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In late October, the Republican candidate for governor of Minnesota posted a video he knew would be controversial.

"I've been called extreme, and perhaps this Facebook video will provide fodder for more people to call me extreme," the candidate, Scott Jensen, told his viewers. In the 20 minutes that followed, Jensen railed against COVID vaccine mandates for kids, questioned the CDC's vaccination schedule for other childhood immunizations, and raised other vague concerns about COVID vaccines that have been credited with saving hundreds of thousands of lives.

"I think in terms of safety, the question is still out there," he said.

The 2022 midterm elections will be like no other: Hundreds of candidates on the ballot this year challenge or deny the results of the previous election. But alongside these false narratives, candidates on the political right are also pushing conspiracies about vaccines.

Few candidates are as outspoken as Jensen, who has in the past appeared alongside many of the nation's most prominent anti-vaccine campaigners. But anti-vaccine rhetoric permeates the language of many Republican politicians. They are appealing to a base who, emerging from the pandemic angry over lockdowns and mask mandates, are increasingly skeptical of vaccination.

Pro-vaccine advocates worry that the rise of these candidates, along with an emboldened anti-vaccine movement, could spell trouble for public health in the years to come.

"I think it's really unfortunate that an issue that has saved so many lives has become partisan and hyper-political," says Northe Saunders, the executive director of the SAFE Communities coalition, a nationwide nonprofit committed to supporting pro-vaccine political candidates and policies.

On the right, anti-vaccine talk offers a political edge

Anti-vaccine proponents used to exist in both Republican and Democratic circles, but the pandemic saw them shift definitively to the political right. It was there that they found allies fighting lockdowns and masks. Republican politicians, particularly on the far right, have eagerly brought anti-vaccine forces into their tent. Anti-vaccine activists appear regularly at some popular right-wing political events, and some politicians have appeared on anti-vaccine shows in recent years.

Among them was Scott Jensen, a Minneapolis-area physician and state senator, who pushed medical misinformation throughout the pandemic. Speaking to anti-vaccine activist Del Bigtree in 2021, Jensen said that hospitals distorted the number of COVID-19 deaths. He has also questioned vaccine safety and pushed ivermectin — a drug that has been proven to be ineffective at treating COVID but continues to be promoted as an alternative therapy in anti-vaccine circles.

Jensen's anti-vaccine views gave him an advantage when he entered the Republican primary for governor, says Karen Ernst, the director of Voices for Vaccines, a Minnesota nonprofit that advocates for inoculation.

"Being anti-vaccine definitely helped Scott Jensen in the primaries," Ernst says. Anti-vaccine activists are highly organized and politically motivated in the state, she says. Jensen's commitment to anti-vaccine ideas helped get an edge in the crowded Republican field.

But as the general election approaches, it's less clear whether support from the anti-vaccine crowd can translate into political success. The vast majority of Americans still believe children should be vaccinated, and Jensen's opponent, Democrat Tim Walz, has won an endorsement from a large Minnesota doctor's group in part because he supports vaccination. Ernst says Jensen might be trying to soften his anti-vaccine image in the run-up to the election. He bailed on a major anti-vaccine rally in October.

"He canceled at the last minute saying he had a wedding he had to attend," she says, but he later posted images on social media from a Minnesota Gophers football game. "There was all sorts of hubbub about that."

Threading the needle

But there are other ways to appeal to the anti-vaccine movement without openly opposing vaccination. Anti-vaccine activists themselves have begun framing the issues around vaccines as ones of bodily autonomy. They have formed a group known as "Stand for Health Freedom," which seeks to overturn vaccine mandates. The group, which was co-founded by a prominent opponent of vaccines named Sayer Ji, claims to represent half-a-million Americans. It has advocated defunding the World Health Organization and urged a rollback of COVID vaccine mandates, but it stops short of spreading medical misinformation on its own website. The organization did not respond to NPR's requests for an interview.

Among the politicians who have won endorsement from the group is Florida Gov. Ron DeSantis. In a video recently posted to Twitter, DeSantis emphatically promised that he would not require children to get COVID vaccines, while at the same time, carefully avoiding questions on vaccine safety.

"I mean you can get into some of the potential side-effects," he said. "You don't even really need to do that."

DeSantis has also installed a doctor closely tied to the anti-vaccine movement as Florida's surgeon general.

Lisa Gwynn, the immediate past president of the Florida Chapter of the American Academy of Pediatrics, says DeSantis may not say directly that he thinks vaccines are dangerous, but his language definitely speaks to the anti-vaccine movement.

DeSantis often talks "like vaccines are bad," she says. She believes that the rhetoric is carefully calibrated to energize the anti-vaccine elements of the Republican base, without appearing to question vaccines themselves.

DeSantis has also taken steps to reduce COVID vaccine access for underserved communities, Gwynn says. Florida does not offer COVID vaccines to children under 5, and as a result, low-income residents seeking COVID vaccines at county health departments may see some of their kids turned away. "Your 6-year-old can get a COVID shot, your 4-year-old cannot get a COVID shot," Gwynn says.

For now, much of the rhetoric is focused on COVID vaccines, but that could soon change. Many states have seen a surge in proposed legislation to weaken requirements for childhood vaccines that protect against dangerous diseases such as polio, mumps and measles. In 2018 there were approximately 81 bills introduced nationwide that the pro-vaccine SAFE group designates as anti-vaccine; in 2022, they count more than 1,500. "There's certainly a lot more anti-vaccine activity," says Saunders.

Saunders says he believes that the anti-vaccine influence in politics is here to stay. "Unfortunately, I don't think the antivaxxers are ever going to go away," he says.