Global Misinformation Spillovers in the Vaccination Debate Before and During the COVID-19 Pandemic: Multilingual Twitter Study

Background: Antivaccination views pervade online social media, fueling distrust in scientific expertise and increasing the number of vaccine-hesitant individuals. Although previous studies focused on specific countries, the COVID-19 pandemic has brought the vaccination discourse worldwide, underpinning the need to tackle low-credible information flows on a global scale to design effective countermeasures. Objective: This study aimed to quantify cross-border misinformation flows among users exposed to antivaccination (no-vax) content and the effects of content moderation on vaccine-related misinformation. Methods: We collected 316 million vaccine-related Twitter (Twitter, Inc) messages in 18 languages from October 2019 to March 2021. We geolocated users in 28 different countries and reconstructed a retweet network and cosharing network for each country. We identified communities of users exposed to no-vax content by detecting communities in the retweet network via hierarchical clustering and manual annotation. We collected a list of low-credibility domains and quantified the interactions and misinformation flows among no-vax communities of different countries. Results: The findings showed that during the pandemic, no-vax communities became more central in the country-specific debates and their cross-border connections strengthened, revealing a global Twitter antivaccination network. US users are central in this network, whereas Russian users also became net exporters of misinformation during vaccination rollout. Interestingly, we found that Twitter's content moderation efforts, in particular the suspension of users following the January 6 US Capitol attack, had a worldwide impact in reducing the spread of misinformation about vaccines. Conclusions: These findings may help public health institutions and social media platforms mitigate the spread of health-related, low-credibility information by revealing vulnerable web-based communities.