"Judah Maccabee Goes to the Doctor: A Story for Hanukkah" does not read like the product of an outraged mind.
The story describes a young boy named Judah who must brave a pediatrician's needle - for his health and, he comes to realize, his little sister's.
The book, published in August, is so zippy and crisp that you can hardly tell author Ann D. Koffsky wrote it from a place of anger. Koffsky is an Orthodox Jew and describes herself as religious.
She said she became furious at reports of Jewish families that claimed religious exemptions from vaccinations and sent their non-vaccinated children to private schools.
"That upset me personally," Koffsky said. "It is at odds, from my perspective, with Jewish values" of protecting communities and embracing science. She channeled her distress into a brightly illustrated holiday book.
When Amazon.com listed "Judah Maccabee Goes to the Doctor" last year, Koffsky was excited.
She refreshed the page continually. The first three reviews (all five stars) gushed about the book. The flood of negative comments, an online tactic known as brigading, came without warning.
"All of a sudden," she said, "I had one-star reviews."
Anti-vaccination reviewers tried to sink the book's rating in a coordinated, 48-hour campaign a month before Hanukkah. Reviewers called her story "extremely disturbing and franky [sic] inaccurate" and repeated falsehoods about "vaccines that are not at all safe."
Years of careful scientific study have thoroughly disproved any link between autism and vaccines, including the one for measles, mumps and rubella. The 1998 report that suggested a connection was retracted, and an investigation concluded that the author, who has been stripped by Britain of his medical license, had committed scientific fraud.
Yet in the alternate reality of Amazon reviews, Koffsky was accused of being a shill for the medical industry.
"I am not in the pocket of big pharma," she said.
As of this writing, "You Wouldn't Want to Live Without Vaccinations!" has a two-star average rating.
Brigades like these usually germinate on Facebook, where anti-vaccine conspiracy theorists can meet like-minded people. If a member of the group senses an unforgivable sin has been committed - an author trying to teach children about vaccines, say, or a pediatrician speaking about herd immunity - they swarm from Facebook to descend on other Internet platforms like locusts.
Amy Pisani, director of the vaccine advocacy organization Every Child by Two, said anti-vaccine groups have tried to sabotage adult and children's books on Amazon as well as the Yelp pages of doctors.
To be fair, in the kids' corner of Amazon, vaccination is not an extremely popular subject. A recent search for "immunization," "vaccine" and similar terms produced 28 children's books about vaccines with at least one review, far fewer than books pegged to subjects such as "slug" or "lawyer."
Ethan Posard, who wrote "The Shots Book: A Little Brother's Superhero Tale" when he was 14, said he has not yet been attacked on Amazon.
"The haters have found me on Twitter, YouTube, Facebook, my website, etc.," said Posard, now 17 and a junior in high school. He added: "I've gotten some crazy stuff about chemtrails and other conspiracies and some disturbing memes."
But as books rise higher in Amazon search results, they can attract the attention of anti-vaxxers who hope to influence the products that parents buy for their children.
Robert Brown, a postdoctoral researcher who studies infectious disease at Cedars-Sinai Medical Center in Los Angeles, was considering writing his own picture book when he noticed the low ratings of pro-vaccine children's books on Amazon.
Brown said he would like to see Amazon partner with a journal such as Science or Nature to feature reviews from professional scientists.
"People need to know whether the science is correct," he said.
Amazon does not specifically monitor listings for ideological reviews. Nor does the company delete them, though Amazon might tweak a listing so that only verified purchasers can leave a review. As of this writing, Koffsky's negative reviews from the November attack remain on the page.
But they have been outnumbered by a wave of pro-vaccine comments from people who came to Koffsky's aid after the author posted a plea for help on Facebook.
These books are fiction in the purest sense. In "Melanie's Marvelous Measles," an unvaccinated girl, Melanie, contracts the disease. She remains in perfect health, credited to a raw-food diet and vitamins. A junk-food-gobbling boy catches measles despite his immunization shot, though his worst symptom appears to be grumpiness.
In reality, measles is a serious illness caused by a virus, not nutrition. Nearly 90,000 people died of measles in 2016, according to the World Health Organization.
"Measles kills," Pisani said. "I can't believe that someone would have the gall to write that book."
"Melanie's Marvelous Measles" was published in 2012 and drew widespread mockery in February 2015, coinciding with news reports of a measles outbreak that started at Disneyland in California.
By 2018, more than 500 people had reviewed the book, many of them satirically. The top review (one star) mocks the book with a list of similar, but fake, titles, from "Abby's Absolutely Abundant Abscess" to "Yolanda's Yummy Yersinia."
A representative for Amazon, when asked about "Melanie's Marvelous Measles," pointed to a note on the listing page.
It reads: "Please note that the following description is provided by the publisher/author of this title and presents the subjective opinions of the publisher/author, which may not be substantiated. The description does not express the views of Amazon."
(Amazon's chief executive, Jeffrey P. Bezos, also owns The Washington Post.)
Yelp has removed anti-vaccine attacks on doctors, Pisani said. Every Child by Two sent Amazon a letter in the fall of 2017 warning the company about books written by anti-vaccine advocates. Amazon, Pisani said, never responded.
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