Amazon’s charitable program is paying tens of thousands of dollars to anti-vaccine groups in a move experts say is “shocking” as millions of Americans remain unvaccinated in the face of another Covid-19 wave. AmazonSmile reportedly donated more than $40,000 to leading sources of vaccine misinformation in 2020, according to separate analyses by Popular Information and the Washington Post. “That’s really shocking,” said Peter Hotez, dean for the National School of Tropical Medicine at Baylor College of Medicine. “That’s incredible that Amazon is supporting those groups.” The charity program of the e-commerce giant donates 0.5% from purchases to designated nonprofits – including at least a dozen organizations working against widespread vaccination in the US. Last year, Amazon donated more than $60m to nonprofits. The portion of anti-vaccine funding is small compared to the full amount, but it may be significant to the fundraising efforts of groups with relatively small budgets. The donations come after ongoing criticism of the retailer’s role in health misinformation, and it raises questions about the roles of technology companies in combating misinformation and countering potential public harms. The donations legitimize anti-vaccine groups, Hotez said. “Beyond the money, it has a lot of power because a powerful organization like Amazon is essentially endorsing them.” The National Vaccine Information Center has received $41,533.71 over the course of several years, according to an anonymous volunteer. Last year, Amazon gave them $12,675, the Post reports – one of a dozen groups to receive such funding. Children’s Health Defense, headed by Robert F Kennedy Jr, received $10,969; Physicians for Informed Consent received $3,626; and Informed Consent Action Network received $2,970.41. More than 1m nonprofits are registered in the program, and organizations supported by AmazonSmile must not “engage in, support, encourage, or promote … illegal, deceptive, or misleading activities,” according to the participation agreement. Nonprofits may participate if they are registered 501(c)(3) organizations. Hate groups and terrorism groups are banned from the program. But in the past, AmazonSmile also reportedly funded anti-LGBTQ groups. In 2019, the Guardian reported on Amazon’s anti-vaccine donations, as well as its “influencer” program allowing those with significant followings – including leading anti-vaccine proponents – to earn commissions on products they recommend. Amazon has remained a home to prominent anti-vaxxers and conspiracy theorists after other platforms banned them, reports show. An Amazon spokesperson said: “We respect that our customers want access to a wide variety of viewpoints on the matter, which is why we continue to list the books in question and include these charities in the list of organizations customers can choose from as part of AmazonSmile.” The spokesperson added: “Organizations that engage in, support, encourage, or promote intolerance, hate, terrorism, violence, money laundering, or other illegal activities are not eligible.” Google, Facebook, YouTube, and Twitter have come under fire for the online spread of misinformation and disinformation, but retailers – including Amazon, the largest retailer in the world – have largely been spared scrutiny around spreading misinformation. “Everybody focuses on social media companies. I lay equal blame at e-commerce companies, especially Amazon,” Hotez said. A search for “vaccine” on Amazon.com shows anti-vaccine books are the third and sixth results, with others following. In a search for “Covid”, a conspiracy theory book is the second result. Many of the books are sold by Amazon itself, not third parties. “Amazon right now is the single largest purveyor of anti-vaccine books,” Hotez said. Amazon is also a commerce platform for anti-vax T-shirts, herbal supplements, and other products. Over the summer, customers posted reviews of ivermectin as a potential treatment for Covid, despite warnings from public health agencies that the deworming medication is not effective against the respiratory virus. And the company doesn’t just host the items, researchers recently found. Its algorithms actively promote anti-vaccine resources and goods, potentially pulling customers deeper into health misinformation and conspiracy theories. Two University of Washington researchers – Prerna Juneja, a doctoral student, and Tanu Mitra, an assistant professor – found Amazon ranks misinformation above quality information, according to their report about misinformation on e-commerce platforms. “Amazon is also ranking these anti-vaccine products higher in the search results as compared to the products that debunk vaccine misinformation,” Juneja said. YouTube, on the other hand, will recommend a debunking video after someone watches a video with misinformation, Juneja said. “I don’t see Amazon doing anything like that.” “The most shocking thing is, you only need to perform one action on these anti-vaccine products. You click on it, you add it to your cart, and then Amazon will actually start pushing you more related stuff,” Juneja said. And authors, including those who write anti-vaccine books, can pay to have their books “sponsored,” or placed higher in search results, she said. “Once users start engaging with the misinformation of these anti-vaccine products on the platform, they will be presented with more misinformative stuff at every point of their Amazon journey.” The spread of misinformation has dire public health costs, Mitra said. “​​There are certain sections of the population which haven’t even received one dose of vaccine. Because this thing actually impacts public health, all these platforms have an ethical responsibility to take some strong steps against this vaccine misinformation.” Hotez agreed. “​​Not only are they profiting enormously on the anti-vaccine empire, but in addition, now they’re going out of their way … to endorse anti-vaccine groups,” Hotez said. “Let’s remember the consequences here: 150,000 unvaccinated Americans have needlessly lost their lives to Covid because they refused Covid vaccines.”