Elsevier

Vaccine

Volume 30, Issue 25, 28 May 2012, Pages 3806-3812
Vaccine

Lessons from an online debate about measles–mumps–rubella (MMR) immunization

https://doi.org/10.1016/j.vaccine.2011.10.072Get rights and content

Abstract

Objective

To provide strategies for immunization advocates on how best to participate in online discussion forums about immunization.

Methods

Content and thematic analysis of an online discussion forum held following the national screening of a documentary about the measles-mumps-rubella (MMR) vaccine and autism scare. A subsample of branches containing more than 20 posts was analysed. Each distinct message (a “post”) was coded for the author's manifest position on immunization, author type, topic, and evidence presented or sought.

Results

From 103 distinct branches there were 1193 posts sent over a 3½ h period. We selected the 13 longest branches containing 466 posts from 166 individuals. One third of these individuals were explicitly critical of MMR immunization and one third sought information. The remainder were ambivalent but seeking no information (5%), supportive (14%), or unstated (15%). Among five author categories, only 4% identified themselves as health professionals. Topics included alleged adverse effects of immunization (35%); autism spectrum disorders treatment and causes (31%); vaccine ingredients (12%); a conspiracy (9%); immunization policies (8%); and measles, mumps or rubella (4%). Scientific concepts of evidence failed to compete with lay concepts and personal anecdotes prevailed.

Conclusions

Health professionals and other advocates of immunization should engage in similar types of post-broadcast online discussion forums in a planned and strategic manner that accounts for the decision processes of lay people. This involves expanding and diversifying the support base of people contributing to the forum; setting the agenda; introducing messages known to influence behaviour; not overselling vaccination; and avoiding personal attacks.

Highlights

► We analysed 466 posts to an online discussion about the MMR vaccine that followed a broadcast of a 2005 documentary regarding the discredited link to autism. ► The forum was dominated by debate about the safety of MMR between critics and advocates of vaccination. ► One third of authors of the posts sought more information but there were not enough health professional authors to address questions. ► Future forums following high profile documentaries about vaccine safety should involve strategic planning by vaccine advocates. This includes pro-active and respectful engagement to ensure that information-seeking parents have their needs met and their trust built.

Introduction

The online environment presents unprecedented challenges and opportunities for communicating about immunization. Individuals and groups with a wide range of views can communicate beliefs, experiences and information in multiple forums. Organised groups who are critical of immunization have been quick to capitalise on these environments and use social media to communicate their messages. Such groups are now active on Facebook, Twitter, MySpace [1], You Tube [2], message boards, and also have dedicated websites [3], [4], [5]. While opponents of immunization are limited in number, they are vocal and active. Many will actively engage in online comment forums to communicate their beliefs, sometimes in an organised fashion [6]. They express strong views against the safety and efficacy of vaccines and provide personal accounts their own children who they believe to have been sickened or disabled by a vaccine [3].

This paper analyses one such forum that was convened following the broadcast of a documentary about immunization [7]. In September 2005 a British documentary concerning a now discredited link between measles-mumps-rubella (MMR) vaccine and autism was broadcast on a prestigious Australian current affairs television program. Simply titled Does the MMR Jab Cause Autism? the documentary outlined Andrew Wakefield's hypothesis linking the MMR vaccine to autism [8]. This research has since been subject to allegations of fraud [9] and was retracted by the Lancet in 2010 [10]. However, at the time the MMR debate held currency in many public arenas. The documentary provided several narratives from parents who attributed their child's autism to MMR alongside experts in the area of vaccination stating that no causative effect had been proven.

At the conclusion of the documentary, viewers were invited to participate in an online forum hosted by a moderator and four invited panellists: an immunization expert; a developmental paediatrician specialising in the autism spectrum disorders; a director of an autism support group; and the president of a consumer activist group opposed to immunization. The response was intense, with the debate extending for over 3 h and featuring 1193 separate posts. While concerns about the perceived adverse effects of immunization remained pivotal, the issues covered were vast, ranging from neurotoxicity of mercury to the government's perceived assault on civil liberties through its coercive promotion of the immunization schedule. Arguments were presented and refuted; evidence sought and cited in multiple formats. It is this expression of evidence and the public's response to it that becomes crucial in understanding the public debate surrounding MMR and vaccines more generally.

By the time the program had screened, MMR immunization rates in England were just rising from a 2003 to 2004 low of 80% while in Australia they remained stable at 94% [11], [12]. Sensational media accounts of children affected by autism captured “the hearts and minds” of the public beyond the evidence offered by health experts and scientific studies [13].

A debate is an art of persuasion. It involves each opponent promoting the superiority of his or her position with various types of evidence. Medical professionals have traditionally dominated discussions about evidence in health. However, with the internet giving voice to wider publics, vaccine opponents have successfully appealed to notions of ‘evidence’ valued in the public domain, such as emotive testimonials and compelling trend observations. This paper attempts to examine the use of such evidence in the MMR–autism public debate. It outlines some distinctions between the kind of evidence shared among the medical community and that which may persuade the public of the so called dangers of immunization. The study involves descriptive coding of the forum's content, authorship and the kind of evidence presented. A thematic analysis then highlights the persuasive power of evidence presented. The intention was to develop an understanding of how epidemiological, scientific and anecdotal evidence interacted with, and shaped, ideas about the MMR vaccine and to provide recommendations for strategically responding to future online debates about safe and effective vaccines like MMR.

Section snippets

Methods

Permission to utilise the online forum for research purposes was gained from its host, the Australian Broadcasting Commission. As this was a publicly available online forum, consent of forum participants was not obtained. However, we have changed potentially identifiable names to pseudonyms. The 3½ h forum consisted of branches and posts. “Branches” refers to a conversation line initiated by an individual with a subject heading. “Posts” refers to a single item sent by an individual within an

Results

A total of 103 branches containing 1193 posts were identified. After excluding those which provided fewer than 20 posts (n = 90 branches) or technical messages from the moderator (n = 8 posts), 13 branches containing 466 posts were analysed (39% of total). The branches included a wide range of subjects including the availability of single vaccines, disputes about whether vaccines cause autism; child development; need for more research; and the causes of measles.

There were 166 contributors or

Discussion

The rapid rise of the internet, mobile technologies and social media raises challenges, in regard to the “well connected” generations of parents frequently accessing online content. The implications of this are poorly understood. Our study contributes an insight into how notions of evidence were contested by different parties to an online debate about MMR immunization. Proponents of each approach interacted, not only on the grounds of evidence, but also they disputed conventional definitions of

Resolve questions of whether to actively engage

There is often the dilemma about whether to respond in such forums, which are often monopolised by vocal opponents of immunization. Here the concern is that participation in the discussion legitimises and even amplifies anti-vaccine arguments. In this case, the forum followed a nationally screened documentary and 37% of posts were information-seeking. The absence of vaccine advocates might have created a void into which misinformation could dominate uncontested.

Prepare

Engage a group of vaccine

Conclusion

This forum provides an example of the challenges for immunization advocates in communicating in online environments. Andrew Wakefield's research created media attention and parental anxiety, some of which lingers today The paper examines some of the complexities of the ongoing immunization discourse and suggests that immunization debates be met in a strategic way, by recognising the appeals of various messages and mounting an appropriate, relevant and evidence-based response.

Acknowledgements

National Centre for Immunization Research and Surveillance is supported by the Australian Government Department of Health and Ageing, the NSW Department of Health and The Children's Hospital at Westmead.

Conflict of interest statement: Julie Leask has received support for research via an Australian Research Council Linkage Grant. Sanofi Pasteur are partner investigators in the grant. Some participants in the forum were known to Julie Leask and included three individuals with whom she has a

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    These authors contributed equally to this work.

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