(De)legitimation of COVID-19 vaccination narratives on Facebook comments in Romania: Beyond the co-occurrence patterns of discursive strategies

Abstract

The postmodern medical paradigm has empowered online users in the (de)legitimating process of health-related topics. By employing a co-occurrence analysis, this study identifies the thematic patterns used by Romanian online users in their multimodal comments to the #storiesfromvaccination Facebook campaign run by the Romanian government. The findings show that the commenters assessed source credibility through two thematic patterns: ‘source exemplarity’ and ‘source distrust’. Health experts were more legitimized than laypersons and role models as sources in the COVID-19 vaccination campaign. Two thematic patterns emerged in the assessment of vaccination, namely: ‘immunization – past and present challenges’ and ‘vaccination supporter versus opponent cleavage’. In the discussion on immunization, a polarization between a nostalgic longing for the past and a present corrupted medical and political system prevailed, whereas the important feature of discursive antagonism could be observed in the latter thematic pattern. The co-occurrences of (de)legitimation strategies are explained with reference to the political and medical context, along with the challenges of social media usage in online vaccination communication campaigns.

Keywords

co-occurrence analysis COVID-19 vaccination (de)legitimation discursive strategies online comments Romania

Introduction

Considered ‘one of the greatest achievements of public health’ (Dubé et al., 2013: 1763), vaccination has also raised a level of public hesitancy that has become even more prominent in the context of COVID-19 vaccination campaigns. However, harbouring doubts about the vaccine safety is considered legitimate since it is seen as ‘an integral part of the development of any vaccine’ especially related to possible side-effects (Mohammed and Rossi, 2022: 135). Identified by the World Health Organization (WHO, 2019) as one of the top ten threats to global health, vaccine hesitancy is fuelled by the postmodern medical paradigm where the ‘legitimacy of science and authority’ is placed under question (Kata, 2012: 3779).

Within this new paradigm where ‘the legitimacy of doubt’ should be acknowledged (Mohammed and Rossi, 2022: 140), international and national health authorities should be aware that social media used in public information campaigns act as ‘two-sided swords of health communication’ either undermining and/or enhancing the public trust in scientific expertise (Van Dijck and Alinejad, 2020: 8). Although public health actors use content strategies to reduce public scepticism and eventually lead to a shift in vaccination behaviour (Dubé et al., 2020; Hinyard and Kreuter, 2007; Ihlen et al., 2021; Warren and Lofstedt, 2021), ‘nonexpert voices (. . .) have substantial impact on the circulation of health information’ (Van Dijck and Alinejad, 2020: 9) through interactive exchanges. Therefore, I consider that in the postmodern medical paradigm it is important to assess what Breeze (2021: 3) labels as the ‘the dynamics of health-related interactions in social media networks’. The focus on a bottom-up perspective is especially essential in the context where the authority dimension is ‘based on perceived legitimacy’ (Gilpin et al., 2010: 263). Thus, although the (de)legitimation of an authority and/or an issue is co-produced through stakeholder participation (Castelló et al., 2016; Glozer et al., 2019), one should not forget that confidence in sources in negotiated (Ihlen et al., 2021) in the postmodern medical paradigm.

Perceived legitimacy of authority is problematic in a region such as Eastern Europe where socio-political factors play a significant role in citizens’ aversion towards experts (Wellcome Global Monitor, 2021). The COVID-19 pandemic revealed that many Eastern European governments prioritized economic interests over health interests thus emphasizing the ‘dire situation’ of health care systems in the region (Bohle and Eihmanis, 2022: 493–494). The citizens’ distrust of national authorities and health specialists could be influenced by the increased perception of corruption in Eastern Europe (Haerpfer et al., 2022) and the rise of populism in the region (Mihelj et al., 2022) which is closely linked to medical populism (Lasco and Curato (2019: 5), a political style characterized by ‘simplified discourse’ and ‘dramatized portrayals’ of crises.

Political instability in Romania (Gherghina and Soare, 2016), with seven ministers¹ running the Ministry of Health since the beginning of the COVID-19 pandemic, may be one of the explanations for the rise of a new far-right party (Alliance for the Unity of Romania/AUR) during the 2020 national elections held in the country.² This party was supported by traditionalist Orthodox priests who consider that the Church has a duty to get involved in the political arena and who were against the governmental restrictions during the pandemic, especially those preventing believers attending church services (Gherghina and Mișcoiu, 2022: 234).

Having one of the highest distrust rates concerning national authorities (Haerpfer et al., 2022), Romania suffered the largest decrease in satisfaction rates concerning the way the national government handled the vaccination strategy (from 51% in May 2021 to 36% in February 2022, Flash Eurobarometer 505, 2022). Research suggests that beyond the increased impact of anti-vaccine online movements worldwide, governmental mismanagement of the pandemic in Eastern Europe played a crucial role in the vaccine uptake (Buštíková and Baboš, 2020; Maleva et al., 2021; Walkowiak et al., 2021; Winiarska-Brodowska, 2022). Therefore, it is no surprise that trust in government is low in East European countries, Romania having one of the lowest confidence rates (20%) in its national government, a phenomenon which should be associated with an increased perception of corruption (54.5%) in society (Haerpfer et al., 2022). These contextual factors played a significant role in the low COVID-19 vaccination rates in post-communist countries, the lowest vaccination coverage by the end of September 2021 being in Bulgaria and Romania (Walkowiak et al., 2021).

According to Yaqub et al. (2014: 2), trust and legitimacy are essential in understanding how the information on vaccination delivered by various sources is recontextualized. Studies have shown that in pro-vaccination campaigns, despite the tendencies towards the usage of evidence-based content focusing on factual information delivered by experts (Dubé et al., 2013), emotional content through personal stories also triggers a positive engagement in fostering vaccine confidence (Betsch et al., 2011; Chou and Budenz, 2020; Pedersen et al., 2020; WHO, 2021). In this article, I will provide a discursive (de)legitimation analysis of COVID-19 vaccination, focusing on the analysis of the multimodal comments in response to the personal stories used as a content strategy in the pro-vaccination Facebook³ campaign run by the Romanian government.⁴ Launched in December 2020, the online Romanian vaccination campaign was criticized in the media for improper audience targeting and the ineffective usage of politicians or various unknown doctors as credible sources (Isăilă, 2021). Within this context of public criticism, the Romanian authorities shifted their content strategy and launched a new Facebook campaign in April 2021. This time the content strategy focused on personal experience narratives of COVID-19 vaccination. This campaign, entitled #storiesfromvaccination/ #poveștidelavaccinare, was awarded the first prize at the national social media competition Webstock for ‘the best use of user generated content’. Analysis of the (de)legitimation strategies used in the multimodal comments on the Facebook posts embedding personal stories is valuable since the ‘hybrid media ecology’ (Ihlen et al., 2021: 6) brings forth a multiplicity of voices and potential counter-discourses (Vestergaard and Uldam, 2022). Therefore, I will adopt a bottom-up perspective to (de)legitimation and the aims of the research are the following:

(1) to identify the degree of (de)legitimation of the message sources (experts, laypersons and role models) whose personal stories were assessed by Romanian commenters on Facebook.

(2) to determine what discursive strategies are used by Facebook commenters (vaccine supporters versus opponents) in the (de)legitimation of (COVID-19) vaccination in Romania.

(3) to shed light on the politicization of vaccination debates in Romania during the COVID-19 pandemic.

(4) to provide insights into effective communication strategies to be used by Romanian health authorities in future public health campaigns.

In the beginning I will provide a brief overview on (de)legitimation as a theoretical background. The second section elaborates on the construction of (de)legitimation of vaccination campaigns on social media. Methodological aspects are explained and followed by the analysis of the thematic patterns present in the multimodal comments. In conclusion, the findings are discussed addressing both the information sources and the issues related to vaccination in the East European region.

Theoretical background

Starting from the idea proposed by Gilpin et al. (2010) that legitimacy of authority ‘must be socially agreed on among those communicating’ (p. 262), it is essential to identify two directions of legitimation (van Dijk, 2000: 257), namely: (a) a top-down direction of legitimation used by institutions with respect to citizens; (b) a bottom-up direction of legitimation used by the ‘masses’ with respect to institutions, elites or leaders. However, the legitimation discourse of a social group triggers the delegitimation of the opposing groups that promote other practices (van Dijk, 2000: 258–260), while this discursive strategy of legitimating one’s position by undermining the other’s position is considered as ‘destructive legitimation’ (Vestergaard and Uldam, 2022: 233).

There are various ways of operationalizing specific models of legitimation analysis. Authorization, rationalization, evaluation and mythopoesis are the four categories of the framework developed by Van Leeuwen (2008). Vaara et al. (2006) outlined the discursive strategy of normalization which is considered to be ‘the primary type of legitimation, as it seeks to render something legitimate by exemplarity’ (p. 798) and also identified authorization, rationalization, moralization and narrativization as discursive strategies to (de)legitimate contemporary organizational phenomena (p. 804).

The various facets of the legitimation process become more important in the context of social media since they act as ‘powerful amplifiers of whatever message is put forward in public’ (Paglieri, 2022: 157). Suddaby et al. (2017) consider that a legitimacy-as-perception approach focuses on ‘processes of making judgments’ (p. 463). Acknowledging the possibility of conflicting with the other’s position in a dialogue, Glozer et al. (2019) develop ‘a dialogical view of discursive legitimation in organization-led social media settings’ (p. 626) by focusing on the importance of polyphony and on the shifting positions of the multiple voices engaged in organizational communication.

Since Facebook was the social media network where the Romanian Ministry of Health ran the #storiesfromvaccination campaign, the interrelated functions of discursive legitimation (discursive authorization, validation and finalization) outlined by Glozer et al. (2019) will constitute the starting point in developing the coding schemes (see the section on methodology) used for the analysis of Romanian online users’ comments.

Social media and constructing (de)legitimation of vaccination

The comparative studies of pro- and anti-vaccination discourses on various social media platforms highlighted that the rhetorical devices used by vaccine promoters and opponents were identified as ‘furthering or reinforcing polarization’ (Meyer et al., 2019: 1769). Social media intensify the formation of the social media echo-chamber effect, people being either in favour or against a topic such as vaccination (e.g.), and not both (Meyer et al., 2019; Nguyen, 2020; Schmidt et al., 2018).

This cleavage between vaccination promoters and opponents has been observed in various studies. In their comparative analysis of Facebook pro- and anti-vaccination comments, Faasse et al. (2016: 5811) found that pro-vaccination narratives revealed a more authentic and anxious nature legitimating vaccination through more family-related messages and societal wellbeing. The usage of official sources and statistics dominates the discourse of vaccine supporters who constantly question the authority of sources employed in the vaccine opponents’ discourse (Meyer et al., 2019). In their network analysis before the development of the COVID-19 vaccine, Johnson et al. (2020: 231) found that unlike pro-vaccine clusters that seem monothematic, the anti-vaccine clusters embed various themes such as concerns about vaccine safety, conspiracy theories, alternative cures or other cures and remedies for the COVID-19 virus. In their study of the anti-vaccination movement on Facebook, Smith and Graham (2019) pointed out that the ‘conspiracy-style’ thinking was fuelled by moral outrage and was related to governmental and media oppression. Hughes et al. (2021) studied the anti-vaccination rhetoric and identified three salient narrative tropes (corrupt elites, vaccine inquiry and sinister origin) within COVID-19 vaccine misinformation. The doubts about vaccine ingredients, safety, effectiveness, on the one hand, and about the trust in authorities and/or official medical experts, on the other hand, are also presented in a study on prominent anti-vaxxers’ discourse on COVID-19 vaccination (Mohammed and Rossi, 2022: 131–132). These findings are consistent with previous studies (Faasse et al., 2016; Kata, 2012; Ma and Stahl, 2017). For example, an analysis by Faasse et al. (2016: 5811) showed that the health, money and work-related terms contained in the vaccine opponents posts encompassed pseudo-factual information which may be considered valid scientific information. In the same line, Ma and Stahl (2017: 307) consider that the vaccine opponents’ discourse focused on sentimentality and reductionism over scientific research, while Kata (2012: 3781) identified four discursive tactics employed by vaccine opponents: skewing the science, shifting hypotheses, censorship and attacking the opposition. However, this last tactic was also observed in the vaccine promoters’ discourse. Breeze (2021) and Meyer et al. (2019) emphasize that both groups use ridicule and sarcasm as means of delegitimizing their opponent’s claims.

Despite this extreme cleavage between vaccine supporters and opponents, the importance of online groups discussing their own fears, doubts and anxiety with respect to vaccination rejection or disease outbreak should be acknowledged (Faasse et al., 2016; Guidry et al., 2017). Online transparency concerning vaccination hesitancy or repercussions of disease outbreak may lead to a means of ‘disseminating knowledge and combating harmful information’ (Guidry et al., 2017: 484).

Data and methodology

CrowdTangle, a social data access tool from Meta, was used to extract all the #storiesfromvaccination posts. This tool tracks only public content giving access to Facebook posts and to the interaction rate for each post without providing information about the users who interacted. The time span, April 5 and December 19, 2021, was chosen because it shows the beginning of the #storiesfromvaccination campaign and the end of the first year since the COVID-19 vaccination campaign had started in the European Union, and particularly Romania. A total of 308 posts including this hashtag were uploaded on the Romanian governmental Facebook platform.

In the first stage of the analysis, I started from the idea that the perception of source trustworthiness is situated and constantly negotiated (Ihlen et al., 2021). Thus, through an iterative process, three main types of sources telling their stories about vaccination were identified in all Facebook posts, namely: health experts, laypersons and role models.

Starting from the idea that contributing (commenting) alongside with consuming (liking) and creating (sharing) focuses on active participation in online conversations (Muntinga et al., 2011), all posts were ranked according to their engagement rate.⁵ The top 5 posts with the highest engagement rate were selected for each of the three sources mentioned above. Therefore, the comments concerning 15 #storiesfromvaccination Facebook posts were taken into consideration. After curating the data, the corpus consisted of 4096 anonymous comments in response to the vaccination narratives.

In the second stage, the (multimodal) comments were imported into QDA Miner 6.0.3- Wordstat 7.1.19., a mixed methods software, the coding of the data being manually conducted. Drawing on various operationalizations of discursive (de)legitimation (Glozer et al., 2019; Luyckx and Janssens, 2016; Vaara et al., 2006; Van Leeuwen, 2008; Vestergaard and Uldam, 2022), the following categories were employed as a set of codes in QDA Miner 6.0.3: legitimation through discursive authorization, discursive validation and discursive co-optation (Table 1) and delegitimation through discursive deauthorization, discursive devalidation and discursive antagonism (Table 2). The coding of the comments showed that the category of mythopoesis (Van Leeuwen, 2008) was not employed in the comments.

Table 1.

Coding scheme – legitimation strategies.

Legitimation	Discursive authorization	Personal authority – comments drawing on personal experience of vaccination;
		Impersonal authority – references to rules, guidelines on vaccination;
		Expert authority – references to expert names related to vaccination, mentions of credentials;
		Role model authority – references to national and international role models who had received their COVID vaccine shots and who could urge other persons to get vaccinated.
	Discursive validation	Normative appeal – comments that draw on retrospective or prospective exemplarity (Vaara et al., 2006: 798) associated with vaccination (e.g. diseases eradicated by vaccination or countries where the COVID-19 vaccine uptake is high), or on advice giving considered as a normal thing to be followed (Glozer et al., 2019: 636).
		Moralization – comments that included evaluations and/or abstract or metaphorical ways of referring to practices or analogies related to vaccination.
		Rationalization (Van Leeuwen, 2008) – comments that included either instances of instrumental rationalization (goals, uses, effects of vaccination) or instances of theoretical rationalization (definitions, predictions, elaborate explanations for actions related to vaccination).
	Discursive co-optation	It focuses on multimodal phrases emphasizing consensus on vaccination or gratitude (e.g. You are right, Thank you or other discursive visual cues and smiley face emoticons). The consensus was coded towards the source of the post and the commenter.

Table 2.

Coding scheme – delegitimation strategies.

Delegitimation	Discursive deauthorization	This included instances of questioning ‘the authenticity, sincerity or relevance’ (Vestergaard and Uldam, 2022: 232) of the personal, impersonal, expert or role model authority used in the #storiesfromvaccination campaign.
	Discursive devalidation	This focuses on: - the removal of validation of practices, events or cases related to vaccination, considered normal by other commenters; - demoralization (Vestergaard and Uldam, 2022: 236), the commenters negatively evaluating others’ behaviours towards vaccination; - the delegitimation of the uses, effects of vaccination or of the explanations for the act of taking COVID vaccine shots.
	Discursive antagonism	This implies purifying one’s image through negative other-presentation, using parody, sarcasm or irony (Luyckx and Janssens, 2016: 1613). Dissent was also coded towards the source of the post and the commenter.

Starting from the idea that ‘discursive legitimating strategies are often intertwined’ (Vaara et al., 2006: 805), in the third stage of the analysis, a co-occurrence analysis was performed in order to determine the code (discursive strategies) clustering pairs. Since code co-occurrence involves a semantic similarity, clusters of codes are considered larger themes. Hence, a co-occurrence analysis helps in identifying the thematic patterns in the data set (Guest and McLellan, 2003).

In the fourth stage of the analysis, for a more in-depth analysis of the lexical choices within the (de)legitimation discursive strategies, Wordstat 7.1.19., a text analysis software, run from QDA miner 6.0.3, was used to conduct a cross-tabulation analysis in order to identify the co-occurrence of words and phrases with the various (de)legitimation categories presented above.

Examples from the comments translated into English by the author will be mentioned.

Findings and discussion

This section presents the results of the frequency and co-occurrence analyses performed on the coded comments posted to the vaccination narratives delivered by health experts, laypersons and role models. The findings are structured in three main sections, namely:

(1) Frequency of online users’ (de)legitimation strategies to sources’ vaccination narratives;

(2) Pro-vaccination source credibility – patterns of consensus and antagonism. Two thematic patterns will be discussed here, namely:

- ‘Source exemplarity’ – the sources’ actions of getting vaccinated are legitimized as moral examples to be followed.

- ‘Source distrust’ – sarcasm and accusations of corruption are used to delegitimize the information sources.

(3) Immunization – patterns of consensus and antagonism. Three thematic patterns were identified, namely:

- ‘Vaccination – past and present challenges’ – polarization is employed to legitimize past vaccination and a past apolitical medical system and to delegitimize COVID-19 vaccines and the present politicized medical system.

- ‘Claiming authority through personal experience’ – a prevalence of personal authority at the expense of expert authority is employed both by supporters and opponents to (de)legitimize their getting vaccinated.

- ‘Vaccination supporter versus opponent cleavage’ – antagonism is used by both groups to (de)legitimize the other. Vaccine promoters are represented as gullible and superior whereas opponents are perceived as illiterate persons with populist beliefs.

Online users’ (de)legitimation strategies to sources’ vaccination narratives – frequency analysis

The Facebook narratives with the highest engagement rate were delivered by nurses, ER doctors and resident physicians (as health experts); children, adults and elderly persons (as laypersons); and priests, artists or Roma representatives (as role models).

As seen in Table 3, a clear discrepancy could be observed in the commenters’ usage of discursive strategies (de)legitimating the narratives of the three sources. The highest percentage (64%) of delegitimation strategies was found within the comments posted concerning the vaccination narratives of the role models, which may suggest that more commenters did not consider the role models chosen for the pro-vaccination campaign as appropriate. As observed, the health experts’ narratives were slightly more legitimized compared with the laypersons’ and role models’ stories. At the same time, the laypersons’ narratives on pro-vaccination were more legitimized (48%) than the other stories. These findings fall in line with a national survey (IRES, 2021) which showed that health experts (physicians) and laypersons (children, parents or friends) were considered the most trustworthy sources throughout the COVID-19 vaccination campaign in Romania.

Table 3.

(De)legitimation strategies in online comments to Facebook posts containing vaccination narratives.

	Health experts’ vaccination narratives	Laypersons’ vaccination narratives	Role models’ vaccination narratives
Legitimation strategies	45% (n = 578)	48% (n = 658)	35% (n = 507)
De-legitimation strategies	42% (n = 549)	54% (n = 729)	64% (n = 919)
Total comments	1295	1358	1443

The assessment of the health experts’ stories from vaccination triggered more consensus among the commenters whereas the role models’ narratives revealed a higher degree of antagonism (see Table 3). The commenters’ consensus almost rose to the level of antagonism when referring to the laypersons’ narratives (see Table 3).

Despite this discrepancy, a similarity was observed in the lexical choices used for validating or discrediting the source credibility. Words, such as ‘Congrats!’ (n = 122), ‘Respect!’ (n = 58) or ‘Bravo!’ (n = 52) were included in the comments targeted towards the pro-vaccination campaign sources. However, the cross-tabulation analysis between these words and the co-optation and antagonism strategies revealed that these lexical choices were used both for legitimating and delegitimating purposes. On the one hand, alongside with discursive cues (clapping hands emojis, in love stickers or congratulations GIFs, see Figure 1), the commenters created what Glozer et al. (2019: 643) call ‘a consensual moment’, praising the behaviour of the laypersons or role models who had received their COVID vaccine shots or the dedication of those doctors who had been attending to COVID-19 infected persons in hospitals.

Figure 1.

Comments embedding appreciative emojis, stickers and GIFs.

On the other hand, a comment such as ‘Congrats! Now you will have a better phone signal! And maybe you will beep on Google Maps’ highlights that words of praise were used in association with forms of delegitimation. Therefore, an analysis of the co-occurrence of the various discursive strategies is necessary since the coding of texts should be performed contextually.

Pro-vaccination source credibility – Patterns of consensus and antagonism

The results of the co-occurrence analysis focusing on validating or discrediting pro-vaccination campaign sources will be presented in this section. The analysis revealed two main clusters, namely:

- The ‘source exemplarity’ thematic pattern included the co-occurrence of discursive co-optation towards the source of a Facebook post with normative appeals and moralization;

- The ‘source distrust’ thematic pattern was formed of the co-occurrence of discursive antagonism towards the source of a Facebook post with demoralization and the (de)legitimation function of normative appeals.

Each of the thematic patterns is presented below.

The ‘source exemplarity’ thematic pattern

The excerpts below show the commenters’ representations associated with different sources: doctors and nurses (1, 2 and 3), children and parents (4 and 5), priests (6 and 7) and representatives of the Roma community (Basha, his wife and nephew, 8).

(1): Respect! Doctors and nurses are the true heroes!

(2): Be like Andreea! People like her should be promoted and supported, not all the scumbags.

(3): Respect! A correct view that should be a lesson for those who doubt the existence of the virus and the superhuman efforts of the medical personnel! We trust you and we respect your work, patience and goodwill but be on TV more often.

(4): Congrats! Real people who trust science. Congrats to the parents! The apple doesn’t fall far from the tree!

(5): I won’t congratulate you! I just say that you are normal and that you behaved as all of us should do.

(6): Congrats! You are unique. For 2 years I have been waiting for a priest to say this about the vaccine. People have a misconception of faith in God!

(7): You are right! As if the Pope did not get the jab. . .

(8): Congrats! Your post (. . .) really makes me hope that we as a nation could improve. That not all gypsies are thieves. You are a shining example. Some could be SMURD⁶ volunteers! You have my respect!

The future normality as a form of prospective exemplarity is achieved through instances of advice given as a form of setting a collective ‘moral compass’ (Glozer et al., 2019: 639) as in excerpt 2 or excerpt 3. ‘Getting the jab’ is legitimized as a normal practice through two types of retrospective exemplarity: an international example is provided by reference to the Pope (excerpt 7) and national examples (medical personnel, laypersons or role models) whose vaccination behaviours are represented as social practices to be followed by Romanians. Orthodox priests as role models is a sensitive issue in Romania as they are associated with an anti-vaccination position (Obreja, 2022) and, as pointed out by Gherghina and Mișcoiu (2022: 234), traditionalist priests supported the new far-right party (Alliance for the Unity of Romania/AUR) in the 2020 election campaigns whereas the more progressive priests adopted a ‘neutral position’ regarding politics. Therefore, the presence of priests as information sources in the COVID-19 vaccination campaign in Romania could be seen as a communication strategy to convince religious believers to follow the examples set by those priests who got vaccinated.

These past or future normative appeals were associated with moralization which had either legitimating or delegitimating purposes. Positivity-laden evaluative adjectives were widely used to emphasize the message sources’ pro-vaccination behaviour as ‘the natural order’ of things (Van Leeuwen, 2008: 111): ‘true heroes’ (excerpt 1), ‘correct opinion’ (excerpt 3), ‘real people’ (excerpt 4), ‘you are normal’ (excerpt 5), ‘you are unique’ (excerpt 6). A positive analogy through an idiomatic expression (‘The apple doesn’t fall far from the tree’, excerpt 4) legitimized the similarity between a child and his parent in their pro-vaccination stance. As observed in excerpts 2 and 8, some commenters provided a negative evaluation using depreciative adjectives (‘scumbags’) or nouns (‘thieves’) to highlight a polarization between the normality of getting vaccinated and that part of Romanian society that promotes corruption or that possesses racial prejudices against the Roma.

The ‘source distrust’ thematic pattern

The excerpts below show instances of questioning the sincerity of the sources who promoted vaccination in the Romanian governmental campaign. As mentioned, dissent was expressed more towards laypersons (excerpts 9, 10, 11) and role models (excerpts 12, 13, 14) than towards health experts (see Table 3). One explanation for this discrepancy could be the usage of those health experts who are perceived to be independent of any political party. Mihelj et al. (2022: 311) consider that ‘independence from political elites’ is likely to have a significant impact on the assessment of expert credibility especially in those East European countries where trust in science and government is low. The Facebook posts with the highest engagement were delivered by doctors and nurses who were not associated with any politicized medical expertise. This goes hand in hand with the findings of Flash Eurobarometer 505 (2022) showing that Romanian respondents trust health professionals, doctors, nurses and pharmacists (61%) more than national health authorities (42%).

Direct criticism of the parents, priests and Roma people used as sources is obtained either through evaluative adjectives or nouns with a delegitimation function (‘stupid’, ‘confused’, ‘garbage’, ‘liars’, ‘obnoxious jerk’) or through depreciative emojis or stickers (Figure 2). The deauthorization of these sources is linked to bribery, as seen in excerpt 11, 13 and 14, the commenters discrediting them for being easily corrupted. This finding is also present in another study on Romanian online users’ comments regarding the COVID-19 vaccination campaign. As pointed out by Obreja (2022: 12), a popular theme was related to the accusations targeted to the vaccine supporters as having been paid to ‘publicly support vaccination’.

Figure 2.

Comments embedding depreciative emojis and stickers – ‘Te-ai vaccinat cu banii enoriașilor scârbă ordinară’/ ‘You got vaccinated with the parishioners’ money, you obnoxious jerk’

(9): Stupid parents! Why do you have to show off to the whole country? What have you done well?

(10): Why should I be interested in who got the jab and what vaccine was used? Don’t you have other topics to post on Facebook? Why does everyone want to become an influencer? Let us think for ourselves and do whatever we want!

(11): How much money did you get to post this garbage about that vaccine that killed thousands of people? Stop brainwashing us and stop this miserable propaganda.

(12): Priests are liars. I say promote sincere people as otherwise you make a fool of yourselves and nobody will take you seriously any longer.

(13): You got vaccinated with the parishioners’ money, you obnoxious jerk.

(14): Let the doctors talk about the jab, stop spreading propaganda for money. Could you tell us who is paying you?

Normative appeals are used to delegitimize the governmental practice of propaganda (‘stop spreading propaganda for money’, ‘Stop brainwashing us and stop this miserable propaganda’) or self-promotion (‘Why does everybody want to become an influencer?’). In excerpt 14 above, the positive counterpart of normalization contributes to acknowledging doctors as legitimating authorities on the topic of vaccination. Some commenters delegitimized priests (excerpts 11, 13) as appropriate sources of persuasion on vaccination and this trend was also highlighted in the IRES (2021) national survey, priests being considered one of the least trustworthy persons by vaccine supporters, opponents and the undecided.

Indirect criticism via sarcasm (Toplak and Katz, 2000) was used to express the commenters’ resentment towards the message sources. Defined as ‘aggressive humour that targets an individual’ (Martin, 2007: 3), sarcasm is employed by making references either to the practice of lying while writing an essay as a pupil (excerpt 15), or to well-known polluted narratives (excerpt 16) and misleading information (vaccination and 5G technology) or to a recontextualization of an idiomatic expression (excerpt 17) within the Roma people’s alleged practice of stealing.

(15): You wrote so nicely about this stupidity of a vaccination that my high school teacher would have given you a 10 with flying colours. I used to write such flourishing lies myself when they asked me to write about autumn.

(16): Congrats! Now you will have a better phone signal! And maybe you will beep on Google Maps.

(17): Good craftsmen steal, bad craftsmen learn.

The GIFs in Figure 3 present the enactment of an ‘affective response’ through the display of an embodied behaviour (Tolins and Samermit, 2016: 89). Therefore, through the employment of anthropomorphism, that is animals being invested with human features (Buijzen and Valkenburg, 2004: 153), the commenters’ visual aggression towards the Roma minority is enhanced. The usage of the animal metaphor as a form of the racist representation of the Roma and degradation is a common multimodal practice among Romanian commenters (Breazu and Machin, 2019), this time the mapping of human-like characteristics (skin colour and the act of stealing) being performed onto a monkey and a pig.

Figure 3.

Comments embedding sarcastic GIFs.

Immunization – Patterns of consensus and antagonism

This section will be divided into three main parts. They constitute the results of the co-occurrence analysis of the discursive strategies used to (de)legitimize immunization within comments. Three main clusters were formed:

- the ‘vaccination – past and present challenges’ thematic pattern combined normative appeals with a legitimating (n = 390, 9.52%) and delegitimating function (n = 336, 8.20%), demoralization (n = 365, 8.91%) and theoretical rationalization for delegitimating purposes (n = 207, 5.05%).

- the ‘claiming authority through personal experience’ thematic pattern included legitimation through personal authority (n = 303, 7.39%) intertwined with theoretical rationalization (n = 198, 4.83%).

- the ‘vaccination supporter versus opponent cleavage’ thematic pattern embedded delegitimation through personal deauthorization (n = 210, 5.12%) alongside discursive antagonism towards the commenter (n = 620, 15.13%). As observed, discursive antagonism was the most frequently used strategy in delegitimizing others’ arguments.

In what follows, each of the thematic patterns will be presented.

‘Vaccination – Past and present challenges’ thematic pattern

Taking into account the above-mentioned co-occurrence of discursive (de)legitimation strategies, the first thematic pattern focused on a two-fold polarization: (a) past vaccination – a legitimate retrospective practice versus COVID-19 vaccination – a negative prospective practice; (b) past apolitical medical system versus present politicized medical system.

The first polarization combines evaluation of vaccination with theoretical rationalization through definitions, explanations and predictions. The cross-tabulation analysis showed that the opponents of COVID-19 vaccination used the derived forms of the noun ‘experiment’ (n = 23) as their main lexical choice when describing this vaccine. Besides ‘experimental’ (excerpt 18), two other explicit negative-laden evaluations (‘broth’ and ‘test for fools’ – excerpt 21) were employed to delegitimize the COVID-19 vaccine compared with previous vaccines. This finding falls in line with a worldwide reluctance towards the surprisingly rapid development of the COVID-19 vaccine (Chou and Budenz, 2020).

(18): Besides, this vaccine is experimental. It is true that vaccination has saved humankind till now. But nowadays we do not know how saved we will be since everything happens as if you were voting, you could get the jab even in a parking lot without anybody asking you if you have contraindications from your family physician or if you have other diseases. . .

(19): Those vaccines were tested for years, not several months. They were developed in years not in 6 months. For those vaccines, the producers did not ask you (. . .) to sign that you are getting the jab on your own risk.

(20): Nowadays some people who produce these vaccines think only of the money. Had we been in Ceaușescu’s time, I definitely wouldn’t have been afraid.

(21): Nowadays this broth of a vaccine is a test for fools.

These excerpts highlight a reframing of the rejecters’ position regarding vaccination in general: although they are pro-vaccination, they are against COVID-19 vaccination. The same phenomenon was observed in previous studies on influenza vaccination (Meyer et al., 2019: 1771), the opponents reframing the anti-vaxx movement from an ‘anti’ to a ‘pro health’ position. The explanatory rationalization specified explicitly either the necessary time span for vaccination testing (‘years’ vs ‘6 months’, excerpt 19), the mismanagement of the vaccination process (‘you could get the jab even in a parking lot’, excerpt 18) or the producers’ and doctors’ hidden interests (excerpts 19 and 20). A multi-faceted reluctance towards the actions of national government ranging from a lack of trust in the Romanian government, media and pharmaceutical industry to a mistrust in the medical system is also present in previous studies (Cmeciu and Coman, 2021; Crăciun and Băban, 2012; Pența and Băban, 2014; Vulpe, 2020).

Most surprising is the usage of an appreciative reference to Ceaușescu, the last Romanian communist president, in the commenter’s prediction (excerpt 20). Iețcu-Fairclough (2007: 37) observes that nostalgia for a ‘golden age’ (the communist regime) expresses an affective orientation specific to populism. The legitimation of the Romanian communist golden age is achieved through an implicit polarization: now (corrupted medical system) versus then (trustworthy medical system). This nostalgia framework is outlined in other studies on vaccination communication in Romania: vaccination during the communist regime was legitimized as ‘a natural process of avoiding mass disease, not a matter of democratic choice’ (Obreja, 2022: 11). At the same time, Ramonaitė’s (2022) study showed that in Lithuania communist nostalgia is closely linked to conspiracy theories.

This polarization between past vaccination versus COVID-19 vaccination shows what Vulpe and Rughiniș (2021: 1514) identify as ‘trade-off pattern of concomitant trust and mistrust in assessing vaccines’, Romania being one of the EU countries with the high proportion of trade-off persons who, despite their trust in vaccines’ effectiveness and usefulness, also believe in probable vaccine harm.

The second polarization refers to the distrust towards the present political class (excerpts 22, 23 and 24) and it falls in line with previous research (Buštíková and Baboš, 2020; Farkas et al., 2022; Mihelj et al., 2022) on health campaigns in former communist countries that highlight the negative consequences of political involvement in medical expertise. Romanian commenters are critical of politicians’ interference in the medical system and they delegitimize the governmental practice of appointing the Ministry of Health on political grounds (excerpt 23). Although this failure of the present Romanian medical system is emphasized in previous studies (Cmeciu and Coman, 2021; Crăciun and Băban, 2012), it should also be related to the national context: within 1 year (December 2020–December 2021), six ministers ran the Ministry of Health in Romania, with four main political parties⁷ appointing their representatives at the head of this ministry.

(22): (. . .) Nowadays everything is political and not for our health. Why does politics have to meddle in this?

(23): The vaccine was not used like today for access or travelling, politicians were not involved. People do not trust Romanian politicians. In those times doctors were respected, now the Minister of Health is appointed on political grounds.

(24): When politics steps into the medical capacity, this is very bad for humankind.

‘Claiming authority through personal experience’ thematic pattern

Personal-based authorizations were employed both by vaccination supporters (excerpts 25–30) and opponents (excerpts 31–33). It was interesting to observe that expert authority was used six times less often than personal authority by commenters.

‘I got the jab’ (n = 10), ‘I am/I was/ we got vaccinated’ (n = 34) and ‘my husband got the jab’ (n = 6) were the mostly frequent lexical choices that cross-tabulated with the legitimation through personal authority within vaccine supporters’ comments. Breeze (2021: 5) observes that this type of discursive strategy is common when commenters provide ‘first-hand experience as a potential source of trustworthy information’. However, sharing this experience of vaccination is also expressed through sarcasm (excerpts 27 and 28), the users ironically acknowledging the well-known conspiracy theory about 5G tracking microchips in COVID-19 vaccines.

(25): We got vaccinated, there is nothing wrong in doing it. We are in 2021. . . No vaccine in this world guarantees total protection.

(26): I got 5 acquaintances who died. And all of them were sick with Covid, including my husband. And they were carefully treated by the medical personnel. Had you gone through what I went through, for example, (. . .) you would run to get vaccinated like hell.

(27): Well, at least we’ve got 5G in our pocket.

(28): They tricked me. I don’t believe that they implanted any microchip in my body. I am feeling as I used to feel. . . Maybe because I didn’t bribe anyone?

Theoretical rationalization through definitions and predictions is used by supporters to provide arguments for legitimizing vaccination. A metaphor is used for the definition of vaccination by employing a positive morally charged mapping of weapons onto vaccines (excerpt 29). Bringing an apocalyptic scenario about the pandemic prolongation and its effects on the medical system is another way of highlighting vaccine effectiveness (excerpt 30).

(29): The vaccine is the only weapon available to fight this deadly virus.

(30): How do you think we can overcome this if it becomes more and more dangerous every day unless we get vaccinated? How can we avoid overcrowded beds in intensive care if we don’t get the jab? (. . .) If we all think like this and we don’t get vaccinated because we don’t trust anybody and anything, how can you imagine that us coming out of this pandemic?

Claiming credibility through personal experience is also present in opponents’ comments. They employed close family members’ and friends’ negative personal experiences as arguments against vaccination (excerpts 31 and 32), thus the focus being on perceptions of personal risk than on the personal or collective benefits of the COVID-19 vaccine. This finding is consistent with the results of Flash Eurobarometer 505 (2022) that showed that only 55% of Romanian respondents considered that it is a civic duty to get vaccinated against COVID-19. Actually, in all former communist countries vaccination as a collective responsibility is below the EU average rate (67%).

In excerpt 33, the online user legitimizes his/her negative position towards vaccination by evoking his/her education and knowledge related to the medical field and by employing self-representation through prediction (turning themselves into a guinea pig if he/she accepts the jab). These two arguments are used to delegitimize the vaccination supporters’ superiority. As Toth (2020b) argues, epistemic superiority focusing on the repertoire of sarcasm is a discursive framework that is to be found in the Romanian vaccine supporters’ repertoires.

(31): Both my parents almost died after getting the jab. Since then they are coughing their lungs out. My mom, an asthma patient, got infected with Covid and had some mild symptoms, but now after this miraculous serum she is spitting her lungs out, running out of breath. . . I won’t get vaccinated.

(32): I refuse to be vaccinated. Out of my friends who got the jab, 40% didn’t feel well.

(33): I am a faculty graduate. I worked in the medical sector and I won’t get vaccinated. I do not know why you who got the jab consider yourselves superior. Every man knows his own problems. I do not want to become a guinea pig.

‘Vaccination supporter versus opponent cleavage’ thematic pattern

The co-occurrence of personal deauthorization and discursive antagonism brings about a two-fold distrust: individual distrust (commenter-commenter interactions) and collective mistrust. The excerpts below are instances of dialogues between vaccination supporters (Vsupp) and vaccination opponents (Vopp). The interplay between delegitimation of personal authority and antagonism took the form of ‘polluting one’s opponent’ (Luyckx and Janssens, 2016: 1612) and was employed by both groups. On the one hand, vaccination opponents made use of ad hominem attacks either to portray the vaccination supporters as animals (sheep) highlighting their gullibility (excerpt 34) or to downplay the credibility of a Romanian medical expert (Arafat – Secretary of State for Health) and of the incumbent President of Romania (Iohannis) by using a play upon words (excerpt 35).

(34): Vopp: You, those who got the jab, went like sheep to be sheared, now your children are next. Do you think that someone cares about your health? Vsupp: What would we, ‘ignorant sheep’, do if there hadn’t been geneticist savants everywhere? Vsupp: I rather think that you were being sheared when grammar lessons were being taught.

(35): Vsupp: Before being a nationalist, you should be humane! You are against vaccination because Iohannis and Arafat insist on it and you cannot stand them because they are foreigners and are not Orthodox. Vopp: I do not give a damn about Iohannis, Arahat [sic] or other malevolent creatures. I am not an extremist, but I am a nationalist.

Appealing to nationalist and xenophobic sentiments, the commenter substitutes one letter (‘f’) with another letter (‘h’) in the surname of the Health Secretary (Arafat) to obtain a new depreciative name – ‘Arahat’ (‘Abullshit’, ‘rahat’ in Romanian is ‘bullshit’). This type of source credibility evaluation is considered to be a heuristic processing of information (Zou and Tang, 2021) associated with a superficial and a less cognitive assessment.

On the other hand, vaccination supporters undermine the opponents’ authority position by humorously labelling them as ‘geneticist savants’ (excerpt 34) and ‘virologists’ (excerpt 36). Mocking vaccine opponents through ridicule was meant to refute their personal authority and expertise.

(36): Vopp: For 2 years you have been terrorizing us. Don’t vaccinate your children! There is still time to get informed to see what this broth contains. Vsupp: Really, what does it contain, Mrs. Virologist?

Users’ conflicting political views in the online threaded comments in excerpts 35, 37 and 38 highlight a clear polarization between vaccine promoters (supporters of the incumbent president – K. Iohannis and the National Liberal Party) and opponents (supporters of the AUR/Alliance for the Unity of Romania party, a right-wing populist and nationalist party). Two main reasons for the success of the AUR (the Romanian acronym for ‘gold’) party in the 2020 national elections could be linked to the improper management of the pandemic by the Romanian authorities and to a political vacuum filled by a populist narrative (Stoica, 2021), Romania being one of the few EU countries without a significant nationalist-populist party since 2015 (Stoica et al., 2021; Taggart and Pirro, 2021). Therefore, the new Romanian far-right party’s rise in 2020 shows that conservative ideas continue to be popular among Romanian voters (Coman and Volintiru, 2023). The political arena was filled with new far-right political figures (Diana Șoșoacă or George Simion) who were very vocal in the online and offline public space during the pandemic, protesting against the lockdown measures or advancing conspiracy theories about the vaccines and the virus. The cross-tabulation analysis showed the extensive usage of the name ‘Sosoaca’ (n = 62), a member of the AUR party, in the comment threads (e.g. excerpt 38). Diana Șoșoacă’s offline and online actions against the COVID-19 restriction measures along with her beliefs against vaccination that could be found in the opponents’ comments resemble the political style of medical populism often used in health crises (Lasco, 2020). Excerpts 37 and 38 embed two AUR assumptions about vaccination (that the COVID-19 vaccine is experimental, induces sterility across three generations or constitutes the planned death of people), thus clearly rendering two features of medical populism mentioned by Lasco (2020: 1419), namely: the ‘forging of division’ (an appeal to Romanians as victims of vaccination versus the government or other elites as dominating forces) and the ‘invocation of knowledge claims’ (a conformity claim through a passive agency – ‘it is acknowledged’ without clear scientific references – excerpt 38).

(37): Vopp: I really do not know if you are a stretcher-bearer. Stop this propaganda with vaccination. You are eligible to go with Iohannis in the vaccination campaign. All you corrupted people get vaccinated in your head.⁸ Vsupp: What about learning the Romanian language? You are aggressive with our beautiful language! Vsupp: How come that all conspirators are illiterate? I bet that you a PSD⁹ or AUR voter.

(38): Vopp: You are all blindfolded. This was prepared long ago. Last year 14,000 pensioners died. Now the purpose is to vaccinate the children. Wake up from this deep slumber. Besides it was acknowledged that it is experimental, you will become sterile across three generations, and nobody is responsible for the side effects.¹⁰ Vsupp: Stay away from Sosoaca, you are wasting your time. Vsupp: Who gives you this information? Sosoaca TV? I do not watch those ‘Trumpist’ TV stations, as you do.

(39): Vsupp: The mother of fools is always pregnant! Vsupp: Yes, it is very difficult with our Romanians. They all have big smartphones (. . .) but there is a total void in their heads. As a journalist used to say, the struggle with functional illiterates is always difficult.

In excerpts 37 and 38 we observe the deauthorization of vaccine opponents by bringing into question their writing skills in Romanian. Labelling the counter interlocutor as a conspirator, the commenter refutes the opponent’s point of view by attributing the negative trait of illiteracy upon him/her. The same assumption is present in excerpt 39 where collective mistrust in Romanians is portrayed. Employing a universal idiomatic expression (‘The mother of fools is always pregnant’), the two like-minded vaccination supporters delegitimize some citizens’ lack of education as a form of collective victimization.

Conclusion

By adopting a bottom-up perspective to (de)legitimation, this article constitutes a scientific contribution to the debate on COVID-19 vaccination in an East European country where trust in national health authorities is low. Since discursive (de)legitimating strategies often intertwine, co-occurrence analysis was employed in order to identify the thematic patterns in the online users’ multimodal comments to the narratives on COVID-19 vaccination delivered in the #storiesfromvaccination Facebook campaign run by the Romanian government. Starting from the findings of the co-occurrence analyses, four main aspects will be outlined in this section: usage of depoliticized information sources in the health messages tailored for East European citizens; online users’ ambivalent perception of (COVID-19) vaccination; communist nostalgia specific to Eastern Europe as a means to foster COVID-19 vaccine reluctance; and the prevalence of personal authority and antagonism in the interaction between vaccine supporters and opponents. The findings will be also discussed in terms of the implications upon communication strategies that could be considered efficient in the tailoring of future public health campaigns in East European countries.

Since people use a variety of information sources to shape their opinions concerning vaccination, confidence and legitimacy play an important role in the assessment of these sources (Yaqub et al., 2014: 9). The analysis of the comments in the #storiesfromvaccination campaign showed a polarization between exemplarity and distrust regarding information sources. Although delegitimation of the sources within the messages seems to prevail, health experts and laypersons as pro-vaccination message transmitters were more legitimized than role models by Romanian online users. This finding is consistent with previous research on types of sources influencing vaccine uptake (Motta et al., 2021): both expert and lay sources can provide an effective strategy in communicating vaccination messages. The socio-political context plays an important role in the assessment of information source trustworthiness. In a region where public authorities’ transparency concerning COVID-19 vaccines was ranked below the EU average rate (56%) by all the respondents from East European countries (Flash Eurobarometer 505, 2022), the existing literature shows that sources associated with different political views have an impact on anti-vaccine attitudes in East European countries (Buštíková and Baboš, 2020; Farkas et al., 2022; Walkowiak et al., 2021). I consider that it was precisely this lack of the politicization of medical expertise associated with health experts in the #storiesfromvaccination campaign that drove Romanian commenters to legitimize expert-sourced pro-vaccine messages more. Corruption was also a driver evoked by commenters delegitimizing the message sources. Therefore, the selection of uncorrupted sources who are independent from political elites (Mihelj et al., 2022) could be considered an effective health communication strategy especially in East European countries that display high levels of corruption and a low level of trust in national health authorities and government.

Besides source assessment, commenters also expressed their opinions concerning immunization. The comparison between previous vaccines as forms of retrospective exemplarity of efficiency and the present COVID-19 vaccine reflects two aspects: the presence of communist nostalgia and an ambivalent attitude towards COVID-19 vaccination. An appreciative collective memory associated with a communist past is a topic present in other studies on the pandemic and vaccination and specific to Eastern Europe (Brujić, 2022; Obreja, 2022; Ramonaitė, 2022). Therefore, national authorities in this region should acknowledge this nostalgia framework in their messages. The results also showed that some commenters’ trust in vaccination combines with their uncertainty regarding the safety of COVID-19 vaccines, thus highlighting a ‘trade-off pattern’ (Vulpe and Rughiniș, 2021) which could be associated with what Mohammed and Rossi (2022) label as ‘an ambivalent doubt’. Tailoring national authorities’ communication around online users’ fears regarding vaccination is considered of paramount importance (Guidry et al., 2017; Petersen et al., 2021). Authorities and experts should include the vaccine opponents’ uncertainty or ‘the ambivalent doubt’ in their messages on vaccine safety and effectiveness (Mohammed and Rossi, 2022: 140). Instrumental and theoretical rationalization could be used as a discursive strategy to provide scientific explanations about the vaccines’ development, to address people’s concerns about the (COVID-19) vaccines’ side effects and safety but also to highlight their benefits. Transparency through discussing the balance between risks and benefits may serve as an effective communication strategy. Although Petersen et al. (2021) consider that this will increase people’s trust in national authorities in the long run, in the East European context this communication strategy seems problematic as long as governmental economic interests are prioritized over citizens’ welfare (Bohle and Eihmanis, 2022). In Romania, a decline in corruption and a stable political climate are considered as prerequisites for an increase of confidence in Romanian governmental communication (Cmeciu et al., 2023: 299).

The results also showed the importance of personal authority compared with expert authority and of antagonism towards commenters compared with consensus towards other online users with different views on vaccination. This dominance of personal authorization and conflict in comments provide significant insights into Romanian user participation in the debate on COVID-19 vaccination. As in previous studies, an ‘epistemological simplification and flattening’ (Breeze, 2021: 9) and a collaboration with other like-minded people (Meyer et al., 2019; Witteman and Zikmund-Fisher, 2012) could be observed both in vaccine supporters’ and opponents’ comments. Two main trends were identified, namely: a focus on personal risk perceptions of vaccine side effects and the politicization of the COVID-19 vaccine debate. The negative personal experiences of potential downsides should be taken into account by national health authorities since they may influence other people’s decision making regarding vaccination. Therefore, dialogic communication between commenters, on the one hand, and national health authorities and doctors, on the other hand, should focus on messages acknowledging personal health risks while also emphasizing collective health risks unless people get vaccinated. Although vaccination against COVID-19 as a civic duty is more appreciated in western countries, it should be noted that Romania alongside with Poland are the only Eastern countries where vaccination as a social responsibility was valued more (55% - Flash Eurobarometer 505, 2022).

The analysis of the threaded user comments showed that the vaccine opponents’ attitudes were highly fuelled by right-wing politicians spreading misinformation about vaccination. The findings are consistent with previous research (Breeze, 2021; Faasse et al, 2016; Meyer et al., 2019; Obreja, 2022; Toth, 2020a) emphasizing: (1) a clear divide between vaccine promoters represented as the enemy of the people and puppets of a corrupt government, on the one hand, and vaccine opponents perceived as illiterate people possessing populist beliefs, on the other hand; (2) a widening of the divide between vaccine opponents and supporters through the usage of sarcasm by both groups. Therefore, within this postmodern medical paradigm, it is of great importance for Romanian health communication practitioners and authorities (1) to engage into conversation with vaccine opponents and supporters in order to combat the fake news spread by populists or online groups; and (2) to constantly and proactively evaluate the online debate on vaccination in order to comprehend the commenters’ convictions, to react to opposing viewpoints and to select the most trustworthy and politically independent sources (laypersons and/or health experts) who could deliver persuasive pro-vaccination messages.

Footnotes

Acknowledgements

The author would like to thank the anonymous reviewers for their insightful comments and suggestions on the earlier versions of the manuscript.

Declaration of conflicting interests

The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author received no financial support for the research, authorship, and/or publication of this article.

Notes

Author biography

Camelia Cmeciu is Professor of organizational communication at Faculty of Journalism and Communication Studies (University of Bucharest) and a researcher at the Research Institute of the University of Bucharest. Her research interests focus on risk and crisis communication, health communication, multimodality and social semiotics.

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