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‘An attempt to swindle nature’: press anti‐immunisation reportage 1993–1997

‘An attempt to swindle nature’: press anti‐immunisation reportage 1993–1997 Abstract: There is some evidence that low childhood immunisation rates in Australia may be attributed partly to parental antipathy toward immunisation. The anti-immunisation movement is becoming more organised in its efforts to lobby against childhood immunisation, while the lessening of the public’s exposure to the effects of vaccine-preventable disease has provided a climate ripe for such a lobby to have a disproportionate influence on parents. Forty months of Australian print media coverage of immunisation were reviewed for anti-immunisation arguments and their underlying ideological subtexts. Of 2440 articles about childhood immunisation, 115 (4.7 per cent) contained statements opposing immunisation. Eight subtexts that referenced wider discourses about medicine, the state and the body dominated anti-immunisation discourse (cover-up; excavation of the facts; unholy alliance for profit; towards totalitarianism; us and them; vaccines as poisonous chemical cocktails; vaccines as cause of idiopathic ills; and back to nature). Attempts to redress claims made against immunisation must not only address specific claims about vaccine efficacy and safety but be grounded in a reframing of the ideological appeals that currently frame the contents of anti-immunisation discourse. (Aust N ZJ Public Health 1998; 22: 17-26) WO hundred years after Jenner’s observations on the protective effect of cowpox on smallpox, Australian childhood immunisation rates remain disturbingly low, with only 52 per cent of Australian children aged three months to six years being fully immunised for their age in 1995.’ Between October 1996 and September 1997 seven infants died from pertussis in Australia.* In the first 10 months of 1997, 6468 pertussis and 535 measles cases were notified throughout A~stralia.~ Low imrnunisation rates have been explained primarily in terms of practical access problems, parental alpathy and provider misconceptions about contraindications.”lO Parental antipathy to immunisation has not been identified as a major factor in studies examining reasons for low immunisation rates. More recently, however, the 1995 Australian national siirvey on childhood immunisation found that 18.4 per cent of parents whose children were not immunised against diphtheria, tetanus and pertussis were opposed to immunisation, with a further 6.6 per cent citing concern about sideeffects as their reason for not vaccinating their children.’ Another Sydney study found ‘concern about side effects’ to be one of four leading reasons parents gave for not having their children fully immunised.” Against .a background of low immunisation rates, many Australian public health workers are expressing concern that the anti-immunisation movement has become more organised and strategic in its efforts and might be influencing immunisation rates. The Public Health Association has held a workshop12and the Commonwealth Department of Health and Family Services has published a booklet13on responding to arguments against immunisation. Following the broadcast of two national television documentaries on a respected science program purporting to examine ‘both sides’ of the immunisation debate,14this journal published a supplement highly critical of the programs.15 While the important role played by media campaigns in promoting immunisation has been studied,16” the effect of negative publicity has received little comment in the l i t e r a t ~ r e . ~ ~ - ~ ~ The potential for the media to damage public confidence in immunisation was demonstrated in the United Kingdom in 1974, when a television documentary showing two children with severe neurological damage allegedly from the pertussis vaccine was followed by a dramatic reduction in immunisation rates.23 Similarly, there has been little research examining the extent to which anti-immunisation arguments are publicised in c ~ r n r n u n i t i e s .In~ ~ ~ ~ ~ ‘ ~ ~ Australia, writings by opponents of immunisation are readily located in the literature of the natural health movement. These are widely available through newsagents, health food shops and at regular public meetings called by community groups like the Immunisation Investigation Group and the Vaccination Awareness Network. Such groups, while claiming not to be anti-immunisation but pro-choice, promote themselves as champions of transparency in public information. They circulate selected research and self-published literature that supports their main argument that vaccination is unsafe and ineffective. While the aggregated circulations of the many publications in these ‘alternative’ fields is substantial, they do not compare with the reach attained by mainstream broadcast and print media. Together these reach nearly 100 per cent of VOL. Correspondence to Associate Professor Simon Chapman, Department of Public Health and Community Medicine, University of Sydney, NSW 2006. Email: simonc@pub.health.usyd.edu.au AUSTRALIAN AND N W ZEALAND JOURNAL O PUBLIC HEALTH 1998 E F 22 NO. 1 the population on most days of the year, and accordingly, are likely to be the vehicles that expose the greatest number of the community to anti-immunisation views. In this paper we examine the coverage of antiimmunisation issues in the Australian print news media. We first quantift. this coverage, comparing it to that given to pro-immunisation news items, and note the most common specific claims made by opponents of immunisation as revealed through their letters to newspapers and in news reports highlighting their claims. In the main part of the paper, we examine the ideological substrate in which these claims are embedded, providing them with their rhetorical force and their newsworthiness. Part of any comprehensive strategy to redress the appeal of anti-immunisation rhetoric must involve a careful analysis not only of what its proponents argue but of how they frame their claims in terms of wider social discourses, which render these claims newsworthy instead of being dismissed as merely eccentric and incredible. Methods All press reports on any aspect of childhood immunisation were obtained from a media monitoring agency for the 40-month period from November 1993 to February 1997. This collection included reports published in all Australian metropolitan and regional newspapers from November 1993 until December 1995, then in metropolitan newspapers only until February 1997. To assess the monitoring agency’s claim to have supplied all articles on immunisation, we compared those supplied by the agency taken from the Sydney Morning Herald with the actual coverage of the subject area, as determined by a search of CD-ROM versions of that newspaper for the entire sample period. Eighty per cent of articles were provided in 1994,94 per cent in 1995 and only 36 per cent in 1996. In view of the poor collection rate for 1996, all articles after January 1996 were excluded from the content analysis but retained for the analysis of subtextual themes. The news clips ( n = 2440) were divided into two categories: those wholly or partly devoted to argu. ment critical of immunisation, including articles in which proponents of immunisation addressed claims being made by anti-immunisationists, and those not containing any reference to arguments opposing immunisation. A content analysis was then undertaken on articles in the first category. These were coded for: newspaper in which published date headline, subheading and any highlighted lead sentences type of article (for example, news item, letter, editorial) perspective of protagonist anti-immunisation claims used spokespersons or experts mentioned. ‘Perspective of protagonist’ refers to the apparent stance of the person introducing the arguments opposing immunisation. They were coded thus: pro-immunisation: the protagonist came from an apparently pro-immunisation perspective anti-immunisation: the protagonist came from an apparently anti-immunisation perspective. ‘Anti-immunisation claims’ refer to the explicit claims about immunisation that appeared in each article. Next, all articles containing quotations from an anti-immunisation protagonist were reviewed for the principal subtexts found in any part of the article. ‘Subtexts’refer to wider systems of ideologcal reference in which these claims were embedded. These go beyond claims specifically anchored to the subject of immunisation and locate anti-immunisation arguments within discourses that give wider meaning to the specific claims being made. Lists of both anti-immunisation claims and subtexts expanded as the coding proceeded. Instances of these were debated between the two authors during coding and the lists refined and adjusted until a coherent scheme was determined that appeared to admit all instances (Table 1). Reliability The coding of articles for the perspective of the protagonist was tested for reliability by supplying three independent reviewers with a random subsample of Table 1: Definitions of subtextual categories A headline, passage or quotation was coded: Cover-up, if it stated or implied that information about immunisation was being wilfully distorted, suppressed or otherwise withheld from the public. Excavation of the ‘facts’, if it referred to allegedly reliable information about immunisation that ran counter to generally accepted wisdom about the benefits, safety and efficacy of vaccines. Included here were accounts of ’experts‘ who disagreed with the orthodoxy on vaccines. Unholy alliance for profit, if it stated or implied that the promotion of vaccines was motivated by monetary gain; and that doctors, pharmaceutical companies, researchers and public health bureaucrak were colluding in this regard. Towards toblibrianisrn, if it stated or implied that regulation of the administration of vaccines involved a threat to civil liberties and was an excessive exertion of governmental control. Us and them, if anti-immunisationists positioned themselves a s caring and concerned friends or allies of parenk, together pitted against the collusive interests of uncaring doctors ond government. Included here were instances when CI parent or advocate against vaccination gave a personal account of a child who had allegedly suffered badly from immunisation. Poisons, if it stated or implied that vaccines are toxic and poisonous or that their contenk are made from undesirable products. Vaccines as the cause of idiopathic ills, if it was suggested that vaccines were the cause of diseases or behavioural problems of unknown or uncertain origin. 6ack to nature, if it implied that ’natural’ methods of preventing diseases are more desirable than the ‘artificial’ method of vaccination. AUSTRALIAN AND N W ZEALAND JOURNAL O PUBLIC HEALTH 1998 E F VOL. 22 NO. 1 PRESS ANTI-IMMUNISATION REPORTAGE 50 articles. The raters, who were blinded to the initial categorisation, were issued with the above definitions of pro-immunisation and anti-immunisation perspectives and were asked to code articles into either category. All raters had perfect agreement with the authors’ classification for all 50 articles. The coding of the eight principal subtextual categories was tested similarly. Three raters coded a random subsample of 40 passages. Each rater was issued with a set of definitions (Table 1) and was asked to assign a category to each passage. The level of inter-rater reliability was measured using a kappa statistic for agreement over and above that expelcted by chance. The equation for kappa specified by Fleiss for multiple-rater agreement was The kappa stacalculated using the STATA program.26 tistic for agreement between authors and each of the three raters was 0.83,0.83 and 0.86, respectively. The combined score for general agreement on subtextual categories for the three raters was 0.76. These scores reflect an acceptable level of agreement.z7 Results From the sample period November 1993 to December 1995, 2440 articles and letters were counted. Ninety per cent ( n = 2196) contained no references to any anti-immunisation claim. Of the 10 per cent ( 244) that referred to anti-immunisation, about half (115) were written by or about people who were opposed to immunisation, with the remainder (129) being written by or about supporters of imnnunisation who identified anti-immunisa- Table 2: Most prominent claims in h e immunisation debate: who introduces them? Perspective Refute OPP= antiimmunisation immunisation Claim tion arguments. In the 115 articles containing statements from those opposed to immunisation, 48 different individuals were quoted. Just under half of those articles (55) contained quotes from the same six people, five of whom were representatives of various immunisation lobby groups. Seventy-five of the anti-immunisation articles (65 per cent) were p u b lished in Queensland and 33 (29 per cent) appeared in two newspapers; the Sunshine Coast Daily and the Northern Star Sixty-five different claims about immunisation were counted in the 244 articles with reference to anti-immunisation. Table 2 shows the eight most common claims classified by the perspective of the protagonist advancing them. Anti-immunisation claims did not occur in isolation. During the period, public calls for parents to immunise their children in the face of disease outbreaks and proposed policy changes aimed at improving immunisation rates provided a context in which the claims of anti-immunisationists were asserted. The school entry requirement of a certificate indicating immunisation status and the introduction of the Australian Childhood Immunisation Register prompted many letters, which, although responding to the perceived invasion of civil liberties, would also proselytise on the dangers of vaccines. Some articles and letters were prompted by a Queensland couple’s decision to take their local council to court in the Equal Opportunity Commission for disallowing their unvaccinated children to attend the council day care centre. Throughout much of 1994 two prominent anti-immunisationists conducted lecture tours through eastern Australia exhorting against immunisation and promoting their self-published books. Rural newspapers would print their claims in articles announcing their visit with headlines: ‘Health expert visits’ or ‘Lectures on using natural health to replace vaccines soon’. In addition, the anti-immunisation lobby group, the Australian Vaccination Network, through their r e p lar newsletter, urge members to write to local newspapers. Subtextual analysis During the sample period, November 1993 to February 1997, 108 letters and 40 news articles that contained statements from persons opposed to childhood immunisation were published. Each letter or article written by or about anti-immunisationists was reviewed for its use of subtexts (Tables 1 and 3). Up to eight subtexts were coded for each article. We provide illustrative examples of passages from articles and letters for each of the eight principal subtexts we found being used. We have prefaced each of these with examples from literature from the turn of the century opposing smallpox vaccination, to illustrate the resilience and continuity of these themes. COVER-UP: [Ilt is a case of downright deliberate falsehood, propagated at the public expense and to the public misleading [1893, p. 77].28 1. Vaccines are dangerous. 2. Vaccines play a causal role in the development of various diseases and conditions. 3. Vaccines are ineffective. A. Homeopathy is an alternative to vaccination. 5. The pertussis vaccine causes brain damlage. 6. The diseases vaccines are meant to prevent have declined, owing to better sewage, water, hygiene and nutrition. 7. Vaccines erode the immune system. 8. Good diet,, exercise, clean water and fresh oir will develop ’natural’ irnmuniiy, making vaccination unnecessary. One of the anti-immunisationists’ most persistent 22 NO. 1 AUSTRALIAN AND NEW ZEALAND JOURNAL O PUBLIC HEALTH 1998 VOL. F LEASK AND CHAPMAN Table 3: Subtexts found in articles and letters featuring statements from persons opposing childhood immunisation: November 1993 t February 1997 o Appearances in articles analysed n = 148 % read English in medical journals. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Australian and New Zealand Journal of Public Health Wiley

‘An attempt to swindle nature’: press anti‐immunisation reportage 1993–1997

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Publisher
Wiley
Copyright
Copyright © 1998 Wiley Subscription Services, Inc., A Wiley Company
ISSN
1326-0200
eISSN
1753-6405
DOI
10.1111/j.1467-842X.1998.tb01140.x
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Abstract

Abstract: There is some evidence that low childhood immunisation rates in Australia may be attributed partly to parental antipathy toward immunisation. The anti-immunisation movement is becoming more organised in its efforts to lobby against childhood immunisation, while the lessening of the public’s exposure to the effects of vaccine-preventable disease has provided a climate ripe for such a lobby to have a disproportionate influence on parents. Forty months of Australian print media coverage of immunisation were reviewed for anti-immunisation arguments and their underlying ideological subtexts. Of 2440 articles about childhood immunisation, 115 (4.7 per cent) contained statements opposing immunisation. Eight subtexts that referenced wider discourses about medicine, the state and the body dominated anti-immunisation discourse (cover-up; excavation of the facts; unholy alliance for profit; towards totalitarianism; us and them; vaccines as poisonous chemical cocktails; vaccines as cause of idiopathic ills; and back to nature). Attempts to redress claims made against immunisation must not only address specific claims about vaccine efficacy and safety but be grounded in a reframing of the ideological appeals that currently frame the contents of anti-immunisation discourse. (Aust N ZJ Public Health 1998; 22: 17-26) WO hundred years after Jenner’s observations on the protective effect of cowpox on smallpox, Australian childhood immunisation rates remain disturbingly low, with only 52 per cent of Australian children aged three months to six years being fully immunised for their age in 1995.’ Between October 1996 and September 1997 seven infants died from pertussis in Australia.* In the first 10 months of 1997, 6468 pertussis and 535 measles cases were notified throughout A~stralia.~ Low imrnunisation rates have been explained primarily in terms of practical access problems, parental alpathy and provider misconceptions about contraindications.”lO Parental antipathy to immunisation has not been identified as a major factor in studies examining reasons for low immunisation rates. More recently, however, the 1995 Australian national siirvey on childhood immunisation found that 18.4 per cent of parents whose children were not immunised against diphtheria, tetanus and pertussis were opposed to immunisation, with a further 6.6 per cent citing concern about sideeffects as their reason for not vaccinating their children.’ Another Sydney study found ‘concern about side effects’ to be one of four leading reasons parents gave for not having their children fully immunised.” Against .a background of low immunisation rates, many Australian public health workers are expressing concern that the anti-immunisation movement has become more organised and strategic in its efforts and might be influencing immunisation rates. The Public Health Association has held a workshop12and the Commonwealth Department of Health and Family Services has published a booklet13on responding to arguments against immunisation. Following the broadcast of two national television documentaries on a respected science program purporting to examine ‘both sides’ of the immunisation debate,14this journal published a supplement highly critical of the programs.15 While the important role played by media campaigns in promoting immunisation has been studied,16” the effect of negative publicity has received little comment in the l i t e r a t ~ r e . ~ ~ - ~ ~ The potential for the media to damage public confidence in immunisation was demonstrated in the United Kingdom in 1974, when a television documentary showing two children with severe neurological damage allegedly from the pertussis vaccine was followed by a dramatic reduction in immunisation rates.23 Similarly, there has been little research examining the extent to which anti-immunisation arguments are publicised in c ~ r n r n u n i t i e s .In~ ~ ~ ~ ~ ‘ ~ ~ Australia, writings by opponents of immunisation are readily located in the literature of the natural health movement. These are widely available through newsagents, health food shops and at regular public meetings called by community groups like the Immunisation Investigation Group and the Vaccination Awareness Network. Such groups, while claiming not to be anti-immunisation but pro-choice, promote themselves as champions of transparency in public information. They circulate selected research and self-published literature that supports their main argument that vaccination is unsafe and ineffective. While the aggregated circulations of the many publications in these ‘alternative’ fields is substantial, they do not compare with the reach attained by mainstream broadcast and print media. Together these reach nearly 100 per cent of VOL. Correspondence to Associate Professor Simon Chapman, Department of Public Health and Community Medicine, University of Sydney, NSW 2006. Email: simonc@pub.health.usyd.edu.au AUSTRALIAN AND N W ZEALAND JOURNAL O PUBLIC HEALTH 1998 E F 22 NO. 1 the population on most days of the year, and accordingly, are likely to be the vehicles that expose the greatest number of the community to anti-immunisation views. In this paper we examine the coverage of antiimmunisation issues in the Australian print news media. We first quantift. this coverage, comparing it to that given to pro-immunisation news items, and note the most common specific claims made by opponents of immunisation as revealed through their letters to newspapers and in news reports highlighting their claims. In the main part of the paper, we examine the ideological substrate in which these claims are embedded, providing them with their rhetorical force and their newsworthiness. Part of any comprehensive strategy to redress the appeal of anti-immunisation rhetoric must involve a careful analysis not only of what its proponents argue but of how they frame their claims in terms of wider social discourses, which render these claims newsworthy instead of being dismissed as merely eccentric and incredible. Methods All press reports on any aspect of childhood immunisation were obtained from a media monitoring agency for the 40-month period from November 1993 to February 1997. This collection included reports published in all Australian metropolitan and regional newspapers from November 1993 until December 1995, then in metropolitan newspapers only until February 1997. To assess the monitoring agency’s claim to have supplied all articles on immunisation, we compared those supplied by the agency taken from the Sydney Morning Herald with the actual coverage of the subject area, as determined by a search of CD-ROM versions of that newspaper for the entire sample period. Eighty per cent of articles were provided in 1994,94 per cent in 1995 and only 36 per cent in 1996. In view of the poor collection rate for 1996, all articles after January 1996 were excluded from the content analysis but retained for the analysis of subtextual themes. The news clips ( n = 2440) were divided into two categories: those wholly or partly devoted to argu. ment critical of immunisation, including articles in which proponents of immunisation addressed claims being made by anti-immunisationists, and those not containing any reference to arguments opposing immunisation. A content analysis was then undertaken on articles in the first category. These were coded for: newspaper in which published date headline, subheading and any highlighted lead sentences type of article (for example, news item, letter, editorial) perspective of protagonist anti-immunisation claims used spokespersons or experts mentioned. ‘Perspective of protagonist’ refers to the apparent stance of the person introducing the arguments opposing immunisation. They were coded thus: pro-immunisation: the protagonist came from an apparently pro-immunisation perspective anti-immunisation: the protagonist came from an apparently anti-immunisation perspective. ‘Anti-immunisation claims’ refer to the explicit claims about immunisation that appeared in each article. Next, all articles containing quotations from an anti-immunisation protagonist were reviewed for the principal subtexts found in any part of the article. ‘Subtexts’refer to wider systems of ideologcal reference in which these claims were embedded. These go beyond claims specifically anchored to the subject of immunisation and locate anti-immunisation arguments within discourses that give wider meaning to the specific claims being made. Lists of both anti-immunisation claims and subtexts expanded as the coding proceeded. Instances of these were debated between the two authors during coding and the lists refined and adjusted until a coherent scheme was determined that appeared to admit all instances (Table 1). Reliability The coding of articles for the perspective of the protagonist was tested for reliability by supplying three independent reviewers with a random subsample of Table 1: Definitions of subtextual categories A headline, passage or quotation was coded: Cover-up, if it stated or implied that information about immunisation was being wilfully distorted, suppressed or otherwise withheld from the public. Excavation of the ‘facts’, if it referred to allegedly reliable information about immunisation that ran counter to generally accepted wisdom about the benefits, safety and efficacy of vaccines. Included here were accounts of ’experts‘ who disagreed with the orthodoxy on vaccines. Unholy alliance for profit, if it stated or implied that the promotion of vaccines was motivated by monetary gain; and that doctors, pharmaceutical companies, researchers and public health bureaucrak were colluding in this regard. Towards toblibrianisrn, if it stated or implied that regulation of the administration of vaccines involved a threat to civil liberties and was an excessive exertion of governmental control. Us and them, if anti-immunisationists positioned themselves a s caring and concerned friends or allies of parenk, together pitted against the collusive interests of uncaring doctors ond government. Included here were instances when CI parent or advocate against vaccination gave a personal account of a child who had allegedly suffered badly from immunisation. Poisons, if it stated or implied that vaccines are toxic and poisonous or that their contenk are made from undesirable products. Vaccines as the cause of idiopathic ills, if it was suggested that vaccines were the cause of diseases or behavioural problems of unknown or uncertain origin. 6ack to nature, if it implied that ’natural’ methods of preventing diseases are more desirable than the ‘artificial’ method of vaccination. AUSTRALIAN AND N W ZEALAND JOURNAL O PUBLIC HEALTH 1998 E F VOL. 22 NO. 1 PRESS ANTI-IMMUNISATION REPORTAGE 50 articles. The raters, who were blinded to the initial categorisation, were issued with the above definitions of pro-immunisation and anti-immunisation perspectives and were asked to code articles into either category. All raters had perfect agreement with the authors’ classification for all 50 articles. The coding of the eight principal subtextual categories was tested similarly. Three raters coded a random subsample of 40 passages. Each rater was issued with a set of definitions (Table 1) and was asked to assign a category to each passage. The level of inter-rater reliability was measured using a kappa statistic for agreement over and above that expelcted by chance. The equation for kappa specified by Fleiss for multiple-rater agreement was The kappa stacalculated using the STATA program.26 tistic for agreement between authors and each of the three raters was 0.83,0.83 and 0.86, respectively. The combined score for general agreement on subtextual categories for the three raters was 0.76. These scores reflect an acceptable level of agreement.z7 Results From the sample period November 1993 to December 1995, 2440 articles and letters were counted. Ninety per cent ( n = 2196) contained no references to any anti-immunisation claim. Of the 10 per cent ( 244) that referred to anti-immunisation, about half (115) were written by or about people who were opposed to immunisation, with the remainder (129) being written by or about supporters of imnnunisation who identified anti-immunisa- Table 2: Most prominent claims in h e immunisation debate: who introduces them? Perspective Refute OPP= antiimmunisation immunisation Claim tion arguments. In the 115 articles containing statements from those opposed to immunisation, 48 different individuals were quoted. Just under half of those articles (55) contained quotes from the same six people, five of whom were representatives of various immunisation lobby groups. Seventy-five of the anti-immunisation articles (65 per cent) were p u b lished in Queensland and 33 (29 per cent) appeared in two newspapers; the Sunshine Coast Daily and the Northern Star Sixty-five different claims about immunisation were counted in the 244 articles with reference to anti-immunisation. Table 2 shows the eight most common claims classified by the perspective of the protagonist advancing them. Anti-immunisation claims did not occur in isolation. During the period, public calls for parents to immunise their children in the face of disease outbreaks and proposed policy changes aimed at improving immunisation rates provided a context in which the claims of anti-immunisationists were asserted. The school entry requirement of a certificate indicating immunisation status and the introduction of the Australian Childhood Immunisation Register prompted many letters, which, although responding to the perceived invasion of civil liberties, would also proselytise on the dangers of vaccines. Some articles and letters were prompted by a Queensland couple’s decision to take their local council to court in the Equal Opportunity Commission for disallowing their unvaccinated children to attend the council day care centre. Throughout much of 1994 two prominent anti-immunisationists conducted lecture tours through eastern Australia exhorting against immunisation and promoting their self-published books. Rural newspapers would print their claims in articles announcing their visit with headlines: ‘Health expert visits’ or ‘Lectures on using natural health to replace vaccines soon’. In addition, the anti-immunisation lobby group, the Australian Vaccination Network, through their r e p lar newsletter, urge members to write to local newspapers. Subtextual analysis During the sample period, November 1993 to February 1997, 108 letters and 40 news articles that contained statements from persons opposed to childhood immunisation were published. Each letter or article written by or about anti-immunisationists was reviewed for its use of subtexts (Tables 1 and 3). Up to eight subtexts were coded for each article. We provide illustrative examples of passages from articles and letters for each of the eight principal subtexts we found being used. We have prefaced each of these with examples from literature from the turn of the century opposing smallpox vaccination, to illustrate the resilience and continuity of these themes. COVER-UP: [Ilt is a case of downright deliberate falsehood, propagated at the public expense and to the public misleading [1893, p. 77].28 1. Vaccines are dangerous. 2. Vaccines play a causal role in the development of various diseases and conditions. 3. Vaccines are ineffective. A. Homeopathy is an alternative to vaccination. 5. The pertussis vaccine causes brain damlage. 6. The diseases vaccines are meant to prevent have declined, owing to better sewage, water, hygiene and nutrition. 7. Vaccines erode the immune system. 8. Good diet,, exercise, clean water and fresh oir will develop ’natural’ irnmuniiy, making vaccination unnecessary. One of the anti-immunisationists’ most persistent 22 NO. 1 AUSTRALIAN AND NEW ZEALAND JOURNAL O PUBLIC HEALTH 1998 VOL. F LEASK AND CHAPMAN Table 3: Subtexts found in articles and letters featuring statements from persons opposing childhood immunisation: November 1993 t February 1997 o Appearances in articles analysed n = 148 % read English in medical journals.

Journal

Australian and New Zealand Journal of Public Health – Wiley

Published: Jan 1, 1998

There are no references for this article.