First published in The Record, Feb. 4, 2021

40 miles from Times Square, this suburban valley is the anti-Vax movement’s institutional heart.

On a two-lane suburban road, 40 miles north of Times Square, stands a central hub in the international movement against vaccines. The radio studios of WRCR 1700 AM are modest. They occupy a second-floor office in a strip mall, above a tobacco shop with a sign that reads “Roll your own!”

But every Monday at 5 p.m., members of the anti-vaccine movement tune into this little radio station in suburban Rockland County for a live show paid for and hosted by Patricia Finn, a lawyer who defends fellow anti-vaccine activists in court. Recent guests include two anti-vaccine lawyers in California currently suing President Joe Biden; a pediatrician in Portland, Oregon, whose patients were hospitalized after he allegedly convinced parents not to vaccinate their children; and a physician from Bar Harbor, Maine, best known for her erroneous claim that humans caused an anthrax outbreak in Zimbabwe. 

Finn’s guests also have included Andrew Wakefield, the former British researcher whose paper claiming to link vaccines with autism was retracted as fraudulent, but not before it made him the most famous anti-vaccine activist in the world.

“I’m very good friends with Andy,” Finn said. “He’s really a remarkable man.”

In Manhattan's shadow, anti-vaccine advocates thrive

The movement against vaccines is diffuse. It includes well-off liberals in New York and California, some groups of ultra-Orthodox Jews around New York City, many conservative Republicans, and minor celebrities including Wakefield and Robert F. Kennedy Jr.

Each of these groups maintains a significant presence in Rockland County. If this sprawling, fractured, still-small-but-growing movement can be said to have a center, Rockland is it.

“The coalition is worldwide. It flourished out of Rockland,” said Finn, who said she has raised $1 million in financial commitments to challenge Andrew Cuomo for governor in 2022. “Rockland is the focal point.”

It’s a strange place for a movement rooted in anti-science conspiracies to grow. From the balding cliff of Hook Mountain State Park here, hundreds of feet above the Hudson River, a person looking south can see both the skyscrapers of Manhattan and the Rockland County town of Pearl River, where 850 Pfizer scientists worked every day for eight months to create the first COVID-19 vaccine authorized by the United States Food and Drug Administration.

Yet a complex mix of demographic trends, strategic organizing and friendships between key movement leaders has turned this county on New York City’s suburban fringe into a central rallying point for anti-vaccine activists around the world.

“In Rockland there is a high degree of vaccine risk awareness,” said Mary Holland, the Rockland-based president and lead attorney for Children’s Health Defense, a nonprofit founded by Kennedy that is perhaps the world’s most prominent anti-vaccine organization. 

Scientists and health experts know that in certain Rockland County communities, vaccine resistance runs strong. The measles epidemic that infected 1,300 people across 31 states in 2019 had a significant outbreak in Rockland, where 80% of people who contracted the disease lacked any measles vaccination whatsoever, according to county health department records. Together with rabbis, infectious disease experts and health clinics, the department launched an emergency campaign that delivered 30,000 doses of the measles vaccine, led workshops about its safety, and successively eradicated the outbreak within a year.

“Measles caught us and the world off guard,” said Alexandra Khorover, an attorney with Refuah Health Center, which helped lead the response. The clinic caters to many Jewish groups in Rockland County, including ultra-Orthodox communities.

“It wasn’t something we thought we’d see in the 21st Century,” she said.

Leaders who beat back the measles see a similar movement gathering now in Rockland to sow fear about the coronavirus vaccine.

“Every community is vulnerable to this type of misinformation, but we are already hard at work combatting it,” said John Lyon, a spokesman for Rockland County Executive Ed Day.

Such misinformation could be especially damaging in some of Rockland's ultra-Orthodox communities, where large families often gather in small spaces for communal and religious events, said Dr. Aaron Glatt, chief of infectious diseases at Mount Sinai South Nassau Hospital.

"I'm very concerned," said Glatt, who visited ultra-Orthodox congregations in Rockland County during the measles outbreak to teach them about vaccine science.

“It’s unbelievably risky to get Covid,” Glatt said. “And it is not unbelievably risky to get the vaccine.”

Public health experts fear much of the developed world may soon experience similar troubles. In May the journal Nature published a paper, described by the National Institutes of Health as “seminal,” by George Washington University physics professor Neil F. Johnson. In it, Johnson compares the anti-vaccine movement’s disinformation efforts “to a battle for the ‘hearts and minds’ of individuals in insurgent warfare.” 

These efforts are so sophisticated, and so effective, they have fueled “the recent explosive growth in anti-vaccination views," Johnson found. If this trend continues, he predicted, “these views will dominate in a decade.”

The anti-vaccine movement leaders of Rockland County agree.

“Candidly, we’ve doubled in size as an organization because of COVID-19. It is an opportunity,” said Holland. “2020 was a tough year for everybody. The silver lining is that the world is waking up to our issue.”

Health experts are hoping to counter Holland's efforts with evidence that the coronavirus vaccines are effective and safe. Testing of 43,500 people found Pfizer's two-injection vaccine to be 95% effective against COVID-19. Less than 2% of vaccine recipients experienced mild or moderate fevers after receiving a shot, and some felt fatigue, side effect rates similar to other viral vaccines, according to a study published in December by the New England Journal of Medicine. 

"If somebody says, 'How can I know the coronavirus is safe?' That's a legitimate question," Glatt said. "If they say it causes little nano robots to tell the government where you are, or it will cause sterility, these things are based on nonsense."

The old coalition

If the classic anti-vaccine activist is liberal, upper-middle class, well-educated and white, Paul is the stereotype’s personification. A former professor turned small businessman, he sent his son to Green Meadow, a private Waldorf school in Rockland County where the annual tuition was $25,000 when his son attended. Many Green Meadow parents distrust vaccines. In 2018, months before the measles outbreak, only 42% of Green Meadow’s students were vaccinated against the measles, according to the New York State Department of Health.

“The research is really clear that kids who don’t get vaccinated are much healthier,” said Paul, who spoke on condition that his full name not appear for fear of retribution against his son, who remains unvaccinated.

Paul maintains an email list of about 150 people, he said. He writes letters to local and state politicians about what he considers the dangers of vaccination. He created a flier claiming Vitamin D protects people from COVID-19. He hung the flier in his local co-op, he said, and asks restaurants near his home to post a copy by the door.

Yet in Rockland County, even grassroots organizers like Paul consider themselves close friends with international figures like Wakefield and Kennedy, whom Paul calls “Andy” and “Bobby.”

“It’s a very diverse coalition standing up for freedom,” Paul said. “You’ve got Democrats, independents, a lot of Republicans.”

The coalition also includes members of ultra-Orthodox Jewish communities. Some news stories published during the height of the measles outbreak seemed to suggest that Hasidic Jews in Rockland County overwhelmingly oppose vaccines, especially when Wakefield co-hosted an anti-vaccine symposium in May 2019 that attracted hundreds of ultra-Orthodox families. 

Hasidic communities are not monolithic, however. Most Hasidic rabbis and their congregants follow the advice of science and medical professionals, believe in the efficacy of vaccines, and get vaccinated, said Rabbi Asher Bush, an Orthodox leader and head of the Congregation Ahavat Yisrael in Spring Valley.

“In some of these Hasidic communities the anti-vaxxer community is very high,” said Bush, who also teaches at The Frisch School, a yeshiva in Paramus, New Jersey. “As a rule, I think our community is very excited about getting the [coronavirus] shot. The orthodox community has so many flavors and slices.”

Because many people in ultra-Orthodox families eschew the internet, anti-vaccine organizers targeted them with analog media, including the in-person symposium and a slickly produced, 40-page magazine. There’s no evidence that activists have repeated these tactics against the coronavirus vaccine, said Khorover of the Refuah clinic.

But some Hasidic congregations remain vulnerable, she said. Communities may be at risk of spreading COVID-19 until nearly 90% of their members are vaccinated, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said in December. 

People on both sides of the vaccination debate doubt whether Rockland County can achieve such high levels of vaccination, especially in some ultra-Orthodox communities.

“I think that there’s probably about 10% of the population in Rockland, maybe 15%, that probably will not use vaccines,” said Michael Sussman, a civil rights lawyer who sent his seven children to the Green Meadow school, and who represents parents in lawsuits opposing mandatory vaccination.

“Everybody now is worried about the vaccine hesitant,” Glatt said. “It’s going to be difficult for us to get herd immunity if we don’t get the majority of people vaccinated.”

The new targets: Extremely online Republicans

If Rockland County’s anti-vaccine movement historically relied on traditional methods to reach new members, its modern target audience is extremely online.

According to data researchers who study social media traffic patterns, that audience includes many of former President Donald Trump’s most ardent supporters. 

In October, Children’s Health Defense overhauled its website, retiring a blog called Kennedy News & Views. The new site is updated almost daily, and, according to Holland, it attracts 3 million users a month.

The movement is growing more quickly on social media. Even as Twitter, Facebook and YouTube announced new procedures to remove vaccine disinformation, the 147 most popular anti-vaccine accounts now have 49 million followers, a 19% increase in just 11 months, according to research by the Center Countering Digital Hate. 

Kennedy alone has nearly 211,000 Twitter followers.

“It’s the model of information contagion,” said Renée DiResta, research manager at the Stanford University Internet Observatory, which surveils the abuse of social media.

Anti-vaccine activists aggressively use A-B testing, the same method used by news organizations (including this one) to try different headlines and Tweets, looking for combinations that attract the biggest audience, DiResta said.

“Something that stays in an anti-vax echo chamber is not remarkable,” said DiResta. “What’s interesting is if that narrative makes it out of the echo chamber into other communities. That’s a hint of what is resonating with the general public.”

Researchers find that the communities most vulnerable to this kind of contagion are Trump voters.

More than 70% of Republicans believe the conspiracy theory that Trump won the 2020 election, according to a recent Washington Post poll. Meanwhile, one-third of Republicans will refuse the COVID-19 vaccination, or will take it only if required by employers and schools, according to a poll by the Kaiser Family Foundation. No other political or demographic group is more opposed to the coronavirus vaccine than Republicans, Kaiser found. Trump supporters were uniquely vulnerable to Trump’s tweets promoting anti-vaccine propaganda, according to research published in the Journal of Experimental Social Psychology. 

These findings intertwine, DiResta said.

“The content doesn’t matter. The structures of influence are what matter,” said DiResta. “You’ve got echo chambers that already were lying about the election, and those same echo chambers are spreading misinformation about COVID and vaccination.”

In Rockland County, Biden won a narrow victory with 50.4% of the vote to Trump's 48.7 percent. If Rockland Republicans follow the national trend, that would mean as many as 24,000 party members could believe coronavirus vaccine disinformation. Combined with liberals attached to the Waldorf community and some Hasidic Jews, that could be enough disbelievers to place Rockland County's entire vaccination effort at risk.

"Getting to herd immunity, is it a concern in the back of our minds?" Khorover said. "I think it is." 

Experts in New York State politics including Gerald Benjamin, a political science professor emeritus at SUNY New Paltz, agree that demographics and voting patterns hint at a looming public health crisis in Rockland County.

"I do think that if we need a very high level of vaccination, we could be in trouble," Benjamin said.  

The big question

To people on both sides of the vaccine debate, this is the most important question now: Which way will Trump voters go? As president, Trump staked his pandemic response –and much of his reelection campaign – on Operation Warp Speed, a frantic effort to create a COVID-19 vaccine quickly. The effort succeeded, and Trump may be unwilling to disavow it.

Then again, Trump and his supporters in the conservative media spent nearly a year lying about the coronavirus.

“Will it be The Trump Vaccine that his followers will want to get?” DiResta said of the decision facing conservative outlets including Fox News, OANN and Newsmax. “Or will they use clickbait and sensationalism to undermine the vaccine while growing their own audience?”

Among Rockland County Republicans, the question remains unanswered.

“There are people who have the very Trumpian view that the whole thing was political, even though Trump took credit for vaccinations, but at the same time he was doubting the disease existed,” Sussman said.

Anecdotal evidence suggests that among Rockland County Republicans, anti-vaccine ideas are spreading. Paul, the Green Meadow parent, said he attended several rallies last year where the voices of traditional activists like himself were drowned out by louder Trump supporters.

“Some people tried to turn it into a Trump rally. I didn’t like it,” Paul said.

As politics and public health grow more entwined, ensuring that enough people get vaccinated to keep everyone safe becomes more important, Benjamin said.

For anti-vaccine activists, keeping vaccination rates low "could become a goal, a measure of their effectiveness and a way of demonstrating their resistance," said Benjamin. "I think its important to keep that from happening. That endangers lots of lives."