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Campaigns by those opposed to immunisation have been followed by falling immunisation rates and outbreaks of vaccine preventable disease.1 The internet has provided antivaccinationists with unprecedented opportunities for exposure. In the USA, 55% of adults with internet access use it to seek health related information.2
For all its benefits, the internet has great potential to disseminate health information that is incorrect and potentially dangerous.3 To date, all studies on health information on the internet have assessed content against a priori standards of evidence, and have not considered the rhetorical subtexts and wider social discourses in which this information is embedded.4,5
We examined the content of 100 antivaccination websites, considering not only the explicit claims made about vaccination, but also the ways these claims are framed to maximise their appeal and influence.
On 23 July 2001 we entered the term “vaccination” and “immunisation OR immunization” into seven leading search engines and examined the first 10 sites delivered by each to estimate the probability of a person seeking information on immunisation quickly encountering a site expressing opposition to vaccines.
Next, using the term “vaccination” on the Google search engine, 845 separate sites were returned, of which 44 were found to contain content encouraging vaccine refusal or emphasising the dangers of vaccines. Further sites linked to this original cohort of 44 were methodically identified in order of discovery until 100 sites had been located (see Appendix 1, available on ADC web site: www.archdischild.com). Sites were then reviewed and their explicit claims and rhetorical appeals noted and categorised, drawing on previous work by the authors (see box 1).4
Box 1 Rhetorical appeals and explicit claims
Authoritative and scientific
Quasi official: organisations with names implying authority or official status
“Scientific” references”: referenced information from established medical journals, alternative health literature, published works by antivaccination “experts”, etc
Both sides: claim to present “both sides” of the vaccination debate for readers to appraise
Actually present both sides: present arguments for and against vaccination
Links to provaccination groups: links to government or health agencies promoting vaccination
Personal testimony: contain personal accounts of illness said to be caused by vaccination or persecution caused by antivaccination beliefs
Responsible parenting: the decision not to vaccinate is in the best interests of children, and parents who refuse are acting responsibly and lovingly in accordance with parental instincts
Us versus them: antivaccinationists are caring and concerned friends and allies of parents, together pitted against the collusive interests of uncaring doctors and government
Back to nature: “natural” methods of preventing disease are more desirable than the “artificial” practice of vaccination, and a natural lifestyle makes vaccination unnecessary
Conspiracy/search for truth
Cover up: information about vaccination is being wilfully distorted, suppressed, or otherwise withheld from the public
Excavation of the facts: sites present allegedly reliable but hitherto neglected or hidden information that counters accepted wisdom about the benefits, safety, and efficacy of vaccines
Free and informed choice: an informed decision about vaccination can only be made by parents in the absence of coercion by medical authorities, and only after becoming familiar with the facts as presented by antivaccinationists
Foolish doctors: medical orthodoxy is ill informed and outdated against the enlightened and compassionate antivaccinationists. Doctors are ignorant, have a vested interest in clinging to outdated myths about vaccination, and are too insecure to acknowledge the truth
Rebel doctors: thoughtful and enlightened medical doctors have broken with medical orthodoxy and now question vaccination
Unholy alliance for profit: promotion of vaccines is motivated by collusion for monetary gain between doctors, pharmaceutical companies, researchers, and public health bureaucrats towards totalitarianism—regulation of the administration of vaccines is a threat to civil liberties and is an excessive exertion of government control
Trivial diseases: the diseases childhood vaccinations are said to guard against are a normal part of growing up and are necessary developmental milestones. Vaccines interfere with this natural process and cause adverse health outcomes
Poisons: vaccines are toxic and poisonous and made from undesirable, bizarre products
Harmful: vaccines cause various diseases
Vaccines erode the immune system
Idiopathic ills: vaccines cause diseases or behavioural problems erroneously said to be of unknown or uncertain origin
Vaccines are ineffective
Alternative health treatments (particularly homeopathy and naturopathy) are superior alternatives to vaccination
Natural lifestyle ensures natural immunity. Those who get sick from these diseases have “unnatural” lifestyles
Disease declines predated vaccination: infectious diseases have declined for reasons other than vaccination
Across all seven sites, 43% of hits using “vaccination” returned antivaccination sites (100% on Google) (table 1). The term “vaccination” was more likely to result in an antivaccination website than the terms “immunisation or immunization”.
Of the 100 sites examined, just over half represented groups or individuals concerned exclusively with opposition to vaccination with the remainder being alternative health, civil rights, and parenting sites containing antivaccination material. Tables 2 and 3 show the proportion of these 100 antivaccination sites which utilised particular rhetorical appeals and which made various explicit claims about vaccines.
Evidence of authority and scientific rigour
Antivaccination groups sought to present themselves as legitimate authorities with scientific credibility: about one in four websites implied official status at national or international level. A majority of sites propounded the scientific validity of their claims by referencing from extensive literature dominated by self published works and the alternative medicine press. Allegedly damning research was often quoted, but without citation of its source. Referencing was frequently incomplete and often indiscriminate, including letters to editors of newspapers and television interviews. Research published in indexed medical journals was also quoted; however, the conclusions drawn were often inconsistent with those of the authors. Overall this produced a spectre of the existence of masses of data on the dangers of vaccination.
Over half of all sites cited rank breaking doctors speaking out against vaccination. Implied division within the medical community reinforced the notion of a “debate” among authorities. One third of sites promoted themselves as sources of non-partisan information on both sides of the immunisation “debate”. Despite these claims a mere 15% contained any information supportive of vaccination. Only a third of sites had links to such sites.
“This lovable, extremely alert baby had never produced such a blood-curdling scream as she did at the moment the shot was given ... four hours later, Lee Ann was dead” (http://www.van.org.uk/index1.htm)
Almost all sites featured the adversarial notion of “us versus them” whereby parents and antivaccinationists stood against the depersonalised “them” of doctors, health bodies, governments, and pharmaceutical companies. Doctors were presented as either willing conspirators cashing in on the vaccine “fraud”, or pawns manipulated by the shadowy vaccine combine; parents' love and compassion whose intuition about vaccination harms was considered a stronger force than cold, analytical science. Accounts of children said to be maimed or killed by vaccines were prominent. The answer to disease prevention was not the “artificial” process of vaccination but the pursuit of natural lifestyle. Many sites asserted that infectious disease was a consequence of lifestyle, not microorganisms.
Evidence of conspiracy, search for truth
“[is immunisation] really designed for prevention or cure or is it planned for increasing diseases and dependency on treatments and medicines?” (http://home.iae.nl/users/lightnet/health/vaccination.htm)
Nearly all sites referred to the antivaccination struggle as a search for truth against a background of cover up and denial. Antivaccinationists portrayed themselves as crusaders excavating hidden truths. The vaccination hoax was a vehicle for the generation of limitless profit and which would produce epidemics of chronic illness, requiring billions of dollars worth of drugs and medical care. To many groups, compulsory vaccination represented the beginning of the slippery slope towards totalitarianism.
“Recent epidemiological studies show homeopathic remedies as equalling or surpassing standard vaccinations in preventing disease” (http://www.unc.edu/~aphillip/www/chf/myths/dvm28.htm)
Vaccination was said to have been shown to be completely ineffective in preventing infectious diseases. Decreases in infectious disease were solely a result of social changes such as better sanitation. Vaccines were demonised as pollutants, alleged to cause numerous idiopathic disorders, usually of children, such as sudden infant death syndrome or autism, and other feared diseases including cancer and AIDS. Vaccines were also responsible for the rise in social “disorders”, such as falling literacy and violent behaviour.
Being unnatural, vaccinations deranged the function of the immune system. The natural immunity provided by infection was considered superior. Many sites urged parents to intentionally expose their children to infectious diseases alleging health benefits.
Many sites proposed that complementary health offered options for disease prevention superior to that of vaccination.
Anyone searching for vaccination information on the internet will rapidly encounter florid antivaccination material. With many such sites masquerading as official scientific sites, some web users may not question the veracity of such material.
The antivaccination message on the internet is far more unbridled than in other media.4 For this reason the internet represents a greater potential for the public to make uninformed decisions about vaccination.
Refutations based solely on “the facts” fail to address the core appeals that attract people to antivaccination sentiment in the first place.8 Any response to antivaccination rhetoric must also acknowledge the wider social discourses from which those arguments generate their appeal.4
Much of the appeal of antivaccination argument lies in the genuine pain of those touched by the tragedy of childhood death or illness. Where medicine is impotent to provide a culprit for many idiopathic disorders, antivaccinationists can fill the void, providing answers and solidarity for parents who feel abandoned by medical authorities. A questioning of authority and scepticism regarding the motivations of doctors and governments pervades antivaccination literature.
Along with alternative health and natural parenting, antivaccination sites represent a return to an idealised, natural existence. Accordingly the antivaccination message has infiltrated these movements.
Concerns about immunisation reveal an individualistic ideology that reveres personal rights and freedoms. In a generation which has rarely seen these diseases first hand the risk of adverse reaction seems more immediate than the bigger picture of disease prevention.
Response to the problem
To defuse conspiratorial claims the public should be made aware of efforts to address the issue of vaccine safety through more active surveillance of adverse events and studies investigating hypothesised links between vaccination and serious chronic diseases.9,10
Since antivaccination websites share many of the characteristics we have described, the themes identified in this article might act as a tool for parents to discern whether the source is trustworthy. The checklist might include:
Highly emotive content
Privately published material, newspapers articles, etc given as sources of information
Claims to have privileged information unknown to medical authorities.
Where refuting antivaccination arguments on the basis of fact alone is insufficient, it may be possible to use similarly emotive tactics to promote immunisation. Emphasis could be given to images and stories of children harmed by vaccine preventable illnesses (see, for example, http://www.immunize.org/stories/unprot.htm).
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