Background: Tools used to appraise the credibility of health information are time-consuming to apply and require context-specific expertise, limiting their use for quickly identifying and mitigating the spread of misinformation as it emerges. Our aim was to estimate the proportion of vaccination-related posts on Twitter are likely to be misinformation, and how unevenly exposure to misinformation was distributed among Twitter users. Methods: Sampling from 144,878 vaccination-related web pages shared on Twitter between January 2017 and March 2018, we used a seven-point checklist adapted from two validated tools to appraise the credibility of a small subset of 474. These were used to train several classifiers (random forest, support vector machines, and a recurrent neural network with transfer learning), using the text from a web page to predict whether the information satisfies each of the seven criteria. Results: Applying the best performing classifier to the 144,878 web pages, we found that 14.4% of relevant posts to text-based communications were linked to webpages of low credibility and made up 9.2% of all potential vaccination-related exposures. However, the 100 most popular links to misinformation were potentially seen by between 2 million and 80 million Twitter users, and for a substantial sub-population of Twitter users engaging with vaccination-related information, links to misinformation appear to dominate the vaccination-related information to which they were exposed. Conclusions: We proposed a new method for automatically appraising the credibility of webpages based on a combination of validated checklist tools. The results suggest that an automatic credibility appraisal tool can be used to find populations at higher risk of exposure to misinformation or applied proactively to add friction to the sharing of low credibility vaccination information.
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