The relationship between vaccine hesitancy and health literacy in pregnant women: a cross-sectional study.

BACKGROUND: Pregnancy; It is an important process that directly affects the mother and the fetus, where women benefit more from health services and the need for health-related decision-making and information increases. It is very important to determine and improve the health literacy level of these women. The study determined the relationship between vaccine hesitancy and health literacy in pregnant women. METHODS: It is a cross-sectional type of research. The research was carried out in a state hospital. The online form was sent to 230 pregnant women. Ethics committee, institution and scale permissions were obtained for the study. The data of the study were collected online by using the questionnaire prepared by scanning the literature, the Anti-Vaccination Scale and the Health Literacy Scale. Statistical analyzes of the data were performed using the SPSS version 25 program. RESULTS: The Vaccine Hesitancy Scale score of the pregnant women was 55.53 ± 10.15, whereas their Health Literacy Scale score was 98.57 ± 21.48. Health literacy was associated with the sociodemographic and obstetric characteristics of the pregnant women. Educational status, economic status, place of residence, and family structure were associated with vaccine hesitancy. CONCLUSIONS: It was determined that there was a negative correlation between the anti-vaccination scale scores of the pregnant women and the health literacy scale scores. As a result, it was determined that the anti-vaccination level of the pregnant women was moderate and the health literacy level was sufficient. It can be recommended to provide appropriate trainings and counseling to target groups, which will increase the health literacy level of pregnant women.

Conservatism, anti-vaccination attitudes, and intellectual humility: examining their associations through a social judgment theory framework.

Previous research has consistently found that more political conservatism is related to higher anti-vaccination attitudes. However, little work has investigated how intellectual humility could potentially contribute to this relationship. Employing the social judgment theory of attitude change, we examined whether conservatism could mediate the association between intellectual humility and anti-vaccination attitudes. Participants (N = 1,293; 40.1% female; Mage = 38.23 years, SDage = 11.61, range of age was 18-78) completed a multifaceted measure of intellectual humility, an assessment of four types of anti-vaccination attitudes, and a measure of political orientation. Results from structural equation modeling revealed that decreased levels of most aspects of intellectual humility (i.e., independence of intellect and ego, openness to revising one's viewpoint, and lack of intellectual overconfidence) are associated with more conservative political views, which in turn is associated with stronger anti-vaccination attitudes, particularly worries about unforeseen future effects, concerns about commercial profiteering, and preference for natural immunity. These findings suggest that intellectual humility could reflect one's latitude widths, thereby predicting their openness to vaccine massaging, and thus may play an important role in addressing anti-vaccination attitudes, especially when politics is involved.

Psychological and Social Aspects of Vaccination Hesitancy-Implications for Travel Medicine in the Aftermath of the COVID-19 Crisis: A Narrative Review.

Vaccines are an important tool of preventive medicine. Although organized vaccination programs have saved large populations from serious infectious diseases, there is a considerable part of the population who oppose vaccinations. In particular, anti-vaccination perceptions, among travelers to countries with endemic diseases, are a major public health concern. Although hesitancy towards vaccinations is not a novel phenomenon, it came back to the forefront during the fight against the COVID-19 pandemic. This review explores the etiology of anti-vaccination beliefs among travelers and draws conclusions about their impact on public health and society in general. For this purpose, a purposeful search for data on the causative factors of vaccine hesitancy and their impact on people's health was conducted. A descriptive analysis of the findings and conclusions regarding possible implications in health policy and clinical practice are presented. A fear of side effects, lack of credence in the necessity of vaccines, and mistrust of medical authorities are important causative factors. Their interplay shapes hesitancy towards vaccines. However, anti-vaccination beliefs can also be an aspect of a more general unconventional stance of life. Health care professionals and organizations must be ready to tackle vaccine hesitancy by making the necessary interventions. Correcting misconceptions about vaccinations is a prerequisite for ensuring personal and public health, especially in the context of a pandemic or epidemic. Moreover, ensuring the efficacy and safety of vaccines, especially in cases of modern technology applications, is a fundamental factor in addressing people's concerns about vaccines. For this purpose, medical authorities and organizations must provide accurate and clear information on vaccines so as to eliminate misinformation. Furthermore, clinicians should cultivate their communication skills in order to convey the appropriate messages to prospective recipients of vaccinations.

[Public Resistance to Vaccination During Epidemics: The Example of COVID-19Resistência da população à vacinação em tempos de epidemias: sobre a COVID-19]. / Resistencia de la población hacia la vacunación en época de epidemias: a propósito de la COVID-19.

Objective: This article presents the findings of a review of the literature on public resistance to vaccines and the main factors that have influenced their decisions about immunoprevention, with a focus on the COVID-19 pandemic. Methods: We searched the literature using the terms DeCs/MeSH, anti-vaccination movement, vaccination refusal, epidemics, COVID-19, and impacts on health, using the Boolean operators OR and AND in Google Scholar, Medline, Lilacs, and Ibecs. Documents from official sources were also considered. Results: Throughout history, since vaccination began, people have had controversial perceptions of the procedure: some accept what the health authorities recommend, and others allege hidden intentions behind immunization. The COVID-19 vaccine against SARS-CoV-2 has been no exception. Conclusions: Vaccination has been one of the greatest scientific achievements in public health. However, despite its benefits, it has raised fear, uncertainty, and suspicion in the population. For this reason, it is important to increase health education actions in the population-with clear, concise, understandable information that is based on reliable and truthful sources-in order to reduce resistance to vaccination and address preventable diseases.

Objetivo: Este artigo busca apresentar os achados de uma revisão da literatura sobre a resistência da população às vacinas e os principais motivos que influenciaram suas decisões em relação à imunoprevenção, com foco na pandemia de COVID-19. Métodos: Foi realizada uma busca na literatura utilizando os termos DeCs/MeSH anti-vaccination movement, vaccination refusal, epidemics, COVID-19 e impacts on health, relacionados entre si pelos operadores booleanos OR e AND, no Google Scholar, MEDLINE, LILACS e IBECS. Documentos de fontes oficiais também foram levados em consideração. Resultados: Ao longo da história, desde o início da vacinação, a percepção das pessoas em relação a esse procedimento foi controversa. Há quem aceite o que as autoridades de saúde recomendam e quem alegue intenções ocultas por trás da imunização. A vacina contra o SARS-CoV-2, que causa a COVID-19, não foi exceção. Conclusões: A vacinação tem sido uma das maiores conquistas científicas em termos de saúde pública ­ um avanço que, apesar de seus benefícios, tem causado medo, incerteza e desconfiança na população. Por isso, é importante aumentar as ações de educação em saúde para a população, com informações claras, concisas e compreensíveis, baseadas em fontes confiáveis e verídicas, a fim de diminuir a resistência à vacinação e evitar doenças preveníveis.

A systematic review to determine the anti-vaccination thoughts of pregnant women and the reasons for not getting vaccinated.

The aim of this study was to determine the anti-vaccination thoughts of pregnant women and the reasons for not getting vaccinated. In this study, data was obtained by retrospectively scanning the cross-sectional and qualitative studies published in the databases of 'PubMed, Cochrane, EBSCOhost, ULAKBIM and Google Scholar' in Turkish and English languages between 2011-2021. The PRISMA method was used in the preparation of the systematic review. In the studies reviewed, it was determined that the rate of pregnant women who were against the vaccine ranged from 6.2% to 98.6%, and the opinions of pregnant women against vaccination and the reasons for not getting vaccinated are presented under seven themes. The results of the study were considered important in terms of showing that quality and important studies were carried out in the literature on the subject and that the data were presented.IMPACT STATEMENTWhat is already known on this subject? Today, with the global coronavirus pandemic, vaccines and their effects are on the agenda again. Especially in pregnant women, opposition to vaccination and not getting vaccinated have emerged for various reasons.What do the results of this study add? The anti-vaccine thoughts of the pregnant women and the reasons for not getting vaccinated were mostly as follows: insufficient level of knowledge, mistrust of vaccines, perception of low infection risk, misconceptions and beliefs about the safety, content, side effects and efficacy of vaccines, worry and fear about the side effects of vaccines, the thought that the vaccine will harm herself and the baby, causes arising from healthcare professionals, financial, temporal and logistical barriers.What the implications are of these findings for clinical practice and/or further research? Scientific studies that can provide comprehensive and strong evidence about vaccine hesitancy and its causes, methods of increasing social approval in vaccination, and solutions should be proposed in the light of these researches in the fight against vaccine rejection.

'Blurred boundaries': When nurses and midwives give anti-vaccination advice on Facebook.

BACKGROUND: Nurses and midwives have a professional obligation to promote health and prevent disease, and therefore they have an essential role to play in vaccination. Despite this, some nurses and midwives have been found to take an anti-vaccination stance and promulgate misinformation about vaccines, often using Facebook as a platform to do so. RESEARCH QUESTION: This article reports on one component and dataset from a larger study - 'the positives, perils and pitfalls of Facebook for nurses'. It explores the specific issue of nurses and midwives who take an anti-vaccination stance, deemed to be unprofessional by crossing professional boundaries and by providing medical information on Facebook that is not within their scope of practice. PARTICIPANTS: Data were collected via an online worldwide survey from nurse and midwife participants, distributed and 'snowballed' through relevant nursing and midwifery groups on Facebook. In total, 1644 Registered Nurses and Midwives, and Enrolled Nurses worldwide attempted the online survey. There were 1100 (66.9%) completed surveys and 54 partially (33.1%) completed surveys. Semi-structured interviews were also conducted online using Skype® with 17 participants in Australia. ETHICAL CONSIDERATIONS: Ethical processes and procedures have been adhered to relating to privacy, confidentiality and anonymity of the participants. FINDINGS/RESULTS: A mixed-methods approach was used, including descriptive and content analysis of the quantitative survey data and thematic analysis of the qualitative interview data. The main theme 'blurred boundaries' was generated, which comprised three sub-themes: 'follow the science, 'abuse of power and erosion of trust' and 'the moral and ethical responsibility to safeguard public health'. The results offer an important and unique understanding of how nurses and midwives interpret the conduct of fellow health professionals as unprofessional and crossing the professional boundary if they used Facebook to promulgate anti-vaccination messages and/or give medical advice online. CONCLUSION: There are many positives and negatives for nurses and midwives associated with using Facebook for personal and professional communication, which is in keeping with the results of the larger study from which this article is taken. Professional behaviour is a key theme in the larger research as is the ethical construct of 'every act has a consequence'; however, in this article, the theme 'blurred boundaries' offers an overall understanding of how nurses and midwives interpret the behaviour of their colleagues who espouse anti-vaccination sentiment and/or give medical advice online that is outside their scope of practice and education.

Examining four types of anti-vaccination attitudes prior to and during the COVID-19 pandemic.

People hold different anti-vaccination attitudes. Having an understanding of how these attitudes have changed prior to and during the COVID-19 pandemic is critical for combatting anti-vaccination attitudes and increasing vaccine intention and uptake. Data were collected from different samples in the United States at three time points prior to (n = 840) and four time points during (n = 1543) the pandemic. All participants completed a multi-dimensional measure of anti-vaccination attitudes (VAX Scale) through an online platform. Results showed that, when it comes to vaccines, worries about unforeseen side effects, concerns about commercial profiteering, and preference for natural immunity were higher during the COVID-19 pandemic than they were prior to it. However, mistrust of vaccine benefit was lower during the COVID-19 pandemic than prior to it. These differences were found even after controlling for the potential effects of participant sex, education, socioeconomic status, age, and race/ethnicity. Additionally, worries about unforeseen side effects, concerns about commercial profiteering, and preference for natural immunity increased linearly alongside the persistence of COVID-19; whereas, mistrust of vaccine benefit showed no change. Although it might be intuitive to emphasize vaccines' effectiveness to increase uptake, the public's trust in vaccine effectiveness did not appear to be the major concern. Thus, public health efforts to increase uptake of vaccines should also focus on reducing concerns about potential side effects from the vaccine, tempering the attention on financial benefits to pharmaceutical companies, and rebuffing the overreliance on natural immunity.

Vaccine Hesitancy, Acceptance, and Anti-Vaccination: Trends and Future Prospects for Public Health.

An often-stated public health comment is that "vaccination is a victim of its own success." While the scientific and medical consensus on the benefits of vaccination is clear and unambiguous, an increasing number of people are perceiving vaccines as unsafe and unnecessary. The World Health Organization identified "the reluctance or refusal to vaccinate despite availability of vaccines" as one of the 10 threats to global health in 2019. The negative influence of anti-vaccination movements is often named as a cause of increasing vaccine resistance in the public. In this review, we give an overview of the current literature on the topic, beginning by agreeing on terminology and concepts before looking at potential causes, consequences, and impacts of resistance to vaccination.

Characteristics of Antivaccine Messages on Social Media: Systematic Review.

BACKGROUND: Supporters of the antivaccination movement can easily spread information that is not scientifically proven on social media. Therefore, learning more about their posts and activities is instrumental in effectively reacting and responding to the false information they publish, which is aimed at discouraging people from taking vaccines. OBJECTIVE: This study aims to gather, assess, and synthesize evidence related to the current state of knowledge about antivaccine social media users' web-based activities. METHODS: We systematically reviewed English-language papers from 3 databases (Scopus, Web of Science, and PubMed). A data extraction form was established, which included authors, year of publication, specific objectives, study design, comparison, and outcomes of significance. We performed an aggregative narrative synthesis of the included studies. RESULTS: The search strategy retrieved 731 records in total. After screening for duplicates and eligibility, 18 articles were included in the qualitative synthesis. Although most of the authors analyzed text messages, some of them studied images or videos. In addition, although most of the studies examined vaccines in general, 5 focused specifically on human papillomavirus vaccines, 2 on measles vaccines, and 1 on influenza vaccines. The synthesized studies dealt with the popularity of provaccination and antivaccination content, the style and manner in which messages about vaccines were formulated for the users, a range of topics concerning vaccines (harmful action, limited freedom of choice, and conspiracy theories), and the role and activity of bots in the dissemination of these messages in social media. CONCLUSIONS: Proponents of the antivaccine movement use a limited number of arguments in their messages; therefore, it is possible to prepare publications clarifying doubts and debunking the most common lies. Public health authorities should continuously monitor social media to quickly find new antivaccine arguments and then create information campaigns for both health professionals and other users.

Content and Dynamics of Websites Shared Over Vaccine-Related Tweets in COVID-19 Conversations: Computational Analysis.

BACKGROUND: The onset of the COVID-19 pandemic and the consequent "infodemic" increased concerns about Twitter's role in advancing antivaccination messages, even before a vaccine became available to the public. New computational methods allow for analysis of cross-platform use by tracking links to websites shared over Twitter, which, in turn, can uncover some of the content and dynamics of information sources and agenda-setting processes. Such understanding can advance theory and efforts to reduce misinformation. OBJECTIVE: Informed by agenda-setting theory, this study aimed to identify the content and temporal patterns of websites shared in vaccine-related tweets posted to COVID-19 conversations on Twitter between February and June 2020. METHODS: We used triangulation of data analysis methods. Data mining consisted of the screening of around 5 million tweets posted to COVID-19 conversations to identify tweets that related to vaccination and including links to websites shared within these tweets. We further analyzed the content the 20 most-shared external websites using a mixed methods approach. RESULTS: Of 841,896 vaccination-related tweets identified, 185,994 (22.1%) contained links to specific websites. A wide range of websites were shared, with the 20 most-tweeted websites constituting 14.5% (27,060/185,994) of the shared websites and typically being shared for only 2 to 3 days. Traditional media constituted the majority of these 20 websites, along with other social media and governmental sources. We identified markers of inauthentic propagation for some of these links. CONCLUSIONS: The topic of vaccination was prevalent in tweets about COVID-19 early in the pandemic. Sharing websites was a common communication strategy, and its "bursty" pattern and inauthentic propagation strategies pose challenges for health promotion efforts. Future studies should consider cross-platform use in dissemination of health information and in counteracting misinformation.

COVID-19 vaccine hesitancy and acceptance in Mexico: a web-based nationwide survey.

OBJECTIVE: To identify factors associated with COVID-19 vaccine hesitancy and acceptance among the Mexican population. METHODS: In a web-based nationwide survey in early December 2020, respondents were inquired about their sociodemographic characteristics and their willingness to accept a hypothetical COVID-19 vaccine given a 50% or 90% effectiveness. A logistic regression model was used to identify the factors associated with hesitancy and acceptance. RESULTS: A total 3 768 responses were analyzed. A 90% effective vaccine was accepted by 85% of respondents, while only 46% would accept being vaccinated with a 50% effective vaccine. In univariate analysis, each age group (40-49, 50-59, and ≥60) was strongly associated with vaccine hesitancy for a 90% effective vaccine (OR 0.48, 95% CI 0.38, 0.63; OR 0.33, 95 CI 0.26, 0.41; and OR 0.28, 95 CI 0.21, 0.38, respectively) compared to the 18-39 age group. After multivariable adjustment, similar magnitudes of association were observed. Being female and higher socioeconomic status were also associated with higher vaccine hesitancy. CONCLUSIONS: Vaccine hesitancy represents a major public health problem in Mexico and is driven by multiple factors. Our study provides relevant insights for the development of effective policies and strategies to ensure widespread vaccination in Mexico.

Is the worship of celebrities associated with resistance to vaccinations? Relationships between celebrity admiration, anti-vaccination attitudes, and beliefs in conspiracy.

Vaccinations and anti-vaccination attitudes have reclaimed the spotlight as a crucial health behavior because of the recent surge in outbreaks of preventable diseases. One factor that may be contributing to this trend is the outspoken role that anti-vaccination celebrities play. The main purpose of the present study was to determine whether anti-vaccination attitudes are related to celebrity admiration. We hypothesized a positive correlation between anti-vaccination attitudes and celebrity interest and admiration. We also hypothesized that persons who are very concerned about the commercial profiteering of vaccinations will also tend to believe in conspiracies. Participants (N = 320, 40% female, mean age = 36.28, SD = 11.32) completed the Celebrity Attitude Scale (CAS) and the Vaccination Attitudes Examination Scale (VAX) through an online survey management system. We found significant positive associations between anti-vaccination attitudes and celebrity admiration and interest. However, celebrity admiration and interest did not correlate with mistrust of vaccine benefits, as measured by a subdomain of the VAX. Additionally, we found that concerns about commercial profiteering from vaccines correlated with beliefs in conspiracy theories. Our study suggests a new way of approaching people's anti-vaccination attitudes that may be used to effectively educate the public about the importance of vaccinations.

The behavioral immune system and conservatism as predictors of disease-avoidant attitudes during the COVID-19 pandemic.

The COVID-19 pandemic presents a unique opportunity to explore the relationships between the behavioral immune system (BIS), Political Ideology, and disease avoidant attitudes (e.g., attitudes toward vaccination and attitudes about COVID-19). The BIS (e.g., disgust) is believed to be the first line of defense against pathogens and has been linked to socially conservative values. Ironically, however, the BIS has also been associated with anti-vaccination attitudes. In the current study, American participants (N = 139) completed an online survey with self-report measures of the BIS (e.g., disgust sensitivity and perceived infectability), political ideology, COVID-19 attitudes, and anti-vaccination attitudes. Disgust sensitivity was positively correlated with anti-vaccination attitudes but not significantly correlated with attitudes toward COVID-19. Perceived infectability, however, was negatively correlated with anti-vaccination attitudes and positively correlated with anxiety and knowledge about COVID-19. Right-wing authoritarianism and support for Trump were negatively correlated with knowledge and anxiety about COVID-19 and positively correlated with anti-vaccination attitudes.

Religion Affects Future Female Doctors' Approach to HPV Vaccination in Czech and Slovak Republics.

The objective of this study is to summarize the factors, including religion, affecting an individual's decision to get vaccinated or reject vaccination. Anonymous questionnaire-based electronic study is conducted in all faculties of medicine in Czech and Slovak republics. One thousand four hundred and six (1406) questionnaires were analyzed. Responders not practicing any religion received vaccination more often and would recommend vaccination more often. Catholic religion was the most important demographic factor affecting the rate of vaccination. In the group of Catholic female students, 21.9% were vaccinated. In the group of non-Catholic female students, 55.5% were vaccinated. In conclusion, female medical students' approach to vaccination depends, among other factors, on their individual beliefs.

Historical Origins of the Personal Belief Exemption to Vaccination Mandates: The View from California.

A number of states, starting with California, have recently removed all non-medical exemptions from their laws requiring vaccinations for schoolchildren. California was also one of the earliest states to include a broad non-medical, or personal, belief exemption in its modern immunization law, which it did with a 1961 law mandating polio vaccination for school enrollment, Assembly Bill 1940 (AB 1940). This paper examines the history of AB 1940's exemption clause as a case study for shedding light on the little-examined history of the personal belief exemption to vaccination in the United States. This history shows that secular belief exemptions date back further than scholars have allowed. It demonstrates that such exemptions resulted from political negotiation critical to ensuring compulsory vaccination's political success. It challenges a historiography in which antivaccination groups and their allies led late-nineteenth and early-twentieth century opposition to vaccination mandates while religious groups drove mid-twentieth century opposition. It also complicates the historiographic idea of a return to compulsion in the late 1960s, instead dating this return a decade earlier, to a time when belief exemptions in polio vaccination mandates helped reconcile the goal of a widely vaccinated population with the sacrosanct idea of health as a personal responsibility.

Characterisation of the online public debate od MMR vaccine against measles, mumps and rubella on the Polish Internet.

INTRODUCTION: MMR vaccine is a controversial topic of public debate. The controversies include such issues as autism, adjuvants or ethical questions related to the culturing of the rubella virus on human cell lines. OBJECTIVE: The objective was to characterise the public debate on MMR vaccination on the Polish Internet between January 2018 and June 2020. MATERIAL AND METHODS: Quantitative and qualitative analysis of Polish-language online content between 1 January 2018 and 30 June 2020 related to MMR vaccination. The quantitative analysis comprised all available mentions of MMR vaccination in postings (n=14,632), while qualitative analysis relied on a systematic sample of 819 mentions. RESULTS: Quantitative study: 79.6% of MMR vaccine-related postings were published on Facebook, 6.9% on Twitter, and the remaining 14.6% appeared on other websites. There were two surges in posting count in November 2018 and March 2019. Qualitative study: 48% of postings expressed anti-vaccination sentiment, 33% were pro-vaccination and 19% were neutral. CONCLUSIONS: The social media play a significant role in the dissemination of untrue medical claims regarding MMR vaccination. A substantial part of the discussion about MMR vaccination in Poland takes place on Facebook. Despite the general availability of research results stating the absence of a link between autism and vaccination, this is an ongoing most frequent topics in the MMR debate. At the same time, more postings on that topic expressed pro-vaccination rather than anti-vaccination sentiment.

[THE ATTITUDE OF RUSSIANS TO VACCINATION AGAINST COVID-19: PROBLEMS AND CONTRADICTIONS].

Despite the unfolding of the COVID-19 pandemic, the rate of involvement of Russians in vaccination remains low, which makes the study of attitudes to this technology particularly relevant. Based on the results of the author's empirical research and data from mass surveys of the Foundation "Public Opinion" and All-Russian Center for the Study of Public Opinion, the article assesses the attitude of residents of our country to immunoprophylaxis against coronavirus. The study revealed that vaccination attitudes are a continuum, and the perception of vaccination against a new virus is associated in Russians with seasonal flu shots, and not with the National Vaccination Calendar. Today, the attitude towards immunoprophylaxis against COVID-19 in Russia can be characterized as distrust of a specific vaccine and approval of vaccination in general as an effective technology for combating epidemics. The key strategy is «waiting¼, and the choice of a personal trajectory of health care is driven by a broader trend of individualization and transformation of traditional social ties.

Populism and health policy: three international case studies of right-wing populist policy frames.

Over the past decade, some of the world's most stable parliamentary democracies have witnessed a revival in right-wing populist political parties, movements and leaders. Although there is a growing body of theoretical and empirical literature documenting the rise of populism, there has been very little exploration of the implications for health policy of this important political development. In this article, we draw from three illustrative international cases, originating from the USA, the UK and Italy, to explore the ways in which right-wing populism influences health policy: the election of President Trump in the United States (and subsequent healthcare reforms), the United Kingdom's vote to withdraw from the European Union (Brexit), and how this has played out in the context of the UK National Health Service, and the rise of a politically aligned anti-vaccination movement in Italy. Drawing on the work of the influential socio-political theorist Ernesto Laclau, we interpret populism as a performative political act, predicated on drawing logics of equivalence (and difference) between different actors. We use this theoretical framing to explore the ways in which the recent upsurge in right-wing populism creates a specific set of barriers and challenges for access to healthcare and the health of populations.

Rhetorical Appeals and Tactics in New York Times Comments About Vaccines: Qualitative Analysis.

BACKGROUND: Improving persuasion in response to vaccine skepticism is a long-standing problem. Elective nonvaccination emerging from skepticism about vaccine safety and efficacy jeopardizes herd immunity, exposing those who are most vulnerable to the risk of serious diseases. OBJECTIVE: This article analyzes vaccine sentiments in the New York Times as a way of improving understanding of why existing persuasive approaches may be ineffective and offers insight into how existing methods might be improved. We categorize pro-vaccine and anti-vaccine arguments, offering an in-depth analysis of pro-vaccine appeals and tactics in particular to enhance current understanding of arguments that support vaccines. METHODS: Qualitative thematic analyses were used to analyze themes in rhetorical appeals across 808 vaccine-specific comments. Pro-vaccine and anti-vaccine comments were categorized to provide a broad analysis of the overall context of vaccine comments across viewpoints, with in-depth rhetorical analysis of pro-vaccine comments to address current gaps in understanding of pro-vaccine arguments in particular. RESULTS: Appeals across 808 anti-vaccine and pro-vaccine comments were similar, though these appeals diverged in tactics and conclusions. Anti-vaccine arguments were more heterogeneous, deploying a wide range of arguments against vaccines. Additional analysis of pro-vaccine comments reveals that these comments use rhetorical strategies that could be counterproductive to producing persuasion. Pro-vaccine comments more frequently used tactics such as ad hominem arguments levied at those who refuse vaccines or used appeals to science to correct beliefs in vaccine skepticism, both of which can be ineffective when attempting to persuade a skeptical audience. CONCLUSIONS: Further study of pro-vaccine argumentation appeals and tactics could illuminate how persuasiveness could be improved in online forums.

Newspaper coverage before and after the HPV vaccination crisis began in Japan: a text mining analysis.

BACKGROUND: The human papillomavirus (HPV) vaccination coverage rate has fallen sharply in Japan since 2013, when newspapers began covering negative campaigns against the vaccination. We examined and compared contents from newspaper articles before and after the start of this HPV vaccination crisis. METHODS: We collected articles published between January 2005 and September 2017 in the four daily national Japanese newspapers with the highest domestic circulation. We then conducted text mining analysis to chronologically examine content distribution. RESULTS: From among the 1178 articles analyzed, 12 types of contents were identified. Contents related to cervical cancer prevention, such as on the risk of developing cervical cancer, causes of cervical cancer, and the effects of vaccination, were frequently conveyed until 2012. However, after March 2013, they were replaced with anti-vaccination contents, such as on adverse effects to vaccines, alleged victims, and related lawsuits. Meanwhile pro-vaccination contents, such as safety statements from the World Health Organization, scarcely received coverage. CONCLUSIONS: Newspaper contents changed profoundly before and after the start of the vaccination crisis. Those newspaper reports potentially had impact on readers' beliefs and actions. Journalists should strive for impartial coverage so readers can make more-informed decisions. Health professionals should be expected to work with journalists to help improve impartiality in newspaper coverage. The Ministry of Health, Labour and Welfare should discus benefits and risks of the HPV vaccination based on the scientific evidences, and consider to resume the proactive recommendation of HPV vaccination. Well-organized advocacy among medical societies, scientists and health professionals will also be needed to influence the government.