Last year the WHO listed vaccine hesitancy as one of the top 10 threats to world health. Historically, democracies have been associated with improved health outcomes due to institutions being accountable to the public, increased levels of public education and generally higher levels of wealth. Paradoxically though, contemporary anti-vaccination sentiment appears to be most concentrated in wealthy and highly educated democracies. Social media, while providing an unprecedented capacity for the public to communicate, has also been a major factor in the rise of fringe opinions damaging to public health. Reconciling principles of free speech with the policing of social media for damaging falsehoods remains a conundrum for democracies…more