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From an uncle’s Facebook post to a well-known news commentator, misinformation about COVID-19 vaccines can appear almost anywhere. But where does it originate, and why do some myths spread faster than others?

NPR examined the rise of one persistent set of lies about COVID-19 vaccines with the help of the internet research firm Graphika: that they can affect female fertility.

Despite a mountain of scientific evidence demonstrating that vaccines are safe and effective, misinformation persists.

Graphika’s data analysis tools enable the company to track key points where information is shared or amplified. It demonstrates how many of these types of lies frequently go viral.

The events described here are a major amplification event for this false information, but they are far from the only source of misinformation about female fertility and the vaccine. Claims about fertility and coronavirus vaccines date back at least to December, and claims about fertility and other vaccines date back even further, in some cases decades.

However, events earlier this year demonstrate how misinformation can spread in a nonlinear fashion, with many different players contributing threads to a web of false content.

The life cycle of a lie is as follows:

Step 1: Begin with a grain of truth.

“A lot of women observed heavy menstrual periods after receiving the COVID-19 vaccine this spring,” says Alice Lu-Culligan, an MD-Ph.D. candidate at Yale University who researches the immune system and reproductive health.

According to Lu-Culligan, immune cells play an essential part in menstruation, therefore it’s possible that the vaccine could modify that process momentarily. “It’s highly likely that you’ll have irregularities in your menstrual cycle,” she explains.

Other scientists concur that it is possible. According to Kathryn Clancy, a researcher at the University of Illinois Urbana-Champaign, a team of biological anthropologists is undertaking a study of experiences with menstruation and vaccines, which has received over 120,000 responses so far. Many thousands of persons who menstruate suffered exceptionally strong flows following immunization, and some older people also experienced breakthrough bleeding, according to the researchers.

Unfortunately, establishing a definitive link has proven difficult, owing in large part to the fact that women were never asked about their periods during trials for the new vaccines. Because of the natural variation in women’s periods from month to month, a controlled clinical trial would be required to determine whether it was occurring. “You really lose an opportunity to study it in a controlled fashion when you don’t collect these data during the clinical trial,” Lu-Culligan says.

According to Melanie Smith, former director of analysis for Graphika, the opportunity lost by scientists became an opportunity for anti-vaccine activists.

Step 2: Find an influencer to spread doubts and questions

With no hard data, stories about menstrual cycle disruption began to circulate in online forums and groups. Many people were simply wondering if it had happened to others and if they should be concerned. But there was one Facebook group in particular that proved to be crucial.

“It’s literally called ‘COVID-19 Vaccine Side Effects,'” Smith explains. There were many posts by ordinary people looking for answers, but there were also anti-vaccine activists in the group.

Naomi Wolf, an anti-vaccine activist, was among those who read this page. Wolf, who was once best known for her feminist writing, has since shifted her focus to anti-vaccine activism. “She is a very well-followed influencer in what we refer to as the pseudo-medical community,” Smith says.

Wolf is not a doctor, but on April 19, she tweeted a link to the Facebook group along with the following message: “Hundreds of women on this page report bleeding/clotting after vaccination, or that they bleed unusually AROUND vaccinated women. Unconfirmed, more research is needed, but there are numerous reports.”

Smith observes that Wolf is employing an old trick: by stating that something “requires further investigation,” she is raising doubts without presenting facts that can be refuted.

Step 3: Add some similar myths to the mix.

The misconception that vaccinated women can pass on negative effects to the unvaccinated was also neatly integrated into Wolf’s tweet.

That, according to Lu-Culligan, is not the case. She goes on to say that this belief echoes another prevalent myth: that women who live together might somehow influence each other’s cycles.

Wolf continued to tweet and spout falsehoods in the form of questions: Is it possible for immunizations to induce infertility? Miscarriages?

This slam went well beyond disrupting menstruation cycles, substantially boosting the stakes. According to Lu-Culligan, the evidence strongly suggests that immunizations are not to blame for these issues.

“At this point, many, many millions of women have received the vaccine, and there have been no scientific reports of any infertility,” she says.

Step 4: In the mainstream media, make waves.

Days after Wolf began tweeting about vaccines and fertility, other influencers began to pick up on it, and a few clickbait websites published fake news stories.

But it was the real news that fueled the lies the most. A week after the initial tweets, the Centner Academy in Miami announced that vaccinated teachers would no longer be permitted in the classroom. It stated that there were too many unknowns regarding the vaccine’s ability to spread to unvaccinated mothers and children.

Leila Centner, the school’s CEO, is a well-known anti-vaccine activist, so her decision was unsurprising. Nonetheless, the ban made national headlines.

“Some people think it’s crazy, and others think it’s because they want to know more, so there’s a reason why you click on it,” Tara Kirk Sell, a senior scholar at the Johns Hopkins Center for Health Security, says. She claims that this perfectly exemplifies how a large enough lie can use the mainstream media to gain traction.

“By covering it, which is important for people to know what’s going on out there,” Sell says, “the other side of that is that the lie spreads faster, and more people see it and pick up on it.”

That’s exactly what happened. The Miami school story drew international attention. “This is the point at which we start to see Spanish and Portuguese content in particular,” says Smith, who previously worked for Graphika.

The lies rode on the back of the school’s news. Other language media outlets began reporting that the vaccine can spread from person to person or cause fertility issues.

Step 5: Morph the messenger to fit.

Finally, because vaccine misinformation is not based on data, it can mutate to fit any political message or worldview.

Vaccine myths about fertility and reproduction are especially powerful because they affect a large portion of the population, especially when they include myths about vaccinated women spreading the side effects. “In some ways, it’s a one-size-fits-all theory, and the potential impact is on everyone, rather than just one community,” Smith says.

Others were using these ideas to attract audiences in the weeks following the initial wave of coverage. Candace Owens, a conservative commentator, raised the issue of vaccines and menstruation on Instagram. Owens never directly repeated the lies about fertility in a six-minute video questioning vaccine safety, but he also didn’t refute them.

Alex Jones, a far-right commentator, incorporated vaccine lies into his conspiracy theories about Google and Facebook, which he claims are attempting to depopulate the Earth. “It’s not just that you’ll be sterile; you won’t be able to have children,” Jones said on a recent broadcast. “You won’t be able to eat beef any longer.”

Step 6: Continue the cycle with new lies.

By late June, the fertility lies had spread all the way from France to Brazil. But then, according to Smith, they began to fade away.

“In terms of the COVID-19 news cycle that happens in these spaces on the internet,” she says, “it seems to have kind of fallen by the wayside.”

And now for the final lesson on lies: They don’t stay long. They pique the reader’s interest, raise questions, and cast doubt, but there is no substance to them. So, once they’ve shocked those they’re supposed to engage, they vanish.