Measles, Moral Regulation and the Social Construction of Risk: Media Narratives of "Anti-Vaxxers" and the 2015 Disneyland Outbreak

"Media coverage arguably contributed to further polarizing of the vaccine debate by obscuring the complex and varied political, economic, and social causes for decreasing rates of full immunization coverage."

This paper examines media coverage of the 2014-15 measles outbreak that began at Disneyland, an amusement park in the state of California, in the United States (US), and spread throughout that country and into Canada and Mexico. The argument made here is that, although parents who hold strong anti-vaccine views are small in number, media representations of so-called "anti-vaxxers" as prominent figures fail to capture the broad range of views and behaviours that constitute vaccine hesitancy and thus impede understanding of a complex health issue.

On January 5 2015, federal heath authorities were notified of five suspected cases of measles in California and Utah. All of the patients had visited Disneyland between December 17 and 28 2014. The outbreak eventually sickened 147 people in the US, and remained active in the province of Quebec, where 159 people from a tight-knit religious community with low vaccination rates were also sickened. The outbreak was extensively covered in the international media for several months, before subsiding as case reports declined. For this study, the researchers examined media coverage of the outbreak in leading national and regional agenda-setting Canadian newspapers, public affairs magazines, and online news sites from December 2014 to April 2015. Their sample of 331 articles was collected in real time.

The researchers draw in this study on classical treatments of "moral panics" as "volatile moments characterized by heightened concern about a group, its conduct or a particular event....Media discourses stereotype and misidentify deviance, which, particularly in the case of health panics, can produce harmful representations that stigmatize certain groups." They find that media coverage of the outbreak focused blame on parents of unvaccinated children and involved calls for state action to restore order through "moral regulation" in the form of expectations that parents will exercise self-governance and vaccinate their children. The coverage subscribed to notions of personal and social responsibility and amplified the risk to public health by focusing on "anti-vaxxers" as a deviant and threatening group.

In reality, though, only a minority of parents in Canada (between 2-4%) refuse to have their children vaccinated. A larger, growing group of "vaccine-hesitant" parents "presents a more difficult and complex dilemma for the public health community. In this case, media coverage stripped the problem of vaccine hesitancy of its complexity by emphasizing a discourse of blame and shame." According to the researchers, news coverage that captured the complexity of this phenomenon came from only a small group of specialist health and science reporters.

There are three key implications of the research:

1. "[M]edia coverage of disease outbreaks has largely moved away from the 'false balance' model of reporting, in which journalists position pro-vaccine and anti-vaccine advocates against each other as though each position has equal weight and value....[D]espite the slow disappearance of anti-vaccine advocates as active sources in the coverage, the 'anti-vaxxer' looms large as a central character in the outbreak narrative." Journalists and public health officials need to understand that this is character is no longer useful in their communications.
2. "The highly moralized tone of outbreak reporting may be a double edged sword. On the one hand, it may serve a productive role in constituting a sense of moral righteousness on the part of pro-vaccine advocates, who value and believe in the importance of immunization for population health protection. This sense of certainty is culturally important to maintaining levels of immunization that health officials note are necessary for herd immunity. Yet, at the same time, the tone of the coverage risks cementing the views of those parents who remain strongly opposed to vaccination, and potentially alienating the growing numbers of other parents who are anxious about vaccines and looking for voices of understanding and not moral approbation. Worried parents who may have legitimate questions about vaccine safety and effectiveness, regardless of the reasons underpinning those questions, may be less likely to raise them publicly for fear of censure and stigmatization, and more likely to seek support from those parents who may share their concerns or seek to benefit from them. In other words, shaming may have the effect of disconnecting an individual from the moral community and forcing them to seek kinship elsewhere."
3. "[O]utbreaks generate opportunities for public health officials to shape the structure and tone of media and public discourse. As the 'anti-vaxxer' remains a dominant character in the media narrative, public health officials may find themselves implicated (by their own words or through association) in the construction of a moral panic about vaccine hesitancy. Here, health officials may be blaming a group that does not actually exist, and in doing so oversimplify the complex causes of declining vaccination rates. These causes include not just attitudes and beliefs about vaccine safety, but also vaccine scheduling, province-specific recommendations about types of immunization, low levels of health literacy relating to socioeconomic disadvantage, and so on. Therefore, greater attention to the importance of narrative, and of strategic communication generally, is needed to reduce polarization and advance the debate in a more constructive manner."

The researchers suggest that further research could explore how these narratives influence or drive public debates on vaccination and vaccine hesitancy in social media. For example, Facebook and Twitter have been identified as playing an important role in disseminating anti-vaccine information, and social media sites have become hubs for supporting the distribution and circulation of news reports from the legacy media. Future research can build upon this study "in exploring how the ever-changing mediascape provides new opportunities or challenges to the formation and contestation of outbreak narratives."