**Background:** Digital misinformation campaigns, particularly those spreading anti-vaccination content, pose a significant public health threat by contributing to vaccine hesitancy. While research has focused on the content and spread of misinformation, the political economy—how these actors fund their operations and sustain their infrastructure—remains understudied. The authors note that none of the 58 indicators in a recent comprehensive summary of misinformation variables concerned material resources. This study addresses that gap by examining how anti-vaccination groups leverage their content to gather money and web infrastructure, drawing on three theoretical models: radical social movements (membership dues, donations, merchandise sales), online celebrities (attention monetization via advertising, donations, merchandise), and junk news websites (primarily third-party advertising).
**Methods:** Between November 2020 and May 2021, the researchers manually selected a sample of 59 English-language anti-vaccination actors, each maintaining at least one website. Websites were thematically coded on a 3-point scale for anti-vaccination content (Krippendorff's alpha = 0.83), and only those categorized as "Almost exclusively anti-vaccination publications" were included. Five researchers conducted content and features analysis in pairs, coding for five monetization strategies: appeals for donations, sale of information products, sale of merchandise/other products, advertising banners, and membership dues. Reliability for all variables exceeded Krippendorff's alpha of 0.6. For the 34 websites that accepted donations, the researchers used browser plug-ins (WhatRuns, Wappalyzer) to identify underlying payment platforms. A linked sites analysis was performed by scraping Google Analytics and Google AdSense IDs from website HTML code and cross-referencing them against the SpyOnWeb database (containing ~12 million unique IDs). Correspondence analysis was used to identify how monetization strategies clustered together.
**Key Results:** Of the 59 websites examined, 85% showed evidence of monetization. Appeals for donations were the most common strategy (34 sites, 58%), followed by sales of information products (24 sites, 41%), sales of merchandise/other products (18 sites, 31%), advertising (13 sites, 22%), and membership dues (10 sites, 17%). Additionally, 10 sites (17%) maintained linked families of websites. Among the 34 donation-accepting sites, PayPal was the dominant payment platform (26 sites, 76.47%), followed by credit card payments (17 sites, 50%), offline payments (11 sites, 32.35%), and cryptocurrencies (3 sites, 8.82%). The linked sites analysis identified a cluster of 20 domains linked to vaccineimpact.com, many of which were e-commerce sites selling diet and nutrition supplements. Correspondence analysis revealed three clusters of strategies: (1) advertising and merchandise sales together; (2) information products, donations, and membership together; and (3) linked websites alone. These two dimensions accounted for 54% of total variance. Notably, the anti-vaccination group Physicians for Informed Consent reported total earnings of $165,188 in 2019, with $46,100 from membership dues and $119,088 from donations/grants.
**Clinical Implications:** This study demonstrates that anti-vaccination actors employ a "hybrid monetization" strategy that blends older movement-based fundraising (donations, membership) with newer digital attention-economy tactics (advertising, merchandise sales, linked e-commerce sites). The finding that donations are more common than advertising challenges previous assumptions that advertising is the primary funding mechanism for misinformation. The authors argue that digital infrastructure access is as vital as funding for these groups, and that deplatforming alone may be insufficient since actors maintain their own websites with diverse revenue streams. Policy recommendations include: payment platforms (PayPal, Google) should refuse services to known anti-vaccination entities; Amazon should remove products disseminating vaccine misinformation; crowdfunding sites should not host anti-vaccination campaigns; and platforms should tackle advertising that funds these groups. The study is limited by its inability to estimate total funds generated, its focus on English-language websites only, and the imperfect proxy of Google IDs for identifying linked websites.