‘The cold hard facts’ immunisation and vaccine preventable diseases in Australia's newsprint media 1993–1998

Abstract

The news media have the potential to influence public perceptions about childhood vaccination. Research has quantified the extent of positive news reportage on immunisation but no studies have explored the rhetorical nature and the core appeals that characterise positive reportage.

To complement our previous research on the rhetorical nature of anti-immunisation reportage, this paper reviews positive coverage of immunisation in over four and a half years of Australian newsprint media. Three core topics dominated the reportage; the problem of vaccine preventable diseases and low immunisation rates, notions of who is responsible and the implied solutions. The threat of vaccine preventable diseases was conveyed using panic language, disease personification, quantification rhetoric, stories of personal tragedies and portentous tales from yesteryear. Attribution for low immunisation rates ranged from blaming parents to blaming lack of government coordination. However, most blame framed individuals as responsible. The most popular spokespersons were representatives of professional medical bodies who tended to be cast as voices of authority, castigating the ignorance and apathy of parents. Urging of compulsory vaccination, pleas for parents to immunise their children and the provision of information about vaccine preventable diseases were the most frequently occurring implied solutions. Immunisation was promoted as a modern medical miracle, health professionals were portrayed as soldiers in the fight against killer diseases and urges to immunise were usually conveyed through the use of stern directives.

Understanding how immunisation messages are framed in the media and the core values to which those messages appeal highlights opportunities for media advocates to enhance desired messages and reframe those which are considered antipathetic to the goals of public health advocacy.

Introduction

Despite the availability of safe and effective vaccines for major childhood diseases, vaccine preventable diseases continue to cause morbidity and mortality in Australia. During the period 1993–1998, there were 34,848 notifications and 9 deaths from pertussis. During that same period, 12,404 cases of measles were notified with 7 deaths from the disease (Communicable Disease Network, 2000).

In 1995, population data indicated that only 52 per cent of children under five years were fully vaccinated for their age (Australian Bureau of Statistics, 1995). The resulting public outcry formed the focus of much immunisation news coverage during the next three years. Recent data indicate that completed immunisation rates are closer to approximately 85 per cent (Communicable Disease Network, 2000). However, rates continue to fall short of the national target of 90 per cent (National Health and Medical Research Council, 1993). Scheduled vaccines are provided free to all Australian children. Doctors in a primary care practice make up 69 per cent of all providers with others including local council clinics, community health centres or Aboriginal health services (Australian Childhood Immunisation Register, 2000).

Reasons for sub-optimal immunisation rates are multifactorial and have been attributed to inadequate political commitment and poor coordination between different levels of government; problems with service provision; provider misconceptions about contraindications; difficulties with a complex and changing immunisation schedule; parental beliefs and misconceptions; and the ‘busy lives’ factor (Bazeley & Kemp, 1994). In recent years, a number of measures designed to improve vaccine coverage have been implemented in Australia including the provision of financial incentives for General Practitioners and measures to encourage parents to immunise their children. These have included the linking of vaccination status to maternity allowance and childcare benefits, a mailed reminder scheme and national media campaigns.

The news media at times can influence the process of parental decision making about immunisation. Mass shifts in public confidence have been attributed to immunisation controversies arising in the media, particularly in the UK (Mason & Donnelly, 2000; Griffith, 1981; Gangarosa et al., 1998). Conversely, studies of mass media campaigns to promote vaccination have also shown an effect (Macdonald & Roder, 1985; Paunio et al., 1991; Zimicki et al., 1994). Immunisation reportage in the news media are an important vehicle through which health workers can promote immunisation.

The Australian print media is characterised by one or two daily newspapers selling in each of the eight state and territory capital cities, plus a plethora of daily and weekly regional newspapers serving regional or rural areas. There is one relatively low selling national newspaper. In a population aged 15 and over of 15.13 million, readership of metropolitan newspapers in 2000 were: Monday–Friday: 48 per cent; Saturday 61 per cent; Sunday: 60 per cent (Asia Pacific Media Directory, 2001).

In the Australian press, controversies about the safety of vaccines arise sporadically and despite rhetoric to the contrary are uncommon proportional to positive or normative news coverage. Our previous study of 2440 press articles about immunisation indicated that the majority of news coverage is normative or promotional with only five percent being oppositional in nature. However, we have argued that it is not the quantity of coverage, but its qualitative nature which renders it newsworthy and memorable to the wider public and to health professionals concerned about its effect (Leask & Chapman, 1998).

How an issue is presented or framed creates appositions with wider social themes that transfer meaning across ostensibly different topics. For example, manifest anti-vaccination claims about vaccines being dangerous and ineffective tend to be located under a canopy of more general newsworthy discourses about cover-up and conspiracy, manipulation by venal private enterprise interests, governments with totalitarian agenda and the back-to-nature idyll (Leask & Chapman, 1998). Themes like these can also be found in reportage of issues such as water fluoridation (Paul, 1961) and gun control (Chapman, 1998). Through these ‘inter-textual’ connections, readers can locate content within a wider constellation of themes providing a frame for understanding.

Similarly, media representation of spokespersons tends to conform to expected stereotypes (e.g.: caring doctors, poker-faced bureaucrats, impassioned whistleblowers, Galileo-like paradigm challenging scientists, to name but a few examples). This draws on the notion that such portrayals allow people to sort information into convenient categories. As Fowler (1991, p. 17) states:

A stereotype is a socially-constructed mental pigeon-hole into which events and individuals can be sorted, thereby making such events and individuals comprehensible…. They are categories which we project onto the world in order to make sense of it.

To the extent that spokespersons tend to be stereotyped, how one seeks to be presented and how they are presented may be two different things (see for example Brown, Chapman, & Lupton, 1996). Therefore, this analysis comes with the qualification that spokespersons may not intend or agree with their portrayals (although some are more adept at being cast by the media in their preferred roles). For public health workers wishing to promote immunisation, insight into the framing of news and how spokespersons are positioned can assist in the maintenance of frames which advance the goals of advocacy and illuminate how undesirable frames might be repositioned (Ryan, 1991; Menashe & Siegel, 1998; Chapman & Lupton, 1994). Hence, this paper sets out to describe the nature of pro-immunisation press coverage and ways in which health workers are positioned within this coverage. The approach will be via a content and framing analysis of all text and images. Discussion shall focus on implications for advocacy.