persuasive speech vaccinations

Lessons learned: What makes vaccine messages persuasive

You’re reading Lessons Learned, which distills practical takeaways from standout campaigns and peer-reviewed research in health and science communication. Want more Lessons Learned? Subscribe to our Call to Action newsletter .

Vaccine hesitancy threatened public health’s response to the COVID-19 pandemic. Scientists at the University of Maryland recently reviewed 47 randomized controlled trials to determine how COVID-19 communications persuaded—or failed to persuade—people to take the vaccine. ( Health Communication , 2023 DOI: 10.1080/10410236.2023.2218145 ).

What they learned: Simply communicating about the vaccine’s safety or efficacy persuaded people to get vaccinated. Urging people to follow the lead of others, by highlighting how many millions were already vaccinated or even trying to induce embarrassment, was also persuasive.

Why it matters: Understanding which message strategies are likely to be persuasive is crucial.

➡️ Idea worth stealing: The authors found that a message’s source didn’t significantly influence its persuasiveness. But messages were more persuasive when source and receivers shared an identity, such as political affiliation.

What to watch: How other formats, such as interactive chatbots and videos, might influence persuasiveness. And whether message tailoring could persuade specific population subgroups.

News from the School

Red meat and diabetes

How for-profit medicine is harming health care

A tradition of mentoring

Promising HIV treatment

Share full article

Supported by

The Morning Newsletter

Vaccine Persuasion

Many vaccine skeptics have changed their minds.

By David Leonhardt

When the Kaiser Family Foundation conducted a poll at the start of the year and asked American adults whether they planned to get vaccinated, 23 percent said no.

But a significant portion of that group — about one quarter of it — has since decided to receive a shot. The Kaiser pollsters recently followed up and asked these converts what led them to change their minds . The answers are important, because they offer insight into how the millions of still unvaccinated Americans might be persuaded to get shots, too.

First, a little background: A few weeks ago, it seemed plausible that Covid-19 might be in permanent retreat, at least in communities with high vaccination rates. But the Delta variant has changed the situation. The number of cases is rising in all 50 states .

Although vaccinated people remain almost guaranteed to avoid serious symptoms, Delta has put the unvaccinated at greater risk of contracting the virus — and, by extension, of hospitalization and death. The Covid death rate in recent days has been significantly higher in states with low vaccination rates than in those with higher rates:

(For more detailed state-level charts, see this piece by my colleagues Lauren Leatherby and Amy Schoenfeld Walker. The same pattern is evident at the county level, as the health policy expert Charles Gaba has been explaining on Twitter.)

Nationwide, more than 99 percent of recent deaths have occurred among unvaccinated people, and more than 97 percent of recent hospitalizations have occurred among the unvaccinated, according to the C.D.C. “Look,” President Biden said on Friday, “the only pandemic we have is among the unvaccinated.”

We are having trouble retrieving the article content.

Please enable JavaScript in your browser settings.

Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.

Thank you for your patience while we verify access.

Already a subscriber? Log in .

Want all of The Times? Subscribe .

Here’s What Will Actually Convince People to Get Vaccinated

O ne of evolution’s cleverest tricks was giving us a sense of shame. It’s a miserable feeling—low, humbling, publicly discomfiting—but it’s supposed to be: if you do something lousy you ought to feel something lousy, so you don’t do it again.

In theory, when so many of the strategies for beating the COVID-19 pandemic depend on abiding by social distancing and other rules, shaming people who don’t ought to be a powerful way to bring us back in line. But increasingly, experts believe, the opposite is true. “The thinking has been that the more you shame people the more they will obey,” says Giovanni Travaglino, an assistant professor of social psychology at Kent University. “But this turns out to be absolutely wrong.”

Last month, Travaglino and Chanki Moon, an assistant professor of psychology at Leeds Beckett University, published a paper in Frontiers in Psychology that threw the ineffectiveness of shaming into relief. They assembled nearly 1,900 people from the U.S., Italy and South Korea—choosing those countries on the basis of their differing sense of the collective culture, with the U.S. judged the most individualistic, South Korea the most group-oriented and Italy in between. The subjects were asked to rate how ashamed or guilty they’d feel if they contracted COVID-19. They were also asked to rate how often they obey guidelines like social distancing and how likely they’d be to tell friends, acquaintances and health authorities if they tested positive. In all three countries, the higher the level of shame and guilt people felt over falling ill, the less likely they were to play it safe and to report their COVID-19 status.

In the U.S. and elsewhere, the antivaccine movement has long been a threat to public health, and many pro-vaccine messages have been designed to shame adherents. A December story in the U.K.’s Metro featured the headline “People think anti-vaxxers are ‘stupid and selfish.'” Attention-grabbing, maybe, but counterproductive. “It’s hard to get people to act in a cooperative manner when you approach them that way,” says Travaglino. “It’s associated with subordination to authority, and people don’t like that.”

A new TIME/Harris Poll survey similarly suggests individual authority figures aren’t very effective at convincing vaccine skeptics.

Of U.S. adults who had recently been vaccinated, only 32% said they were influenced by a local official reaching out directly via email, phone or mail. Much more effective, it seems, are appeals to people’s individual needs and desires. Some 52% of those polled said they got the vaccine because they wanted to travel, for example. The people around us also play a major role, with 56% of respondents saying they got vaccinated after a friend or family member did, and 59% saying they were influenced merely by having a conversation with such a closely connected person. And despite our ostensible mistrust in the media, 63% said they were influenced by news reports about people who had already been vaccinated.

Indeed, past research shows value in appealing to us through personal stories. In a 2015 study published in the PNAS , volunteers took a survey on their attitudes about vaccines and were then divided into three groups, each given one of three things to read: material showing that autism and vaccines are not related; a paragraph of a mother describing her child’s bout with measles; and material on an unrelated science topic. When the subjects took the vaccine survey again, all were more pro-vaccine than before, but the ones who read the mother’s account were dramatically more so, with an increase five times as great as that of the group that had read the material on autism and six times that of the control group.

Personal accounts can have a negative impact too. A new study published in PLOS ONE, by researchers from the University of Illinois and the Annenberg Public Policy Center, found that subjects who saw a video clip of Dr. Anthony Fauci talking about the safety and effectiveness of the measles vaccine came away from it more favorably disposed to vaccination overall. But the positive effect was diminished when they saw another video clip first, of a mother describing the severe rash one of her children developed after receiving the vaccine. The solution, the paper concluded, is not for the media to censor such accounts but to precede them with real-world data on the minimal risks and the considerable benefits of vaccines.

What doesn’t work, clearly, is pointing fingers and casting blame and shame. It’s the virus that’s the enemy, after all, not the people it infects.

More Must-Reads from TIME

The 100 Most Influential People in AI 2024
Inside the Rise of Bitcoin-Powered Pools and Bathhouses
How Nayib Bukele’s ‘Iron Fist’ Has Transformed El Salvador
What Makes a Friendship Last Forever?
Long COVID Looks Different in Kids
Your Questions About Early Voting , Answered
Column: Your Cynicism Isn’t Helping Anybody
The 32 Most Anticipated Books of Fall 2024

Write to Jeffrey Kluger at [email protected]

A business journal from the Wharton School of the University of Pennsylvania

Knowledge at Wharton Podcast

What will persuade people to take a vaccine, november 24, 2020 • 11 min listen.

Behavioral scientists at Wharton and Penn are studying the best communication strategies that nudge people into getting vaccinated for the flu, with implications for controlling the COVID-19 pandemic.

Wharton’s Katy Milkman talks with Wharton Business Daily on SiriusXM about a new study to find the most effective ways to persuade people to be vaccinated.

Vaccines are a powerful weapon in the fight against disease, but only if they are taken. A team of behavioral scientists at Wharton and Penn is studying the best methods of communication to persuade more people to get off the fence and into their doctor’s offices or local pharmacies to get vaccinated.

The Behavior Change for Good Initiative (BCFG) has partnered with Walmart to conduct the largest-ever study aimed at increasing vaccinations by examining what kinds of messages encourage compliance. Conceived in March, the study was originally designed for the 2020 flu season, just as the coronavirus pandemic was sweeping the country with exponential growth.

“We realized with the COVID-19 outbreak that there was a much bigger challenge we could try to help tackle,” BCFG co-director Katy Milkman said. “If we could use the opportunity of flu season to test what really encouraged vaccination in a way that might be portable to the COVID-19 vaccine, we could make a really big, positive impact. So, we scaled up our ambitions quite enormously.”

Milkman is a professor in Wharton’s operations, information and decisions department and holds a secondary appointment at Penn’s Perelman School of Medicine. She led the study along with Wharton professors Mitesh Patel and Angela Duckworth.

The scholars created a tournament, inviting over 125 world-renowned behavioral scientists on the BCFG scientific team to submit their best messaging strategies to nudge people from intention to action. The competition yielded 75 submissions, which were further narrowed to 37 fielded tests, and the results of the study will be finalized in a few weeks and released in late 2020 or early 2021. Milkman joined the Wharton Business Daily radio show on SiriusXM to discuss the study as the world anxiously awaits the release of a COVID-19 vaccine, which government officials said could happen as soon as mid-December . (Listen to the podcast at the top of this page.)

The Last Mile

There has always been reluctance around vaccines — a skepticism has been fueled in recent years by the anti-vaxxer movement that has spread through misinformation on social media. Some people are nervous about the safety and efficacy of three COVID-19 vaccines being produced by pharmaceutical companies Pfizer, Moderna and AstraZeneca because the government has fast-tracked approval. In an encouraging sign, monthly polls have shown an increase in Americans’ willingness to take a COVID-19 vaccine since September, although the numbers are still just below 60% and lower than they were last spring.

“What that means is that those people [are] interested in the vaccine at a high level, and they’re persuadable,” Milkman said. “They’re not strong anti-vaxxers, but they need to feel like it’s going to be safe. And if they’re not sure or they’re a little hesitant, we need to make it as easy as possible and as appealing as possible so that they do get the vaccine, so that we can achieve herd immunity.”

Milkman said many people have every intention of getting vaccinated, but they procrastinate or simply don’t follow through. Closing that gap between intention and action is key, and something Milkman has studied for years. She calls it “the last-mile problem,” a business term that refers to the final hurdle standing between consumers receiving products or services.

“We’re pretty convinced [a vaccine] is probably a good idea. We have a little hesitation. Hassle factors, or the sense that, ‘Oh, this is going to be kind of unpleasant,’ can get in the way if we don’t get the communications right,” Milkman said.

Getting the Message Just Right

A few of the messaging strategies in the study really stood out to Milkman. One was created by BCFG team member Gretchen Chapman , a psychology professor at Carnegie Mellon University who is also a member of the Penn Center for Health Incentives and Behavioral Economics.

In a previous study on flu shots, Chapman randomly assigned subjects to receive a message from their employers with information about a walk-in clinic and inviting them to book an appointment. Others received a message that their employers had already booked an appointment for them at a specific date and time, but it could be rescheduled.

“We’re going to need to understand what’s holding someone back, what sub-populations have different concerns, and try to tackle those things.” –Katy Milkman

The message with a specific appointment time “increased vaccination rates dramatically,” Milkman said, so Chapman tried a related approach in the BCFG study, letting people know that a vaccine had already been reserved for them specifically.

The BCFG study tested dozens of additional ideas designed by other team behavioral scientists including asking people to commit in advance to getting a vaccine, sending reminders to people minutes before they’d have a chance to get vaccinated, and asking participants to message their family and friends to get vaccinated.

“By essentially turning you into a proselytizer for the vaccine, it can change your own psychology and your own likelihood to go, as well as helping encourage your friends and family,” Milkman said.

The team even tried ramping up friendly competition between cities, like pushing Pennsylvanians to beat New Yorkers on vaccination rates, for example. The goal of so many different approaches is to find what works best for each group of consumers and tailor messages accordingly.

“We’re going to need to understand what’s holding someone back, what sub-populations have different concerns, and try to tackle those things,” Milkman said.

Scientists are charging ahead to make a COVID-19 vaccine available, working out the challenging logistics of wide-scale production and distribution. Milkman is hopeful that the work of the BCFG team will, in turn, help more people take the vaccine.

“Even if we get the supply chain issues right, even if we get every corner drugstore to someday be supplying these, we have to get them into arms in order for them to change the course of the pandemic,” she said. “And the messaging is going to be key to that.”

More From Knowledge at Wharton

Stacey Andrade-Wells, CMO of Liquid I.V.

CEO of Playa Hotels: Travelers Require Personalized Customer Service and Experiences

Jeanelle teves, chief commercial officer at bugaboo, looking for more insights.

Rhetorical Questions and Real Answers About Vaccination

Reflections on the third act of the pandemic: the jab.

Posted April 26, 2021 | Reviewed by Matt Huston

Decision making in the face of uncertainty is complex.
Using a risk-benefit framework is an effective means of making decisions in the face of uncertainty.
What we know so far about vaccination indicates that its benefits outweigh its risks.

I hope this will be my last post on the pandemic. Not because it is “over,” but because the advice I have to offer is unlikely to be updated beyond this reflection.

This weekend I got my second vaccine dose. I felt fine afterwards, and even got to work on addressing my “quarantine 15 (pounds)” with a run the next day. In a few weeks, I am looking forward to eating inside a restaurant for the first time in over a year. I will order an appetizer, wine, and dessert—and when I am done I will not have to wash the dishes. It will be decadent .

I joined about 3 million other Americans in getting a dose that day, including about 1.5 million getting their first dose. That over 40 percent of Americans have gotten at least one shot already, only four months since the first vaccine was approved, is a medical miracle. Why do I use such flowery language? Because of how confusing and frustrating the vaccine rollout has been. The media keeps reporting on “ softening demand ” for the vaccine, but let’s be real: There is a special breed of person who is willing to camp outside Best Buy starting at 3 a.m. the day after Thanksgiving to get a deal on a TV and deal with a mob, and then there is the vast majority of people who want a TV but don’t want to sleep on a sidewalk to get one.

Every state had to submit their own “plan” for how they were going to roll out the vaccine this fall, and in my estimation, those plans were graded on a “participation award” scale. At least here in Michigan , prior to the past 10 days, if you wanted to get a vaccine it meant checking multiple websites, multiple times a day, in hopes of finding an appointment. Most sites had no ability to be added to a waitlist. And when you did get an appointment, it meant driving a long distance—most people I know drove about an hour each way—to get the jab. I am not surprised that more Americans weren’t chomping at the bit to get into that circus.

Yes, there is about 20 percent of Americans who are pretty hesitant about vaccination (a group that spans the political spectrum ). If you are in that 20 percent, I encourage you to talk to people you trust—healthcare providers, pastors, family, and friends about those concerns. In the meantime, let me try to answer some of the (rhetorical) questions you may be asking yourself.

For example, if you feel that the vaccine was “rushed,” ask yourself: Under what circumstances would you feel that the vaccine pace was appropriate? That is, how long would it have taken for you to not feel it was “rushed?" One year? Two years? A decade?

If you don’t have a clear answer to that, then maybe your concern is really about the “emergency” nature of the FDA authorization. Do you have a clear idea of what “emergency” means in this situation? I certainly didn’t, but I looked it up and now I know that it means a) there is a serious health threat, b) there is a product that may be effective at addressing that threat, c) “the known and potential benefits of the product, when used to diagnose, prevent, or treat the identified disease or condition, outweigh the known and potential risks of the product,” and d) there is no alternative to address the threat. Seems reasonable, and I’m glad the FDA can grant such authorizations during crises like the one we are in now.

Still feeling unsure? Well, when the FDA approves the first vaccine fully (which will likely happen within the next month or so), will that convince you of its safety and efficacy? If not, why not? Does this mean you don’t trust the FDA as a whole? If so, why not?

I’m not an advocate of blind trust in any institution—government, private business, non-profits, etc.—but I am an advocate of realism. If there is literally no evidence that would convince you that the vaccine is safe and effective—that you are better off with it than without it—then your issue likely isn’t just with the vaccine, but with the entire practice of medicine and scientific research . That's a big pill to swallow (metaphorically, of course).

If you say you need “more data” to feel comfortable with the vaccine, ask yourself : How much data did you require the last time your doctor prescribed you antibiotics for an infection? Or advised you to start taking statins for your high cholesterol?

You can pore over the factsheets for these vaccines (akin to the advertisements for drugs you see in magazines), but if you are like me, the answer is "next to none," even though I have the quantitative chops to drill down into studies and data if I wanted to. That is, I trusted them that they had my best interest in mind when they gave me that advice or wrote me that prescription.

Do I read about the risks and benefits of any treatment I consider taking? Of course, and sometimes I even read the original studies. But do I demand evidence that does not and cannot yet exist—like, “Will the COVID vaccine protect me for more than six months? What if there are side effects from the vaccine that only emerge years later?”—when not enough time has passed for us to even begin to answer those questions? No.

Now, I understand why these questions feel compelling: they feel persuasive because the truth is “We don’t know...” But here’s the second half of that truth that I ask you to keep in mind: “...but what we know so far indicates that the benefits of vaccination far outweigh the risks.”

Every decision has risks and benefits—even the decision to not get vaccinated has the mental benefit of “ not being told what to do .” But that benefit won’t end the pandemic any sooner, it won’t reduce the risk of you inadvertently infecting your loved ones with the virus, it won’t comfort you if you are unlucky enough to get infected and require hospitalization (which will involve you being alone, with your family unable to visit you), and it won’t reduce your risk of dying from this virus to nearly zero. All of those are benefits that you can expect from vaccination .

If you don’t have a healthcare professional in your life that you trust, I suggest you fire the ones you have and find someone who works better for you—not just for the vaccine, but for all your healthcare needs. And by healthcare professional, I don’t mean a “wellness” coach or someone trying to sell you oils, crystals, or something else. I mean a person that you trust with your health, the most important asset you have.

People who have been through a health crisis—whether cancer, a stroke, a heart attack, or a serious accident—know the true value of that asset, how quickly it can shift from minor troubles to a life-threatening emergency, and how no one gets through that kind of crisis alone. And the same is true for this collective crisis.

Briana Mezuk, Ph.D. , is a Professor of Epidemiology and Director of the Center for Social Epidemiology and Population Health at the University of Michigan's School of Public Health.

Find a Therapist
Find a Treatment Center
Find a Psychiatrist
Find a Support Group
Find Online Therapy
United States
Brooklyn, NY
Chicago, IL
Houston, TX
Los Angeles, CA
New York, NY
Portland, OR
San Diego, CA
San Francisco, CA
Seattle, WA
Washington, DC
Asperger's
Bipolar Disorder
Chronic Pain
Eating Disorders
Passive Aggression
Personality
Goal Setting
Positive Psychology
Stopping Smoking
Low Sexual Desire
Relationships
Child Development
Self Tests NEW
Therapy Center
Diagnosis Dictionary
Types of Therapy

It’s increasingly common for someone to be diagnosed with a condition such as ADHD or autism as an adult. A diagnosis often brings relief, but it can also come with as many questions as answers.

Emotional Intelligence
Gaslighting
Affective Forecasting
Neuroscience

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Publications
Account settings
My Bibliography
Collections
Citation manager

Save citation to file

Email citation, add to collections.

Create a new collection
Add to an existing collection

Add to My Bibliography

Your saved search, create a file for external citation management software, your rss feed.

Search in PubMed
Search in NLM Catalog
Add to Search

Persuasive messaging to increase COVID-19 vaccine uptake intentions

Affiliations.

1 Yale Institute for Global Health, New Haven, CT, USA; Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA.
2 Institution for Social and Policy Studies, Yale University, New Haven, CT, USA; Center for the Study of American Politics, Yale University, New Haven, CT, USA.
3 Institution for Social and Policy Studies, Yale University, New Haven, CT, USA; Center for the Study of American Politics, Yale University, New Haven, CT, USA; Department of Political Science, Yale University, New Haven, CT, USA.
4 Yale Institute for Global Health, New Haven, CT, USA; Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA; Yale School of Nursing, West Haven, CT, USA.
5 Institution for Social and Policy Studies, Yale University, New Haven, CT, USA; Center for the Study of American Politics, Yale University, New Haven, CT, USA; Department of Political Science, Yale University, New Haven, CT, USA. Electronic address: [email protected].
PMID: 34774363
PMCID: PMC8531257
DOI: 10.1016/j.vaccine.2021.10.039

Widespread vaccination remains the best option for controlling the spread of COVID-19 and ending the pandemic. Despite the considerable disruption the virus has caused to people's lives, many people are still hesitant to receive a vaccine. Without high rates of uptake, however, the pandemic is likely to be prolonged. Here we use two survey experiments to study how persuasive messaging affects COVID-19 vaccine uptake intentions. In the first experiment, we test a large number of treatment messages. One subgroup of messages draws on the idea that mass vaccination is a collective action problem and highlighting the prosocial benefit of vaccination or the reputational costs that one might incur if one chooses not to vaccinate. Another subgroup of messages built on contemporary concerns about the pandemic, like issues of restricting personal freedom or economic security. We find that persuasive messaging that invokes prosocial vaccination and social image concerns is effective at increasing intended uptake and also the willingness to persuade others and judgments of non-vaccinators. We replicate this result on a nationally representative sample of Americans and observe that prosocial messaging is robust across subgroups, including those who are most hesitant about vaccines generally. The experiments demonstrate how persuasive messaging can induce individuals to be more likely to vaccinate and also create spillover effects to persuade others to do so as well. The first experiment in this study was registered at clinicaltrials.gov and can be found under the ID number NCT04460703 . This study was registered at Open Science Framework (OSF) at: https://osf.io/qu8nb/?view_only=82f06ecad77f4e54b02e8581a65047d7.

PubMed Disclaimer

Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Experiment 1. Messages that frame…

Experiment 1. Messages that frame vaccination as a cooperative action to protect others…

Experiment 2. The Not Bravery,…

Experiment 2. The Not Bravery, Community Interest, and Community Interest + Embarrassment messages…

Publication types

Search in MeSH

Associated data

Search in ClinicalTrials.gov

Related information

Grants and funding.

UL1 TR001863/TR/NCATS NIH HHS/United States

LinkOut - more resources

Full text sources.

Elsevier Science
Europe PubMed Central
PubMed Central
MedlinePlus Health Information
Citation Manager

NCBI Literature Resources

MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

View all journals
Explore content
About the journal
Publish with us
Sign up for alerts
26 October 2022

Mastering the art of persuasion during a pandemic

Elizabeth Svoboda 0

Elizabeth Svoboda is a science writer in San Jose, California.

You can also search for this author in PubMed Google Scholar

Credit: Sam Falconer

When Robb Willer looks back on the early days of the COVID-19 pandemic — when leaders still had a chance to stop the virus from bringing the world to a halt — there’s a fateful moment that stands out. In February 2020, global health authorities spoke in one voice, advising the public not to wear masks to prevent infection.

Access options

Access Nature and 54 other Nature Portfolio journals

Get Nature+, our best-value online-access subscription

24,99 € / 30 days

cancel any time

Subscribe to this journal

Receive 51 print issues and online access

185,98 € per year

only 3,65 € per issue

Rent or buy this article

Prices vary by article type

Prices may be subject to local taxes which are calculated during checkout

Nature 610 , S34-S36 (2022)

doi: https://doi.org/10.1038/d41586-022-03354-8

This article is part of Nature Outlook: Pandemic preparedness , an editorially independent supplement produced with the financial support of third parties. About this content .

Cure, L. & Van Enk, R. Am. J. Infect. Control 43 , 917–921 (2015).

Article PubMed Google Scholar

Milkman, K. L. et al. Proc. Natl Acad. Sci. USA 118 , e2101165118 (2021).

Law, A. C. et al. JAMA Intern Med. 182 , 235–237 (2022).

Brewer, N. T. et al. Lancet Reg. Health Am. 8 , 100205 (2022).

PubMed Google Scholar

Milkman, K. L. et al. Nature Hum. Behav . https://doi.org/10.1038/s41562-022-01437-0 (2022).

Article Google Scholar

Pfattheicher, S. et al. Psychol Sci. 31 , 1363–1373 (2020).

Galasso, V. et al. NBER Working Paper 29741 https://doi.org/10.3386/w29741 (2022).

Basol, M., Roozenbeek, J. & van der Linden, S. J. Cogn. 3 , 2 (2020).

Larsen, B. et al. NBER Working Paper 29896 https://doi.org/10.3386/w29896 (2022).

Barari, S. et al. Preprint at medRxiv https://doi.org/10.1101/2020.03.27.20042820 (2020).

Krpan, D. et al. Behav. Public Policy. 5 , 153–179 (2021).

COVID-19 National Preparedness Collaborators Lancet 399 , 1489–1512 (2022).

Download references

Sponsor feature: Enabling rapid responses to infectious diseases

Sponsor feature: How to build an mRNA arsenal for pandemic prevention

Public health
Human behaviour

Mpox is spreading rapidly. Here are the questions researchers are racing to answer

News Explainer 28 AUG 24

What accelerates brain ageing? This AI ‘brain clock’ points to answers

News 27 AUG 24

Mysterious Oropouche virus is spreading: what you should know

News Q&A 26 AUG 24

Energy storage overcapacity can cause power system instability and blackouts, too

Correspondence 10 SEP 24

Update regulator guidance to show that animal research really is no longer king

Europe sidelines Alzheimer’s drug: lessons must be learnt

World View 10 SEP 24

How ‘green’ electricity from wood harms the planet — and people

News Feature 20 AUG 24

The science of protests: how to shape public opinion and swing votes

News Feature 26 JUN 24

‘It can feel like there’s no way out’ — political scientists face pushback on their work

News Feature 19 JUN 24

Al Medical Engineering at School of Biomedical Engineering

Tsinghua BME offers faculty positions in the emerging research direction of AI Medical Engineering

Beijing, China

Tsinghua University

Assistant Professor in Forest Genetics

Assistant Professor position in Forest Genetics with focus on genetic biodiversity in relation to forestry at Umeå Plant Science Centre

Umeå (Kommun), Västerbotten (SE)

Swedish University of Agricultural Sciences (SLU)

Associate Professor/Professor (Tenure-Track) in Human Genetics [Req#: 810264]

Dallas, Texas (US)

The University of Texas Southwestern Medical Center (UT Southwestern Medical Center)

Southeast University Future Technology Institute Recruitment Notice

Professor openings in mechanical engineering, control science and engineering, and integrating emerging interdisciplinary majors

Nanjing, Jiangsu (CN)

Southeast University

Scripps Research Institute, Fellow Position, Fall 2025

Scripps Research Institute is seeking an outstanding candidate for the 2025 Fellow position in La Jolla, CA.

La Jolla, California

Scripps Research Institute

Quick links

Explore articles by subject
Guide to authors
Editorial policies

LISTEN: What does it take to persuade people to get vaccinated against COVID-19?

Kathleen mazor and kimberly fisher explain research into vaccine hesitancy.

By Sarah Willey and Bryan Goodchild

In a new Voices of UMass Chan podcast, two UMass Chan Medical School researchers who have been tracking vaccine acceptance since the COVID-19 pandemic share reliable advice based on their findings.

Vaccine hesitancy is, “a very, complex tangled problem,” said Kathleen Mazor, EdD, professor of medicine and associate director of the Meyers Primary Care Institute. “There are some people, however, who can be moved and influenced to get vaccinated.”

Dr. Mazor and colleague Kimberly Fisher, MD, associate professor of medicine, began conducting national surveys early in the pandemic to better understand the common reasons people will or will not get a COVID shot.

“The most common concern people have is that they’re worried it’s not going to be safe,” Dr. Fisher said.

Fisher and Mazor said people want to turn to an available, trusted voice for information and vaccine delivery.

“Among people who are hesitant to be vaccinated, they're more likely to want to be vaccinated in a doctor's office,” said Fisher. “We found that the people who received an explicit recommendation were much more likely to indicate that they would get vaccinated at that visit.”

To learn more about this research and advice on how anyone can address vaccine hesitancy among friends and family, listen to the Voices of UMass Chan podcast at: umassmed.edu/news/voices .

The Voices of UMass Chan podcast, formerly Voices of UMassMed, was renamed to reflect the Medical School’s name change in Sept. 2021 to UMass Chan Medical School following a $175 million philanthropic gift from The Morningside Foundation.

Related stories on UMassMed News: A direct recommendation from a doctor may help with vaccine hesitancy Researchers to study health care providers’ influence on COVID-19 vaccine acceptance UMass Medical School students to administer COVID-19 vaccinations for Worcester area UMMS researchers study attitudes toward potential COVID-19 vaccine

Academic Medicine
Acid Base, Electrolytes, Fluids
Allergy and Clinical Immunology
American Indian or Alaska Natives
Anesthesiology
Anticoagulation
Art and Images in Psychiatry
Artificial Intelligence
Assisted Reproduction
Bleeding and Transfusion
Caring for the Critically Ill Patient
Challenges in Clinical Electrocardiography
Climate and Health
Climate Change
Clinical Challenge
Clinical Decision Support
Clinical Implications of Basic Neuroscience
Clinical Pharmacy and Pharmacology
Complementary and Alternative Medicine
Consensus Statements
Coronavirus (COVID-19)
Critical Care Medicine
Cultural Competency
Dental Medicine
Dermatology
Diabetes and Endocrinology
Diagnostic Test Interpretation
Drug Development
Electronic Health Records
Emergency Medicine
End of Life, Hospice, Palliative Care
Environmental Health
Equity, Diversity, and Inclusion
Facial Plastic Surgery
Gastroenterology and Hepatology
Genetics and Genomics
Genomics and Precision Health
Global Health
Guide to Statistics and Methods
Hair Disorders
Health Care Delivery Models
Health Care Economics, Insurance, Payment
Health Care Quality
Health Care Reform
Health Care Safety
Health Care Workforce
Health Disparities
Health Inequities
Health Policy
Health Systems Science
History of Medicine
Hypertension
Images in Neurology
Implementation Science
Infectious Diseases
Innovations in Health Care Delivery
JAMA Infographic
Law and Medicine
Leading Change
Less is More
LGBTQIA Medicine
Lifestyle Behaviors
Medical Coding
Medical Devices and Equipment
Medical Education
Medical Education and Training
Medical Journals and Publishing
Mobile Health and Telemedicine
Narrative Medicine
Neuroscience and Psychiatry
Notable Notes
Nutrition, Obesity, Exercise
Obstetrics and Gynecology
Occupational Health
Ophthalmology
Orthopedics
Otolaryngology
Pain Medicine
Palliative Care
Pathology and Laboratory Medicine
Patient Care
Patient Information
Performance Improvement
Performance Measures
Perioperative Care and Consultation
Pharmacoeconomics
Pharmacoepidemiology
Pharmacogenetics
Pharmacy and Clinical Pharmacology
Physical Medicine and Rehabilitation
Physical Therapy
Physician Leadership
Population Health
Primary Care
Professional Well-being
Professionalism
Psychiatry and Behavioral Health
Public Health
Pulmonary Medicine
Regulatory Agencies
Reproductive Health
Research, Methods, Statistics
Resuscitation
Rheumatology
Risk Management
Scientific Discovery and the Future of Medicine
Shared Decision Making and Communication
Sleep Medicine
Sports Medicine
Stem Cell Transplantation
Substance Use and Addiction Medicine
Surgical Innovation
Surgical Pearls
Teachable Moment
Technology and Finance
The Art of JAMA
The Arts and Medicine
The Rational Clinical Examination
Tobacco and e-Cigarettes
Translational Medicine
Trauma and Injury
Treatment Adherence
Ultrasonography
Users' Guide to the Medical Literature
Vaccination
Venous Thromboembolism
Veterans Health
Women's Health
Workflow and Process
Wound Care, Infection, Healing
Download PDF
Share X Facebook Email LinkedIn
Permissions

Vaccine Misinformation and the First Amendment—The Price of Free Speech

1 Stanford Law School, Stanford, California
2 Department of Health Policy, Stanford University School of Medicine, Stanford, California
Viewpoint Public Health Messaging in an Era of Social Media Raina M. Merchant, MD, MSHP; Eugenia C. South, MD, MSHP; Nicole Lurie, MD, MSPH JAMA
Medical News & Perspectives When Physicians Spread Unscientific Information About COVID-19 Rita Rubin, MA JAMA
Viewpoint Reducing “COVID-19 Misinformation” While Preserving Free Speech William M. Sage, MD, JD; Y. Tony Yang, ScD, LLM, MPH JAMA
Viewpoint Government Role in Regulating Vaccine Misinformation on Social Media Platforms Y. Tony Yang, ScD, LLM, MPH; David A. Broniatowski, PhD; Dorit Rubinstein Reiss, PhD JAMA Pediatrics

During COVID-19, the public health toll of vaccine misinformation has risen from bothersome to titanic. As many as 12 million persons may have forgone COVID-19 vaccination in the US because of misinformation, resulting in an estimated 1200 excess hospitalizations and 300 deaths per day. If 5 fully loaded 747s crashed each week due to wrong information, regulators would be apoplectic.

Several other countries have criminalized the spread of vaccine misinformation. But because of the Supreme Court’s attachment to a particular conception of free speech rights, the thrust of the US government’s response is to disseminate accurate vaccine information and hope it corrects misconceptions. Although a few kinds of false statements lie outside the First Amendment’s protections, many others are considered protected speech. The Supreme Court recognizes that false speech can cause harm, but is more willing to abridge speech rights to avoid some kinds of harm than others. Legal scholars have long bemoaned the Supreme Court’s selective attention to harm avoidance, and the pandemic has exposed its public health consequences.

In a 2012 case invalidating a law that criminalized lying about receiving military medals, the Supreme Court refused to hold that false statements lie wholly outside First Amendment protection. The Supreme Court emphasized that false statements can have value; allowing widespread consensus to be challenged without fear of reprisal may facilitate truth discovery. 1

When a government-imposed restriction on misinformation is based on the content of the speech, courts will apply their most intensive level of review. The government must show that its restriction furthers a compelling government interest that a more narrowly tailored policy—one that burdens speech less—could not achieve as effectively. Allowable restrictions on false speech include bans on perjury, false statements to the government, impersonating government officials, commercial fraud, and defamation. These prohibitions “protect the integrity of Government processes,” preclude people from gaining material advantage through deceit, and prevent “tangible harm to others.” 1

Courts would certainly deem combating COVID-19 a compelling interest, and the government could readily demonstrate that vaccine misinformation harms its interest. The problem is that courts have proven too willing to endorse more narrowly tailored policy alternatives. Although in theory courts limit their review to “effective alternatives,” 1 in cases involving other important health matters, courts have suggested policies that public health experts would find laughable—for example, in lieu of restricting prescription drug sales representatives from promoting off-label uses , capping the number of off-label prescriptions a physician can write; instead of requiring that “crisis pregnancy centers” inform patients that the State of California offers low-cost family planning services, funding a public advertising campaign (something California had already tried).

Arguments that health officials could simply fight vaccine misinformation with “counter speech” would find favor, despite evidence that false beliefs arising from vaccine misinformation are extremely difficult to dislodge. 2 , 3 The volume of misinformation, its rapid spread through trusted social networks, and cognitive biases reinforcing preexisting beliefs all undercut the notion that the solution to false speech is more speech in this case.

Courts’ readiness to accept ineffectual policies when public health is at stake underscores that the scales are heavily tipped toward First Amendment rights. Yet, restricting false statements about health products in some contexts is permissible. For commercial speech (such as advertising), misleading statements enjoy no First Amendment protection. 4 The US Food and Drug Administration can act against companies that claim without sufficient evidence that their products help prevent or treat disease. The Federal Trade Commission and state attorneys general can bring civil and criminal actions against businesses that sell health products using deceptive advertising or fraudulent misrepresentations. There is also latitude for regulating professional speech: state medical licensing boards can suspend the licenses of physicians whose statements constitute unprofessional conduct, 5 and have done so occasionally when physicians have spread false information about COVID-19 vaccines and therapeutics.

Thus, the Supreme Court will allow the government to police false statements in some contexts regardless of how remote the risk of actual harm. But other falsities that can directly lead to serious harm enjoy legal protection. Although an advertisement from a health products company calling vaccines less safe and effective against COVID-19 than hydrogen peroxide is actionable, the same statement from a television news pundit is not. Moreover, noncommercial harms that the Supreme Court has allowed the government to prevent through speech restrictions—like ensuring that government processes function smoothly and a person’s reputation is not damaged by defamatory statements—pale compared with other harms arising from false speech, such as prolonging a pandemic.

Certainly, allowing the government to police false claims has real risks. Although some claims are demonstrably false, others are less so, and regulators may err in distinguishing among them. Especially in the scientific realm, the knowledge that makes statements demonstrably true or false evolves. In addition, some people who disseminate false statements know they are lies, whereas others believe they are true. Thus, there is a risk of suppressing speech that ultimately proves to be truthful, and of chilling discourse by making people worry about whether they can back up their claims.

But these problems also apply to areas where courts allow regulation of false statements. Lawmakers have found ways of addressing them, such as by requiring the government to prove certain things about the statement or the speaker’s state of mind. These measures could also be applied to vaccine misinformation.

If courts are concerned about disruption of government processes and tangible harm to individuals, they should recognize that vaccine misinformation causes both. Furthermore, if courts allow the government to restrict false speech to prevent economic harms such as being defrauded, should they not also allow speech restrictions to prevent loss of life? If officials may ban false advertising to prevent people from ingesting unsafe, unproven treatments, why can they not also ban false statements to prevent people from forgoing safe, proven vaccines?

At a minimum, courts ought to permit prohibitions on false information disseminated with reckless disregard for its falsity that materially influences people’s vaccination decisions. And yet, the current Supreme Court is unlikely to do so. The risks associated with allowing the government to suppress information about a contested scientific issue would be considered too great.

This leaves the government with anemic countermeasures for false speech about important health issues. It can continue to issue messages supporting vaccine safety and fund vaccine education initiatives. It can also continue to pressure social media platforms to do what the government itself cannot. 6 , 7 Because the First Amendment does not apply to private actors, digital media companies such as Facebook, Twitter, and Spotify have more latitude to restrict speech.

However, making corporations the primary bulwarks against vaccine misinformation is an unpromising public health strategy. Platforms have scant incentives to aggressively monitor vaccine-related speech, even if they could someday gain the technical capacity to do swiftly, at scale, with low error rates. 7 COVID-19 vaccine misinformation also spreads through television and radio outlets, which may be economically rewarded for spreading misinformation and appear disinclined to stop.

Vaccine misinformation during the COVID-19 pandemic underscores how reverence for freedom of speech in the US intensifies our vulnerability to public health threats. Given what we know about how vaccine misinformation influences vaccine acceptance and how intractable false beliefs are, this misinformation may be among the most significant barriers to controlling infectious disease in the 21st century.

Published: March 10, 2022. doi:10.1001/jamahealthforum.2022.0732

Corresponding Author: Michelle M. Mello, JD, PhD, MPhil, Stanford Law School and Department of Health Research and Policy, Stanford School of Medicine, 559 Nathan Abbott Way, Stanford, CA 94305 ( [email protected] ).

Conflict of Interest Disclosures: Dr Mello reported receiving personal fees for serving as an adviser to Verily Life Sciences LLC on a product designed to facilitate safe return to work and school during COVID-19, for serving as an expert witness on behalf of a generic pharmaceutical company in an antitrust lawsuit against other pharmaceutical manufacturers, and for serving as an expert witness on behalf of a health insurer in litigation against a brand-name drug manufacturer relating to off-label drug promotion.

See More About

Mello MM. Vaccine Misinformation and the First Amendment—The Price of Free Speech. JAMA Health Forum. 2022;3(3):e220732. doi:10.1001/jamahealthforum.2022.0732

Manage citations:

Artificial Intelligence Resource Center

Best of JAMA Network 2022

Browse and subscribe to JAMA Network podcasts!

Others Also Liked

Mobile Menu Overlay

The White House 1600 Pennsylvania Ave NW Washington, DC 20500

Remarks by President Biden on the COVID- ⁠ 19 Response and Vaccination Program

South Court Auditorium

1:41 P.M. EDT

THE PRESIDENT: Good afternoon. Today, the Vice President and I would like to lay out our plan for June, to counter — continue, I should say, our successful fight against the pandemic as we approach the July 4th date. In just four months, thanks to the American people, we have made incredible progress getting people vaccinated quickly, efficiently, and equitably. Nearly 170 million Americans of every party, every background, every walk of life have stepped up, rolled up their sleeves, and gotten the shot. Fifty-two percent of adults are now fully vaccinated, including seventy-five percent of all seniors. Twenty-eight states and the District of Columbia have achieved 50 percent of adults being fully vaccinated in their jurisdictions. And it’s clearer than ever: The more people we get vaccinated, the more success we’re going to have in our fight against this virus. Since January 20 — and we’re talking, now, about 15 [5] months — the average daily cases are down from 184,000 to 19,000, below 20,000 for the first time since March of 2020. Average hospitalizations are down from 117,000 to 21,000. Death rates are down over 85 percent. And this didn’t just happen by chance. We got to this moment because we took aggressive action from day one with a whole-of-government response. We used every lever at our disposal to get this done. We experienced the production and expanded it in a significant way: in lifesaving vaccines available for every single American. They’re available, and we knew that was the case months ago. We worked with cities and states to create over 80,000 vaccination sites. We deployed over 9,000 federal staff, including 5,100 active-duty troops to help get shots in arms. Now, as a result, we have built a world-class vaccination program. I promised you we’d marshal a wartime effort to defeat this virus, and that’s just what we’ve been doing. And now, tens of millions of Americans have been vaccinated. They’re able to return to closer to a — closer-to-normal life. Fully vaccinated people are safely shredding [shedding] their masks and greeting one another with a smile. Grandparents are hugging their grandkids again. Small-business owners are reopening storefronts and restaurants. Because of the vaccination strategy, our economic strategy, we’re — experienced the strongest economic recovery this country has seen in decades. There is a group called the Organization of Economic Co-operation and Development — OECD — which includes most of the world’s largest economies in its membership. They’ve been one of those leading bodies analyzing economic growth across — around the world for 60 years. Just this week, they increased their projection for the U.S. economic growth this year to 6.9 percent — 6.9 percent. That’s the fastest pace in nearly four decades. And that’s because of our vaccination program and our economic response, which, alone, are adding 3 to 4 percentage points to our growth; driving stronger growth not just there — not just this year, but in years to come. In fact, America is the only major country where global forecasters have actually increased their five-year forecasts for economic growth since January of 2020. And because of that, America is headed into the summer dramatically different from last year’s summer: a summer of freedom, a summer of joy, a summer of get-togethers and celebrations. An all-American summer that this country deserves after a long, long, dark winter that we’ve all endured. But what happens after the summer? The data could not be clearer: For all the progress we’re making as a country, if you are unvaccinated, you are still at risk of getting seriously ill or dying, or spreading disease to others, especially when Americans spend more time indoors again, closely gathered in the fall, as — and as we face the potential threat of a new, more dangerous variants. Even now, if you look at the areas of the country where vaccination rates are the highest, the death — the death rates are dramatically falling. They — the vaccines are effective; they’re effective against the variants currently circulating in the United States. On the other hand, COVID deaths are unchanged in many parts of our country that are lagging behind in vaccinations. And for young people who may think this doesn’t affect you, listen up, please: This virus, even a mild case, can be with you for months. It will impact on your social life. It could have long-term implications for your health that we don’t even know about yet or fully understand yet. It’s true that young people are much less likely to die from COVID. But if you do not get vaccinated, you could get COVID sooner or later. But you could get COVID still. A substantial percentage of people with COVID, even young people, will suffer illnesses, and some will have long-term health impacts as a consequence. If you’re thinking that the side effects from the shot are worse than the COVID, or that you can’t just take a chance, you are just dead wrong. Do it for yourself. Do it to protect those more vulnerable than you: your friends, you family, your community. You know, some people have questions about how quickly the vaccines were developed. They say they’ve been developed so quickly, they can’t be that good. Well, here’s what you need to know: Vaccines were developed over a decade of research in similar viruses, and they’ve gone through strict FDA clinical trials. The bottom line is this — I promise you: They are safe. They are safe. And even more importantly, they’re extremely effective. And if you’re vaccinated, you are protected. If you are not vaccinated, you are not protected. Places with high vaccination rates will also see fewer cases of COVID moving forward. Places with lower vaccination rates are going to see more. You know, we were elected to be President and Vice President for all Americans. And I don’t want to see the country that is already too divided become divided in a new way — between places where people live free from fear of COVID and places where, when the fall arrives, death and severe illnesses return. The vaccine is free, it’s safe, and it’s effective. Getting the vaccine is not a partisan act. The science was done under Democratic and Republican administrations. Matter of fact, the first vaccines were authorized under a Republican President and widely developed by a Democratic President — deployed by a Democratic President. All over the world, people are desperate to get a shot that every American can get at their neighborhood drug store at no cost, with no wait. Every American over 12 years of age — no matter where you live, what you believe, who you voted for — has the right to get vaccinated. It’s your choice. So, please, exercise your freedom, live without fear. We need to be one America, united — free from fear this fall. Now, how will we keep beating this virus as we enter — as we enter the fall after summer? On May 4, I asked Americans to come together to get 70 percent of adults with one shot by July 4th — 70 percent at least with one shot. To date, 12 states have already reached this important milestone. We expect — we expect more to make this milestone this week. Nationally, we are at 63 percent of adults with one shot. And we are getting closer, but we still have work to do. With 73 percent of Americans over the age of 40 with one shot, and as — we especially need people under 40 to step up. Over 40 is doing much better. That’s why, today, we’re announcing a month-long effort to pull all the stops — all the stops to free ourselves from this virus and get to 70 percent of adult Americans vaccinated. Now, I’m going to take everyone — you know, it’s going to take everyone — everyone — the federal government; the state governments; local, Tribal, and territorial governments; the private sector; and, most importantly, the American people — to get to the 70 percent mark so we can declare our independence from COVID-19 and free ourselves from the grip it has held over us — our lives for the better part of a year. Each of you has the power to help us gain this freedom as a nation. If you get a shot this week, you can be fully vaccinated by July 4th — by the week of July the 4th. And you can celebrate Independence Day free from fear or worry. This effort has five key parts. First, we’re making it easier than ever to get vaccinated. Ninety percent of you live within five miles of a vaccination site. The vaccinations are free, and most places allow walk-up vaccinations. No appointment needed. You can go to Vaccines.gov or text your ZIP Code to 438829 to get a text back with the places you can get a shot that are close by. And now, we’re going to make it even easier. In response to our call to action, businesses and organizations across the country have stepped up to help everyone get vaccinated. Starting next week, many vaccination sites will be offering extended hours during the month of June, including pharmacies that will be open 24 hours every Friday night — for 24 hours they’ll be open — this month. And if you’re too busy at work or school, you can get vaccinated around the clock on any Friday. Any Friday. For parents who haven’t been able to get the shot because they didn’t have the childcare: Starting today, KinderCare, Learning Care Group, the Bright Horizons, alongside with hundreds of YMC- loc- — YMCA locations, are going to offer free drop-in childcare while the parents are getting vaccinated. In addition, Uber and Lyft are both offering free rides to and from vaccination sites — vaccination centers. It’s easier than ever to get vaccinated. So, again, text 438829 to vi- — to find out what the nearest places you can get vaccinated are from where you — from where your ZIP Code. And visit pharmacies with an extended-hour and walk-up shots that are available. Free childcare, free rides, free shots. Second, we’re going to reduce [redouble] our outreach and public education efforts. We’re going to relaunch them, in effect. We’re going to launch a national vaccination tour to encourage people to take the shot. The Vice President is going to lead that tour across the South and the Midwest, where we still had millions of people to vaccinate. She’s going to be joined by Jill — by the First Lady and the Second Gentleman and Cabinet Secretaries along the way. In the spirit of meeting people where they are, we’ll also be working with the Black Coalition Against COVID and other organizations to launch a new initiative called “Shots at the Shop.” Barbershops, beauty shops are hubs of activity and information in Black and brown communities in particular, but in many communities across the nation. Local barbers, stylists, they become key advocates for vaccinations in their communities, offering information to customers, booking appointments for them, even using their own businesses as vaccination sites. We’re going to work with shops across the country to make an even bigger impact over the next month. We’ll also kick things off this weekend with a National Canvassing Weekend, where thousands of volunteers will be out knocking on doors and encourage their communities to get vaccinated. And mayors — mayors will be stepping up even more over the next month and partnering with us on the City Vaccination Challenge to see which city can grow its vaccination rate the fastest — the most — by July 4th. We need you to join these efforts. This is the kind of on-the-ground work that’s going to get the job done. Third, we’ll be increasing our work with employers — employers. A lot of working people are holding back because they’re concerned about losing pay if they take time off to get a shot, or if they don’t feel well the next day. I’ve said before: For small- and medium-sized employers, if you give people paid time off to get a shot, you’ll get a tax credit to cover that cost. Already, millions of workers across the country are eligible for paid time off and incentives from their employers. I’m asking all employers: Do the right thing. And we’re making it easy for employers to set up on-the-job vaccination clinics to make it even more convenient for their employees to get a shot. Fourth, we’re going to continue encouraging people to get vaccinated with incentives and fun rewards. The state of Ohio had a heck of a fun reward — a new millionaire last week — thanks to the creative idea of the governor for holding a vaccination — a vaccine lottery. The grocery store, Kroger, announced that they’re going to give away $1 million each week to someone who gets vaccinated at one of their pharmacies. The NBA, the NHL, NASCAR — NASCAR tracks — they’re offering vaccine- — vaccines outside playoff games and at races. Major League Baseball will be offering free tickets to people who get vaccinated at the ballpark. And to top it off, Anheuser-Busch announced that beer is on them on July the 4th. That’s right, get a shot and have a beer. Free beer for everyone 21 years or over to celebrate the independence from the virus. Fifth, and finally, we’re asking the American people to help. We need you. We need you to get your friends, family, neighbors, and coworkers vaccinated. Help them find an appointment. Drive them to the site. Talk to them about why you made the choice for yourself. So many Americans have already stepped up to help get their communities vaccinated. And over the next month, we’re going to need you more than ever. We need every American to commit to the five actions I’ve mentioned this month. Go to WeCanDoThis.HHS.gov — WeCanDoThis.HHS.gov — to sign up to volunteer and learn more about how you can help. Take at least five actions to help in June. And you might even be invited to visit us at the White House in July to celebrate independence together. I’ll close with this: We need everyone across the country to pull together to get us over the finish line. I promise you we can do this. Just look at what we’ve already done — we’ve already accomplished together in only four months. We know it for a fact: Americans could do anything when we do it together. So, please, do your part. Give it your all through July the 4th. Let’s reach our 70 percent goal. Let’s go into the summer freer and safer. Let’s celebrate a truly historic Independence Day. Thank you for listening. Please get engaged. May God bless you all, and may God protect our troops. Thank you. Q Mr. President, will you retaliate against Russia for this latest ransomware attack? THE PRESIDENT: We’re looking closely at that issue. Q Do you think Putin is testing you? THE PRESIDENT: No. 1:58 P.M. EDT

Stay Connected

We'll be in touch with the latest information on how President Biden and his administration are working for the American people, as well as ways you can get involved and help our country build back better.

Opt in to send and receive text messages from President Biden.

Essay Service Examples Health Vaccination

Why You Should Get Vaccinated Persuasive Essay

100 words essay on vaccination, 250 words essay on vaccination, 400 words essay on vaccination, 500 words essay on vaccination.

Proper editing and formatting
Free revision, title page, and bibliography
Flexible prices and money-back guarantee

Our writers will provide you with an essay sample written from scratch: any topic, any deadline, any instructions.

Cite this paper

Join our 150k of happy users

Get original paper written according to your instructions
Save time for what matters most

Fair Use Policy

EduBirdie considers academic integrity to be the essential part of the learning process and does not support any violation of the academic standards. Should you have any questions regarding our Fair Use Policy or become aware of any violations, please do not hesitate to contact us via [email protected].

We are here 24/7 to write your paper in as fast as 3 hours.

Provide your email, and we'll send you this sample!

By providing your email, you agree to our Terms & Conditions and Privacy Policy .

Say goodbye to copy-pasting!

Get custom-crafted papers for you.

Enter your email, and we'll promptly send you the full essay. No need to copy piece by piece. It's in your inbox!

Fact sheets
Facts in pictures
Publications
Questions and answers
Tools and toolkits
Endometriosis
Excessive heat
Mental disorders
Polycystic ovary syndrome
All countries
Eastern Mediterranean
South-East Asia
Western Pacific
Data by country
Country presence
Country strengthening
Country cooperation strategies
News releases
Feature stories
Press conferences
Commentaries
Photo library
Afghanistan
Cholera
Coronavirus disease (COVID-19)
Greater Horn of Africa
Israel and occupied Palestinian territory
Disease Outbreak News
Situation reports
Weekly Epidemiological Record
Surveillance
Health emergency appeal
International Health Regulations
Independent Oversight and Advisory Committee
Classifications
Data collections
Global Health Observatory
Global Health Estimates
Mortality Database
Sustainable Development Goals
Health Inequality Monitor
Global Progress
World Health Statistics
Partnerships
Committees and advisory groups
Collaborating centres
Technical teams
Organizational structure
Initiatives
General Programme of Work
WHO Academy
Investment in WHO
WHO Foundation
External audit
Financial statements
Internal audit and investigations
Programme Budget
Results reports
Governing bodies
World Health Assembly
Executive Board
Member States Portal
WHO Director-General /

WHO Director-General's opening remarks at the Vaccines and Global Health Symposium – 23 February 2021

Covid-19 vaccine development, strategy and implementation.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Publications
Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

Advanced Search
Journal List
J Med Internet Res
v.17(5); 2015 May

Vaccination Persuasion Online: A Qualitative Study of Two Provaccine and Two Vaccine-Skeptical Websites

Lenny grant.

1 Vaccination Research Group, Department of English, Virginia Tech, Blacksburg, VA, United States

Bernice L Hausman

Margaret cashion, nicholas lucchesi, kelsey patel, jonathan roberts.

Current concerns about vaccination resistance often cite the Internet as a source of vaccine controversy. Most academic studies of vaccine resistance online use quantitative methods to describe misinformation on vaccine-skeptical websites. Findings from these studies are useful for categorizing the generic features of these websites, but they do not provide insights into why these websites successfully persuade their viewers. To date, there have been few attempts to understand, qualitatively, the persuasive features of provaccine or vaccine-skeptical websites.

The purpose of this research was to examine the persuasive features of provaccine and vaccine-skeptical websites. The qualitative analysis was conducted to generate hypotheses concerning what features of these websites are persuasive to people seeking information about vaccination and vaccine-related practices.

This study employed a fully qualitative case study methodology that used the anthropological method of thick description to detail and carefully review the rhetorical features of 1 provaccine government website, 1 provaccine hospital website, 1 vaccine-skeptical information website focused on general vaccine safety, and 1 vaccine-skeptical website focused on a specific vaccine. The data gathered were organized into 5 domains: website ownership, visual and textual content, user experience, hyperlinking, and social interactivity.

The study found that the 2 provaccine websites analyzed functioned as encyclopedias of vaccine information. Both of the websites had relatively small digital ecologies because they only linked to government websites or websites that endorsed vaccination and evidence-based medicine. Neither of these websites offered visitors interactive features or made extensive use of the affordances of Web 2.0. The study also found that the 2 vaccine-skeptical websites had larger digital ecologies because they linked to a variety of vaccine-related websites, including government websites. They leveraged the affordances of Web 2.0 with their interactive features and digital media.

Conclusions

By employing a rhetorical framework, this study found that the provaccine websites analyzed concentrate on the accurate transmission of evidence-based scientific research about vaccines and government-endorsed vaccination-related practices, whereas the vaccine-skeptical websites focus on creating communities of people affected by vaccines and vaccine-related practices. From this personal framework, these websites then challenge the information presented in scientific literature and government documents. At the same time, the vaccine-skeptical websites in this study are repositories of vaccine information and vaccination-related resources. Future studies on vaccination and the Internet should take into consideration the rhetorical features of provaccine and vaccine-skeptical websites and further investigate the influence of Web 2.0 community-building features on people seeking information about vaccine-related practices.

Introduction

Current concerns about vaccination resistance often cite the Internet as a source of vaccine controversy. Despite the United States’ high vaccination rates among children and adults, physicians and researchers have perpetuated the belief that vaccine-skeptical websites contribute to lower levels of vaccination among children by effectively persuading parents against immunizing their children. Websites promoting vaccine-skeptical discourses are scrutinized routinely in the academic literature; however, the preponderance of this research aims at demonstrating that the information they circulate is inaccurate and deceptive to visitors seeking information on vaccines and vaccination-related practices. It is true that as a result of these studies, the medical community has gained a greater understanding of the types of information presented on vaccine-skeptical websites and deeper insights into how these websites deploy this information to make persuasive arguments against vaccines and vaccination. The majority of academic studies of vaccine-skeptical websites use quantitative methods to taxonomize arguments against vaccination on these websites. Although this information is useful for categorizing their generic features, it has not provided insights into why these websites successfully persuade their viewers.

To date, there has been no attempt to understand the qualitative features of vaccine-skeptical websites. The research presented in this paper attempts to fill this gap by employing a case study approach to a smaller number of websites than is typical of quantitative studies of vaccine skepticism on the Internet. In addition, this study examines both vaccine-skeptical and vaccine-promoting websites to compare the rhetorical features through which they attempt to reach their audiences. By deploying a qualitative methodology, researchers can better understand the rhetorical features of both types of websites. As a result of this study, we can better understand the specific mechanisms by which vaccine-skeptical organizations have been able to use the Internet to successfully spread their messages.

Literature Review

Since the United Kingdom passed the Vaccination Act of 1853, vaccine-skeptical groups have leveraged the available means of persuasion to voice their opposition to compulsory vaccination. Some groups resorted to public demonstrations, legal actions, and the occasional riot after the passage of the 1853 law, but others, such as the Anti-Compulsory Vaccination League, which formed in response to the 1867 Vaccination Act, found publishing their ideas in newsletters and journals to be a more effective means of responding to government vaccine mandates for children [ 1 ]. Other groups followed suit. The Anti-Vaccinator journal was founded in 1869 followed by the National Anti-Compulsory Vaccination Reporter in 1874 and the Vaccination Inquirer in 1879 [ 2 ]. After a smallpox epidemic in the 1870s, US vaccine-skeptical movements circulated pamphlets and journals in response to state attempts to pass new vaccine legislation or enforce extant laws. During the Progressive Era, regional antivaccination movements, such as the one in Portland, Oregon, assumed the political mantle of the populist democracy movement [ 3 ]. At that time, resistance to vaccination in the United States took 2 dominant forms: ordinary Americans who resisted compulsory vaccination and self-identified antivaccination activists who joined societies, wrote newsletters, and were largely middle class [ 4 ]. Political opposition to vaccine mandates and the circulation of populist information continued throughout the 20th century, although it changed as a result of the rapid development of many vaccines in the second half of the century.

In the late 20th century, the Internet transformed mass communication, affording its users new means of sharing information, forging interpersonal connections, and establishing association [ 5 - 8 ]. The relatively short history of the Internet can be divided into 2 epochs: Web 1.0, which emerged in the 1980s, and Web 2.0, which emerged in the mid-2000s. Web 1.0 is characterized by static webpages that display information [ 9 , 10 ] and text-based online virtual communities where users interact with one another on topics of mutual interest [ 6 , 8 , 11 ]. Web 1.0 also introduced hyperlinking, the now-familiar clicking process that redirects a Web user to another website. One static website could be hyperlinked to another for a myriad of rhetorical purposes, including demonstrating affinity, offering additional information, or leveraging another website’s credibility [ 7 ]. Web 2.0 is best characterized as a platform for Internet applications that afford users the ability to “harness collective intelligence” [ 9 ]. Web 2.0 permits users to generate and post their own content and comment on what others have shared [ 9 , 10 ]. One of its most defining characteristics is that it affords 2-way communication via social media, such as blogs, Facebook, Twitter, YouTube, and other websites. Where the static Web pages of Web 1.0 allowed unidirectional communication (a user reading text on a screen), Web 2.0 promotes interactivity between users who can easily respond to one another via text and images.

The Internet and Web 2.0 have changed the way that people access health information. Ordinary people have greater access to medical information [ 12 ] and online patient communities have organized on websites [ 13 ] and social media [ 14 ] to provide information and support for many diagnoses. Easy access to information has led to both self-diagnosis and self-doctoring [ 15 ]. According to Pew Research’s Health Online 2013 poll, 72% of Internet users surveyed looked for health information online and 35% opted to self-diagnose with Web-based information rather than visit a clinician [ 16 ]. It is estimated that 16% of those seeking online medical information searched for vaccination information, with 70% of this group stating that their findings influenced their vaccine decisions [ 17 ]. In addition to peer-reviewed medical information, Internet users also have access to health information generated by nonmedical practitioners, which has raised concerns about the quality of online medical information available on the Internet [ 18 ].

Online Vaccination Skepticism and Web 1.0

Current accounts of vaccine skepticism tend to identify its origins in the present period with the circulation of information on the Internet (eg, Kodish [ 19 ]). Although early proponents of the Internet saw its potential as a means of promoting democracy through the circulation of information [ 8 , 20 ], others viewed the Internet as a “Pandora’s box” of misinformation [ 21 ]. As Internet use proliferated at the end of the 20th and beginning of the 21st centuries, researchers began to pay attention to the World Wide Web as a site of information dissemination for vaccine skeptics. Many of these studies employed a Web 1.0 understanding of online communication even after Web 2.0′s social media paradigm was well in place (ie, they conceived the Internet as a repository of information and not a dynamic space were users interact with one another). The main objectives of these studies were to ascertain the philosophies of so-called antivaccination websites and point out the misleading or inaccurate information they circulated in cyberspace. A number of these studies created taxonomies or tried to identify specific features of the misunderstandings that these sites were thought to perpetuate. The article that best exemplifies this tendency is Jacobson et al [ 22 ], the title of which is indicative of the approach: “A Taxonomy of Reasoning Flaws in the Anti-Vaccine Movement.”

During this period, 2 studies about vaccination influenced by the Pandora’s box metaphor appeared in the pages of medical journals [ 23 , 24 ]. Taking as his exigence the concern that vaccine-skeptical groups were using the Internet to gain political momentum in the United States and Western Europe, Nasir [ 23 ] analyzed 51 websites that opposed routine childhood vaccination, addressing content, common themes, philosophy, links to other websites, and strategies to avoid routine immunization. Although the websites promoted a variety of philosophies, they exhibited some commonalities: they listed adverse effects of vaccines and presented themselves as unbiased toward vaccination [ 23 ]. Nasir found that clicking deeper into the websites revealed a strong bias against vaccines and vaccination and concluded that the availability of vaccine-skeptical information on the Internet is troublesome. Nasir expressed concern that Web surfers are ill equipped to assess its reliability, an argument that is nearly ubiquitous in subsequent studies of vaccine skepticism on the Internet [ 23 ].

Two years later, Davies et al [ 25 ] examined the content of 100 similar websites from a rhetorical perspective to better understand the social discourses in which vaccine-skeptical claims are embedded. Their rhetorical analysis revealed that vaccine-skeptical websites portrayed themselves as authorities on vaccination, appealed to viewers’ emotions through personal testimonies of vaccine injury and calls for parental responsibility, and maintained a discourse of truth seeking often advancing evidence of medical conspiracies bolstered by their own privileged information. Davies and colleagues caution medical practitioners from refuting vaccine-skeptical discourses based solely on “the facts,” suggesting instead that provaccination websites employ emotional counterappeals featuring “images and stories of children harmed by vaccine-preventable illnesses” [ 25 ].

Another study by Wolfe et al [ 26 ] made similar observations in its analyses of the content and design attributes of 22 vaccine-skeptical websites. From their content analyses, they found that all websites in their sample expressed “a variety of claims that are largely unsupported by peer-reviewed scientific literature,” including themes of concern about vaccine safety and efficacy, “governmental abuses” of civil liberties, and preferences for alternative (nonbiomedical) health practices. Their analyses of the websites’ design attributes resulted in a list of 10 common themes that, from a rhetorical perspective, conflate content (narratives of parents of vaccine-injured children), digital ecology (the content to which the website links), visual rhetoric (images of “scary needles” and “harmed children”), and commerce (solicitations of donations and merchandise for sale) [ 26 ]. The authors do note that defining what counts as content on a website is “a problem” [ 26 ]. Such a problem is likely to occur when websites are treated like pages in a book rather than interactive spaces where users connect to share experiences, expertise, and interpretations of information.

Online Vaccine Skepticism and Web 2.0

The ascendency of social media in the mid-2000s adds another layer of complexity to online vaccine discourses. The multimedia nature of Web 2.0 websites allows vaccine-skeptical groups a means of constructing more sophisticated arguments than a single medium could afford. One study notes that antivaccine movements are well versed in multimedia communication because the groups often are led by spokespersons who use a variety of media (eg, books, television appearances) to build their ethos (credibility) as whistleblowers [ 27 ]. Although researchers have created sophisticated taxonomies of static websites [ 22 , 28 , 29 ], the strategies they offer to counter vaccine-skeptical discourses either have not been adopted by provaccine websites or have not been effective in general. For instance, one strategy offered is mass education campaigns that share images and personal narratives of people affected by vaccine-preventable diseases, such as pertussis [ 28 ]. They also suggest communicating statistics that demonstrate how vaccine-preventable diseases increase as vaccination rates decline. Using scare tactics and arguing about facts has not proven to be an effective strategy for making vaccine-skeptical parents amenable to childhood vaccination [ 24 , 30 ]. One main reason is the social networking features of Web 2.0 [ 31 ] that transform static Web pages into information hubs where viewers can share personal experiences in the form of images and narrative to create or participate in a community with individuals who share their vaccination beliefs.

Web 2.0′s social networking capabilities have aided health communicators in targeting messages to specific audiences [ 32 ] and helped patients and medical practitioners to gather information about diseases and diagnoses [ 27 ]. Although social networking technologies make it easy for users to crowdsource information, there is widespread concern about the quality of the information that is circulated among users and the extent to which that information influences people’s decisions to vaccinate themselves [ 33 ] and their children [ 34 ]. As users grow more accustomed to Web 2.0 technologies, it becomes more difficult to impose the authority of establishment medicine on online discourse. Witteman and Zikmund-Fisher [ 35 ] suggest “in this Web environment, effective communication about vaccinations is not about controlling what is available but rather, it is about responding and participating in an interactive, user-responsive environment.” To this end, a growing number of studies attempt to understand the flow of information on specific Web 2.0 sites.

Research on vaccination and Web 2.0 suggests that websites featuring user-generated content are more likely to support vaccination viewpoints that counter or question medical science [ 36 ]. Venkatraman et al [ 36 ] found that websites that support greater freedom of speech (ie, the website’s content is not moderated, edited, or peer-reviewed), such as YouTube and Google, are more likely to contain antivaccination content than moderated websites such as Wikipedia and PubMed. Another study analyzed nearly 40,000 opinionated Twitter users’ posts about the H1N1 vaccine and found that more information was circulated among users who shared the same positive or negative sentiments about the vaccine [ 37 ], suggesting that social media is more of an echo chamber for circulating opinions among like minds than a means of randomly influencing less opinionated users. A study of 172 YouTube videos about the human papillomavirus (HPV) vaccines found that slightly more than half of the videos expressed explicitly negative sentiments about the vaccine and that negative videos garnered a higher number of average likes than videos endorsing the HPV vaccine [ 38 ]. Compared to previous studies of HPV vaccines on YouTube, which found that approximately one-quarter [ 39 ] to approximately one-third [ 40 ] of videos opposed the HPV vaccine, Briones et al’s [ 38 ] findings suggest that vaccine critics are more effective than vaccine promoters at using social media to communicate their messages. It is also worth noting that the shift from majority positive HPV vaccine sentiments to majority negative occurred in fewer than 5 years. The relatively short time span in which attitudes change also appears to be a feature of Web 2.0, where private and public discourses about vaccines can spread virally around the Internet [ 31 ].

In an effort to counter the rhetorical efficacy of online vaccine skepticism [ 25 ], provaccine researchers have developed a 2-pronged approach that is grounded in earlier Internet studies. It begins by first attributing contemporary vaccine skepticism to Wakefield et al’s [ 41 ] now discredited claim that the measles, mumps, and rubella (MMR) vaccine contributed to the development of autism in children and then calls for the medical community to do a better job of communicating accurate medical information about childhood vaccination [ 42 - 44 ]. This 2-step maneuver attempts to deny the premise of vaccine skepticism through a reductio ad absurdum argument and creates a space for new, more accurate facts to fill the social vacuum. This tactic seems logical to vaccine proponents, but it appears to be ineffective. Although some research suggests that psychological investments may be the cause of entrenchment in antivaccine positions [ 45 ], another reason may be that vaccine-skeptical discourses predate the Wakefield debacle [ 46 ]. After all, many 21st-century arguments against vaccines are rhetorically similar to discourses in the 19th and early 20th centuries [ 26 , 28 , 47 ].

Online Vaccination Skepticism and Postmodern Medicine

The strategy of correcting vaccine-skeptical beliefs appears to be based on a misreading of both the context of and reasons for those views. Public health attempts to correct so-called flawed reasoning are inadequate in the full context of vaccine skepticism in culture [ 48 , 49 ]. Hobson-West’s [ 30 ] study found that “vaccine-critical groups” tend to be differently oriented to issues of vaccination, with “radical” groups outright rejecting vaccine and “reformist” groups seeking changes to vaccination policy [ 30 ]. Both groups distrust provaccine discourses and policies and, as a result, they have reframed the notion of risk to be incommensurable with medicine’s traditional understanding [ 30 ]. Similarly, recent research suggests that corralling all discourse that does not promote vaccination under the big tent of the “antivaccination movement” collapses the variety of critical stances on vaccination [ 48 , 50 - 52 ]. Terms such as “vaccine selective” [ 50 ], “vaccine resistance” [ 51 ], and “vaccine hesitancy” [ 52 ] are used to reflect a spectrum of orientations rather than the catch-all “antivaccination.” We prefer the term “vaccine skeptical” because it denotes a variable attitude toward vaccines and vaccination versus a term, such as vaccine resistance, which forefronts an action taken against vaccines.

Beyond rejecting or reframing provaccine discourses, vaccine-skeptical websites do not subscribe to one notion of the truth; therefore, these websites’ adherents do not seem to be persuaded by claims that their beliefs are misinformed [ 45 ]. Under the current postmodern medical paradigm [ 53 ], doctors are no longer the sole arbiters of authoritative information about health and healing. The expectations that patients should inform themselves to take charge of their health decisions has resulted in “new priorities for health care” [ 54 ], such as medicine based on both social values and empirical evidence, an increased emphasis on the risks of treatment, and informed patients taking charge of their own health care decisions [ 53 ]. Kata [ 54 ] has articulated the relationship between postmodern medicine and Web 2.0 as one of flattened hierarchies where “infinite personal truths presented online are each portrayed as legitimate, thus supplanting the primacy of medical facts with a multiplicity of personal meanings and ways of knowing.” Thus, vaccine-skeptical groups appear to use the Internet to leverage postmodern notions of truth that are based on their own experiences with vaccines and their own understandings of medical science. Within the postmodern paradigm, the knowledge they generate and circulate online is not easily dismissible by attempts to better educate the public about vaccination.

Previous studies of vaccination information websites have taken objective approaches to locating websites via search engines. These methods included gathering and examining websites based on keyword searches. We opted for a fully qualitative case study methodology, choosing to carefully review the rhetorical features of 1 provaccine government website, 1 provaccine hospital website, 1 vaccine-skeptical information website, and 1 vaccine-skeptical website focused on a specific vaccine. The websites selected for analysis were the US Department of Health and Human Services (HHS) vaccine website Vaccines.gov [ 55 ], the Children’s Hospital of Philadelphia (CHOP) Vaccine Education Center (VEC) [ 56 ], National Vaccine Information Center (NVIC) [ 57 ], and SANE Vax, Inc [ 58 ], respectively.

Website Selection

The websites were chosen specifically for their representativeness of specific positions in the current vaccination controversy—their choice was deliberate, not random, to demonstrate proof of concept in this pilot study. Both the Vaccines.gov and VEC websites are targeted to the general public and meant to educate. They were chosen as the representative provaccine websites because they are the US federal government’s website for the education of its citizens and a hospital-based educational site developed overseen by one of the most prominent medical proponents of vaccination, Dr Paul A Offit [ 59 - 61 ]. The vaccine-skeptical websites included the most established vaccine-skeptical organization (NVIC) which began in the early 1980s as Dissatisfied Parents Together [ 57 ] and a newer organization targeting concerns about the HPV vaccine, SANE Vax. Opposition to the HPV vaccines Gardasil and Cervarix has coalesced around specific injury narratives [ 62 ], and SANE Vax is one of the prominent Web venues proffering a space for these discourses. Choosing these specific websites allowed us to focus on the specific rhetorical features of each website to determine if the provaccine and vaccine-skeptical sites differed in this regard.

Data Acquisition

To gather information from the websites, we adapted the qualitative research method of thick description to the online environment. Thick description requires the researcher to pay close attention to the contextual aspects of a research setting including minute details of the setting, the social events taking place therein, and the behaviors of the participants [ 63 ]. As a means of controlling data acquisition for consistency across the 4 websites, 5 categories of analysis were developed: information about the websites’ owners, the visual and textual content of websites, user experience, hyperlinking, and social interactivity within the website. Each of these categories corresponds to a different rhetorical element of effective communication with respect to the interactive nature of Web 2.0.

Digital Ecologies

Aristotelian rhetoric holds that 3 modes are necessary for persuasion to take place [ 64 ]. These features are ethos, pathos, and logos. Ethos refers to the character of the speaker who attempts to persuade an audience. Pathos is the manner in which the speaker appeals to the audience’s emotions. Logos refers to the types of information a speaker uses to make an argument. These modes linked to the 5 categories of analysis in the following way. The website’s ownership and hyperlinks to other websites determined its ethos. The visual and textual content was the website’s logos. Social interactivity and user experience lent to the website’s pathos. Taken together, these features contributed to the website’s rhetorical efficacy.

The theoretical framework that guided this study took these Aristotelian rhetorical elements as an analytical starting place. In the second half of the 20th century, rhetoricians came to understand that persuasion is situational [ 65 - 68 ]. Theorists first formulated the rhetorical situation as a response to a problem, or exigence, in the world that commanded a person to communicate to change it [ 65 ]. Yet despite the robust, multifactorial nature of theories of the rhetorical situation, such a framework cannot account for the fluidity of rhetoric in networked environments. To address this shortcoming and to create a notion of rhetoric that accounted for the interconnectedness of human communication and the viral circulation of information, Edbauer [ 69 ] developed the concept of rhetorical ecologies. In a rhetorical ecology, rhetoric is not limited to a taxonomy of tropes; instead, rhetorical ecologies enable the flow information from one part of an ecosystem, such as the Internet, to another.

Because the viral circulation of information is not bounded by specific media in Edbauer’s model, we followed the lead of scholars of digital rhetoric who examined ecologies in online spaces, such as websites and gaming platforms [ 70 , 71 ]. Throughout this paper, we employ the term “digital ecology” to mean the discursive connections created and propagated by a website. There are 2 benefits to using the term digital ecologies to refer to rhetorical ecologies within digital spaces. The first is that the term suggests the active engagement of readers of online discourse as well as underscoring the rhetorical nature of hyperlinking [ 72 ]. The second benefit of using a term such as ecology to describe online activity is that it recalls ecosystems in nature. A website, through its links to other websites and its interactive features, can be analyzed by its size (the number it links it contains) and its diversity (whether it is open to discourses from vantage points other than its own or closed to differing opinions). For Web 2.0, an ecological model addresses the fact that the quality of information alone is insufficient to persuade someone. Rather, persuasion is effected by the information, where it is found online, how the user interacts with that information, how that information interacts with other information, and the community surrounding it.

In considering these factors, this study also took the usability of vaccine websites into account. Usability studies are traditionally focused on making a product or application more functional for the end user [ 73 ]. When applied to online health information, a usability perspective can highlight the ways that Web design and content presentation can deny users access to information because a website is visually overwhelming, difficult to navigate, or written in such a way that it misses its target audience [ 74 , 75 ]. Although the prime objective of usability studies is ease of use [ 76 ], the straightforward transmission of information online has the potential to make Internet users “passive consumers of digital content” [ 77 ]. More recent studies of the usability of websites evaluated the usefulness [ 78 , 79 ] of websites based on the website’s ability to facilitate inquiry about the topic at hand, promote collaboration between the website’s users, and offer a multidimensional perspective that extends beyond the mere transmission of information. For the purpose of our study, we used the website usability guidelines available at Usability.gov [ 80 ] because it incorporated aspects of both ease of use and usefulness; in addition, it provided the guidelines that the federal government uses itself to evaluate website information and user experience.

Data Analysis

Data analysis was conducted by a team of 4 advanced undergraduate researchers, who participated in Virginia Tech’s Vaccination Research Group. Each researcher was assigned a website and asked to conduct 5 rounds of observation using the thick description criteria. After each round, the group convened to discuss the findings and develop an initial analysis. Through this iterative process, each researcher synthesized his or her findings into a preliminary report with brief conclusions. These reports were a starting point for the final analysis of each case as the primary author went back to each website to confirm the findings, deepen the interpretation, develop conclusions, and write the article.

The results are brief descriptions of the websites examined in our study. Websites are content-rich, interactive genres that do not easily lend themselves to concise textual description. Rather than offering in-depth descriptions of all aspects of each website, we present 4 case studies of the salient features of Vaccines.gov [ 55 ], VEC [ 56 ], NVIC [ 57 ], and SANE Vax [ 58 ].

Case Study 1: Vaccines.gov

The US federal government’s omnibus website, Vaccines.gov [ 55 ], bills itself as a “gateway” to information on vaccines and immunization for infants, children, teenagers, adults, and seniors” ( Figure 1 ) The HHS National Vaccine Program Office (NVPO) coordinates the website and its content, which is created by US federal agencies including the Food and Drug Administration (FDA), Health Resources and Services Administration, National Institutes of Health, HHS, and NVPO. The intended audience of Vaccines.gov is the US general public and, as per federal mandate, the website is designed to be accessible to individuals of varying levels of literacy and ability [ 81 ]. Although all information on the website is sanctioned by the US federal government, the website carries several disclaimers, stating that the “site is not intended to be a substitute for professional medical advice, diagnosis, or treatment” and advising viewers to seek the advice of physicians and qualified health care providers regarding any questions or health concerns they may have.

An external file that holds a picture, illustration, etc.
Object name is jmir_v17i5e133_fig1.jpg

Screenshot of the Vaccine.gov home page.

Vaccines.gov contains general information about vaccines and vaccination-related practices, as well as vaccine-specific information for 22 diseases. General information is listed under 2 separate tabs on the website’s toolbar. The “Basics” tab contains information on the safety of vaccines, the efficacy of vaccines, prevention of diseases, and community (or herd) immunity. The “Getting Vaccinated” tab contains information about what children and adults can expect during vaccination, an interactive section in which visitors can enter their zip codes to find providers of adult vaccines near them, an interactive map of the United States that links to each state’s department of health, and information on how to pay for vaccinations with the Affordable Care Act and the Centers for Disease Control’s (CDC) Vaccine for Children Program. There is also a separate “Travel” tab on the navigation bar with information that links to the CDC Travel Health site.

Vaccine-specific information is categorized under 2 tabs: “Diseases” and “Who and When.” Under the “Diseases” tab, 22 vaccine-preventable diseases are listed. Each disease has its own page, most with subsections with information about the disease, information on its respective vaccine, and a tab labeled “Take Action” that includes additional government information about the disease and resources for finding where to get vaccinated. The “Who and When” tab contains vaccination schedules for 7 specific populations: infants, children, and teens aged 0 to 18 years; the Catch-up Schedule for Children aged 4 months to 18 years; college and young adults aged 19 to 24 years; adults aged 19 and older; seniors aged 65 years and older; pregnant women; and persons with health conditions.

Vaccines.gov is predominantly text based and all information references either government or scientific literature. The website also includes a limited number of images, videos, spreadsheets, and an infographic. Images feature most prominently on the website’s landing page, where they serve to illustrate the seasonal content Vaccines.gov promotes. The videos embedded on its “Features: News & Video” page offer flu vaccine information targeted at a variety of audiences, such as cartoons about the flu shot for children and scientific simulations of how the disease spreads for adults. All 19 videos are produced by government agencies.

As a repository of US federal government vaccine information, Vaccines.gov links exclusively to federal and state government websites. Although hyperlinks are numerous, the website functions as a hub for vaccine information within a relatively small network of websites.

Vaccines.gov’s limited social interactivity mirrors the website’s small digital ecology. The website’s sole interactive feature is a checkbox at the bottom of each page that asks the user “Was this page helpful?” The results of these page-by-page surveys are not available on the website, so there is no means for a user to see the feedback left by others. Additionally, the website does not include any functions that would permit users to communicate directly or indirectly with one another.

Using the guidelines published on the US federal government’s encyclopedic usability website, Usability.gov [ 80 ], as a heuristic, Vaccines.gov is best characterized as a website that employs a subject organizational scheme that organizes its content according to a variety of topics while also supporting task-oriented navigation. Visually, the website is uncluttered and easily legible due to its predominantly black text on a white background.

Case Study 2: Children’s Hospital of Philadelphia Vaccine Education Center

The VEC website was launched by CHOP in 2000 to “provide accurate, comprehensive, and up-to-date information about vaccines and the diseases they prevent to parents and health care professionals” [ 32 ] ( Figure 2 ). The website’s main goal is to correct “misinformation” and “misconceptions” about vaccines and vaccination practices. The VEC is a member of the World Health Organization’s Vaccine Safety Net “because its website meets the criteria for credibility and content as defined by the Global Advisory Committee on Vaccine Safety” [ 56 ].

An external file that holds a picture, illustration, etc.
Object name is jmir_v17i5e133_fig2.jpg

Screenshot of the Vaccine Education Center home page.

On the “About” page, VEC discloses that funding for the website comes entirely from CHOP and not from “vaccine manufacturers.” Visitors have the option to donate to the CHOP Foundation via a button on the main CHOP website; however, there is no donation link displayed on the VEC website itself. Additionally, the “About” page provides short biographies of the “team of scientists, physicians, mothers, and fathers” who administer, advise, and staff the VEC. The website also carries the disclaimer that none of its information is intended to be patient-specific or replace the viewer’s relationship with a qualified health care professional.

The VEC website contains information on 21 individual vaccines and 9 combination vaccines. Information on each vaccine is accessible either through the website’s sidebar or through a cluster of buttons within body of the landing page. Clicking on the “A Look at Each Vaccine” button in either location directs the viewer to a page with specific information about the vaccine and its corresponding disease. The pages are structured in a question-and-answer format, with questions moving from generic inquiries about what the disease is and how it is contracted to more population-specific questions. For instance, clicking on “Anthrax Vaccine” displays the question “Why should military personnel be vaccinated?” Similarly, “Meningococcus Vaccine” contains information targeted at college students.

The VEC uses a variety of textual and visual genres to provide information to visitors. Its landing page features links to 2 videos about infant and childhood vaccination, as well as downloadable materials for parents and health care providers. In addition to information on each vaccine, the website’s sidebar offers many other resources including vaccine schedules and vaccine safety information. There are also other scientific resources under tabs labeled “Vaccines: Practical Considerations,” “Vaccine Science,” and “Rash Information.” Information on all these pages is accompanied by references to scientific publications. The “Vaccine-Related News” tab directs users to information and resources from the CDC. Other than images of the CHOP app, links to downloadable documents, and links to videos, only one static image is used throughout the website. The VEC banner features a tightly cropped headshot of a smiling girl accented by a pink background with stars.

All content on the VEC website is created by the organization, including links to scholarly and popular press publications by the VEC’s staff, and all pages within the website are reviewed and dated by the VEC director, Dr Paul A Offit. Although the vast majority of hyperlinks direct the viewer to content within the VEC website, there are external links to “Professional and Parent Groups,” “Resources for Kids and Teens,” and “Further Reading” on the “Additional Resources” page. There are also downloadable PDF versions of CHOP’s booklets, pamphlets, and other brief communications in both English and Spanish.

The VEC website does not offer users any means of interacting with one another within its pages. Each page on the VEC website contains links to CHOP’s Twitter, Facebook, and YouTube sites; however, the content of these pages informs visitors about CHOP in general and is not specific to the VEC.

Although there is no social networking capability on the VEC website, it does offer some Web 2.0 features, such as an email newsletter, games, and a mobile app. The mobile app, called “Vaccines on the Go: What You Need to Know,” is available on both iOS and Android platforms. In addition to content from the VEC website, it includes “[a] place to save questions for the next doctor’s visit” and gives users “[t]he opportunity to easily email the VEC for answers to vaccine-related questions.”

Much like Vaccines.gov [ 55 ], the VEC website employs a combination topic and task schema. The website is easily legible with its use of black text on a white background; soft accent colors indicate items that can be clicked for more information. Its streamlined design omits a navigation bar; therefore, more content appears on screen. Despite the lack of this typical feature, its sidebar-content-sidebar layout makes the site easily navigable. The website extends its utility through its numerous downloads, which can be read offline.

Case Study 3: National Vaccine Information Center

A nonprofit organization, NVIC describes itself as “the oldest and largest consumer-led organization advocating for the institution of vaccine safety and informed consent protections in the public health system” [ 57 ] ( Figure 3 ). NVIC states that its mission is to prevent vaccine-related injuries and deaths through public education and to promote informed consent in medicine. Additionally, NVIC funds research on vaccines and vaccination and “provides assistance to those who have suffered vaccine reactions.”

An external file that holds a picture, illustration, etc.
Object name is jmir_v17i5e133_fig3.jpg

Screenshot of the National Vaccine Information Center home page.

Barbara Loe Fisher, NVIC’s founder, has a significant presence on the website because the current organization grew out of her advocacy against childhood vaccines in the 1980s. Fisher’s commentary runs throughout the website and much of the site is dedicated to documenting her past and present advocacy efforts. Although her presence is ubiquitous on the website, NVIC includes graphical links to its 2 partner organizations: Mercola.com, a self-described natural health information website, and the United Way of the National Capital Area.

The landing page of the NVIC website is separated into 2 columns under a navigation bar. Atop the broad left column headed is a set of links imbedded in a rotating picture box displaying links to the website’s subsections and a right side bar with Breaking News. Current News fills up the lower left-hand side. Along the bottom of the banner at the top of the page, a series of navigation tabs lead the user into the site: “Home,” “About Us,” “Vaccines,” “Law and Policy,” “News and Events,” “Resources,” “Vaccine Reactions,” and “FAQs.” “Subscribe Now!,” “Donate Now!,” “PayPal Donation,” and “Volunteer Now!” buttons appear above and below the picture on the left side of the screen, next to links for Facebook, Twitter, and YouTube. The links embedded in the rotating picture box include “Ask 8 Questions,” “Diseases and Vaccines,” “State Vaccine Law,” “NVIC Advocacy Portal,” “Vaccine Ingredients,” “Injury Compensation,” “Informed Consent,” “Vaccine Victim Memorial,” and “Vaccine Freedom Wall.”

Although the group states on its “About Us” webpage that it “does not advocate for or against the use of vaccines,” the preponderance of the content on its website questions the safety and efficacy of vaccines and vaccination practices, such as the CDC childhood vaccination schedule. Visitors can also download informational pamphlets designed by the organization. The downloadable literature is targeted at parents and is designed to raise questions about current vaccination practices, with emphatic titles such as “49 DOSES OF 14 VACCINES BEFORE AGE 6? 69 DOSES OF 16 VACCINES BY AGE 18? Before you take the risk, find out what it is. ”

As an “information clearinghouse,” the NVIC website connects visitors to a diverse array of resources about vaccine safety, ranging from government agencies, such as the CDC and the Institute of Medicine, to news outlets that broadcast interviews with the group’s founder, Barbara Loe Fisher. It also provides links to vaccine advocacy events, such as Vaccine Awareness Week and antivaccination conferences.

The NVIC relies heavily on its social media outreach program, and much of its work is done through this outlet. Indeed, many of the sources on the traditional Web pages appear to be somewhat out of date, whereas its Facebook page is updated daily. In its 2011 Annual Report, NVIC states that “350,000 unique visitors accessed information on NVIC.org during FY2011,” [ 57 ], that the “Vaccine Ingredient Calculator (VIC) alone attracted more than 46,000 visits from users in 133 nations,” that its “online vaccine freedom wall saw an increase in reports of harassment by parents and health care professionals,” and that the NVIC’s “Facebook and social media outreach experience sustained growth in FY2011” [ 57 ]. Although NVIC’s traditional Web pages have as their purpose the dissemination of information about infectious disease and vaccination, the NVIC Facebook page contains posts about vaccination and other controversies in health, such as gluten allergy.

Although visitors to the NVIC website will find a great deal of governmental and scientific information on vaccines and vaccination, they are also faced with a vast number of resources that cast vaccines as dangerous. The landing page, as described previously, presents visitors with several types of information, which can make for less than straightforward navigation for the visitor seeking to learn more about a specific vaccine. The website is a repository for information on vaccine injury with links to state and federal legislation, such as the National Childhood Vaccine Injury Act of 1986, as well as links to agencies and groups that report and compensate vaccination injuries. To bolster its legitimacy, the website reflects the design choices typically employed on governmental and medical websites, replete with patriotic red, white, and blue accents on an easily legible white background, a layout resembling Vaccines.gov [ 55 ].

Case Study 4: SANE Vax, Inc

SANE Vax states that its mission is “to promote only safe, affordable, necessary, and effective vaccines and vaccination practices through education and information” [ 58 ] ( Figure 4 ). The nonprofit organization espouses a belief in science-based medicine and states that it offers information necessary for its visitors to make informed health decisions. Of its 5 board members, 2 state in their biographies that they are the parents of vaccine-injured children. SANE Vax presents itself as a grassroots organization in need of financial support to keep up with “popular demand” and solicits donations via a PayPal link on each page.

An external file that holds a picture, illustration, etc.
Object name is jmir_v17i5e133_fig4.jpg

Screenshot of the SANE Vax, Inc home page.

The majority of content on the SANE Vax website focuses on the dangers of the HPV vaccines Cervarix and Gardasil (sold in some countries as Silgard). The website’s landing page is divided into several sections corresponding to the group’s mission. Against a purple background, the upper half of the page features 2 columns: “Victims,” which is a series of short, clickable posts featuring images of vaccine-injured young women and their stories, and “SANE Vax Press Releases,” a list of position papers on vaccine policy last updated in 2011. Atop the press release column, a rotating picture box displays images of young women with narrative descriptions of their lives before and after they were vaccinated against HPV. Visitors can explore the webpage via 2 navigation bars that categorize its almost overwhelming amount of content into a series of blogs, resource pages, press release pages, and video pages. Additionally, a sidebar on the right side of the page solicits donations, displays “This Week’s Victim,” additional links to HPV-related groups, and a table listing data about HPV claims from the most recent report of the Vaccine Adverse Event Reporting System, a surveillance program sponsored by the CDC and FDA which permits anyone to submit an incident report about vaccine-related adverse effects.

There are several ways for visitors to access victims’ stories. For example, clicking on the “Victims” tab at the top of the page drops down a list of pages including a “Victims Memorial” dedicated to family remembrances of young women who died after receiving an HPV vaccine and a blog page where users submit stories about their family members who died after receiving an HPV vaccine. Most of the information on the website is text based; however, SANE Vax contains a great deal of images and videos that illustrate the stories of vaccine-injured young women. These stories tend to be narrated by family members who chronicle the young women’s healthy lives before they received the vaccination and their subsequent declines postvaccination. The text and video narratives almost always conclude by urging viewers to “investigate before you vaccinate.” The narratives are structured to juxtapose emotional appeals of vaccine injury with logical appeals to scientific research. By placing these 2 forms of persuasion side-by-side, SANE Vax achieves 2 rhetorical effects. First, it makes the argument that the scientific record is inaccurate because it omits information about vaccine injury and, second, it hopes that the viewer will place personal narratives on equal footing with scientific studies. SANE Vax’s postmodern understanding of scientific truth enables it to construct a broad digital ecology where personal truths, clinical truths, and scientific truths coexist. Although the website privileges vaccine-skeptical information, it provides a space where information can be produced and consumed in a fluid, nonhierarchical manner that, in turn, creates a more capacious understanding of vaccine and vaccine-related practices.

Like NVIC [ 57 ], SANE Vax supports a considerable digital ecology. The website links to a variety of advocacy groups, news websites, and government agencies. Keeping in-line with the website’s content, all the external information presented focuses on the dangers of vaccine and vaccination. This information comes from news reports and personal accounts from several continents giving SANE Vax a global reach, despite its status as a US nonprofit organization.

SANE Vax houses several blogs to which users can contribute after they register for a free membership to the website. The membership also permits users to upload their own text and video HPV vaccine injury narratives as well as comment others’ content. In this regard, SANE Vax creates an online community of users from around the world who share personal stories and opine about current vaccine policies.

Unlike the Vaccines.gov [ 55 ] and VEC [ 56 ] websites, SANE Vax attempts to use an exact organization scheme. According to Usability.gov, “exact organization schemes objectively divide information into mutually exclusive sections” [ 80 ]. One of the challenges this type of website organization poses to visitors of SANE Vax is that they are presented with numerous discrete categories of information on the website’s many dropdown menus. Visitors to the Vaccines.gov [ 55 ] and VEC [ 56 ] websites can access all the information about a specific disease and its vaccine with a single click, whereas visitors to the SANE Vax website are presented with information about HPV vaccines in numerous tabs and dropdown menus. The implications of this organization scheme are discussed subsequently in “User Experience.”

Each of the websites presented in this study offered information about its sponsoring organization. Only VEC [ 56 ] and SANE Vax [ 58 ] offered biographical information about the personnel affiliated with the website and the organization it represents. Vaccines.org [ 55 ] presented disclosures of the institutions that created the content displayed on the website. As a governmental entity, it is more interested in presenting the positions of government agencies than the backgrounds of individuals holding positions within those agencies. On the other hand, the NVIC [ 57 ] “About Us” page offered no biographical data about the organization’s founder, Barbara Loe Fisher. The only mention of Fisher in this section of the website was found in a list of Frequently Asked Questions: “How do I contact NVIC, Barbara Loe Fisher, or update my contact information with NVIC?” However, Fisher’s writings and videos are showcased throughout the website.

VEC and SANE Vax disclosed their affiliated personnel’s professional achievements and personal attachments, a feature that permits users to learn more about the people presenting them with information on vaccine and vaccination-related practices. This feature also allows the website’s visitors to assess the ethos of the organizations in light of the people who founded and work for it. Although such an omission of data on Vaccines.gov is understandable because it is a convention of government agency websites, it raises questions with regard to the NVIC website. The majority of the content on NVIC was dedicated to Fisher’s advocacy work. Omitting information about her role in the organization may appear to give NVIC an official, authoritative ethos, such as that of Vaccines.gov; however, it distances the organization from the actions and positions of its founder, a rhetorical maneuver that attempts to maintain the appearance of a balanced position on vaccines and vaccination that some viewers might question.

The Vaccines.gov and VEC websites were the only 2 that included disclaimers about the medical information they presented in their “About Us” sections (and in other parts of the websites). The disclaimers functioned in 3 rhetorical ways. First, the disclaimers underscored that the information presented was not a substitute for medical treatment and opinion. These websites endorsed vaccine and vaccination. Appealing to the authority of medical practitioners demonstrated that the content presented was aligned with best medical practices. It also assumed that medical practitioners endorse vaccine and vaccination. Second, the disclaimers offered visitors a means of finding further information in the form of a medical consultation specific to their health needs. Lastly, they signified that the information presented on the website was not monolithic despite the ethos of the organizations that presented it.

Textual and Visual Content

All the websites in this study presented findings from the scientific literature about vaccines and vaccination. The VEC [ 56 ] and Vaccines.gov [ 55 ] websites presented the scientific information either directly or in a synthesized form and offered no further commentary on it. Thus, the logos of VEC and Vaccines.gov relied on the straightforward distribution of scientific information and governmental policies. On the other hand, NVIC [ 57 ] and SANE Vax [ 58 ] tended to present scientific information indirectly and with commentary about its quality and the conflicts of interest of its authors. It was common to find allegations on these sites that research is sponsored by the pharmaceutical industry accompanying scientific data on vaccines and vaccination.

Both NVIC and SANE Vax constructed arguments in conjunction with the presentation of scientific information and government policy. These organizations created their logos through questioning, clarifying, and challenging scientific findings. Additionally, NVIC and SANE Vax promoted alternative scientific research that accorded with their vaccine-skeptical positions. These 2 organizations constructed their “watchdog” ethos through challenging scientific and governmental knowledge and, therefore, presented counterarguments in the form of differing scientific findings and opinions on vaccine and vaccination.

Visual content played a minor role on the VEC, Vaccines.gov, and NVIC websites. Because scientific information is disseminated in text form, these websites assumed the logos, or logical argument structure, of scientific medicine even when the mission was to challenge its findings. Text-based websites are easily skimmable and searchable, aiding visitors in finding the information they seek. The encyclopedic feel of these websites added to their ethos of reputable information providers.

SANE Vax was the only website in this study that presented large amounts of visual data to its viewers. Images are the currency of Web 2.0 because they can present a large amount of information in an efficient package. SANE Vax fused its logos with the pathos of emotionally charged images that display the dangers of HPV vaccine, effectively placing scientific logic on equal ground with the personal experiences of the lay visitors and thus building a community of lay experts sympathetic to vaccine injury. Its predominately text-based counterparts in this study tended to make assertions about vaccines and vaccination based on logic and scientific reasoning. SANE Vax subverted this way of understanding vaccines by linking the faces of human suffering to vaccine. This method of argumentation requires the viewer to construct meaning in a way that differs from reading text. Reading a video image calls on the viewer’s personal knowledge, in this case about the human body and illness, thus creating a relationship between the viewer and the image. Compared to text-based reading, reading images is a more intersubjective and affective experience that makes the viewer empathize with the suffering and loss illustrated in the images. Thus, SANE Vax used pathos to build its arguments against vaccination.

As a comparison, Vaccines.gov included a few videos, but those watched by the research group seemed overly scripted and unnatural, limiting their rhetorical efficacy. This rather amateur use of video seemed half-hearted in its attempt to respond to authentic viewer concerns, presenting instead its own version of those concerns in a way that rang false. Because the videos seemed like attempts to engage viewers but were experienced as inauthentic, they not only failed to convince viewers but also diminished the ethos of the website overall.

Hyperlinking

The hyperlinking feature of websites (eg, its digital ecology) describes its interconnectivity with other sites. Of the 4 case studies presented, Vaccines.gov [ 55 ] contained the fewest hyperlinks to other websites. The few websites to which it linked were government agencies. The other websites in this study had considerably larger digital ecologies because they linked to numerous other websites. VEC linked to other vaccine-promoting websites, where viewers could find additional resources on special topics, such as vaccines for tween girls, and products such as provaccination children’s books. Although VEC’s [ 56 ] digital ecology may be larger than Vaccine.gov’s, its overall ecology was somewhat closed because it omitted positions on vaccines that differed from its own.

Both NVIC [ 57 ] and SANE Vax [ 58 ] linked to websites that questioned vaccine and vaccination practices as well as vaccine-related medical journal articles and government websites. Viewers navigating these websites were exposed to a variety of resources and perspectives on vaccine. NVIC and SANE Vax adopted this logical strategy to familiarize viewers with the provaccine discourses they challenged. In turn, viewers learned argumentative strategies and counterpoints to challenge the messages of websites such as VEC and Vaccines.gov. Their rhetorical strategy for hyperlinking is to demonstrate that there are many available positions on vaccines and vaccination for viewers to take. Additionally, the hyperlinking strategy demonstrated that scientific and government information is open to interpretation. In this way, NVIC and SANE Vax acknowledged the breadth and diversity of thought on vaccines and vaccination on the Internet by representing and linking to a greater diversity of positions on the subject. That is, their rhetorical ecologies were open and diverse, encouraging a variety of viewpoints even as they focused more insistently on skeptical perspectives.

Social Interactivity

Each of the websites offered some kind of interactive feature for viewers. Vaccines.gov [ 55 ] offered viewers surveys at the bottom of each of its pages; however, it solicited feedback to make future design and content changes to its websites. This practice is typical of US government websites. VEC [ 56 ] offered a mobile app so that viewers could reference information from its website in a smartphone-friendly format, but it did not include any social networking functions. NVIC [ 57 ] and VEC [ 58 ] displayed links to their social media accounts, where users could interact with one another. SANE Vax was the only website that permitted users to contribute their own content to its website. The website also enabled users to comment on others’ content. Contributing and commenting are 2 key community-building functions of Web 2.0 websites. The lack of interactivity of the provaccine websites seems to fit with their hierarchical understanding of scientific authority about vaccines and vaccination. The vaccine-skeptical websites allowed for more interaction and, thus, engaged the viewer in the coconstruction of knowledge about vaccination, especially with the links to social media. The most vaccine-skeptical of the websites, SANE Vax, allowed the most user engagement with content creation on the website.

As a result, SANE Vax built and supported a community of lay experts who circulated alternative knowledge about vaccines. Instead of presenting peer-reviewed scientific literature, the website created a community of peers who could view and comment on one another’s narratives. Rather than reading information on vaccines, the community members shared their experiences with vaccines, adding another level of vaccine data that Vaccines.gov and VEC could not support with their Web architecture. On the other hand, Vaccines.gov and VEC directed users to seek personal support and information from medical practitioners. These differences in interactivity clearly affect user experience and help the vaccine-skeptical websites build loyal and engaged communities, whereas the provaccine websites merely exist as online information repositories. The NVIC website occupied a somewhat middle position in this regard.

User Experience

All 4 of the websites in this study presented themselves to their visitors as information resources. The organizational structure of Vaccines.org [ 55 ] and VEC [ 56 ] lent itself to targeted searches about specific vaccines and vaccination-related topics. Neither of these websites offered additional commentary about vaccines and vaccination outside the realms of science and government, nor did they offer news on current events pertaining to vaccines or vaccination.

NVIC [ 57 ] and SANE Vax [ 58 ] offered many types of information about vaccines and vaccination. As a result, the websites were more difficult to navigate and their overall purposes were more difficult to discern. The NVIC website was particularly interesting with regard to purpose because it presented a more neutral position concerning vaccination on its landing page than in the rest of the website. Navigating into the site revealed deeply antivaccination sentiments that were often presented through tautological citations and links to publications by Fisher and other prominent vaccine-skeptical figures (eg, Dr Mercola of Mercola.com).

As noted previously, SANE Vax used an exact organization scheme to organize its links and information. The exact organization scheme benefits visitors looking for specific information about political action groups, manufacturers of vaccines, and victims of Gardasil in different countries. Users seeking more general information were potentially overwhelmed with scientific and lay data on vaccines, vaccine news from governments around the world, and transmissions from the website’s staff. However, SANE Vax’s design reinforced the relationship between scientific and governmental literature and personal testimony that could be used for 2 purposes. A visitor interested in personal accounts of HPV vaccine injury would find that SANE Vax’s research blogs and analyses of scientific literature reinforced the video accounts, whereas a visitor researching vaccines would find that the testimonials provided additional information to bolster SANE Vax’s claims. Thus, despite the potential confusion, SANE Vax’s architecture reflected its 2 purposes, which were to show that there are vast bodies of knowledge (in the form of personal accounts of vaccine injury) that are suppressed in the scientific and governmental literature and to demonstrate that HPV vaccines are controversial and injurious around the world. By placing personal accounts on equal footing with scientific information, the website invited visitors to share their own personal experiences in a manner that the other websites did not.

The provaccine websites examined in this study do not leverage the affordances of Web 2.0. The primary purpose of Vaccines.gov [ 55 ] and VEC [ 56 ] is to transmit medical and government information to viewers who are seeking specific vaccine information. Although they incorporate different types of media, those media reinforce the information-driven purposes of the websites. The unidirectional transmission of information denies viewers the opportunity to share their experiences with vaccines or to challenge the information that is presented to them. Their rhetorical ecologies are closed rather than open. The content on Vaccines.gov and VEC is vetted by physicians and government workers, but neither website acknowledges the effect that the information and policies have on the lived experiences of those who visit the websites. This unidirectional flow of information is reinforced by both websites’ hyperlinking practices. Vaccines.gov only links to other government agencies; VEC only links to provaccine websites. This practice reinforces the websites’ positions on public health while denying that there are members of the public who do not subscribe to their provaccine stances. Of course, it is not in the interest of either website to acknowledge positions that challenge their own, which may explain why neither website permits visitors to comment publicly on the information they present.

By not including interactive or community-building features on their websites, both Vaccines.gov and VEC attempt to solidify their positions as authorities on vaccines and vaccination-related practices. The obverse side of this decision is that the websites foster an image of unsympathetic authoritarians who only care about well-being at the level of the public instead of at the level of the individual. In effect, individuals whose experiences differ from the health outcomes presented on these websites have no means of interacting with those who tout vaccines and mandate vaccination practices. It is clear that many of these individuals seek an online forum where their experiences can be publicly presented and validated by a receptive community. As stated previously, according to a Pew Research’s Health Online 2013 poll, 72% of Internet users surveyed looked for health information online and 35% opted to self-diagnose with Web-based information rather than visit a clinician [ 16 ]. Considering these statistics, the lack of interactivity on the Vaccines.gov and VEC websites may turn people who have had adverse experiences with vaccines into vaccine skeptics because the only online places where their alternative experiences will be acknowledged may be vaccine-skeptical websites.

Although the quality of online vaccination information is a constant concern for researchers and practitioners, both NVIC and SANE Vax demonstrate that studies conducted in the early 2000s are inaccurate in their claims that vaccine-skeptical websites misunderstand scientific information. Rather than circulating deliberate misunderstandings of medical research, both websites strip evidence-based scientific information of its authority by questioning its primacy and call for alternative scientific studies that are sympathetic to its claims. The websites substantiate their calls for alternative research by fostering a community of individuals whose experiences with vaccines counter the information transmitted by medical and governmental websites. Through the community-building functions of Web 2.0, they curate interactive accounts of vaccine injury and skepticism, thus providing a corpus of medical texts that adhere to a different standard for scientific information; that is, the personal experience of vaccination, a purview that is absent in the information offered by Vaccines.gov and VEC.

The research presented in this study is necessarily limited because it makes case studies of only 4 of the many vaccine-related websites on the World Wide Web. However, it presents an opportunity for future research on Internet vaccine information. By employing a rhetorical framework, this study found that both provaccine websites studied concentrate on the accurate transmission of evidence-based scientific research about vaccines and government-endorsed vaccination-related practices. On the other hand, the vaccine-skeptical websites investigated focus on creating communities of people affected by vaccines and vaccine-related practices. From this more personal framework (see also Lawrence et al [ 49 ]), the websites then challenge the information presented in scientific literature and government documents. At the same time, the vaccine-skeptical websites in this study are repositories of vaccine information and vaccination-related resources.

Future studies on vaccination and the Internet should take into consideration the rhetorical features of provaccine and vaccine-skeptical websites and further investigate the role of Web 2.0 community-building features on vaccine-related practices. More work needs to be done to determine if the findings of this small pilot study can be replicated across more provaccine and vaccine-skeptical websites; that is, whether the features identified here are generalizable.

Abbreviations

CDC	Centers for Disease Control
CHOP	Children’s Hospital of Philadelphia
FDA	Food and Drug Administration
HHS	Health and Human Services
HPV	human papillomavirus
MMR	measles, mumps, rubella
NVIC	National Vaccine Information Center
NVPO	National Vaccine Program Office
VEC	Vaccine Education Center
VIC	Vaccine Ingredient Calculator

Authors' Contributions: Lenny Grant is the primary author. Bernice Hausman is the second author. Margaret Cashion, Nicholas Lucchesi, Kelsey Patel, and Jonathan Roberts provided preliminary research for the study.

Conflicts of Interest: None declared.

IMAGES

Producing Prevention: How Vaccines Are Developed
Doctors Learn to Talk Vaccines
≫ Vaccinations: Are There any Real Benefits? Free Essay Sample on
📗 Paper Example. Speech over the Importance of Mandatory Vaccinations
A trusted voice on vaccinations
Vaccine Persuasion

VIDEO

Persuasive Speech
Persuasive Speech: Childhood Immunizations
Persuasive Speech- The Reason Mental Health is So Important
persuasive speech comm1103_RobertSnelson_WK3Assignment2
Persuasive Speech: Consider those with food allergies when flying
Persuasive Speech: People Should Prioritize Sleep

COMMENTS

Lessons learned: What makes vaccine messages persuasive
Vaccine hesitancy threatened public health's response to the COVID-19 pandemic. Scientists at the University of Maryland recently reviewed 47 randomized controlled trials to determine how COVID-19 communications persuaded—or failed to persuade—people to take the vaccine. (Health Communication, 2023 DOI: 10.1080/10410236.2023.2218145).
The 7 Best Tactics to Persuade the Vaccine-Hesitant
Helping to make the person's decision feel less forced upon them can actually make them more willing to get it! 3. Find a Common Enemy With the Person. Sometimes, there is no truer saying than ...
Vaccine Persuasion
Hearing pro-vaccine messages from doctors, friends and relatives. For many people who got vaccinated, messages from politicians, national experts and the mass media were persuasive.
Persuasive messaging to increase COVID-19 vaccine uptake intentions
Here we use two survey experiments to study how persuasive messaging affects COVID-19 vaccine uptake intentions. In the first experiment, we test a large number of treatment messages. One subgroup of messages draws on the idea that mass vaccination is a collective action problem and highlighting the prosocial benefit of vaccination or the ...
Here's What Will Actually Convince People to Get Vaccinated
Here's What Will Actually Convince People to Get Vaccinated
What Will Persuade People to Take a Vaccine?
A team of behavioral scientists at Wharton and Penn is studying the best methods of communication to persuade more people to get off the fence and into their doctor's offices or local pharmacies ...
Rhetorical Questions and Real Answers About Vaccination
Key points. Decision making in the face of uncertainty is complex. Using a risk-benefit framework is an effective means of making decisions in the face of uncertainty. What we know so far about ...
Persuasive messaging to increase COVID-19 vaccine uptake ...
Without high rates of uptake, however, the pandemic is likely to be prolonged. Here we use two survey experiments to study how persuasive messaging affects COVID-19 vaccine uptake intentions. In the first experiment, we test a large number of treatment messages. One subgroup of messages draws on the idea that mass vaccination is a collective ...
Mastering the art of persuasion during a pandemic
After the first COVID-19 vaccines were rolled out in the United States, local and state officials invested millions in the idea that waving money at people would convince them to get the jabs ...
Increasing trust and vaccine uptake: Offering invitational rhetoric as
Traditional persuasive responses to vaccine hesitancy in the past have included using fear-based messaging about the risks of not vaccinating ... went with a family was tied to whether or not they chose to vaccinate after I tried to give them my very convincing speech. So I would feel like the visit was a failure if they walked out of there ...
Examining persuasive message type to encourage staying at home during
Behavioral change is the only prevention against the COVID-19 pandemic until vaccines become available. This is the first study to examine the most persuasive message type in terms of narrator difference in encouraging people to stay at home during the COVID-19 pandemic and social lockdown.
LISTEN: What does it take to persuade people to get vaccinated against
In a new Voices of UMass Chan podcast, two UMass Chan Medical School researchers who have been tracking vaccine acceptance since the COVID-19 pandemic share reliable advice based on their findings.. Vaccine hesitancy is, "a very, complex tangled problem," said Kathleen Mazor, EdD, professor of medicine and associate director of the Meyers Primary Care Institute.
Vaccine Misinformation and the First Amendment—The Price of Free Speech
Vaccine misinformation during the COVID-19 pandemic underscores how reverence for freedom of speech in the US intensifies our vulnerability to public health threats. Given what we know about how vaccine misinformation influences vaccine acceptance and how intractable false beliefs are, this misinformation may be among the most significant ...
This simple text message can encourage people to get vaccinated ...
02:02 - Source: CNN. CNN —. A simple text message may be able to provide the nudge some people need to get vaccinated, researchers say. Researchers with the University of Pennsylvania found that ...
Remarks by President Biden on the COVID-19 Response and Vaccination
19 Response and Vaccination. Program. 1:41 P.M. EDT. THE PRESIDENT: Good afternoon. Today, the Vice President and I would like to lay out our plan for June, to counter — continue, I should say ...
Why You Should Get Vaccinated Persuasive Essay
Vaccination is one of the most effective public health measures, crucial in preventing infectious diseases and saving countless lives. The principle behind vaccination is to trigger an immune response by introducing a vaccine, which typically contains components resembling a disease-causing microorganism.
Persuasive Speech On Vaccinations
Persuasive Speech On Vaccinations. Decent Essays. 905 Words. 4 Pages. Open Document. Throughout history, the introduction of vaccinations in societies around the world have significantly reduced the threat of deadly viruses. Despite the many benefits of immunizations, some parents refuse to vaccinate their children due to the health risks ...
WHO Director-General's opening remarks at the Vaccines and Global
As you know, the first major speech I gave after my election as Director-General in 2017 was at the World Leaders Forum at Columbia, on the subject of health security. ... The West African Ebola outbreak gave rise to vaccines, but it also gave rise to WHO's Research and Development Blueprint for epidemics, a strategy to facilitate the rapid ...
Vaccine Persuasive Speech
Persuasive Speech On Mandatory Vaccinations For Children. Mandatory Vaccinations for Children This speech was delivered by U.S. Secretary of Health and Human Services, Sylvia Mathews Burwell, to Congress on December 4, 2015. She persuades the federal government to pass a bill of mandatory vaccinations for children.
Persuasive Speech Outline On Immunizations
Open Document. Persuasive Speech Outline. Immunizations. Specific Purpose: The specific purpose of my topic is to persuade my audience that immunizations are important and actually do more good than harm. Thesis: Immunizations are one of the most important medical advances in history. They have severely reduced the effects of dozens of viral ...
Vaccination Persuasion Online: A Qualitative Study of Two Provaccine
To date, there have been few attempts to understand, qualitatively, the persuasive features of provaccine or vaccine-skeptical websites. ... Venkatraman A, Garg N, Kumar N. Greater freedom of speech on Web 2.0 correlates with dominance of views linking vaccines to autism. Vaccine. 2015 Mar 17; 33 (12):1422-5. doi: ...
Persuasive Speech On Vaccination
Vaccinate Persuasive Letters. 265 Words | 2 Pages. Each year in the U.S., 50,000 adults die from a disease that could have easily been prevented if they simply got vaccinated. Also, most vaccines are for deadly diseases; if someone neglects getting vaccinated, that makes them very vulnerable.
Vaccination Persuasive Speech
Persuasive Speech On Vaccinations Throughout history, the introduction of vaccinations in societies around the world have significantly reduced the threat of deadly viruses. Despite the many benefits of immunizations, some parents refuse to vaccinate their children due to the health risks associated with them.