As if interfering with elections wasn't enough, authors linked to several accounts identified as Russian backed antagonists – or trolls, if you prefer – are stirring up hatred and confusion on vaccines.
Researchers from George Washington University in Washington DC didn't set out to uncover Russian interference in US health discussions. Now that they've found it, we've got an even greater need to arm ourselves against this insidious new form of warfare.
The study was initially an attempt to find ways to improve social media communication on vaccination. It didn't take them long to realise there was a familiar influence seeding discord among online discussions.
Using a sample of nearly 1.8 million tweets posted between July 2014 and September 2017, the researchers measured the impact of suspected bots, trolls, and content polluters that seeded and amplified content intended to polarise the vaccine debate.
They also used data from a qualitative study on the influence of collection of tweets hashtagged #VaccinateUS authored by accounts linked to the Internet Research Agency, also known as Glavsat.
If this group doesn't sound familiar, they're a Russian company with alleged ties to the Putin government associated with meddling in US democratic processes through large-scale trolling operations.
In some ways, their methods aren't novel. Propaganda in various forms has been around for as long as war itself, destabilising the enemy's community through fear and mistrust.
The big difference is the media – automated bots boosting extreme views, trolls inflaming passions on the fringe, and content polluters spreading malware are creating noise that makes civil discussion online far more difficult.
It's not clear how far this interference spreads, with some research suggesting we can't lay the blame on Twitter trolls for our current political divisions. Not entirely, at least.
But can the same be said about divisions in our healthcare?
"By playing both sides, they erode public trust in vaccination, exposing us all to the risk of infectious diseases," Johns Hopkins computer scientist Mark Dredze told Jessica Glenza from The Guardian.
" Viruses don't respect national boundaries."
It doesn't take much of a dip in vaccination rates for disease to spread through a community, putting those with low immunity at risk.
Falling vaccination rates in Europe are suspected to be behind a record measles outbreak that's seen 37 deaths and 41,000 infections in the first six months of 2018.
Targeting online vaccination discussions and flooding them with polarising messages sets a dangerous precedent in what is proving to be an insidious weapon.
"Although it's impossible to know exactly how many tweets were generated by bots and trolls, our findings suggest that a significant portion of the online discourse about vaccines may be generated by malicious actors with a range of hidden agendas," lead author David Broniatowski told The Guardian.
To be clear, the aim may not necessarily be to use outbreaks of disease as a weapon, as much as finding a new avenue to destabilise trust in democratic processes.
Tweets with #VaccinateUS associated with bots and trolls mirrored the general vaccine debate, with one small difference – there was a greater tendency to weave in political language, appealing to "freedom," and "constitutional rights."
By contrast, other authors tended to use terms such as "parental rights".
Whether the goal is to wreak havoc with the democratic process or to simply promote mistrust between communities, the outcome is still a dangerous one.
Controlling the tide of fake accounts and malicious content is a formidable task for social media companies, one that could ultimately prove futile.
Ironically the ability for such weapons to wreak havoc relies largely on our tribal nature, and the ease with which we distrust anybody who doesn't think like we do.
Changing that fundamental part of human nature might be just as challenging.
This research was published in the American Journal of Public Health.