Abstract
Childhood vaccines are credited with markedly reducing deaths from infectious diseases. For most children, vaccines are extremely safe and effective. Despite this, childhood vaccination-rates are steadily decreasing worldwide, and in the last decade, there have been several outbreaks of vaccine-preventable infectious diseases such as measles, with fatal consequences. Declining vaccination rates are thought to be caused partly by an abundance of conflicting vaccine information online.
This research examined online vaccine information and had two aims. First, to investigate what a parent looking online for vaccine information would likely find and second, to critically analyse how language-use in online vaccine information might influence vaccine decision-making.
Websites and social media platforms were searched for childhood vaccine information between September 2017 and January 2018 using methods designed to minimise bias from internet platform algorithms. A plethora of vaccine information displaying a variety of vaccine stances, including a significant minority of vaccine-negative information, was readily accessible online.
Three websites were selected for detailed analysis of texts and images using a critical discourse analysis framework to unpack three key functions of the language used: to say things, be things, and do things. These concepts were integrated to investigate each organisation's ideologies in relation to scheduled childhood vaccinations. Two vaccine-positive websites (Centers for Disease Control and Prevention from the United States and the Immunisation Advisory Centre from New Zealand) and one vaccine-negative website (Physicians for Informed Consent from the United States) were analysed.
The vaccine-positive websites asserted and implied vaccine-promoting stances in their information. Physicians for Informed Consent asserted a vaccine-neutral stance but their implicit stance was critical of childhood vaccination. Each organisation used manipulative discourse, however, because Physicians for Informed Consent disguised their vaccine-critical stance, their information delivery was considered more manipulative and potentially coercive.
Centers for Disease Control and Prevention and the Immunisation Advisory Centre discursively distanced themselves from the parent-reader. In contrast, Physicians for Informed Consent discursively narrowed the power gap between themselves and parents. They bolstered their referent power base and fostered empowerment and solidarity with parents.
A key conclusion from this research is that contrasting and conflicting discourses about vaccines are not simply a result of conflicting knowledges, but reveal conflicting ideologies. Therefore providing more "knowledge" to parents is unlikely to overcome vaccine hesitancy, where that is the goal.
Several recommendations that may serve to depolarise vaccine information and reduce vaccine hesitancy are made. For example, vaccine-promoting organisations and healthcare providers should consider discourse strategies that empower parents and build solidarity, creating a shared goal to improve children's health through vaccination. Care should be taken that this information is not deceptive or coercive. Vaccine-promoting organisations could increase the transparency of their information by disclosing rare vaccine harms without euphemism and parents could be supported to resist manipulation in vaccine information through learning critical appraisal skills.
Although this research looked primarily at vaccine information, the findings and reccomendations could be expanded beyond vaccines to other contested health topics where minority groups advocate against established and effective health measures, for example water fluoridation.
Parents will inevitably continue to look for vaccine information online: this information and the way it is presented is likely to influence their vaccine decisions. The findings of this research call for a re-evaluation of how vaccine-promoting information is provided to parents.