A clear global strategy is needed to “counter vaccine misinformation from the United States” (US),  Heidi Larson and Simon Piatek write in The Lancet this week.

This should be based on ensuring the independence of scientific institutions that deal with vaccines and the regulation of digital platforms to “address cross-border health harms”, they argue.

Global immunisation programmes are already being being undermined by a lack of resources, with the global vaccine alliance, Gavi, reporting this week that it is facing a $3 billion shortfall that will result in “a slowdown” in some of the immunisation programmes it supports.

Meanwhile, “the USA, long a cornerstone of global health leadership, has become an unexpected source of global instability in vaccination confidence”, argue Larsen, who heads the Vaccine Confidence Project at the  London School of Hygiene, and Piatek, founder of New Imagination Lab, which researches digital influence.

“An analysis of 316 million vaccine-related tweets from October 2019 to March 2021 across 18 languages found that the US functioned as a major exporter of COVID-19 vaccine misinformation, with American accounts disproportionately represented as central hubs in global misinformation networks”, they report.

Kennedy: Misinformation ‘super-spreader’

A separate longitudinal analysis of almost 300 million tweets on Twitter (now X) in 2021 found that 800 “superspreader” accounts were responsible for a third of all vaccine misinformation retweets – and the most prominent of these accounts belonged to Robert F Kennedy Jr, appointed US Health Secretary earlier this year.

Kennedy was responsible “for more than 13% of these retweets”, while most of the other super-spreader accounts also “operated primarily within the US digital ecosystem but had global reach, reinforcing the role of American-origin misinformation as a destabilising force in international vaccination confidence”, they report.

The impact of the US misinformation has been global. In 2023, UNICEF reported that in West Africa, particularly Nigeria and Ghana, “viral social media posts from the USA promoting conspiracy theories” eroded trust and reduced demand for COVID-19 and childhood vaccines.

Similarly, in Eastern Europe, particularly Romania and Bulgaria, misinformation has translated in lower vaccine uptake, write Larsen and Piatek.

Aid cuts undermines vaccines

They also argue that the US defunding of “substantial portions of international funding for science as well as vaccine delivery” has also allowed “conspiracy and misinformation to flourish globally”. 

Countering “US vaccine misinformation” should rest primarily on the protection of “scientific independence within federal health agencies”.

“Political appointees should not interfere with technical guidance. Congressional mechanisms must guarantee the autonomy of bodies such as the CDC and NIH, irrespective of the incumbent administration,” they argue.

Secondly, the regulation of digital platforms should take the form of “a binding international code on digital health integrity”, which could be developed by the World Health Organization and regional organisations such as the African Union and the Association of Southeast Asian Nations (ASEAN).

“Central to such a framework must be algorithmic transparency,” they argue, pointing to the European Union’s Digital Services Act as an example of what could be possible.

“Coordinated fact-checking infrastructure should be built into platform operations, not outsourced or voluntary, and must be adaptable to local languages and sociocultural contexts,” they assert, noting that while digital platforms operate globally, “regulatory responses remain national and fragmented”. 

“A world fragmented by health #misinformation is ill-prepared to respond to the next pandemic threat.”@ProfHeidiLarson & @sjpiatek in @TheLancet on impact of US leadership/politics on global health & #vaccine confidence.https://t.co/OggRnqAc8z

— London School of Hygiene & Tropical Medicine (@LSHTM) August 1, 2025

Next pandemic is incubating

“The urgency is compounded by what lies ahead. With climate-linked disease emergence, conflict-driven displacement, and increasing zoonotic risk, the next pandemic might already be incubating. A world fragmented by health misinformation is ill-prepared to respond to the next pandemic threat,” they conclude.

“There is still time to act. But it requires confronting uncomfortable truths about the role of the USA in fuelling mistrust, and the political choices that have allowed it. The world cannot afford another crisis in which lives are lost not for lack of vaccines, but for lack of truth.”

Image Credits: UNICEF.