Community Immunity
Does this look familiar? It reads like something from today, but it was written in 1896, printed on postcards, and mailed across Britain by the National Anti-Vaccination League. Here are examples of the originals. Researchers have documented common manipulation tactics, such as cherry-picked data, fake experts, conspiracy theories, emotional appeals, and the exploitation of scientific uncertainty. When I speak about vaccine communication with health professionals, I frequently get questions implying these techniques are new. But the tactics were all there 130 years ago, long before social media. This playbook is not new. So, if the tactics are identical, then what has actually changed? Two things. The first is obvious: the size, scale, and speed at which messages can spread. A postcard in 1896 may have reached dozens of neighborhoods and towns over the course of weeks. A social media post reaches the world in seconds, amplified by an algorithm optimized for outrage, and with no accountability. The information ecosystem today is completely different. However, the second change is the one I keep thinking about, and I don’t think it gets enough attention. In his book Bowling Alone [http://bowlingalone.com], Robert Putnam discusses the quiet collapse of America’s community life: we are joining fewer civic organizations, knowing fewer neighbors, and attending fewer community gatherings. We have lost what Putnam called social capital—the value of collective social networks that serve one another and build trust. That erosion matters for how health misinformation influences people today. For over a century, misleading claims existed alongside shared institutions that could buffer against extreme messaging. The local church, newspaper, and doctor. Rotary clubs, PTAs, and neighborhood associations. These institutions were far from perfect. They often reflected the biases of their time and were frequently exclusionary toward marginalized communities. Yet, for those within them, they functioned as a collective anchor. Today, many of those institutions still exist, but people no longer show up. Church congregations have declined over recent decades. Local newspapers have closed or been bought out by non-local actors. Civic organizations are dwindling. And physicians—still the most trusted source of vaccine information in survey after survey [https://www.kff.org/health-information-trust/kff-tracking-poll-on-health-information-and-trust-vaccine-safety-and-trust/]—are seeing patients for shorter visits, often lack long-term therapeutic relationships, and have increasingly limited availability. Instead of community forming around where we live, work, worship, or play, new substitutes for community are increasingly shaped by partisan political identification or social media algorithms. I want to acknowledge that many past community institutions were often gated and built on exclusion. However, the breakdown of those structures hasn't necessarily led to a more inclusive shared reality. Instead, we traded the old institutions, with all their flaws, for new, digital communities that thrive on fragmentation rather than community-building. The tactics of the Anti-Vaccination League were potent enough in that era to shape policy and influence large groups of people. Today, those same tactics travel to millions instantly, and the institutions that once provided a buffer have eroded. As early as 1896, the Anti-Vaccination League recognized the need for community work. The postcards were more than just propaganda; they came with an invitation to belong. That combination is part of what gave the movement its staying power. And it continues today, only now with tools that scale to millions instantly and far fewer competing sources of trust to push back. The uncomfortable truth is that the anti-vaccination movement has figured out that people need to belong to something. They aren’t just selling people on their set of “facts”; they are calling people into a community. The health and science world often misses this reality. Many believe that people have weighed the evidence on both sides and accepted an alternative set of facts. The reality is, they have decided to accept an invitation to join a community that welcomes them. Evidence needs a community to give it weight. Around vaccines, that work is already happening in small ways. Health care is a team effort, and trust lives not just with physicians but with the medical assistant who rooms the patient, the nurse who answers the portal message, the local pharmacist, family navigators, social workers, and the community health worker. My own work aims at improving how all these people communicate and build trust with families. Trusted voices in faith communities, schools, and neighborhoods still matter too. I was part of a recent science-and-faith gathering [https://open.substack.com/pub/youcanknowthings/p/faith-facts-and-trust?r=4zhyob&utm_campaign=post-expanded-share&utm_medium=web] that filled me with hope about the possibility of working together on shared messaging. And the work has to extend online too, whether we like it or not, because that's where people are increasingly building community. There is no silver bullet. But we won’t make progress unless we recognize that the work is about more than just correcting misleading claims; it's about rebuilding the connective tissue that makes communities more resilient before the next postcard arrives, in whatever form it takes. I want to hear from you, and I’m curious what you’re seeing. Can you think of a time that a non-medical trusted voice in your community influenced your health decisions? Why did you listen to them? Thanks, as always, for being part of this community. -David Community Immunity [https://communityimmunity.substack.com] is written by Dr. David Higgins, MD, MPH [http://www.linkedin.com/in/drhigginsmd], a practicing pediatrician and public health physician whose work focuses on vaccine delivery, health policy, and communication. This newsletter is where he writes about vaccines, public health, and community. When he’s not seeing patients or writing, he’s coaching youth soccer or exploring the outdoors with his family. Find him on LinkedIn [http://www.linkedin.com/in/drhigginsmd], Instagram [https://www.instagram.com/drhigginsmd/], Substack Notes [https://substack.com/@drhigginsmd], and Bluesky [https://bsky.app/profile/drhigginsmd.bsky.social]. This newsletter is free for everyone. If you want to support the work that goes into it, a paid subscription means a lot. 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