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As anti-vaccine activists from across the country prepare to gather on the steps of the Lincoln Memorial on Sunday, they are hoping their rally will mark a once-fringe movements arrival as a lasting force in American society.

That hope, some public health experts fear, is justified.

Almost two years into the coronavirus pandemic, the movement to challenge vaccines' safety - and reject vaccine mandates - has never been stronger. An ideology whose most notable adherents were once religious fundamentalists and minor celebrities is now firmly entrenched among tens of millions of Americans.

Baseless fears of vaccines have been a driving force among the approximately 20 percent of U.S. adults who have refused some of the most effective medicines in human history: the mRNA vaccines developed against the coronavirus by Pfizer, with German partner BioNTech, and Moderna. The nation that produced Jonas Salk has exported anti-vaccine propaganda around the globe, wreaking havoc on public health campaigns in places such as Germany and Kenya.

That propaganda has also found its way into many reaches of American life. It has invaded people's offices and shaped the daily decisions of school principals. It has riven families and boosted political campaigns. What was once an overwhelming public consensus on vaccine safety is now a new front in the nation's culture wars. It is no accident that some in the anti-vaccine movement are describing Sunday's rally as their first equivalent of the March for Life, the annual antiabortion rally taking place in Washington on Friday.

"Our worst worries have been manifested," said Joe Smyser, chief executive of the Public Good Projects, a nonprofit group that tracks and seeks to combat vaccine misinformation. "These fringe ideas are no longer fringe ideas."

Despite signs from the earliest days of the pandemic that the anti-vaccine movement was advancing its cause by preying on the uncertainty and social division that accompanied the virus, the U.S. public health establishment never mounted a true counteroffensive, Smyser said - a view shared by other public health experts and epidemiologists.

"I think we were really naive," he said. "This movement was allowed to get stronger and stronger with almost no pushback."

The 153 most influential anti-vaccine social media accounts and groups have accumulated 2.9 million net new followers since January 2020, according to the Center for Countering Digital Hate, an advocacy organization focused on fighting vaccine misinformation. Imran Ahmed, the center's chief executive, said those gains are especially remarkable in light of social media platforms' renewed efforts to crack down on vaccine misinformation.

Vaccine skeptics notched another victory just last week, when the U.S. Supreme Court blocked President Biden's vaccination requirement for large employers. (A smaller mandate for workers at health-care facilities that get federal funding was left intact.)

Robert F. Kennedy Jr., a longtime anti-vaccine activist who will speak at Sunday's march, said the widening distrust of vaccines is an organic outgrowth of people's firsthand experiences with negative side effects from the coronavirus vaccines. He pointed to the large number of reports of reactions to those vaccines now on file in the Vaccine Adverse Event Reporting System (VAERS), a database maintained by the Centers for Disease Control and Prevention.

More than 750,000 such reports have been filed from the United States and its territories. But claims of bad reactions in VAERS have not been independently verified, and anyone can make them. Controlled studies of the coronavirus vaccines offer a more accurate picture of how they work, and those studies have repeatedly shown the medicines cause no serious side effects for the overwhelming majority of people who receive them.

Kennedy said the growing number of infections among the vaccinated from the omicron variant of the coronavirus has also eroded public confidence in a key selling point for vaccine mandates - that they stop the spread of the virus to vulnerable populations.

Although the vaccines are markedly less effective at stopping infection by the new variant, early evidence suggests they still confer protection against hospitalization or death.

"I think there's a lot more skepticism," Kennedy said. "You have a product that simply does not work as advertised."

What remains to be seen is whether the movement's success in sowing fear of the coronavirus vaccines can be translated to a broader public rejection of other forms of inoculation, chiefly the immunization of children against diseases such as measles and diphtheria. Casting doubt on such vaccines and erasing school mandates requiring them were the anti-vaccine movement's long-standing goals before the emergence of the coronavirus.

Tara C. Smith, a professor of epidemiology at the Kent State University College of Public Health, said it is far too early for the movement to declare victory on those fronts. Arguments that have proved effective against the mRNA vaccines, like questioning their relative novelty and the possibility of long-term side effects, could be less convincing when it comes to established vaccines that many American adults received decades ago without being harmed.

"What will we see when things are somewhat back to normal, and covid doesn't dominate everything every day? Is this going to bleed over into other things, like childhood vaccinations? I really don't know," Smith said. "And that's the fear."

Several pediatricians interviewed by The Washington Post said they are not yet seeing an increase in the number of parents refusing vaccines for their children, but there are worrisome signs.

Deborah Greenhouse, a pediatrician in Columbia, S.C., said she has fielded eyebrow-raising questions from parents. Some, repeating a conspiracy theory that has circulated since early in the pandemic, ask whether the coronavirus vaccine injections will implant microchips in their children's bodies. Others accuse her and other pediatricians of promoting the vaccines for personal profit. One father worried that a coronavirus test swab would give his child cancer.

"This has been the most frustrating time period in my entire career," said Greenhouse, who has been a pediatrician for nearly 30 years.

Greenhouse said she has not seen an uptick of similar concerns about other vaccines among her patients, but worries it could just be a matter of time.

"It's truly frightening for the future," she said.

The scientific case for the full range of vaccines recommended by public health authorities in the United States remains as solid as ever. Research has shown those vaccines - which have all but eliminated diseases that once sickened, debilitated or killed millions every year - to be safe for the vast majority of those who receive them. The 1998 study by Andrew Wakefield that claimed a link between a common childhood vaccine and autism, launching the modern anti-vaccination movement, was exposed as fraudulent.

The mRNA coronavirus vaccines have proved to be some of the best ever added to physicians' arsenal. As of October, according to the most recent estimates from the CDC, those who received two doses of the Pfizer-BioNTech or Moderna vaccines and a booster were 40 times less likely to die of the virus than the unvaccinated. There is not yet sufficient evidence to judge the vaccines' exact level of protection against severe outcomes from the omicron variant, but early research in the United Kingdom and South Africa has been promising.

Nevertheless, national surveys show about 1 in 5 U.S. adults remain unvaccinated. Among children ages 5 to 11, who became eligible for the shots in November, fewer than 20 percent are vaccinated.

A November poll from the Kaiser Family Foundation found majorities of unvaccinated adults saying they will "definitely not" get a vaccine and are not confident in the vaccines' safety.

Republicans were much more likely than Democrats to reject the vaccines - another ominous sign for public health officials, who worry that resistance to inoculation could become a permanent trapping of political identity.

Eric Topol, a professor of molecular medicine at Scripps Research, said the enthusiasm ahead of Sunday's rally is a dispiriting reminder of how little has been done to combat the anti-vaccine movement's rise over the past two years.

Topol said he has repeatedly, but unsuccessfully, urged federal health officials to do more to counter rampant falsehoods about vaccines.

"Misinformation spreads far quicker and more broadly than truth," Topol said. "The administration does nothing to call them out, and that has left them to continue to grow like a metastasis. They just get bigger and more toxic, and they hoodwink and bamboozle more people who might have been neutral."

Sunday's rally in D.C. could be a case study in the amplification of anti-vaccine views by media sources that threaten to drown out more conventional, evidence-based voices. Organizer Matt Tune said the march's website saw a "huge spike" in traffic after Robert Malone, a physician who has become a prominent skeptic of the coronavirus vaccines, mentioned it on Joe Rogan's popular podcast. (Malone's appearance provoked a condemnatory letter to Spotify, which hosts the podcast, from hundreds of doctors and public health experts.)

Organizers estimate that 20,000 people will attend the rally, marching from the Washington Monument to the Lincoln Memorial, according to a permit issued by the National Park Service. D.C. police will be fully activated from Friday, during the annual March for Life, through Sunday, the anti-vaccine mandate rally, spokesman Dustin Sternbeck said.

The march is billed as a protest of vaccine mandates, such as those recently enacted in D.C. and other cities, rather than the medicines themselves. But similar rhetoric - emphasizing individual autonomy rather than untenable scientific ideas - has long characterized the broader anti-vaccine movement, and the march's speakers include movement veterans such as Kennedy and Del Bigtree, founder of the anti-vaccine group Informed Consent Action Network.

Other speakers include Malone and former CBS News correspondent Lara Logan, who in a November appearance on Fox News compared White House chief medical adviser Anthony S. Fauci to the Nazi doctor Josef Mengele. Public employee associations that have formed to protest their employers' vaccine mandates, such as Feds for Medical Freedom and D.C. Firefighters Bodily Autonomy Affirmation Group, are also participating.

"The goal is to show a unified front of bringing people together - vaccinated, unvaccinated, Democrats, Republicans, all together in solidarity," said Tune, an unvaccinated 48-year-old from Chicago. He said he wants the event "to help change the current narrative . . . which is basically saying that we're a bunch of weirdos and freaks who don't care about humanity. And that's not true at all."

About 12,000 people have joined a Facebook group for the rally, with many saying they will stay overnight and eat in Northern Virginia to avoid the District's vaccine mandate. Some commenters on the group's page have compared vaccine mandates to the Holocaust and urged people not to get tested for the virus. One commenter wrote: "This is an intentional permanent tyrannical dictatorship if they are not stopped by FORCE!!!!!!"

Facebook did not respond to questions about whether the page violates the platform's policies on covid-19 and vaccine misinformation, which prohibit "content calling to action, advocating, or promoting that others not get the COVID-19 vaccine."

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The Washington Posts Dan Keating and Scott Clement contributed to this report.

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Anti-vaccine activists, reveling in their pandemic successes, will rally in D.C. against mandates - The Philadelphia Inquirer