A postmodern Pandora's box: Anti-vaccination misinformation on the Internet
Introduction
With morbidity and mortality from vaccine-preventable diseases [VPDs] having reached record lows [1], vaccines are one of the most successful tools for biomedical science and public health. Yet paradoxically, the effectiveness of vaccination has led to the re-emergence of anti-vaccination sentiments. Vaccines may be seen as unnecessary or dangerous because incidence rates of VPDs in developed countries have plummeted. Vaccine “reactions” – negative health events following vaccination, attributed to the vaccine – then appear to be more common than the diseases themselves [2]. In this way, vaccines can be considered victims of their own success.
The media plays a large role in disseminating and sensationalizing vaccine objections. Such objections are part of what has been called the “anti-vaccination movement”, which has had a demonstrable impact on vaccination policies, and individual and community health [3]. A common sequence to vaccination scares involves scientific debate about potential vaccine risks, which communication technology transmits via a rhetoric of doubt; parents incorporate this with personal experiences and spread their views to their social groups [4]. These social groups exert considerable pressure on vaccination decisions by creating a “local vaccination culture” [5]. With the prominence of the Internet in today's world, the attitudes, beliefs, and experiences of that local culture can quickly become global.
Internet usage statistics show approximately 74% of Americans and 72% of Canadians are online [6]. An estimated 75–80% of users search for health information online [7]. Of these users, 70% say the information they encounter online influences their treatment decisions [8]. In 2006, 16% of users searched online for information on immunizations or vaccinations [9]. While online research is more convenient and accessible than reading medical literature or visiting health practitioners, too great a reliance on Internet-based information can be problematic. Over half (52%) of users believe “almost all” or “most” information on health websites is credible [8]; yet the availability of inaccurate and deceptive information online has labelled the Internet a “modern Pandora's box” [10]. The nature of the Internet allows any and all opinions to spread widely and instantaneously. Individuals and groups gain exposure online without being filtered or reviewed – and anti-vaccination advocates have taken advantage of this fact. Anti-vaccination messages are more common on the Internet than in other forms of media, increasing the likelihood that vaccination decisions may be based on misleading information [11]. Indeed, parents who exempt children from vaccination are more likely to have obtained information from the Internet than parents who have their children vaccinated; they are also more likely to have used certain anti-vaccination websites [12]. This demonstrates the importance of understanding what messages are presented online and why they may be accepted.
The body of research examining online anti-vaccinationism is not large, nor has there been a recent update [11], [13], [14], [15], [16], [17], [18]. Only one analysis [13] examined misinformation and deception on such sites, but was not quantitative. Prior research also acknowledged the need to understand discourses underlying anti-vaccination arguments [19], [20], but did not elaborate upon them. This analysis aims to address these issues by answering two main questions. First, what information is proffered on anti-vaccination websites, and what is its accuracy? Second, what discourses make these vaccine objections appealing?
Section snippets
Data collection
Web searches were conducted on May 21, 2009 using the terms “vaccine”, “vaccination”, and “immunization OR immunisation” input into Google.com (the American version of the search engine) and Google.ca (the Canadian version). Google was chosen as it is the most popular search engine, accounting for 73% of all Internet searches [21]. Results were classified as anti-vaccination and included for content analysis if they opposed childhood vaccination for any reason, without meeting any of the
Proportion of anti-vaccination websites
The proportions of pro- and anti-vaccination sites found per search term are illustrated in Fig. 1. Overall, American searches returned more anti-vaccination results (24%) than Canadian searches (6%), indicating American parents are more likely to encounter anti-vaccination sites via Google than are Canadian parents. Neither search engine returned any anti-vaccination results for “immunization OR immunisation”; this was expected based on research that found anti-vaccination groups avoid using
Discussion
The websites examined demonstrated the use of numerous anti-vaccination themes. Of particular interest in this analysis was the use of misinformation, which had not been previously quantified. Every website save one contained arguments against vaccination that could be considered disingenuous. A proponent of vaccination would likely wish to counter with the “correct” information; indeed, the most commonly proposed intervention to combat vaccine misinformation is education. Using a vaccination
Conclusion
This analysis detailed the many arguments proffered on anti-vaccination websites. On such sites, misinformation was pervasive. While this may be considered the principle obstacle to vaccination, providing better education has not been effective. Many “hard-core activists” are not persuadable [15], no matter the amount of information provided. For this reason, more consideration must be given to the social discourses underlying anti-vaccinationism – reasons for refusing vaccines may involve
Acknowledgements
The author would like to thank Tina Moffat, Ann Herring, Tiffany Deschamps, Sonia Kata, Elizabeth Kata, and Julie Flaczynski for their input on earlier drafts of this article, as well as the anonymous reviewers for their comments.
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