The first anti-vaccine message of the coronavirus pandemic was posted on Facebook months before there were any concrete plans for a vaccine. "It was February of 2020," said Seth Kalichman, a professor in psychological sciences at the University of Connecticut. "Operation Warp Speed, I think, was officially announced in April, if I'm not mistaken." Anti-COVID vaccine messages were being promulgated on Facebook before anyone had even heard of the coronavirus. "No one was calling it COVID. It wasn't named yet, when they were talking about it," Kalichman said. "Their first post called it 'this new virus in China,' the 'China virus,' and the 'new SARS.'" Since then, vaccines to fight COVID have been developed, approved and distributed to millions of people nationwide though, behind the scenes, a war of words and ideas have raged. "There's no doubt that there is a messaging battle going on," said Max Reiss, a spokesperson for Gov. Ned Lamont's administration. Which side is winning that battle is a matter of opinion. Pointing to high vaccine rates in Connecticut, Reiss said, "the right side of the debate is winning." Kalichman, though, said agencies like the Centers for Disease Control and Prevention have "failed to accurately and convincingly and coherently provide public health messaging." He and his UConn colleague, Lisa Eaton, had been studying health messaging around HIV. When the coronavirus pandemic struck, like so many other researchers, they shifted their focus, attempting to determine the earliest origins of the anti-COVID vaccine movement on Facebook. Kalichman and Eaton believe the anti-vaccine machine has been more effective than vaccine supporters. "They are being beat. There is no question that they're being beat at their own game, and it's not just the anti-vax groups," Kalichman said. "It filters beyond them into media and into social networks, people's lives. That information just moves very differently than evidence-based, science-based information." Timing may be everything The state of Connecticut has budgeted $11 million for communications during the pandemic, which includes development of the COVID Alert CT phone application and contact tracing efforts, among more traditional communication efforts like advertisements. "As of now, roughly $10 million has been spent, total," Reiss said, approximating that $2 million has been spent since January, when the first vaccines were distributed in the state. For context, Reiss said the state's "entire tourism campaign this year is $1.2 million," calling the $11 million COVID communications budget "an investment that Connecticut has never made before at this level." The state published its first pro-vaccine messaging in December 2020 - 10 months after Kalichman and Eaton say the first anti-vaccine messages were posted on Facebook. The problem, experts say, is that pro-vaccine messages rely on science. They are nuanced and careful, intellectually honest and deliberately worded. Anti-vaccination messages rely on pure emotion, confirming fears and anxieties about government overreach, about corrupt politicians or greedy pharmaceutical companies. "They don't have any rules, and they don't have to worry about credibility," Eaton said. "So that's a huge step up." Those fears are distilled into social media posts by anti-vaccination-focused groups, which are then shared far and wide, taking on lives of their own. "They have, like, this propaganda machine," Kalichman said. "Now, who does that influence, who does it impact? We don't really know." You might not believe your uncle when he argues there are microchips in every vaccine dose, but his argument is difficult to refute. But timing, Eaton and Kalichman say, is the key to fighting anti-vaccine messages. Like a vaccine inoculates a patient before they contract that disease, so must pro-vaccine messaging pave the way for any misinformation that might derail vaccination efforts, Eaton said. "The solution is a vaccine, a social vaccine, it's to inoculate people against these beliefs before the vaccine conspiracy advocates do," Eaton said. "If you can get ahead of the messaging, you can actually socially inoculate people from these malignant messages about health care." 'Hearts and minds' When asked about vaccine messaging, Yale New Haven Health's chief policy and communications officer, Vin Petrini, quoted Mark Twain: "A lie can travel halfway around the world, while the truth is still tying its shoes." In a way, anti-vaccine proponents are waging a guerrilla war. The use of social media is asynchronous, using emotion and shock value. In that way, a small group of people can have an outsized effect. "It's been estimated that of anti-vaccine social media, 12 people are putting out 90 percent of the material, said Sten Vermund, dean of the Yale School of Public Health. "And those 12 people get packaged and repackaged and repackaged." Those posts consist of certain themes that have proven effective and so are regurgitated over and over. "They have the same content, they have the same themes," Kalichman said. "Anti-government, mistrust of public health authorities, concerns about side effects and the overwhelmingly better option of natural immunity." There is also the idea that the vaccines were produced too quickly for them to be safe, according to Eaton. "There's a little bit of a fallacy around believing that just because something's fast means that it's inferior," she said. "That's something new that came with the COVID vaccine, you hear a lot of people say that." According to Vermund, the way to combat that tactic is on the ground, where people live, through the mouths of people they trust. "We in the public health field need to be more strategic and more effective in the public communication narratives," Vermund said. "We also need to touch hearts, and not just minds. We also need to influence people through influencers." Vermund pointed to a video posted by Dolly Parton. She was vaccinated publicly, and sang an altered version of her iconic song, "Jolene." "That's what we need in spades," Vermund said. "At the end of the day, I think that's the kind of thing that we need much more of." It's not just Dolly Parton. Morgan Freeman has appeared in a public service announcement, and though he didn't get vaccinated publicly, a short piece about former President Donald Trump that appeared on FOX News has been repurposed as a pro-vaccination message. "If it's conspiracy theorists, Donald Trump has to be the spokesperson in favor of vaccines," Vermund said. "If it's religiously motivated opposition, religious leaders have to be the spokespersons. If it is political opponents like Rand Paul-types, sort of libertarian, don't tread on me, don't tell me what to do, then it's going to have to be advocates for libertarianism." 'The 10 percent rule' Imagine three groups of people. First, you have those who are willing or even excited to be vaccinated. On the other side of the spectrum, you have people who are not able to be persuaded, who will never get a vaccine. In the middle, you have the battleground. "It's 'persuading the persuadable,' as we like to say," Petrini said. "We used to use the 10 percent rule: 10 percent that will do it no matter what, there's 10 percent that won't do it no matter what, and there's that 80 percent middle, generally speaking, that we really need to speak to." For some, there are historical concerns, which Eaton said she understands. "Some of our participants can talk about medical abuse, the legacy of medical abuse in our society," she said. "That is something to be talked through. And I do think for some people, there is sincerely a fear for their children, like they do feel fear in saying, 'Yes, you can vaccinate my child.'" Some people will respond to science-based discussion on the myths. Others might respond to appeals to one's sense of civic responsibility or personal responsibility. Some might respond to the idea that they are protecting their friends and family from ruin. For each of those objections, there are different responses. "There's probably hundreds of reasons why people are hesitant to get the vaccine," Petrini said. But Vermund said there's a difference between hesitancy and opposition. "It's important not to conflate those because hesitancy tends to be people who are not against vaccines, they just are not keen to be front in line for a new vaccine that doesn't have full FDA approval yet," he said. "That group is shrinking every single month into the vaccinated group. "That's a very different challenge than the vaccine oppositional group, which has a cadre of religious opposition, political opposition, conspiracy theory-ism," Vermund said, calling them "tough nuts to crack." Vermund is fully aware that hearing a message from the dean of the Yale School of Public Health will likely have the opposite effect. "That's not going to impress the conspiracy theorist," he said. "Just the fact that I say it will confirm that they're right." What matters more than anything, he said, is whose voice is speaking the message. Trump did not release a pro-vaccine PSA, but it would have been more effective if he had. "That would be a lot more influential than the rest of us making one of these things and just putting it out there because it's easy to overlook it when it's not the big boy speaking for himself," Vermund said. "Dolly Parton, I think, was responsible for getting a lot of people vaccinated. I think a lot of people in her constituency saw that video, which was widely circulated. And that's why Tennessee and Alabama rates are not even worse." That strategy is also effective on a local level within Connecticut. "What's been particularly effective is partnering with community organizations, and places like churches, and groups that have embedded credibility with audiences," Petrini said. "So you can talk to an organization that will then, by its presence, endorse the strength of that message."