#Facebook said it would stop recommending anti-vaccine groups. It didn’t.

Even more recently, on April 27, another Citizen Browser panelist received a suggestion to follow the “Worldwide Health Freedom” page. One of the latest posts on this page links to a blog about a gym that offers free memberships to anyone refusing to be vaccinated.

“We have a policy against recommending health-related groups on our platforms,” Kevin McAlister, a Facebook spokesperson, said in an email. “And while some of these groups were already removed for violating our policies or not being recommended, we are investigating why others were recommended in the first place.”

Other groups recommended to Citizen Browser panelists over the past six months included “Pennsylvania for Medical Freedom” and “VACCINES: LEARN THE RISKS.” Facebook also recommended “Health Freedom Group,” which had more than 73,000 members and was run by prominent anti-vaccine advocate Erin Elizabeth. Facebook shuttered the group last week after it had reached this size in just under a year of operation. In all, a total of 16 groups and pages filled with vaccine misinformation were recommended to our panelists.

We also found 15 recommendations for groups or pages that explicitly encouraged members to flout mask-wearing safety guidelines, including “Ohio against masks!,” “Christians Against Facemasks,” and “Do not support PA businesses that require masks”—the latter of which was recommended to four panelists.

Some of the anti-vaccination pages have been dormant for months or years—but Facebook nevertheless pushed them to our panelists in their group recommendations. “Southern California Proud Parents of Unvaccinated Children,” for example, hasn’t posted since April 2015, and the last post for “Ann Arbor for Medical Freedom” was in July 2020. “Worldwide Health Freedom” posted once in March, but before that its most recent post was in October.

These pages have from around 200 to 500 followers and have posts like “No shots, no school? Not true” and “for every human illness there exists a plant, which is the cure.” In all of the pages suggested to our panelists, Facebook shows users a recommendation box that offers “Related Pages” to explore. Those related pages are also filled with vaccine misinformation and have names like “Vaccine Doubt,” “Vaccine Injury Lawyers,” and “Vaxfreekids.” When users click on those pages, the recommendation rabbit hole continues.

“In terms of the recommendations, there’s something in Facebook’s policy that’s broken,” said Fadi Quran, a campaign director who studies social media misinformation for Avaaz, a nonprofit advocacy group. “Facebook’s algorithm learns to recommend content to people that is in many cases inflammatory and misinformation, even when the platform says it wants to do the opposite.”

Shifting Policies

Over the past couple of years, Facebook has struggled over what to do with anti-vaccine content on its platform, often changing its approach on how to handle it. During the pandemic, the company’s policy shifts have become even more frequent.

Originally, Facebook said it would stop recommending groups that contained vaccine misinformation, in March 2019. Then, last September, the company said it would stop recommending health groups to users as a way to cut down on misinformation. In October, it announced it would ban vaccine misinformation in ads. And in November it said it would take down some of the biggest accounts peddling such content. In February came the announcement of the site-wide purge.

With that pledge, the company said it worked with public health agencies to create a list of dozens of false claims surrounding the coronavirus, including the idea that COVID-19 is man-made and that vaccines aren’t effective at protecting against the virus. The company said it would begin enforcing the policy immediately. In March, Facebook CEO Mark Zuckerberg submitted written testimony to Congress saying, “[W]e have made fighting misinformation and providing people with authoritative information a priority for the company.”

Facebook spokesperson McAlister said the company has removed more than “18 million pieces of content” globally for violating its rules on vaccine misinformation. It also applied “false” warning labels to more than “167 million pieces of COVID-19 content” that he said were rated by independent fact-checkers. “We’re continuing to work with health experts to keep pace with the evolving nature of the pandemic and update our policies as new facts and trends emerge,” McAlister added.

“Every time Facebook puts out a policy, it’s exhausting,” said Madelyn Webb, a senior researcher who focuses on social media and misinformation at Media Matters. “You can’t just take down a piece of content and expect it to be gone; you have to look at the networks. It’s silly to claim that these actions are addressing misinformation in any way.”

As recently as late April, Webb and her colleagues found 117 active groups on Facebook that they identified as anti-vaccine. Combined, those groups had roughly 275,000 members. Many of the groups explicitly called themselves “anti-vaxx” or “anti-vaccine,” according to Webb.

With health groups overall, Facebook’s vow to stop recommendations has been particularly confusing.

“Facebook Groups, including health groups, can be a positive space for giving and receiving support during difficult life circumstances,” Tom Alison, Facebook’s vice president of engineering, wrote in the September blog post. But “to prioritize connecting people with accurate health information, we are starting to no longer show health groups in recommendations.”

Still, some Facebook users, including reporters for The Markup, see a “health” category when looking to find new groups to join through the site’s “Discover” tab. And a total of 1,159 Citizen Browser panelists—well over a third of the panel—received recommendations for groups that contained one of our health keywords, such as “health,” “COVID,” or “vaccine.”

A brief scan of these recommended groups shows that many appear to be dedicated to topics like healthy living or fitness routines. Some seem explicitly contrary to the sorts of health discussion that Alison referred to in his post, like “Liver and Gallbladder Flush for Optimal Health,” “Open Heart Surgery Support Group,” and “Panniculectomy Recovery.” The “Whipple Surgery Survivor Group” says it’s for people familiar with the surgery typically done to treat pancreatic cancer. The “About” section of the page states that people should contact their doctors for medical advice and shouldn’t change their medical routines without first consulting their personal physicians.

Other groups recommended to our panelists tout remedies that could run counter to medical professionals’ opinions. For example, several promote alternative medicine, such as “Psychedelics, Sacred Medicines, Purpose & Business” and “Herbal Recovery From Opiates.” Others encourage plastic surgery or 1,200-calorie-and-less diets. One group, “Meat Health,” provides information and support around a “carnivore” diet.

When asked why Facebook is still recommending health groups, despite its stated policy, McAlister said, “We use machine learning to remove groups that post a significant amount of health or medical advice from our recommendation surfaces. Groups with a focus on positive health topics including fitness, wellness or personal development are still permitted.”

The Biggest Groups

Experts say groups that look like healthy lifestyle forums can sometimes harbor anti-vaccine motives, and for anti-vaccine activists that health focus can have a two-fold effect. First, it brings in members who might not otherwise join anti-vaccination groups; and second, it makes it easier for anti-vaccination groups to camouflage themselves within the health category and hide from Facebook’s moderators.

“What Facebook does is kind of a surface clean,” said Naomi Smith, a sociologist at Federation University Australia who studies vaccine misinformation on social media. “Users are smart. They can figure out how to get around these things. Even if you have a public page, if you make it about natural health, then they’ll probably leave you alone.”

That tactic seemed to work for two of the biggest anti-vaccine groups recommended to users in the Citizen Browser panel, “Health Freedom Group” and “Holistic Lives,” which had more than 73,000 members and more than 65,000 members, respectively.

Up until last Thursday, the two groups were active, posting around a dozen times per day. Both groups listed Erin Elizabeth as an admin. Elizabeth, a self-described “health nut,” posted about things like mental health being related to a “leaky gut” and how raw food is the solution to good health. Interspersed were conspiracies about Microsoft co-founder Bill Gates nefariously pushing vaccines, alleged deaths from COVID-19 vaccines, and how Elizabeth was constantly under threat of being censored by Facebook.