Misinformation about COVID-19 vaccines can appear almost anywhere: from an uncle's Facebook post to a well-trusted news commentator. But where does it come from, and why do some myths spread further than others?
With the help of the internet research firm Graphika, NPR analyzed the rise of one persistent set of lies about COVID-19 vaccines: that they can affect female fertility.
Despite a mountain of scientific evidence showing the vaccines are safe and effective, the false information persists.
Graphika's data analysis tools allow the firm to track key points at which a piece of information is shared or amplified. It can illustrate how many of these kinds of lies often go viral.
The events outlined here represent a major amplification event for this false information, but they're by no means the only source of lies about female fertility and the vaccine. Claims about fertility and the coronavirus vaccines go back to at least December, and fertility claims about other vaccines date back even further, in some cases decades.
But the events of earlier this year illustrate how misinformation can spread in a nonlinear manner with many different players adding threads to a web of false content.
Here then is the life cycle of a lie:
Step 1: Start with a kernel of truth
After receiving the COVID-19 vaccine this spring, "a lot of women noted heavy menstrual periods," says Alice Lu-Culligan, an MD-Ph.D. candidate at Yale University who studies the immune system and reproductive health.
Lu-Culligan says that immune cells play an important role in menstruation, and so it is in fact possible that the vaccine could temporarily alter that process. "It's very plausible that you could have abnormalities to the typical menstrual cycle," she says.
Other scientists agree it's possible. One team of biological anthropologists is conducting a survey of experiences with menstruation and the vaccines, which has had over 120,000 responses so far, according to Kathryn Clancy, a researcher at the University of Illinois Urbana-Champaign. The researchers learned many thousands of people who menstruate have unusually heavy flows after vaccination, and some older people also experienced breakthrough bleeding.
Unfortunately, definitively establishing a link has proved difficult, in large part because trials for the new vaccines never asked women about their periods. Because there is so much natural variation in women's periods month to month, a controlled clinical trial would be needed to try and establish whether it was happening. "When you don't collect these data during the clinical trial, you really lose an opportunity to study it in a controlled fashion," Lu-Culligan says.
The lost opportunity for scientists became an opening for anti-vaccine activists, says Melanie Smith, former director of analysis for Graphika. "In the more successful misinformation cases that we see, there is always that gap of knowledge," she says.
Step 2: Find an influencer to spread doubts and questions
With no firm data, stories about the disruption to menstrual cycles began popping up in forums and groups. Many were just wondering if it had happened to others and whether they should be worried. But there was one Facebook group in particular that turned out to be important.
"It's called, literally 'COVID-19 Vaccine Side Effects,' " Smith says. There were a lot of posts by ordinary people there, looking for answers, but anti-vaccine activists were also part of the group.
One of the people reading this page was an anti-vaccine campaigner named Naomi Wolf. Formerly best known for her writing about feminism, Wolf has, over the years, drifted into anti-vaccine advocacy. "She is a very highly followed influencer in what we call the pseudo-medical community," Smith says.
Wolf is not a medical doctor, and yet on April 19, she tweeted out a link to the Facebook group along with this message: "Hundreds of women on this page say that they are having bleeding/clotting after vaccination, or that they bleed oddly AROUND vaccinated women. Unconfirmed, needs more investigation, but lots of reports."
Smith points out that Wolf is using an old trick: by saying something "needs more investigation," she's raising doubts, without presenting facts that can be refuted.
Step 3: Pile on some related myths
Wolf's tweet also seamlessly inserted a myth: that somehow vaccinated women could pass side effects on to the unvaccinated.
Lu-Culligan says that's absolutely not the case. She adds that this myth seems to echo another popular falsehood: that somehow women who live together can influence each other's cycles.
Wolf kept tweeting and piling on more misinformation in question form: Can vaccines cause infertility? Miscarriages?
This slam went well beyond disruption to menstrual cycles, raising the stakes dramatically. Lu-Culligan says the evidence overwhelmingly shows that the vaccines do not cause these problems. "At this point there have been many, many millions of women who have gotten the vaccine, and there have been no scientific reports of any infertility," she says.
The Centers for Disease Control and Prevention also says that the available data shows that vaccines are safe for those who are pregnant or nursing.
Step 4: Make waves in mainstream media
Days after Wolf started tweeting about vaccines and fertility, other influencers began picking it up, and a few clickbait websites wrote fake news stories.
But it was the real news that gave the lies their biggest boost. About a week after the initial tweets, a Miami private school, the Centner Academy, announced it would no longer allow vaccinated teachers into the classroom. It said there were too many questions about whether the vaccine could spread to unvaccinated mothers and children.
The school's CEO, Leila Centner, is an established anti-vaccine advocate, so her decision wasn't surprising. But the ban made national news anyway.
"To some people it's crazy and to others they question it because they want to know more, so for everyone there's a reason why you click on it," says Tara Kirk Sell, a senior scholar at the Johns Hopkins Center for Health Security. She says this perfectly illustrates how a lie that's grown big enough can use the mainstream media to get a further boost.
"By covering it, which is important for people to know what kind of stuff is going on out there, the other side of that is that the lie spreads faster, and more people see it and more people pick up on it," Sell says.
And that's what happened. The Miami school story led to global coverage. "This is the point at which we start to see Spanish and Portuguese content, specifically," says Smith, formerly of Graphika.
The lies piggybacked along with news of the school. Outlets in other languages began reporting that the vaccine can spread person to person, or cause fertility problems.
Step 5: Morph to fit the messenger
Finally, because misinformation about vaccines is not grounded in data, it can mutate to fit any political message or worldview.
Vaccine myths about fertility and reproduction are particularly potent because they affect a large swath of the population, particularly when they incorporate myths about vaccinated women spreading the side effects. "It's kind of a one-size-fits-all theory in some ways, and the potential impact is everyone, rather than one specific community," Smith says.
In the weeks following the initial wave of coverage, others were using these ideas to grab audiences. Conservative commentator Candace Owens brought the link between vaccines and menstruation up on Instagram. In a six-minute video questioning vaccine safety, Owens never directly repeated the lies about fertility but didn't refute them either.
Far-right commentator Alex Jones folded the vaccine lies into his conspiracy theories about Google and Facebook, which he claims are trying to depopulate the Earth. "It's not just that you're going to be sterile, you're not going to be able to have children," Jones said during a recent broadcast. "You're not going to be able to eat beef anymore."
Step 6: Repeat the cycle with new lies
By late June, the lies about fertility had spread everywhere from France to Brazil. But then, Smith says, they started fading away.
"It seems to have kind of fallen by the wayside in terms of the COVID-19 news cycle that happens in these spaces on the internet," she says.
And that's the last lesson about the lies: They don't stick around. They grab the attention, raise questions and doubt, but there's no substance there. So once they've shocked those they're meant to engage, they disappear.
Or more properly, they're replaced by a new, incredible story.
A previous version of this web story mischaracterized the survey of experiences with menstruation and the vaccine as only including women. In fact, the survey includes people who menstruate or have in the past. In addition, the story incorrectly labeled the authors of this study as medical anthropologists. They are biological anthropologists.
A MARTINEZ, HOST:
Misinformation about COVID-19 vaccines can appear almost anywhere online. But where does it come from?
NPR's Geoff Brumfiel traced the origins of one piece of vaccine misinformation and how it ended up taking on a life of its own.
GEOFF BRUMFIEL, BYLINE: You're about to hear a lot of lies. But it all starts with a kernel of truth. After receiving the COVID-19 vaccine this spring, many women noticed what seemed like an important side effect.
ALICE LU-CULLIGAN: A lot of women noted heavy menstrual periods.
BRUMFIEL: Alice Lu-Culligan is an M.D.-Ph.D. candidate at Yale University who studies the immune system and reproductive health. She says that immune cells play an important role in menstruation. And so it is, in fact, possible that the vaccine could temporarily alter that process.
LU-CULLIGAN: To me, it's very plausible that you could have abnormalities to the typical menstrual cycle.
BRUMFIEL: But, she says, scientists aren't sure because clinical trials of the new COVID vaccines did not ask women participating about menstruation. That lack of data created an opening for anti-vaccine activists.
Melanie Smith analyzed what happened next for Graphika, a company that tracks vaccine misinformation online.
MELANIE SMITH: In the more kind of successful misinformation cases that we see, there is always that gap of knowledge.
BRUMFIEL: Stories about the disruption to menstrual cycles began popping up in forums and groups. And there was one Facebook group in particular that turned out to be important.
SMITH: It's called literally COVID-19 Vaccine Side Effects.
BRUMFIEL: Smith says, there were a lot of posts by ordinary people on there just trying to figure out whether they should be worried. But anti-vaccine activists were also part of the group. One of the people reading the page was an anti-vaccine campaigner named Naomi Wolf.
SMITH: She is a very highly followed influencer in the kind of what we call pseudo-medical community.
BRUMFIEL: Wolf is not a medical doctor. And yet on April 19, she tweeted this message.
SMITH: (Reading) Hundreds of women on this page say that they are having bleeding/clotting after vaccination or that they bleed oddly around vaccinated women.
Around is in capitals.
(Reading) Unconfirmed - needs more investigation - but lots of reports.
BRUMFIEL: And right there came the distortions. First, Wolf uses an old trick - says something needs more investigation. She asks a question, raises doubt but doesn't present facts that can be refuted. And second, by saying these side effects happened around vaccinated women, Wolf has seamlessly added a complete myth to the real concern.
SMITH: It's this idea essentially that even if you choose not to be vaccinated, you can potentially absorb some of the supposed negative impact by being around people that are.
BRUMFIEL: Now, I know I said this report would be filled with lies. But I just want to take a moment here to point out that, no, vaccinated people cannot spread side effects to the unvaccinated - again, immunologist Alice Lu-Culligan.
LU-CULLIGAN: A good scientist never says impossible. But, I mean, this one is like, it's not happening. Come on. (Laughter).
BRUMFIEL: But Wolf keeps tweeting and piling on more misinformation. Can vaccines cause infertility, miscarriages? The answer to all this is no.
LU-CULLIGAN: At this point, there have been many, many millions of women who have gotten the vaccine. And to date, there have been no scientific reports on any incidence of infertility.
BRUMFIEL: Still, internet researcher Melanie Smith sees it all getting hundreds of retweets.
SMITH: I'm looking at this and thinking, this is going to start some form of conversation and likely will be a narrative that we need to monitor over the next few weeks
BRUMFIEL: In just days, other influencers start picking it up. And then a week after that first tweet...
(SOUNDBITE OF ARCHIVED RECORDING)
UNIDENTIFIED REPORTER #1: New controversy concerning the coronavirus pandemic - a Miami private school now says it won't employ teachers or staff who get their COVID-19 vaccine.
BRUMFIEL: A Miami school said there were too many questions about whether the vaccine could spread to unvaccinated people. The school's owner's a well-known anti-vaccine advocate. So her decision wasn't surprising. But many news outlets covered it anyway.
Tara Kirk Sell, a senior scholar at the Johns Hopkins Center for Health Security, says, these stories are popular.
TARA KIRK SELL: To some people, it's crazy. And to others, they want to know more because they question it. So to everyone, there's a reason why you click on it.
BRUMFIEL: She says, this perfectly illustrates how a lie that's grown big enough can use the mainstream media to get a further boost.
SELL: By covering it, which is important for people to know - what kind of stuff's going on out there. The other side of that is that the lie spreads faster. And, you know, more people see it. And more people pick up on it.
BRUMFIEL: And that's just what happened. The Miami school story led to global coverage.
(SOUNDBITE OF ARCHIVED RECORDING)
UNIDENTIFIED REPORTER #2: (Speaking Spanish).
SMITH: This is the point at which we start to see Spanish and Portuguese content specifically.
BRUMFIEL: And the lies piggybacked along with the news at the school. Outlets in other languages began reporting that vaccines can spread person-to-person or cause fertility problems. Back in the U.S., others were using these ideas to grab audiences.
Conservative commentator Candace Owens brought it up on Instagram.
(SOUNDBITE OF ARCHIVED RECORDING)
CANDACE OWENS: Since she got the Pfizer vaccine, she has had menstruation issues.
BRUMFIEL: Owens never directly repeated the lies. But she didn't refute them either. And she asked a lot of questions about vaccine safety.
(SOUNDBITE OF ARCHIVED RECORDING)
OWENS: Pretend that the questions are not allowed. And there are a lot of questions around these vaccines that deserve to be answered.
BRUMFIEL: And then there's people like far-right commentator Alex Jones. He folded the lies about the vaccine into his grand conspiracy theories about Google and Facebook, which he claims are depopulating the earth.
(SOUNDBITE OF ARCHIVED RECORDING)
ALEX JONES: So it's not just, you're going to be sterile. It's not just, you're not going to be able to have children. You're not going to be able to eat beef anymore.
BRUMFIEL: Full disclosure - Google and Facebook are sponsors of NPR. Also, they're not in the process of depopulating the earth. Also, vaccines are not going to make you allergic to beef. By June, just two months after it all started, the lie about fertility and vaccines spreading had gone everywhere, from France to Brazil.
But then, researcher Melanie Smith says, it started fading away.
SMITH: It seems to have kind of fallen by the wayside as - in terms of the COVID vaccine news cycle that happens in these spaces on the internet.
BRUMFIEL: Partially, that's because social media companies are getting stricter. Naomi Wolf, who first spread the myth, was suspended from Twitter. But it's also a feature of the lies themselves. They grab attention. But there's no substance there. So once they've shocked those they're meant to engage, they disappear - or more properly, they're replaced by a new incredible story.
Geoff Brumfiel, NPR News.
(SOUNDBITE OF KETTEL'S "QUICKPIG") Transcript provided by NPR, Copyright NPR.