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As described in a previous section, sensationalized and irresponsible media coverage of Wakefield’s fraudulent study has been responsible for a dramatic increase in concerns regarding vaccines and consequent decreased vaccination rates, particularly so for MMR vaccination.

Recently, however, the Internet has become more prominent in spreading and maintaining anti-vaccination groups and their beliefs. This is borne out by three recent studies that have looked at the role of the Internet in the present day anti-vaccination movement. I shall briefly discuss these three relevant papers, mentioning their main findings, and then summarize some important conclusions that have important implications for those who seek to engage with anti-vaccine views.

(4.2.1) Kata 2010

Kata shows in this paper that the anti-vaccination movement has in recent times created a visible presence on the internet, and that they use the internet to disseminate their ideas. This is to be thought of against the background of a contemporary culture that relies heavily on the Internet for health information. Kata cites statistics that 75-80% of Internet users search for health information using the Internet, and 70% if these indicate that the information on the

100 Internet influences their healthcare decisions. Furthermore, 52% of users believe that most of the health information they access on the Internet is true and accurate. It has also been shown that parents who decline vaccinations are more likely to have gained information on vaccination from the Internet, and that they use certain anti-vaccination websites.

Kata performed vaccination related searches on Google.com and Google.ca, and analyzed the content of the websites so retrieved. American searches overall returned 24% anti-vaccine information, and Canadian searches 6%. Certain search terms retrieved much higher rates of anti-vaccine websites, such as the term “vaccination” returning 71% anti-vaccination results.

The websites abounded in emotive appeals, featuring pictures of injured children and of scary needles. Main themes were:

 Denying safety and effectiveness of vaccines. For example, this includes claims that vaccines cause Sudden Infant Death Syndrome, autism and asthma. There are also claims that vaccines do not confer immunity and actually weaken the immune system. Another common claim is that the vaccine-preventable diseases such as measles and smallpox are actually not harmful, and that these diseases were already disappearing before vaccines were created.

 Promoting alternative medicine and alternative views of health. This includes ideas such as “moving back to nature” and using more natural ways of treating illness. There is a large scepticism in these posts towards science and the scientific method.

 Focus on civil liberties. A number of the websites contain allegations of totalitarianism and government control, and encouraged parents to take up their rights and protect their children.

 Conspiracy theories or “search for the truth”. All the anti-vaccination websites had some component of conspiracy theory. This included the idea that important information is systematically being hidden from the public by government agencies and/or pharmaceutical companies. Typically people like Andrew Wakefield is seen as a martyr who dared to stand up to the system.

 Religious themes. Only 25% of the websites cited religious arguments against vaccination, such as God making a perfect immune system and using vaccines therefore being an affront to God.

 Falsehoods and incorrect information. Misinformation was found to be widespread, on at least 88% of anti-vaccination websites analyzed. This included half-truths and blatant falsehoods. There were many claims that were not evidence based, such as that polio is caused by sugar. Interestingly enough, the Wikipedia vaccination page contained no misinformation and was the most accurate of all the websites viewed. Kata argues that this is probably because of the way Wikipedia works, where all users can edit content.

This created a sort of informal “peer-review”, where errors and misinformation was corrected by users.

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 Emotional appeals. Many of the websites contained emotionally laden stories and appeals, meant to sway opinion by use of emotion. This would be something like “do what is best for your children by protecting them from these harmful vaccines”.

Three main themes emerge from the analysis of the websites. They are:

1) Belief in and promotion of alternate models of health. This includes rejection of biomedicine, and focus on combination of “natural” views and mind-body-spiritual type views.

2) Parental autonomy and responsibility. Parents are encouraged to be “experts” on their own child and take responsibility for their own child, against a healthcare system that does not care.

3) Suspicion of expertise. The anti-vaccination movement propagates the idea that the healthcare system is not trustworthy, and that “experts” should be viewed with suspicion.

Kata argues that these themes are part of a view of the world that may be thought of as postmodern. Typically, adherents of a postmodern view would seek alternate explanations for illness, not limiting themselves to “evidence” or “facts”. The postmodern view also is skeptical of truth-claims, of experts, and of authority figures. Many of the arguments are that parents themselves are the experts, and that parents should educate themselves in order to not be taken in by the perspectives of the “expert” or “authority”. Postmodernism does not accept one version of the truth; therefore the misinformation and misleading statements in the anti-vaccine movement is not seen as false, but rather as their version of the truth.

Thus, Kata argues that it is not effective to try and combat the anti-vaccine movement solely with education or arguments based on scientific data. These types of approaches are seen either as part of a conspiracy, or is seen as “your version of the truth”. Education and evidence therefore does not remove “my version of the truth”. Thus, although education is important, it really is not enough to remove the arguments typically forwarded within the anti-vaccine movement.

(4.2.2) Kata 2012

In this paper, Kata does a follow up analysis of the anti-vaccination movement, specifically on the Internet. Since the previous paper, the Internet has become much more focused on user-generated content, called “Web 2.0”. This means that information is readily shared and accessed through social media sites and other ways of user-generated content such as posted videos and comments.

The main content of anti-vaccine messages includes various strategies, such as shifting hypotheses, censorship of pro-vaccine information, attacking critics, misinformation and misrepresentations of science. There are also certain often repeated tropes, such as “I am not against vaccines, I am for safe vaccines” and that “vaccines are unnatural”. These approaches are usually in the form of compelling narratives and are not based on scientific evidence.

Kata argues that the contemporary medical paradigm is postmodern, and this means shared decision making instead of medical authority, emphasizing values in conjunction with evidence

102 and prioritizing risk over benefit. Web 2.0 plays an important role in this. Users can access health information on their own, and educate themselves at “the University of Google”. Many think of this as the empowered patient. The trouble, however, is that not all the information is reliable and that many users have no way of distinguishing reliable from non-reliable information. Kata argues that the contemporary medical paradigm is one where authority is not always trusted, anyone can be an “expert”, and suspicion towards science.

Mainstream media, such as news and television, have now swung away from the anti-vaccine messages and recently are against the anti-vaccination movement. Yet, the anti-vaccination movement thrives and flourishes online through various social media sites. They form their own communities, in which the mentioned anti-vaccination messages are shared and distributed.

It is once again clear in Kata’s analysis that the anti-vaccination movement embraces a postmodern view. This means they are skeptical of authority and experts, there are many different truths, facts and evidence are less important than narrative and belief/values. Kata therefore argues again that education and correcting of flawed arguments, though important, are not enough engage the anti-vaccine movement. The anti-vaccination paradigm is sceptical of a scientific paradigm, and views evidence and facts as “just another opinion”.

(4.2.3) Bean 2011

Bean also analyzed anti-vaccine content on the Internet. Similarly, it was found that anti-vaccine websites are plentiful. On such sites, safety and effectiveness of vaccines are denied, there is a focus on civil liberties and totalitarianism from government, there are alternative explanations for sickness and health and there is a large focus on conspiracy theories.

A new theme identified is an increase in anti-vaccine testimony that is alleged to be from physicians. This can persuade people who are otherwise uncertain or on the fence, since it brings in a supposed “expert view”. This is rather ironic, since the anti-vaccine movement is sceptical of authority but seems to embrace those expert and authority figures that supposedly agree with their point of view.

Bean argues that vaccine refusers are often well-meaning parents who want the best for their children, and who are confused by the anti-vaccine messages. Such people attach value to the opinions of their social group, those people with whom they share commitments. “The people they trust, naturally enough, tend to be the ones who share their worldview.” Thus, taking this argument Bean forwards, the healthcare provider who wishes to address concerns with the parent will need to be in a position of trust.

Secondly, Bean shows that anti-vaccine messages are typically in narrative form, with substantial emotive appeal. Such messages are compelling for emotional reasons. Merely trying to combat such messages through evidence is not enough. Bean suggests that narrative and emotive components also be incorporated in pro-vaccine messages. This would mean that sound scientific evidence be communicated in a way that is gripping and narratively interesting. As an

103 example, Bean mentions a video on the CDC parents’ portal, where parents have a conversation with a pediatrician regarding their vaccine fears.