!with!sentiment!(pro,!anti)!and!time!(until!2015Q4!vs.!following)!as!factors!and!
comments! and! likes! as! dependent! variables! F(2,55)! =! 12.218,! p! <! 0.001;! eta2!=! 0.31;! both ! main! effects! are!
highly!significant).!
!
!
:$;0/&,C,=,J0F6&/,)9,"#($!&,3";&',>E&9(?,"%B,0'&/',>/$;+(?,$%,&"#+,#)FF0%$(HG,X&,B&9$%&,",3";&,"',"#($!&,$%,",'3&#$9$#,R0"/(&/,$9,$(,F"B&,",
3)'(,>6)(()F,3"%&E?D,/&#&$!&B,",E$7&,>F$BBE&,3"%&E?,)/,#)FF&%(,>033&/,3"%&E?,$%,(+"(,3&/$)BG,X&,B&9$%&,",0'&/,"',"#($!&,$%,", #)FF0%$(H,
)%,",;$!&%,R0"/(&/D,$9,(+&H,;"!&,",E$7&,>6)(()F,3"%&E?,)/,#)FF&%(,>()3,3"%&E?,(),"%H,3";&,)9,(+"(,#)FF0%$(H,$%,(+"(,($F&G!!
!
Another!important!factor!to!consider!is!the!cohesiveness!of!the!pro-vaccines!and!anti-vaccines!communities.!In!
order! to! analyze! whether! the! growth! of! the! communities! depends! on! the! emergence! of! isolated! pages!or!
whether!it!grows!steadily,!we!split!the!projections!of!the!bipartite!likes!and!comments!graph!by!the!community!
of!the! pages.!This!results!in!4!sub-graphs,!each!containing! the! pages!of!one!community,!pro-vaccines!or! anti-
vaccines,! and! the! common! users! that! linked! them! considering! the! likes! or! the! comments.! We! can! then!
calculate!the!fragmentation!of!each!community!by!applying!the!community!detection!algorithms!and!obtaining!
their!partition.!
Figure!5!shows!the!number!of!pages!of! the! biggest! sub-community! of! the! anti-vaccines!(left)! or! pro-vaccines!
communities! (right)! in! a! given! quarter,! that! is,! the! largest! connected! component! found! with! the! different!
community!detection!algorithms.!The!black!line!represents!the!total!number!of!pages!in!the!sub-graphs!in!that!
quarter.!It! marks!the!maximum! possible! size!for!the!largest!connected! component!to!take!in!that!moment!in!
time.!The!closer!the!size!of!the!largest!connected!component!is!to!the!total!number!of!pages!in!the!system,!the!
more!tightly!linked!that!community!is!in!that!moment!in!time.!
!
:$;0/&, A, 4, Y$N&, )9, (+&, E"/;&'(, #)%%&#(&B, #)F3)%&%(, 5$(+$%, (+&, '&(, )9, 3";&', (";;&B, "', "%($4!"##$%&', "%B, 3/)4!"##$%&', )!&/, ($F&D,
#)%'$B&/$%;,!"/$)0',#)FF0%$(H,B&(&#($)%,"E;)/$(+F'G,*+&,6E"#7, E$%&,/&3/&'&%(',(+&,()("E,%0F6&/,)9,3";&', )!&/,($F&,$%,(+&,"%($4!"##$%&',
"%B,3/)4!"##$%&', #)FF0%$($&'D,(+"(, $'D, (+&, F"Q$F0F,3)''$6E&,'$N&, 9)/, (+&,E"/;&'(,#)%%&#(&B, #)F3)%&%(,$%,(+"(, F)F&%(, $%, ($F&G,*+&,
;/"3+,'+)5',(+"(,(+&,"%($4!"##$%&',#)FF0%$(H,;/)5',#)+&'$!&EHD,5$(+,(+&,%&5,3";&',8)$%$%;,(+&,"E/&"BH,&Q$'($%;, ;/)03,)9, 3";&'D,5+$E&,
(+&,3/)4!"##$%&',#)FF0%$(H,;/)5',$%,",F)/&,9/";F&%(&BD,$%B&3&%B&%(,5"HG,,
The!plots!show! that!in! the!anti-vaccines! community! the! number! of! pages! in! the! largest! component!remains!
close!to!the!total!number!of!pages!in!the!system.!In!the!case!of!the!pro-vaccines!sub-graphs,!however,!the!size!
of!the!largest!community!does!not!increase!closely!with!the!number!of!pages!in!the!system.!This!signifies!that!
the!anti-vaccines!community!grows!in!a!more!cohesive!manner,!with!pages!tightly!linked!by!their!users'!activity,!
while!the!pro-vaccines!community!is!more!fragmented.!!
Discussion((
By!means!of!quantitative!analysis!of!Facebook!likes!and!comments!we!validated!the!existence!of!two!opposing!
narratives! regarding! the! vaccination! debate! on! Facebook.! We! show! that! the! communities! emerge! from! the!
users’!consumption!habits!and!that!users!are!highly!polarized,!that!is,!the!majority!of!users!only!consumes!and!
produces!information!in!favor!or!against!vaccines,!not!both.!
We!also!showed!that!both!narratives!are!subjected!to!selective!exposure,!and!that!the!more!active!a!user!is!on!
Facebook!the!smaller! is!the!variety!of! sources! they!tend!to!consume.!We!note,! however,! that!the!users!from!
the!anti-vaccination!community!consume!more!sources!compared!to!the!pro-vaccine! users.! This! is!consistent!
with! the! results! of! previous! studies! [14]!that! show! that! people! in! conspiracy-like! groups! show! higher!
engagement!with!the!community.!
We!also!analyzed!the!communities’!evolution!over!time.!While!the!pro-vaccine!pages!are!generally!more!active,!
the!anti-vaccine!pages!concentrate!the!majority!of!the!debate,!receiving!more!comments!from!users.!We!show!
that!the!anti-vaccine!community!had!a!more!active!user!base!until!the!end!of!2015,!where!the!activity!seems!to!
stall.!This!matches!with!the!outbreak!of!measles!at!Disneyland![4],!which!put!the!anti-vaccination!movement!in!
the!spotlight! and!gained!the!attention!of!mainstream!media![28-34].!Further!studies!are!needed!to!determine!
the!reason!for!this!stagnation.!
Finally,!we! show! that! while!both!narratives!have!gained! attention! on! Facebook!over!time,!anti-vaccine!pages!
display!a!more!cohesive!growth!(i.e.!pages!are!liked!by!the!same!people),!while!the!pro-vaccine!pages!seem!to!
grow!in!a!highly!fragmented!fashion!(i.e.!pages!are!liked!by!different!people).!
Limitations((
The! data! collection! process! was! done! the! 5th! of! June! 2017! and!represents! a! snapshot! of! the! pages,! posts,!
comments!and!likes!available!at!the!time.!Pages,!posts,!likes!and!comments!that!were!made!in!the!downloaded!
period!(1st! January! 2010!to!31st!May!2017)! and! were! removed!before!the!download!date!are!not!present!in!
the! dataset.! The! data! only! includes! the! likes! and! comments! by! users! whose! privacy! settings! allowed! pub lic!
access!to!their!activity!on!public!pages!on!the!download!date.!!
Conclusions((
Facebook! allows! echo-chambers! to! emerge,! in! which! pro-! and! anti-vaccination! attitudes! polarize! the! users.!
Social!media!campaigns!that!advocate! for!vaccination!and!provide!accurate!information!should!expect!to!only!
reach!pro-vaccination!users!as!there!is!nearly!no!interaction!between!the!groups.!Overall,!social!media!seem!to!
be!a! powerful!promoter!of!different!sentiments!about!vaccination!and!therefore!it!is! likely! that! it!contributes!
to!vaccine!hesitancy.!!
Appendix(
*"6E&,K,4,1"("'&(,1&'#/$3($)%G,
!
Anti-vaccines!
Pro-vaccines!
Pages!
98!
145!
Posts!
189,759!
108,259!
Likes!
12,696,440!
11,459,295!
Likers!
1,145,650&
1,325,511!
Comments!
1,351,839!
749,209!
Commenters!
271,598!
146,196!
Users!
1,277,170!
1,388,677!
Note:!The!posts,!likes!and! comments!are! considered!pro!or!anti!vaccines!if!they!were!made!on!a!page! classified!as!such.!
Likers! is! the! number! of! unique! users! who! have! given! at! least! one! like! to! the! community.! Commenters! is! the! unique!
number!of!users!who!have!given!at!least!one!comment!to!the!community.!Users!is!the!number!people!who!have!given!at!
least!a!like!or!a!comment!to!the!community.(
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The anti‐vaccine movement is arguably one of the more concerning social movements to have surfaced during the first two decades of the current century. Opposition to vaccination is particularly worrisome for its actual and potential impacts to public health, including increased frequency and severity of outbreaks, heightened virus positivity and death rates, and threats to herd immunity. While public reaction against vaccination regimens is hardly a new phenomenon, rarely if ever has such resistance congealed into the type of potent and widespread movement seen today. This resistance has been most pronounced in countries where vaccines are most readily available, particularly for COVID‐19, as in the European Union countries, Russia, and the United States, which is the primary focus of this entry. Moreover, the rise in vaccine skepticism, particularly in the US, is representative of a deepening fault line in the twenty‐first century marked by political polarization, competing social realities, and an erosion of institutional trust.
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In 2019 the World Health Organization named vaccine hesitancy a top-10 threat to global health (World Health Organization, 2019). To understand the historical roots of this phenomenon and its contemporary implications, this chapter will begin with the history of vaccine development and policy for multiple infectious diseases and an overview of the growth of the anti-vaccine movement. Next, we will place findings from research on vaccine misinformation on social media into a broader historical framework. Finally, we will discuss how applying a historical perspective can help counter the impact and spread of vaccine misinformation, thus improving vaccine education, promotion, and policy.
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Research has extensively studied parental vaccination decision-making drivers and barriers. The most powerful predictors of vaccination actions include the understanding of the risks posed by the disease; and the side effects of vaccination; vaccine beliefs and attitudes; and their effectiveness and safety concerns. Thus, this study aimed to explore the parents decision-making experience in choosing MMR vaccine in Banten, Indonesia. In qualitative study, a purposeful sampling process was used to identify parents with a variety of expected MMR decisions: (1) accept MMR on time, (2) accept MMR late, (3) receive one or more individuals, (4) obtain no MMR or individuals. A qualitative quality analysis was used to interpret the transcribed text. A total of 25 participants from 5 different FGDs were included in this study. This qualitative interview resulted in 4 themes, namely: healthy life, own health perceptions, disease history, perceived severity, and susceptibility of vaccine-preventable illnesses. Research on the MMR vaccination should move a step forward and include studies looking at similarities and differences in the factors predicting parents’ intention to follow MMR vaccination recommendations by comparing parents of very young children, being the primary target group of MMR vaccination campaigns and interventions, with parents of adolescent children. Keywords: decision process, MMR vaccine, qualitative study
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Anti-vaccination sentiments have grown strong in public discourse in recent decades and especially during the Covid-19 pandemic, as online environment has proved to be the fertile setting for spreading conspiracy theories and false news. Anti-vaccine groups are using social networks to spread dubious health information, creating their own content without any evidence to confuse users who access their pages (Ortiz-Sánchez, Velando-Soriano et.al, 2020). Recent surveys found men were more likely to take the Covid-19 vaccine, compared to women (National Geographic survey, Gallup poll, Pew Survey, etc.), whilst existing studies show that the "vast majority" of people commenting, sharing, and liking anti-vaccination information on Facebook are women. Therefore, it is essential to comprehend, how notions about femininity and motherhood relate to decisions about vaccination.
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The inner dynamics of the multiple actors of the informations systems - i.e, T.V., newspapers, blogs, social network platforms, - play a fundamental role on the evolution of the public opinion. Coherently with the recent history of the information system (from few main stream media to the massive diffusion of socio-technical system), in this work we investigate how main stream media signed interaction might shape the opinion space. In particular we focus on how different size (in the number of media) and interaction patterns of the information system may affect collective debates and thus the opinions' distribution. We introduce a sophisticated computational model of opinion dynamics which accounts for the coexistence of media and gossip as separated mechanisms and for their feedback loops. The model accounts also for the effect of the media communication patterns by considering both the simple case where each medium mimics the behavior of the most successful one (to maximize the audience) and the case where there is polarization and thus competition among media memes. We show that plurality and competition within information sources lead to stable configurations where several and distant cultures coexist.
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The World Economic Forum listed massive digital misinformation as one of the main threats for our society. The spreading of unsubstantiated rumors may have serious consequences on public opinion such as in the case of rumors about Ebola causing disruption to health-care workers. In this work we target Facebook to characterize information consumption patterns of 1.2 M Italian users with respect to verified (science news) and unverified (conspiracy news) contents. Through a thorough quantitative analysis we provide important insights about the anatomy of the system across which misinformation might spread. In particular, we show that users’ engagement on verified (or unverified) content correlates with the number of friends having similar consumption patterns (homophily). Finally, we measure how this social system responded to the injection of 4,709 false information. We find that the frequent (and selective) exposure to specific kind of content (polarization) is a good proxy for the detection of homophile clusters where certain kind of rumors are more likely to spread.
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Social media aggregate people around common interests eliciting collective framing of narratives and worldviews. However, in such a disintermediated environment misinformation is pervasive and attempts to debunk are often undertaken to contrast this trend. In this work, we examine the effectiveness of debunking on Facebook through a quantitative analysis of 54 million users over a time span of five years (Jan 2010, Dec 2014). In particular, we compare how users usually consuming proven (scientific) and unsubstantiated (conspiracy-like) information on Facebook US interact with specific debunking posts. Our findings confirm the existence of echo chambers where users interact primarily with either conspiracy-like or scientific pages. However, both groups interact similarly with the information within their echo chamber. Then, we measure how users from both echo chambers interacted with 50,220 debunking posts accounting for both users consumption patterns and the sentiment expressed in their comments. Sentiment analysis reveals a dominant negativity in the comments to debunking posts. Furthermore, such posts remain mainly confined to the scientific echo chamber. Only few conspiracy users engage with corrections and their liking and commenting rates on conspiracy posts increases after the interaction.
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Background: Influenza vaccine hesitancy is a significant threat to global efforts to reduce the burden of seasonal and pandemic influenza. Potential barriers of influenza vaccination need to be identified to inform interventions to raise awareness, influenza vaccine acceptance and uptake. Objective: This review aims to (1) identify relevant studies and extract individual barriers of seasonal and pandemic influenza vaccination for risk groups and the general public; and (2) map knowledge gaps in understanding influenza vaccine hesitancy to derive directions for further research and inform interventions in this area. Methods: Thirteen databases covering the areas of Medicine, Bioscience, Psychology, Sociology and Public Health were searched for peer-reviewed articles published between the years 2005 and 2016. Following the PRISMA approach, 470 articles were selected and analyzed for significant barriers to influenza vaccine uptake or intention. The barriers for different risk groups and flu types were clustered according to a conceptual framework based on the Theory of Planned Behavior and discussed using the 4C model of reasons for non-vaccination. Results: Most studies were conducted in the American and European region. Health care personnel (HCP) and the general public were the most studied populations, while parental decisions for children at high risk were under-represented. This study also identifies understudied concepts. A lack of confidence, inconvenience, calculation and complacency were identified to different extents as barriers to influenza vaccine uptake in risk groups. Conclusion: Many different psychological, contextual, sociodemographic and physical barriers that are specific to certain risk groups were identified. While most sociodemographic and physical variables may be significantly related to influenza vaccine hesitancy, they cannot be used to explain its emergence or intensity. Psychological determinants were meaningfully related to uptake and should therefore be measured in a valid and comparable way. A compendium of measurements for future use is suggested as supporting information.
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Recent findings showed that users on Facebook tend to select information that adhere to their system of beliefs and to form polarized groups -- i.e., echo chambers. Such a tendency dominates information cascades and might affect public debates on social relevant issues. In this work we explore the structural evolution of communities of interest by accounting for users emotions and engagement. Focusing on the Facebook pages reporting on scientific and conspiracy content, we characterize the evolution of the size of the two communities by fitting daily resolution data with three growth models -- i.e. the Gompertz model, the Logistic model, and the Log-logistic model. Then, we explore the interplay between emotional state and engagement of users in the group dynamics. Our findings show that communities' emotional behavior is affected by the users' involvement inside the echo chamber. Indeed, to an higher involvement corresponds a more negative approach. Moreover, we observe that, on average, more active users show a faster shift towards the negativity than less active ones.
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Significance The wide availability of user-provided content in online social media facilitates the aggregation of people around common interests, worldviews, and narratives. However, the World Wide Web is a fruitful environment for the massive diffusion of unverified rumors. In this work, using a massive quantitative analysis of Facebook, we show that information related to distinct narratives––conspiracy theories and scientific news––generates homogeneous and polarized communities (i.e., echo chambers) having similar information consumption patterns. Then, we derive a data-driven percolation model of rumor spreading that demonstrates that homogeneity and polarization are the main determinants for predicting cascades’ size.
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Even though there are policies in place, and safe and effective vaccines available, almost every country struggles with vaccine hesitancy, i.e., a delay in acceptance or refusal of vaccination. Consequently, it is important to understand the determinants of individual vaccination decisions in order to establish effective strategies to support the success of country-specific public health policies. Vaccine refusal can result from complacency, inconvenience, a lack of confidence, and a rational calculation of pros and cons. Interventions should therefore be carefully targeted to focus on the reason for non-vaccination. We suggest that there are several interventions that may be effective for complacent, convenient, and calculating individuals while interventions that might be effective for those who lack confidence are scarce. Thus, efforts should be concentrated on motivating the complacent, removing barriers for those for whom vaccination is inconvenient, and adding incentives and additional utility for the calculating. These strategies might be more promising, economic, and effective than convincing those who lack confidence in vaccination.
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During outbreaks of vaccine-preventable diseases, compulsory vaccination is often discussed as a last resort to counter vaccine refusal. Besides ethical arguments, however, empirical evidence on the consequences of making selected vaccinations compulsory is lacking. Such evidence is needed to make informed public health decisions. Objective. To assess the effect of partial compulsory vaccination on the uptake of other voluntary vaccines. Method. In an incentivized behavioral vaccination game, N = 297 participants were randomized to the compulsory vaccination intervention or voluntary vaccination control group, which determined the decision architecture of a first decision. The critical second decision was voluntary for all participants. Results. Compulsory vaccination increased the level of anger among individuals with a rather negative vaccination attitude, whereas voluntary vaccination did not. This led to a decrease in vaccination uptake by 39% in the second voluntary vaccination. Conclusion. Making only selected vaccinations compulsory can have detrimental effects on the vaccination program by decreasing the uptake of voluntary vaccinations. As this effect occurred especially for vaccine hesitant participants, the prevalence of vaccine hesitancy within a society will influence the damage of partial compulsory vaccination.