Promoting conspiracy theory: From AIDS to COVID-19

ABSTRACT Conspiracy theories (evidence-free, improbable narratives about powerful agents conspiring to harm people) circulated widely during the acquired immune deficiency syndrome (AIDS) and COVID-19 epidemics. They travelled over time and space, adapted to local conditions and anxieties, and were promoted for commercial and political purposes. Russian conspiracy theories claiming the viruses were United States bioweapons appeared in both epidemics. So did ‘cultropreneurs’ who, as a marketing strategy for their ‘alternative’ therapies, promoted conspiracy theories about scientific medicine. Pro-science activists sought to counter medical misinformation and debunk faux cures, but their task was harder in the ‘post-truth’ social-media driven context of COVID-19. Conspiracy theories about vaccines are an ongoing challenge for public health.


Introduction
Conspiracy theories (evidence-free, improbable narratives about powerful agents conspiring to harm people) circulated widely during the acquired immune deficiency syndrome (AIDS) and COVID-19 epidemics.Most made 'conspiratorial moves' against medical science by suggesting it had been corrupted by political and/or commercial interests and that governments were covering up the truth (Nattrass, 2012a(Nattrass, , 2012b)).This mattered for public health.In the United States (US) where the AIDS epidemic was first identified, and South Africa which has the largest antiretroviral treatment programme in the world, AIDS conspiracy beliefs were associated with risky sex (e.g. Bogart and Thorburn, 2005;Grebe and Nattrass, 2012), not adhering to antiretroviral treatment (e.g. Bogart et al., 2010) and not testing for the human immunodeficiency virus (HIV) (e.g.Bohnert and Latkin, 2009).During the COVID-19 epidemic, conspiracy theories and related distrust of vaccines were associated in both countries with opposition to public-health measures such as mask mandates and social distancing, and with vaccine hesitancy (e.g.Romer and Jamieson, 2020;Bronstein et al., 2022;Berger et al., 2021).
This article focusses on the synergistic links between the promotion of conspiracy theories and 'alternative' therapies.Conspiracy theories about AIDS and COVID-19 can reflect local history and contemporary anxieties, but have also been invented and manipulated in the service of geopolitical propaganda and promoted for commercial and political purposes.The growing power of social media and the involvement of organised interests has complicated efforts to counter medical misinformation.
That conspiracy theories work politically is well understood.Lasco and Curato (2019) coined the term 'medical populism' to refer to the performative conspiratorial 'political style' in which leaders during a health crisis position themselves as the voice of 'the people' pitted against 'the establishment'.The concept has usefully been employed in considering controversies over immunisation programmes in Nigeria, Italy, Ukraine, and the Philippines (Lasco and Larson, 2020), and responses to COVID-19 in the US, the Philippines, Brazil, the United Kingdom, and Italy (e.g.Lasco, 2020;Speed and Mannion, 2020;Hedges and Lasco, 2021).Depending on the case, however, it may be important to distinguish between conspiracy theories aimed rhetorically at some shadowy 'elite' or establishment, and conspiracy theories targeting medical science itself.Whereas the former simply invites followers to rail against perfidious elites (and to support the politicians doing so), making a conspiratorial move against medical science raises the obvious problem of what to offer people in its place.'Alternative' therapies provide a solution.There are thus powerful synergies between the political interests of medical populists and the commercial interests of 'cultropreneurs' (those who, as a marketing strategy for their 'alternative' therapies, promote conspiracy theories to undermine trust in scientific medicine (Nattrass, 2012a(Nattrass, , 2012b))).
In their opening 'illustrative example' of medical populism -South Africa during the AIDS epidemic under President Mbeki -Lasco and Curato failed to appreciate the importance of that synergy and misunderstood the politics involved.Relying on early interpretations of Mbeki's political discourse (notably Fassin and Schneider, 2003;Sheckles, 2004;Wang, 2008) they assumed that Mbeki had united South Africans against 'the West' by articulating shared African suspicions of scientific medicine arising out of the colonial experience and resentment of Western hegemony (Lasco and Curato, 2019, p. 4).Mbeki was certainly suspicious of the international pharmaceutical industry, even promoting a conspiracy theory that it was working in cahoots with the US Central Intelligence Agency (CIA) to poison Africans with antiretrovirals (Mbeki and Mokaba, 2002), yet as later work emphasised, his stance was unpopular politically and was rooted primarily in AIDS denialist notions imported from the US and Australia (Nattrass, 2007(Nattrass, , 2008(Nattrass, , 2013;;Geffen, 2010).Mbeki took seriously the claims made by foreign AIDS denialists about flawed HIV science and supposedly deadly toxic antiretrovirals and he invited the leading proponents onto his 'expert panel' to debate South African scientists.Demonstrating the synergy between conspiratorial moves against medical science and the promotion of 'alternative' therapies, the AIDS denialists rejected all evidence that HIV caused AIDS and that antiretrovirals prevented infections and deaths.They recommended instead that Mbeki's government consider 'ginseng, Chinese cucumber, curcumin, aloe vera, garlic and echinacea … massage therapy, music therapy, yoga, spiritual care, homeopathy, Indian ayurvedic medicine, light therapy, and many other methods' (PAAPR, 2001, p. 65) to address immune deficiency.Roberto Giraldo, a US-based cultropreneur and member of Mbeki's panel, subsequently worked as a consultant for the South African Ministry of Health to promote nutritional alternatives to antiretrovirals (Nattrass, 2012a(Nattrass, , 2012b).Mbeki's stance on AIDS was not only catastrophic for the country (the delayed rollout of antiretrovirals caused over three hundred thousand unnecessary deaths (Nattrass, 2008)) it was a disaster for Mbeki personally.Rather than unite South Africans behind some sort of anti-colonial agenda, as suggested by Lasco and Curato, Mbeki's policies prompted unprecedented protests, a cabinet revolt, and ultimately his removal as president (Nattrass, 2007;Geffen, 2010).
Mbeki was not the only political leader to dabble in 'alternative' remedies in the face of a health crisis.During the AIDS epidemic, Gambian President Jammeh developed his own home-grown 'cure' for AIDS (Cassidy and Leach, 2009).During the COVID-19 epidemic, Tanzanian President John Magufuli (who subsequently died of COVID-19) downplayed COVID-19 statistics (calling them 'imperialist sabotage') and put his faith in prayer and a Madagascan Artemisia-based herbal remedy (Fabricus, 2020;Patterson, 2021).The pro-business, populist presidents Donald Trump (in the US) and Jair Bolsonaro (in Brazil) both downplayed the dangers of COVID-19, resisted social distancing measures, and suggested untested and ineffective treatments for COVID-19 such as household bleach and hydroxychloroquine (Fonseca et al., 2021).
The connection between 'alternative' medicine, mysticism and conspiratorial moves against medical science was first emphasised by Colin Campbell (2002).He coined the term 'cultic milieu' to refer to that fluid counter-cultural space in which conspiracy theories flourishe across ideological divides and where alternative therapists, traditional healers, etc., ply their trade (Campbell, 2002).Two decades on, the cultic milieu has been magnified by the internet and the rise of social media, allowing cultropreneurs access to vast audiences.The twenty-first century has been aptly described as a 'post-truth' era, in which 'alternative facts' compete for attention in virtual spaces, where respect for authority and expertise has diminished, and society has become more divided (e.g.Sunstein, 2017).The informational resources of the internet may have empowered patients, allowing them to become more knowledgeable, or 'reflexive' (e.g.Numerato et al., 2019), but it has also exposed millions to manipulative marketing (Zuboff, 2015), conspiracy theories, faux health products and politically polarising misinformation (Lucas et al., 2021;Dubow et al., 2021).Some of those working within the cultic milieu have medical credentials, allowing them to switch between conventional medicine, mystical discourse and 'alternative' therapies depending on context and opportunity.An example is Dr Stella Immanuel, a medical doctor practising in the US who reportedly claims that certain gynaecological conditions are caused by dream sex with demons, that alien DNA was being used in medical experiments and that there are alien reptilians in the US government (Somer, 2020).Immanuel was part of the Trump-supporting organisation America's Frontline Doctors 1 linked to SpeakWithAnMD, a fraudulent telemarketing service selling prescriptions for hydroxychloroquine and Ivermectin (Bergeguen, 2021).There is no reliable evidence of efficacy against COVID-19 for either of these drugs (see reviews by Freilich et al. (2022) and Rothrock et al. ( 2022)) yet by leveraging their status as medical professionals, America's Frontline Doctors provided a patina of scientific credibility to this marketing exercise.Members routinely wore white coats, a symbol of medical respectability, to press conferences where they questioned the scientific consensus, promoted untested therapies, and asserted that social distancing and the wearing of masks was unnecessary (Somer, 2020;Bergeguen, 2021). 2 As discussed further below, dissident scientists also leveraged scientific/professional credentials to play the role of 'hero scientists' in both the AIDS denialist and anti-COVID-19 vaccination movements.

The social and political propulsion of conspiracy theories
Scholars of rumours, folk narratives and conspiracy theories understand these cultural phenomena as 'epidemics of explanation' or 'aetiological narratives' arising in a context of uncertain information and fear, especially of disease (see Tai and Sun 2011, pp. 677-680, 684).This dovetails with social theory emphasising that modernity is fraught with risk and uncertainty (Beck 1992, Lyotard 1984), where master-narratives have been replaced by a multiplicity of meanings and where practices of the imagination have become increasingly important (Appadurai 1996;Aupers 2012).The interdisciplinary literature on conspiracy theory draws on these theoretical underpinnings in emphasising its social and historical roots, political character, and psycho-cultural dimensions (e.g.Hofstadter, 1965, Knight, 2002;Mason, 2002;Van Prooijen and Douglas, 2017;Eberl et al., 2021;Erokhin et al., 2022).
Conspiracy theories work politically in constructing common enemies and expressing shared values.Both left-and right-wing conspiracy theories blame powerful corporations and economic elites (which they believe manipulate the world) for events and forces beyond the control of individuals.This was evident in conspiracy theories during both the AIDS and COVID-19 epidemics.Old antisemitic conspiracy theories and tropes about the New World Order and the Illuminati reemerged during the AIDS pandemic (see e.g.Cooper 1991;Horowitz, 1996) and again during the COVID-19 pandemic (Bonhomme, 2021;Day and Carlson, 2021).Antisemitism is now a mainstay of re-emergent right-wing global fascism centred around Russian President Putin, a recurrent theme being that 'a global cabal of Jews were (and are) the real agents of violence against Russian Christians and the real victims of the Nazis were not the Jews, but rather this group' (Stanley, 2022).
Conspiracy theories about AIDS and COVID-19, like folk narratives more broadly, often reflect local concerns and historical events.South African conspiracy theories about HIV as a man-made poison have been linked to the history of apartheid-era poisoning of activists (Berger and Gould, 2002;Niehaus and Jonsson, 2005) and local anxieties about witchcraft attacks (Ashforth, 2002;Stadler, 2003).Experiments conducted by the Nazis on Jewish prisoners, and the infamous US Tuskegee study  which left syphilis patients in the American South deliberately untreated (Thomas and Quinn, 1991;Reverby, 2009), contributed to a real history of unethical medical experimentation that was ripe for exploitation by conspiracy theorists.During the AIDS epidemic, conspiracy theorists incorporated revelations about CIA dirty tricks abroad (Mendez, 1999) and secret weapons, such as a poison-dart gun, into conspiracy theories about the involvement of the CIA in spreading HIV (Nattrass, 2012b, pp. 34-37).During the COVID-19 epidemic, contemporary anxieties about technology and surveillance found their way into conspiracy theoriesfor example fears that 5G towers were involved in the spread of COVID-19 and that they might be involved in surveillance, perhaps in concert with microchips supposedly placed into people's arms via vaccination (Vincent, 2020;Shahsavari et al., 2020;Hsu, 2022;Erokhin et al., 2022).Such conspiracy theories have been linked to broader distrust in government and technology elites (Eberl et al., 2021).
Recent analyses of COVID-19 conspiracy ideation emphasise psychological determinants such as depression/anxiety (De Coninck et al., 2021) and feelings of lack of control especially amongst those with lower social status (e.g.Šrol et al., 2021;Bronstein et al., 2022).The construction and promotion of conspiracy theories provides a semblance of agency, if only in terms of 'connecting the dots' and identifying causal agents for stressful social circumstances (Tuters, 2020).The American QAnon conspiracy was popular in part because the cryptic clues or 'breadcrumbs' left by a supposedly high-ranking intelligence official 'Q' 3 offered this kind of agency.The conspiracy appealed primarily to Republican voters, 'white' people, those with incomes under $50,000 and without a college degree (PRRI, 2022).It embodied their core libertarian political values, identified heroes and villains (Donald Trump was going to save America in a coming 'storm' from a Democratic network of Satan-worshiping paedophiles) and suggested courses of action, including acting against the state (as in the storming of the US Capital in 2021).
The QAnon conspiracy theory was notable for its social reach, but also for the way that it, like the cultic milieu, incorporated elements from various sources, notably Russian political misinformation (Ellick and Westbrook, 2018) and anti-vaccination conspiracies circulated by white supremacist groups (Hay, 2021).When Russia invaded Ukraine in February 2022, some QAnon conspiracy memes were revamped to claim that Trump and Russian president Putin were working together on the war aimed at taking down a cabal of global elites involved in sex trafficking (Alba and Thompson, 2022).Some theories linked to an ongoing Russian misinformation campaign rebooted the old biological weapon conspiracy theory by justifying Russian aggression as necessary to take out secret US biological weapons labs in Ukraine (Evon, 2022).These and other conspiracy theories about the human origin of COVID-19 were circulated by both Russia and China for geopolitical purposes (Molter and Webster, 2020;Lucas et al., 2021;Dubow et al. 2021).

Organised conspiratorial moves against medical science during the AIDS and COVID-19 epidemics
Organised interests, backed by politically libertarian donors, were involved in spreading misinformation during both the AIDS and COVID-19 epidemics.During the AIDS epidemic, a group of journalists, activists, 'dissident'/denialist scientists and cultropreneurs co-ordinated their efforts through an organisation called Rethinking AIDS.It, and the work of dissident scientist Peter Duesberg, 4 was reportedly funded by the libertarian venture capitalist Robert Leppo (Farber, 1999).
Sympathetic journalists lauded Duesberg as a 'hero scientist'a brave truth-teller standing up to an oppressive/corrupt scientific establishment.Another hero scientist for the AIDS denialist movement was Kary Mullis, an eccentric 5 chemist who won a Nobel Prize for inventing the polymerase chain reaction (an important discovery subsequently used in testing for HIV and COVID-19).Both Duesberg (who served on Mbeki's panel) and Mullis had serious scientific credentials, but neither had expertise in HIV.Duesberg's speculations about HIV as a harmless passenger virus were plausible only in the mid-1980s when HIV science was new.His persistent refusal to consider countervailing evidence made him a pariah in the scientific community 6 and prompted the editor of Nature to announce he would stop publishing Duesberg's 'tendentious' claims (Maddox, 1993).AIDS denialists read this conspiratorially, as evidence that the scientific establishment was colluding to oppress Duesberg and suppress the truth.
Cultropreneurs, including Roberto Giraldo, were essential to Rethinking AIDS because they stepped into the therapeutic void created by such conspiratorial moves against AIDS science.HIV-positive AIDS denialists living without antiretrovirals became 'living icons' or living proof that 'alternative' approaches worked. 7Christine Maggiore, a leading member of Rethinking AIDS appeared whilst pregnant on the cover of Mothering Magazine to advocate against the use of antiretrovirals for mother to child transmission of HIV.Her run as living icon ended when her baby daughter, and then she herself, died of AIDS-related illnesses.
Living icons and hero scientists were evident also in the anti-COVID-19 vaccination movement.Celebrities who rejected the COVID-19 vaccine were constructed as emblematic of the values of rugged individualism and of 'taking control' of one's body.When the unvaccinated tennis star Novak Djokovic was deported from Australia for not complying with COVID-19 protocols, he was described as a 'monumental martyr' to the cause for being denied the opportunity to compete in the Australian Open in 2022 (Rudin, 2022).The Canadian truckers who blocked bridges between the US and Canada and occupied central Ottawa for weeks in opposition to quarantine restrictions for unvaccinated drivers, were similarly constructed as 'heroes' 8 for their libertarian stance in favour of 'freedom'.
The main candidate for hero scientist within the COVID-19 vaccine movement was Robert Malone, the lead author of a group of scientists who showed, thirty years earlier, that mRNA could be injected into cells using lipids (Malone et al., 1989).Malone leveraged his involvement in this research to lend a veneer of credibility to his claim that mRNA vaccines were harmful.He also made conspiratorial moves against medical science in suggesting that the pharmaceutical company Pfizer and 'Israeli scientists' had covered up data on vaccine side-effects, and that a state in India had beaten COVID-19 using Ivermectin but that this news was being suppressed (Bartlett, 2021, McCarthy, 2022).
There is substantial and growing evidence that mRNA and other COVID-19 vaccines are effective in preventing infection and limiting hospitalisation and death (see review by Zheng et al., 2022 and summary of studies by the Centers for Disease Control and Prevention 9 ).Conspiracy theories about vaccine safety gain social traction despite this by drawing on public anxieties about vaccine side-effects.Early reports about rare blood clots associated with Johnson and Johnson COVID-19 vaccine may have inspired subsequent conspiracy theories about COVID-19 vaccines turning blood into 'sludge' (Hay, 2022).In 1976, a swine flu vaccination campaign had been cancelled in the US over concerns that the science may have been rushed (Sencer and Millar, 2006).That history might also have resonated for people worried about the new mRNA vaccines.Yet the role of hero scientists, and the organisations backing them, was crucial in lending credibility to such suspicions and magnifying them socially.
Organised opposition to public health restrictions and COVID-19 vaccines was, like AIDS denialism, linked to politically libertarian funders (Bragman and Kotch, 2021).Early in 2020, as European countries shut down their societies and economies to save lives and protect health services from being overwhelmed (Tooze, 2021), the libertarian American Institute for Economic Research (AIER) hosted a meeting at which three epidemiologists drew up the 'Great Barrington Declaration' (named after the town where the meeting took place).The Declaration stated that the economic costs of lockdowns were too high, that older people should be isolated for their own protection and that public policy should rely on achieving 'herd immunity' rather than social distancing (Kulddorff et al., 2020).Through the work of the Brownstone Institute (a spinoff of the AIER) the Declaration was influential in encouraging President Trump in the US and Prime Minister Boris Johnson in the United Kingdom, to pursue relatively laissez faire approaches in the early stages of the epidemic (Gorski, 2022).The Koch brothers and other politically right-wing donors supported the work of the Brownstone Institute (Bragman and Kotch, 2021).
Public health measures are underpinned by collectivist (or solidaristic) values: people are asked to wear a mask, obey social distancing regulations, tolerate lockdowns, and get vaccinated not only to protect themselves, but to protect others.Although difficult to identify the precise impact, there is evidence that such measures were highly effective during the early stages of the COVID-19 pandemic in reducing infections and death in the US (Chernozhukov et al., 2021) and globally (Brauner et al., 2021).Lockdowns, mask-and vaccine mandates, however, are anathema to libertarians who favour less government intervention, more freedom of choice and often espouse rugged individualism in the place of collectivism.It was thus perhaps inevitable that vaccination status became caught up with political identity in the US.As of December 2021, about 90% of Democrats had been vaccinated and only 60% of Republicans had received at least one vaccine dose (Yang, 2021).Also unsurprisingly, death rates from COVID-19 were significantly higher in Republican than Democratic voting areas (Wood and Brumfiel, 2021).
Libertarian opposition to government lockdowns often morphed into opposition to vaccine mandates.Two of the three drafters of the Great Barrington Declaration, Martin Kulddorff and Jay Bhattacharaya, went on to work for the Brownstone Institute, where their pronouncements became both increasingly libertarian and sceptical to the point of making conspiratorial moves against COVID-19 vaccines, for example suggesting that information about side-effects was being suppressed (Gorski, 2022;Kramer, 2022;Howard, 2022).
The Great Barrington Declaration was promoted in South Africa by the libertarian organisation Pandemics Data and Analytics (Panda), which like the Brownstone Institute was funded by private capital (Ahmed and Davis, 2021).Panda initially focussed on opposing lockdown measures, citing primarily economic costs, but then moved on to raising concerns about vaccine mandates and vaccine side-effects whilst supporting ineffective alternative treatments such as Ivermectin (see critical assessment by Geffen, 2021).Panda made various conspiratorial moves in claiming that the public had been lied to over vaccines, that the World Health Organisation had been corrupted by corporate interests, and that universal vaccination initiatives spoke to the 'surveillance and control ambitions of the technocracy' (Panda, 2020, p. 65).
Cultropreneurs were evident in South Africa and the US during both epidemics, often repackaging and promoting the same products.The 'Rath Health Foundation', a Netherlands-based vitamin company infamous for running an unsuccessful and deadly 'trial' in South Africa of its high-dose vitamins as a cure for AIDS (Geffen, 2010), claimed during the COVID-19 epidemic that its micronutrients were more effective against COVID-19 than 'synthetic' vaccines. 10Leonard Horowitz, an American cultropreneur, promoted his 'oxysilver' cure during both epidemics and was cautioned by the US Food and Drug Administration (FDA) for doing so. 11Horowitz, a prolific generator of conspiracy theories, argued that the same global cabal behind the New World Order and AIDS (Horowitz, 1996) was also behind COVID-19, and that vaccines were part of their 'final solution' (Horowitz, 2021).In an image straight out of the contemporary right-wing antisemitic playbook, the cover of his book on COVID-19 depicted Dr Anthony Fauci, the head of the US National Institute of Allergy and Diseases Infectious (NIAID), as a Nazi.

Pro-science activism then and now
Fauci served as a chief advisor to President George W. Bush during the AIDS epidemic and under both President Trump and Biden during COVID-19.He thus experienced two very different epidemics and responses to them.Whereas AIDS activists had to combat stigma and fight for increased attention to the disease (Shilts, 1987;Epstein, 1996), governments and scientists collaborated at an unprecedented level during the COVID-19 epidemic to produce, in an extraordinarily short space of time, effective vaccines (Tooze, 2021;Kolata and Mueller, 2022).During the AIDS epidemic Fauci was seen as an ally of AIDS activism (see e.g.Piot, 2016) but during the COVID-19 epidemic he was the subject of extremely hostile conspiracy theories, becoming a personification of the evil scientist and requiring 24-hour security at his home (Erokhin et al., 2022;Zak and Roberts, 2022). 12 For many veteran AIDS activists who fought for universal access to antiretrovirals, the contestation over vaccine patents and the monopolisation of supply by the advanced capitalist countries when vaccines became available had a distinctly déjà vu feel to it (Hassan et al., 2021).Yet activists on both sides of the Atlantic were dismayed by the phenomenon of people refusing vaccines when eventually offered them.By February 2022, less than two-thirds of adults were fully vaccinated in the US, despite there being substantial supplies of free vaccines available. 13Unsurprisingly, COVID-19 deaths were primarily amongst the unvaccinated. 14In South Africa, the government had hoped to vaccinate two thirds of the adult population by early 2022, but less than half had been fully vaccinated by that time despite there being substantial surplus vaccine in the system (Nattrass and Seekings, 2021).As was the case in the US, the bulk of COVID-19 hospitalisations were amongst the unvaccinated. 15Part of the problem was the government's slow and overly complex rollout, and failure to reach people in rural areas (Seekings and Nattrass, 2020;Nattrass andSeekings, 2021, 2022).But by late 2021 there was also growing evidence of vaccine hesitancy, especially amongst young urban dwellers and users of social media (Berger et al., 2021;Ministerial Advisory Committee, 2021).Post-truth social polarisation and conspiratorial thinking about vaccines was associated with this phenomenon in both the US and South Africa (e.g.Romer and Jamieson, 2020;Bronstein et al., 2022;Berger et al., 2021;Hsu, 2022).
The AIDS struggle was fought prior to rise of social media, which can be dated to 2006 when Facebook opened membership to anyone over thirteen.Back in the early 2000s, people could search online for information about antiretrovirals and find both AIDS-denialist websites and activist sites countering them.One of these was AIDStruth.org 16which included a page listing the names of AIDS denialists and erstwhile living icons, such as Maggiore, who had died.The website Sorryantivaxxer 17 used the same strategy to jolt people into changing their minds (in this case to consider vaccination) by listing the names of prominent anti-vaccine activists who subsequently died of COVID-19.Websites such as Quackwatch 18 warned people about ineffective treatments for AIDS and related scams and continued to expose quack cures during the COVID-19 epidemic.Many of the scientists who fought against AIDS denialism continued to fight against vaccine misinformation. 19Yet pro-science activists who had confronted a relatively small trickle of dissident websites during the AIDS epidemic found themselves facing a social media-fuelled firehose of misinformation during the COVID-19 epidemic.
Facebook's attention-grabbing algorithms super-charged the spread of misinformation, and the rise of internet streaming provided additional opportunities.Notably, the Joe Rogan Experience, for which Spotify reportedly paid Joe Rogan $100 million and which reached an estimated 11 million people per episode, became a vehicle for spreading conspiracy theories (e.g. about microchips being injected into arms), misinformation about mRNA vaccines, and promoting Ivermectin as a cure for COVID- 19 (Paterson, 2021).In January 2022, 270 medical professionals wrote an open letter 20 to Spotify pointing to the dangers posed by this podcast and several music stars removed their music from the platform in support.Spotify subsequently announced that it would add 'content advisories' pertaining to COVID-19 but declined to provide any content moderation.
By 2020, the large tech platforms had started to combat misinformation by posting warnings and advisories, directing readers to websites that promoted science-based medicine, and by removing the most egregious content.Yet the internet remained largely anarchic with plenty of loopholes for cultropreneurs to exploit.Notably Joseph Mercola, who was warned by the FDA for his misleading advertising, 21 identified by the Centre for Countering Digital Hate as the leading spreader of COVID-19 misinformation (CCDH, 2021) and pushed off Facebook and YouTube, was able to move seamlessly to Substack, where he took his 'censored library' with him and continued to operate a highly profitable newsletter (Fiore, 2022).The social media giant Twitter was a major spreader of conspiracy theories about COVID- 19 (Erokhin et al., 2022).Between January 2020 and September 2022, over 11,000 accounts, including that of Robert Malone, were suspended by content moderators.Yet after Elon Musk purchased the company, Twitter stopped enforcing its COVID-19 misleading information policy, 22 implemented drastic cuts to content moderation teams and reinstated Robert Malone's account (Hsu, 2022).The social media platform TikTok, which is very popular with young users, introduced some content moderation, but digital researchers found that misleading information about vaccines and home-grown cures (including how to make your own hydroxychloroquine) was easily found and even promoted by TikTok's algorithm (Brewster et al., 2022).

Conclusion
Public health advocates in the US and South Africa emphasise that many of the vaccine hesitant are not hardened conspiracy theorists, may have reasonable fears about side-effects and are potentially open to persuasion, especially if their concerns are taken seriously by interlocuters they trust (MAC, 2021;CDC, 2021).But the fact that trusted interlocuters are needed at all is indicative of the scale of challenge posed by conspiratorial moves against scientific medicine.In December 2022 the New York Times reported that medical professionals continued to be frustrated by the persistence of 'outlandish' narratives about COVID-19 vaccines (such as containing injectable microchips for surveillances purposes) that discourage vaccination (Hsu, 2022).
That suspicions towards, and even conspiracy theories about, vaccines have social, political, and psychological dimensions makes the task of persuasion more difficult than merely providing correct information about a vaccine or drug.The involvement of organised commercial and/or political interests in spreading misinformationand the role of social media in amplifying itcomplicates the challenge yet further.
We have emphasised the persistent synergistic connections, from AIDS to COVID-19, between conspiratorial moves against medical science and the promotion of 'alternative' therapies.Cultropreneurs, dissident scientists and their libertarian funders often imply that the medical establishment (and even science itself) has been corrupted by political and commercial interests.The irony here is that cultropreneurs themselves have commercial interests in spreading misinformation about scientific medicine, and libertarian donors have obvious political agendas.Pointing this out is grist for the mill of pro-science activists, but they face an uphill struggle in today's post-truth social context.