Elsevier

Vaccine

Volume 29, Issue 10, 24 February 2011, Pages 1874-1880
Vaccine

Emerging and continuing trends in vaccine opposition website content

https://doi.org/10.1016/j.vaccine.2011.01.003Get rights and content

Abstract

Context

Anti-vaccination websites appeal to persons searching the Internet for vaccine information that reinforces their predilection to avoid vaccination for themselves or their children. Few published studies have systematically examined these sites.

Objectives

The aim of this study was to employ content analysis as a useful tool for examining and comparing anti-vaccination websites for recurring and changing emphases in content, design, and credibility themes since earlier anti-vaccination website content analyses were conducted.

Methods

Between February and May 2010, using a commonly available search engine followed by a deep web search, 25 websites that contained anti-vaccination content were reviewed and analyzed for 24 content, 14 design, and 13 credibility attributes.

Results

Although several content claims remained similar to earlier analyses, two new themes emerged: (1) the 2009 H1N1 epidemic threat was “manufactured,” and (2) the increasing presence of so-called “expert” testimony in opposing vaccination.

Conclusion

Anti-vaccination websites are constantly changing in response to the trends in public health and the success of vaccination. Monitoring the changes can permit public health workers to mount programs more quickly to counter the opposition arguments. Additionally, opposition claims commonly appeal to emotions whereas the supporting claims appeal to reason. Effective vaccine support may be better served by including more emotionally compelling content.

Introduction

Vaccines are the most important public health achievement of the last century [1], saving as many as 3 million lives each year [2]. For example, smallpox, now eradicated, once killed 30% of its victims and, in 1967 when the global eradication campaign began, still infected 10–15 million persons a year [3]. As vaccines have become increasingly available to combat a growing number of pathogens, vaccine-preventable diseases (VPDs) have declined [4], [5], [6]. Many countries have instituted mandatory vaccination programs as public health measures, but the U.S. has not done so on a national level and vaccination policy and practice varies by state and within states. All states permit opting out of vaccines using a medical objection or for religious reasons [7]. In addition, 21 states have relaxed the religious exemption to include a philosophical opt-out choice for pediatric and other vaccinations [4], [8]. Of these 21 states,1 several have experienced lower than 70% immunization rates for children under the age of 2 years, including Idaho, Oklahoma, and Oregon.2 Although a recent report from the U.S. Centers for Disease Control and Prevention (CDC) notes an overall high level of vaccination for children ages 19–35 months, pockets of low vaccination levels still exist as shown on the state-by-state tables [9]. Low vaccination rates and resulting outbreaks of vaccine-preventable diseases have been shown to be geographically related to pockets of vaccine opposition [4], [10], [11]. Vaccine opposition is a social movement, fueled in part by anti-vaccine information on the Internet [12], [13], [14], [15], [16]. Well-organized advocacy groups, the growing popularity of alternative health care, and new rapid communication technologies have all contributed to geographical clusters of lower vaccination rates [11], [17].

Although health care providers are the primary source for medical advice, including vaccination advice [18], [19], the public is increasingly turning to other sources, including the Internet. Traditionally, the public has received information from the printed page, radio, and television. One advantage of these traditional commercial information sources is their financial stake in truthfulness. Yet increasingly, all media—including the Internet—sensationalize both vaccine objections and vaccine adverse events. One source dates the emergence of the “vaccine-damaged child” as a new medical entity to a television program broadcast in 19823 [20].

As a new source of information, the Internet is as indiscriminate as were the earliest medieval broadsheets, and anything can be published by anyone willing to take the time to launch a website [12]. In 2009, more than 175 million Americans searched the Internet for health information, a six-fold increase since 1998 [21]. The National Center for Health Statistics reported that in 2009, 46% of adults older than 18 years of age searched for health information in the previous 12 months [22]. Anti-vaccination messages are more common on the Internet than in print or broadcast and the Internet may be more likely to contain unverified information [12]. One study found that a search on the word “vaccination” was more likely to produce a list of anti-vaccination than pro-vaccination websites [23]. This results in an increased possibility of misleading information on vaccines and, thus, vaccination decisions may be made based on such misleading information [12]. In a German study, subjects viewing anti-vaccine websites for only 5–10 min increased their perceptions of vaccination risks, decreased their perceptions of the risks of avoiding vaccination, and lowered their vaccination intentions compared to viewing neutral websites [24]. The content and design of websites with anti-vaccination content promote and reinforce existing beliefs that vaccines are harmful. Blume reports that the messages on these sites can encourage parents to find ways to avoid vaccines, especially for their children, despite advice from health care providers to vaccinate their children [14].

Section snippets

Methods

The aim of this study was to employ content analysis as a useful tool for examining and comparing anti-vaccination websites for recurring and changing emphases in content, design, and credibility themes since earlier website content analyses were conducted.

On February 2, 2010, a search was conducted using Google® (Google, Inc., Mountain View, CA), the most popular Internet search engine and one likely to be used by parents. One separate search was conducted for each of 10 keywords: vaccine,

Results

Each of the websites in two previous anti-vaccine website content analyses were examined—100 sites noted by Davies et al. [12] and 8 sites listed in the Kata study [29]. For a third study by Wolfe et al., the actual URLs for the websites analyzed (n = 22) were unavailable, so an exact comparison was not possible [16]. During a May 23, 2010, search conducted on all 100 of the websites in the Davies study [12], 3 were found to be duplicate listings, 62 of the remaining 97 websites had vanished

Discussion

This study has several limitations, including that it examined only English-language websites, and therefore may not represent the full spectrum of anti-vaccine activity on the Internet. In addition, it was a cross-sectional study rather than longitudinal. A third limitation is the absence of coders other than the author. Website home pages only were examined and not threads or hyperlinks. This study should be seen as a snapshot in time—from February to May, 2010. Despite these limitations, the

Recommendations

People tend to endorse positions held by those “with whom they share important commitments,“according to the theory of cultural cognition [43], [44]. “Cultural orientations condition individuals’ beliefs about risk through a set of in-group/out-group dynamics. When faced with conflicting claims and data, individuals usually are not in a position to determine for themselves how large particular risks… really are. Instead, they must rely on those whom they trust to tell them which risk claims are

Acknowledgements

I thank the two reviewers for their careful reading and extensive suggestions on an earlier version of this paper. I also thank Joseph Catania, PhD, Professor, Peter Lachenbruch, PhD, Professor Emeritus, Department of Public Health, Oregon State University; and Dwaine Plaza, PhD, Associate Professor, Department of Sociology, Oregon State University, for their mentorship, comments, and suggestions. The author declares no conflict of interest in the research for this study.

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  • Cited by (0)

    This findings from this analysis were presented at two conferences in 2010: The American Association for the Advancement of Science, Pacific Division, Annual Conference, June 14, 2010; and a slightly different version at the Association for Bahá’í Studies annual conference, Vancouver, B.C., August 14, 2010.

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