Your Thoughts Matter

News stories about the flu shot spawn debates about vaccines in general

(Centers for Disease Control and Prevention)

Comment sections on news articles about the flu vaccine turned into polarized “echo chambers,” where like-minded people reinforced and amplified each other’s beliefs about vaccination in general, according to an analysis of 2,042 reader responses to Canadian Broadcasting Corporation (CBC) online news reports.

The paper, published in Vaccine in March 2019, focuses on themes (discussion of vaccines in general) and rhetorical devices (such as sarcasm or personal anecdotes) apparent in these comments.

Included for analysis were comments on all text-based news reports that mentioned the flu vaccine published on the CBC’s website between September 2015 and October 2016. The comments posted on these articles were extracted and reviewed by three researchers to identify patterns.

The articles generally discussed immunization as a product and/or a service. They tended to share information about flu immunization recommendations and where people could go to get the shot. Articles studied tended not to contain information about risks associated with the vaccine.

The researchers chose to study the flu vaccine in particular for a few reasons. “The influenza vaccine is unique for a number of reasons,” said Richard Violette, research coordinator of special projects at the Ontario Pharmacy Evidence Network and an author on the paper, in a phone call with Journalist’s Resource. “The main component of that difference is its variable effectiveness.”

From season to season, the flu vaccine differs in how well it works. According to data from the Centers for Disease Control and Prevention, the flu vaccine for the 2017-2018 season was 38 percent effective; for the 2018-2019 season, preliminary estimates put the effectiveness of the vaccine at 47 percent. “I think that creates this nebulousness around that specific vaccine,” Violette said. “It lends to a more difficult decision for individuals.”

Violette added that there’s complacency around influenza as a disease, too – a sense that it’s not a particularly serious illness.

For these reasons, the researchers thought comments about the flu vaccine in particular might offer a window into the minds of those who fall in the middle of the “vaccine hesitancy continuum” – not staunch anti-vaxxers, but not avid vaccine promoters, either.

However, the researchers found that despite the specific focus of the articles, the comments became a highly polarized space, and one that extended beyond the scope of the flu vaccine. Rather, it turned into a place to debate whether to vaccinate at all.

“Comment threads under the included articles largely deviated from article content, instead serving as a forum to exchange information about vaccines and immunization more broadly,” the authors write.

“We were a bit surprised by that,” Violette said. “We did think initially the comments would be revolving around influenza vaccines specifically.”

But online comment sections sometimes evolve or devolve beyond the topic of the article.

As Violette put it, “The forum that opens up beneath rapidly transforms into a place where people can speak about vaccination more generally.”

“These online spaces tend to attract the extremely polarized,” he added. “Those are the individuals that are the most vocal.”

The vaccine hesitant individuals the researchers were first interested in understanding “don’t seem to participate in these online spaces,” Violette said.

In fact, the participants in the dialogue themselves spurred on further polarization: “The binary is so pervasive in threaded comments that some users actively reminded other users to explicitly position themselves on either side of the debate,” the authors write. They cite a comment to illustrate their point: “‘Remember, you are either FOR all vaccines OR you are AGAINST all vaccines!’” one user wrote.

Rhetorical devices

The following bullet points highlight the most commonly used rhetorical devices in the comments and examples of each:

  • Sarcasm: “We’re talking about flu shots, not polio vaccinations. But sure, just go ahead and take whatever is on offer, no need to apply any critical thinking to make informed choices on your own healthcare. It’s not like anybody is in the pharmaceutical industry to make money on you, right?”
  • Correcting misinformation: “That is simply not true. Please stop spreading misinformation. Washing hands is great, but it is certainly not a cure all for influenza. The best defense against spread of the flu is immunization. No other measure even comes close.”
  • Anecdote: “I’ve had full-blown influenza once and I never want to feel like that again. It’s not at all the same as a bad cold; it’s systemic and just plain nasty. That was 20 years ago and I’ve had my annual flu shot ever since.”
  • Ridicule: “Cue the big pharma hipsters and soccer mommies who think they know more than doctors and scientists.”
  • Use of evidence: “Not only is the flu vaccine not a magical 100% barrier to transmitting the flu to vulnerable patient’s, there is evidence that receiving the recent ineffective vaccines makes individuals more vulnerable to mutated strains of the flu.”
  • Request for proof: “Source? Evidence? Any proof of this?”
  • Analogy: “If you had a 50% chance of winning the lottery, would you refuse to buy a ticket because of the equal possibility you won’t win?”
  • Knowledge deficit: “More ‘aluminum’ in a pickle than a dose of flu vaccine. Do you know ‘aluminum’ (sulfate) is used in water purification systems? So much scaremongering with the word mercury and aluminum due to the level of ignorance about basic chemistry which sadly seems to go hand in glove with the antivaxx mindset.”

Though both sides used a number of these techniques, there were key differences in exactly how they used them.

Take, for example, the use of evidence.

Violette called vaccine refusers “experts” at creating and subsequently linking to websites and social media that disseminate their views.

And it’s not just the medium, it’s also the message.

“The anti-vaxxers have just developed a really great way to communicate in these spaces,” he told Journalist’s Resource.

With regard to trying to dispute these views with scientific evidence, “one of the problems with that is, a lot of the science supportive of vaccination is not really easily accessible to the layperson, whether by content or by access,” he said.

For Violette, the most concerning aspect of this polarized debate is the impact it might have on the vaccine hesitant population he and his coauthors initially wanted to study. “We can safely assume there’s a large number of individuals who’d qualify as vaccine hesitant … who are passively consuming those dialogues online,” he said.

“Effectively, these online spaces, because they are so polarized, it erases any space for people who have doubts, it erases any space for people who have questions,” he added. Further, this debate is now “feeding into the assembly of their evidence base on which they could be making their future vaccine decisions.”

As Facebook and Instagram move to moderate anti-vaccination content on their platforms, Violette suggested a focus on correct information, rather than moderation, might be the best path forward.

“There is a responsibility to be diffusing the correct information,” he said. “Does that mean erasing the misinformation? I’m not sure. Enabling individuals who may not have had the training or education to read scientific literature, to sift through information and be more critical — that might potentially be the role public health needs to play.”

And although this study focused on a Canadian news organization, Violette said he believes the findings are generalizable. “At the end of the day the phenomenon of back-and-forth, really polarized comments … I think it’s pretty generalizable across the board,” he said.

Story suggestions

For journalists interested in pursuing stories related to this research, Violette suggested investigating the views and beliefs of vaccine hesitant individuals. How do these individuals make sense of the information they find online about vaccines – how do they determine what’s credible, and what’s not? And how are debates like those analyzed in the study informing the decision-making of vaccine hesitant individuals?


Looking for more? Tara Haelle rounded up peer-reviewed studies on vaccine hesitancy for the Association for Health Care Journalists. At Journalist’s Resource, we’ve summarized research on the flu vaccine and how often and why parents refuse vaccines for their children.

Citation: Meyer, Samantha B.; et al. "Vaccine Hesitancy and Web 2.0: Exploring How Attitudes and Beliefs About Influenza Vaccination Are Exchanged in Online Threaded User Comments," Vaccine, March 2019. doi: 10.1016/j.vaccine.2019.02.028.