Distrust,danger,and confidence: A content analysis of the Australian Vaccination-Risks Network Blog

Abstract

The Australian Vaccination-risks Network is Australia’s most active counter-vaccine lobby group. This study employs a content analysis of the organization’s 2012–2019 blog posts, while further considering Australian-specific vaccine contexts. The goal is to identify the persuasion attributes of these counter-vaccine articles, and the ways that the group’s media employs persuasive cues when communicating to Australian publics. The project gauges the occurrence rates of message variables associated with the Elaboration Likelihood Model of persuasion, including those labeled as the Scarcity Principle, Arousal of Fear, Asking Questions, Source Cues, the Contrast Principle and Negativity Effect, as well as Statistics and Technical Jargon. Three overarching themes collectively exhibited by these message variables are further identified and described as Distrust, Danger, and Confidence. In view of these findings, the study then considers how persuasive cue expression in Australian Vaccination-risks Network blog posts corresponds with Australian vaccine hesitancies and the country’s No Jab No Pay/Play policies.

Keywords

antivaccination Australia Australian Vaccination-risks Network blog Internet media persuasion vaccination vaccines

Australia maintains widespread support for immunizations, with the majority of citizens reporting positive attitudes toward vaccines. Nevertheless, a subset of the population expresses vaccine hesitancy, with anxieties frequently linked to concerns about the safety and efficacy of vaccinations, including fears about vaccine ingredients, overloading the immune system, as well as the perceived likelihood of adverse vaccine-triggered side effects and ailments. Although Australia’s vaccination rates remain high, the potential clustering of individuals who harbor apprehensions increases the risk of vaccine preventable disease outbreaks. Such outbreaks can occur when vaccine hesitancy translates into immunization refusal or incomplete vaccination rates for enough people located in a given geographical area. The prospect of regions with suboptimal vaccination rates experiencing future vaccine preventable disease outbreaks is particularly salient when considering that potentially one-third to one-half of Australian parents articulate concerns about vaccines (Beard et al., 2016: 275; Costa-Pinto et al., 2018: 7). Also of note is that vaccination anxieties may be fueled by small groups of media vocal ardent vaccine-deniers, exemplified by the Australian Vaccination-risks Network (AVN).

This study takes into account Australia’s immunization contexts and features a content analysis of the AVN’s blog posts published from 2012 to 2019. The goal is to identify the persuasion attributes of this counter-vaccine material, and the ways by which AVN media makers are utilizing persuasive cues when communicating to Australian publics. To do this, the project gauges the occurrence rates of message variables associated with the Elaboration Likelihood Model (ELM) of persuasion, and explores how these persuasive characteristics are being articulated to audiences. Three overarching themes collectively exhibited by these message variables are then identified and described as Distrust, Danger, and Confidence. In view of these findings, the study then considers how persuasive cue expression in AVN blog posts corresponds with observed Australian vaccine hesitancies and the country’s pro-vaccine policies. To that end, these Australian-specific particularities will first be examined, together with a brief overview of the AVN.

1. Hesitancies, policies, and the AVN

Australia boasts an extensive, publicly funded immunization program that has helped to limit or fully eradicate numerous infectious diseases. In 2014, for instance, the World Health Organization declared the country to be free of endemic measles; an achievement owed to Australia’s immunization initiatives and ensuing levels of vaccine uptake. However, following this declaration outbreaks of the virus have occurred in cities throughout Australia, resulting from unvaccinated travelers who were infected overseas returning with the highly communicable illness. When these individuals arrive back to communities exhibiting relatively low measles vaccination rates, the virus is then able to spread. The reasons why some Australians are not completely vaccinated against measles, as well as other diseases covered under the National Immunisation Program, can be complex. Hence, a small segment of the population is not up to date with the full complement of available vaccinations simply because of practical barriers to being completely immunized. These barriers can include logistical and scheduling difficulties that hinder making vaccination appointments for themselves and their family members, with competing priorities that can limit access to health services (Beard et al., 2016). Nevertheless, in some cases, vaccine hesitancies may also be contributing to less than optimal immunization rates.

The term vaccine hesitancy has been used in a variety of different and sometimes ambiguous ways to refer to attitudes, beliefs, behaviors, and decision-making processes associated with vaccination (Peretti-Watel et al., 2015). Within this study, vaccine hesitancies are conceived as reasons why people refuse or delay vaccination in the context of a decision-making process. In Australia, such decision-making can be affected by fears about vaccine safety (Forbes et al., 2015: 2899), including persistent worries that the MMR vaccine causes autism, along with concerns that children are being over-vaccinated, while vaccine effectiveness is also questioned (Lawrence et al., 2004: 568–571). Moreover, it is apparent that personal stories about presumed vaccine injury can be particularly influential, and these accounts are often shared online as well as in the local networks of concerned parents (Helps et al., 2019: 4). Distrust in healthcare authorities and conventional medicine may be further compounded by negative encounters with medical practitioners who dismiss patients’ vaccine concerns, as well as pro-vaccination policies and actions that are interpreted to be coercive or conducted without valid consent (Helps et al., 2019: 5–6).

Regarding perceptions of coercion, the sense that one’s choices around vaccines are forcibly being limited can induce what has been described as psychological reactance. Psychological reactance refers to a “set of motivational consequences that can be expected to occur whenever freedoms are threatened or lost” (Brehm and Brehm, 1981: 3–4). The theory of psychological reactance asserts that when a person feels as though their freedom of behavior has been removed or restricted in some fashion, the “threat to or loss of freedom motivates the individual to restore that freedom” (Brehm and Brehm, 1981: 4). It has been suggested that reactance may be a key psychological factor contributing to vaccine rejection in Australia and other countries (Hornsey et al., 2018). In effect, people can resent being told what to think or how to act, so they may reject authoritative commands around vaccines (Helps et al., 2019: 5–6).

Considerations of psychological reactance are of particular relevance to the Australian context, because in 2015, the government introduced its “No Jab No Pay” measures that took effect on 1 January 2016 (Haire et al., 2018). The policy removed conscientious objections on non-medical grounds from the country’s immunization exemption criteria, and curtailed government welfare assistance for families with low to middle incomes who have children not up to date on their immunizations. Under this scheme parents with children less than 20 years of age, who are not fully vaccinated in line with the National Immunisation Program’s schedule, would no longer be eligible for state childcare payments and family tax rebates. In 2018, the policy was expanded with additional tax reductions, while several states also introduced “No Jab No Play” legislation. The state-level No Jab No Play regulations limited or restricted access to childcare for children who are not fully immunized, or not on a vaccination catch-up program.

In the years ensuing its enactment, No Jab No Pay/Play (NJNP/P) resulted in hundreds of thousands of children being brought up to date with the immunization schedule. However, numerous stakeholders have warned that the policy does not impact high income families, while it disproportionately affects the poor. Such policies may also be failing to change “vaccination behavior as intended for vaccine hesitant parents who are one of the key target groups” (Armiento et al., 2020: 5231). Concerns have been further raised about NJNP/P backfiring by eroding trust in the government and Australia’s healthcare system; entrenching opinions that policymakers are coercively undermining personal choice and medical autonomy (Haire et al., 2018). Accordingly,

Overall it is felt that No Jab, No Pay has had little effect on the views of those who object to the concept of vaccination, except to reinforce their negativity around the subject, as they now feel the government is “forcing” people to vaccinate their children. (Smith et al., 2016: 26)

Although not every individual beset with immunization hesitancies has been financially impacted by NJNP/P policies, it has been observed that some Australians expressing vaccination concerns endeavor to seek out the “real truth” about vaccines (Helps et al., 2019: 3). This involves speaking to local healthcare practitioners, while relying upon information gathered through online searches and peer-to-peer discussions (Chow et al., 2017). Such quests for truth, it seems, are partly sparked by the opinion that the total spectrum of data on vaccine safety and efficacy is not being freely tendered to the public by healthcare professionals. Conscientious citizens, therefore, must seek out the full facts for themselves, including scouting online information (Smith et al., 2016: 74). Among the gamut of Internet sources that information seekers can alight on are websites dedicated to circulating counter-immunization messages. In Australia, the most prominent antivaccination lobby group producing these online messages is the AVN.

The AVN is headquartered in Bangalow, New South Wales, and it was officially established in 1997 as the Australian Vaccination Network when several smaller state-level antivaccination groups consolidated into a single organization (Leask, 2002: 40–41). The group’s founder, Meryl Dorey, had originally formed the Vaccination Awareness Network in 1994, and by 2000 the AVN claimed to have 1500 members from across the country. In succeeding years, the group’s name changed to the Australian Vaccination-skeptics Network, because the New South Wales Fair Trading Department forced the AVN to use less misleading nomenclature (Dorey, 2012b). The name was subsequently modified to the current AVN because members disliked the term “skeptics” (David, 2018b). Regardless of the organization’s name changes, however, a consistent endeavor of the group has been distributing messages critical of vaccines. Notably, a Department of Health study conducted an audit of online vaccine information accessed in Australia. The report found that the “information scale is dominated by the likes of the Australian Vaccination-Skeptics Network” (Smith et al., 2016: 73), and, “At present, it seems that the AVN is often the first result to come up in searches” (p. 84). The AVN’s website, and its accompanying blog, remains an important platform for disseminating the group’s antivaccine messages. The AVN blog features articles on vaccines written by active members, letters from community supporters, updates and invites pertaining to the group’s activities, as well as re-posts and links to other antivaccination media. Cumulatively, the blog posts typify the varieties of claims and styles of communication featured throughout years of the AVN’s vaccine-skeptical messaging. As such, the blog also embodies the persuasive qualities of AVN media, while revealing the suasion foci of the AVN’s online communications efforts.

In considering Australian vaccine contexts, the AVN, and online antivaccine media, it is of note that research has found people elsewhere also report turning to the Internet for vaccine information (Betsch and Sachse, 2012). Investigators have further warned of the effects of antivaccine communications, indicating that even brief exposures to online antivaccination rhetoric can have long-lasting negative influences upon immunization attitudes and behaviors (Betsch, 2011). Such rhetoric includes emphasizing the purported risks of vaccine ingredients, as well as professed hazards to overstimulating infant immune systems (Zimmerman et al., 2005). In addition, some counter-vaccine websites insist that pro-vaccination policies encroach upon civil liberties and are suggestive of totalitarian regimes, while they also question whether there is truly enough empirical data to support vaccine efficacy (Arthur, 2016; Kata, 2010). Such messages can feature conspiratorial claims that vaccine-deniers are being censored by a powerful Pharma-supporting cadre, which is hiding the ineffectual and dangerous nature of vaccines for financial gain (Heller, 2016). This media frequently accentuates the apparent expertise of vaccine skeptics, and in some instances, maintains that a parent’s understanding of their own family’s health overrides a physicians’ inferior book learning (Archer, 2014). Furthermore, counter-vaccination broadcasts often feature personal narratives of vaccine injury (Archer, 2014; Arthur, 2016).

This study seeks to build upon such accounts by examining not simply the arguments presented on the AVN’s blog, but the persuasive characteristics that undergird the organization’s messages. To do this, a content analysis of AVN posts is employed to investigate the expression of several persuasive cues associated with the ELM. The goal of this exercise is to address this study’s three research questions:

RQ1. What are the chief persuasive cues exhibited within AVN blog posts?

RQ2. How are frequently occurring persuasive cues articulated to audiences via AVN blog posts?

RQ3. What persuasion themes are collectively expressed by persuasive cues in AVN posts?

2. Method

This study employs a directed content analysis design, incorporating both quantitative and qualitative procedures to investigate a sample of AVN blog posts. Quantitative procedures are applied to tabulate code frequencies and co-occurrences. These basic quantitative findings guide qualitative analysis, which involves describing how codes are being expressed throughout the sample, and the interpretation of broader themes signaled by code co-occurrences. The directed content analysis approach involved developing the study’s coding scheme from the Elaboration Likelihood Model of persuasion.

The ELM of persuasion has remained one of the most enduring and empirically substantiated persuasion frameworks, which proposes that there are two major avenues of persuasion resulting from exposure to communications: the central and peripheral routes (Petty and Cacioppo, 1984: 70). The central route encompasses attitude change through an individual’s diligent scrutiny of a persuasive message, described as high elaboration. The central route requires the use of appreciable mental effort in order to carefully examine both the quality and cogency of a communication’s arguments. The peripheral route, however, consists of low elaboration, which tends to occur when there is a lack of time, motivation, or ability to systematically investigate and process a message’s contentions. Low elaboration involves comparatively less cognitive effort than does the central route, and with it audiences tend to rely upon various “mental shortcuts,” or persuasion “cues,” to help formulate opinions and behaviors (Anastasio et al., 1999: 154).

Using the ELM is beneficial for the analysis of antivaccination media because ELM research has already identified a suite of message variables that can act as persuasive cues in communications (O’Keefe, 2002: 137–168; Schumann et al., 2012). These include rhetorical devices that have not explicitly been analyzed in antivaccination media. ELM research has also detailed the prospective ways that certain message variables can persuasively operate. Therefore, the ELM assists by not only helping to identify the persuasive attributes of antivaccination communications, but it also supplies a systematic framework for interpreting how such persuasive attributes can function in counter-vaccine communications. This is important because it helps to move analysis beyond simply detecting rhetorical tactics by also providing the conceptual apparatus for understanding how certain cues in antivaccination media may function. With this in mind, this study developed the following code list of 13 message variables, which can be positioned within the ELM as persuasive cues in situations of low-to-medium elaboration likelihood (see Supplemental material for a list of literature used to derive the code list):

Arousal of Fear;

Asking Questions;

The Contrast Principle and Negativity Effect (CPNE);

Disrupt-then-Reframe (DtR);

Message Repetition;

Number of Message Arguments (NMA);

Rule of Reciprocity;

Scarcity Principle;

Self-Referencing;

Social Consensus;

Source Cues;

Statistics and Technical Jargon (STJ);

Two-Sided Persuasion (TSP).

The message variables in this tally that appear most frequently within AVN articles are described throughout this article (see Supplemental material for descriptions of the six message variables not outlined within this article).

The study analyzed every AVN blog post currently hosted on the AVN website, from the date of the first entry in 2012 to the end of 2019, which resulted in a sample of 191 articles. The author served as the primary coder, with coding conducted in consideration of an intercoder reliability test that utilized the abovementioned 13 codes (see Supplemental material). Following coding, the occurrence counts for the message variables were tabulated, along with percentages of the articles featuring each code. The overall results were also categorized into themes, which were distinguished by patterns of co-expressed message variables in AVN posts. These patterns were initially conceptualized during coding through the observation of cues articulated together in blog posts. A code co-occurrence table was then generated, and c-coefficients were calculated to ascertain how often and consistently codes overlap in the sample (Friese, 2012: 175–176). This analysis resulted in three themes described as Distrust, Danger, and Confidence, which are outlined below.

3. Results

The first research question asks what persuasive cues are exhibited in AVN blog posts. Table 1 provides a summary of the persuasive cues identified, including the total occurrences, the number of articles each variable occurs in, as well as the percentage of articles from the total sample featuring each persuasive cue. In total, 10 of the 13 coded message variables were found in AVN articles. However, three of the persuasive cues identified in the sample (NMA, TSP, and Self-Referencing), each represent less than 1% of the total number of message variable incidents, and together these three codes only accounted for just over 1% of the total code occurrences (N = 17, 1.08%). Consequently, this study refrains from discussing these three cues. Instead, the second research question is addressed by focusing upon how the seven topmost occurring message variables are articulated throughout AVN articles. Of these seven cues, the Scarcity Principle occurs most often.

Table 1.

Persuasive cues in AVN blog posts.

Persuasive cue	N (% out of 1575)	In # of articles	% out of 191 articles
Scarcity principle	402 (25.52)	139	72.77
Arousal of fear	310 (19.68)	90	47.12
Asking questions	230 (14.60)	62	32.46
Source cues	209 (13.27)	90	47.12
CPNE	189 (12.00)	74	38.74
STJ	136 (8.63)	58	30.37
Social consensus	82 (5.21)	46	24.08
NMA	11 (0.70)	10	5.24
TSP	5 (0.32)	4	2.09
Self-referencing	1 (0.06)	1	0.52
Total	1575	–	–

CPNE: contrast principle and negativity effect; NMA: number of message arguments; STJ: statistics and technical jargon; TSP: two-sided persuasion.

The scarcity principle

When an item appears to be in limited supply, its scarcity can serve as compelling peripheral cue, causing perceptions of its value and subjective desirability to be greatly increased. Relatedly, when items or ideas become banned or censored, appetites for these commodities and notions are often intensified due to their perceived scarcity (Aechtner, 2014: 192). In view of these effects, this study demarcates assertions that a commodity, concept, or activity is in short supply or being suppressed as cases of the Scarcity Principle in AVN media.

Notably, the Scarcity Principle (N = 402) occurs in 72.77% of all AVN blog posts. Therefore, it is not only the most frequently observed persuasive cue, but it is also the only variable found in more than 50% of the sample. There are several interrelated ways in which this variable is expressed across 139 posts. In the majority of cases, AVN scarcity claims convey to audiences that Australian policymakers are stripping away personal health choices around vaccines. Although such assertions are primarily focused upon No Jab No Pay/Play, scarcity sentiments are also a central feature of articles written before these policies were enforced. As Meryl Dorey (2012f) explained years before NJNP/P legislation was first enacted, “Today, more then [sic] ever, the government and the medical community are trying to restrict your right to make informed health choices for yourself and your family.” Even so, assertions about the government restricting people’s right to choose are characteristic of blog entries aimed at Australia’s vaccine penalty system, which associate No Jab No Pay/Play to scarcity-referencing blackmail, bullying, and coercion.

A 2016 post titled “The suffering continues-does the government care?” exemplifies such assertions in a series of quotes from distraught Australians opposed to the NJNP/P. “This law is outrageous, it’s blackmail and financial coercion on a massive scale,” protests one of the article’s letter writers. The central scarcity message delivered throughout this and other AVN blog posts is that the government is cruelly taking away citizens’ medical autonomy, and mercilessly limiting funding to parents with vaccine hesitancies (Australian Vaccination-Risks Network, 2018g; Lahn, 2018). As AVN posters refer to NJNP/P health choice restrictions, they also allude to notions of psychological reactance that can accompany scarcity. “I am starving myself now to ensure my kids have food and specialised education,” writes a parent (Australian Vaccination-Risks Network, 2016a). The contributor (Australian Vaccination-Risks Network, 2016a) then asserts, “I will not vaccinate for monetary gains. Blackmail.” As one of the AVN’s earliest, pre-NJNP/P blog articles also insists (Dorey, 2012e), the “harder doctors and government officials try to push and the more they try to suppress information and force complaince [sic], the more they will find that people are saying no—even if saying no means losing their job.”

In combination with these No Jab No Pay/Play scarcity statements are recurrent claims that such choice restrictions reflect how Australia is becoming a more censorial police state (Australian Vaccination-Risks Network, 2016a, 2016d). In this vein, AVN contributors liken NJNP/P to the activities of repressive communist regimes or the Third Reich (Australian Vaccination-Risks Network, 2016a, 2016d). Overlapping with NJNP/P scarcity assertions are less common, but notable claims that scientific data revealing the dangers and ineffectiveness of vaccines are being censored (Australian Vaccination-Risks Network, 2018f). In addition, allegations are made that media makers, scientists, and medical practitioners who threaten to reveal these suppressed truths to the public are also actively censored (Australian Vaccination-Risks Network, 2017c). Much of this censorship, readers are told, is tied to a BigPharma-government conspiracy driven by financial gain through the peddling of potentially hazardous, ineffectual vaccines. This has led to “high-handed fraud perpetrated on the Australian public by our health authorities at the behest of pharmaceutical interests, for the dual purpose of concealing vaccine failure, and expanding market penetration of vaccination to adults” (Australian Vaccination-Risks Network, 2017e). Together with BigPharma-government suppression, audiences are also told of censorship perpetrated by the major news networks and social media providers, because apparently the “last thing that Facebook, Pharma or our corrupt government officials want is to see Australian citizens retaining the right to say what goes into our bodies or the bodies of our children” (David, 2016b). Through such claims, AVN blog posts often articulate the Scarcity Principle via assertions that counter-vaccination spokespeople and data are persistently being repressed by an anti-choice, undemocratic, “pro-censorship ‘book burning’ cartel” (2016g). Of particular significance regarding such Scarcity Principle incidences are claims that what is being censored are the true risks of vaccination. These covered up dangers are those articulated across a range of Arousal of Fear cases in AVN media.

Arousal of fear

It is no coincidence that the word “risks” is included in AVN’s name, for a central feature of the organization’s messaging involves sowing doubt regarding vaccine safety. Throughout AVN blog posts, this focus coincides with Arousal of Fear incidents (N = 310), which appear in 47.12% of the sample. With regard to this message variable, researchers have found that in certain circumstances, fear may cause audiences to rely upon available peripheral cues within a message (Gleicher and Petty, 1992). Accordingly, if a message provokes sensations of fear then message recipients seem to rely upon peripheral cues for persuasion rather than engaging in central route processing. Within this study, any explicit claim that a product/idea is unsafe or dangerous, including a threat to life or personal values, is categorized as an attempt to arouse fear.

Across AVN blog posts, Arousal of Fear is expressed in numerous references to adverse vaccination reactions, ranging from anaphylaxis to autism and death, while other fear claims concern vaccine ingredients. Many of these cases are related through personal, firsthand narratives about vaccine injury provided by parents. These stories chronicle not only numerous types of harmful reactions, but also the crippling life changes that vaccine-related damage cause the wounded and their families. Such stories include those of AVN’s Tasha David (2018a), who tells audiences that vaccines injected into “my babies caused them numerous health issues and robbed three of my children of ever being able to live an independent life, of being able to fall in love or able to have a family of their own.” An article written by former GP John Piesse (2017) shares another particularly alarming eyewitness story:

I have been encountering cases of vaccine injury for over 40 years. In June it was a happy, healthy nearly 5-year-old whose parents were required to put her on a catch-up schedule, in order to get her into kindergarten. She won’t be going to kinder. She’s in a wheel-chair, brain-damaged. Her life ruined.

Many similar personal accounts (Australian Vaccination-Risks Network, 2016c) mention vaccine-induced cerebral palsy, schizophrenia, while other posts list such adverse effects such as “multiple sclerosis, brain inflammation, strokes, seizures, rheumatoid arthritis, disabling fatigue, cardiac arrhythmias, muscle pain and weakness, blood clots and death” (Australian Vaccination-Risks Network, 2018c).

References to vaccine-provoked deaths are, in fact, a mainstay of AVN media. Audiences are also sometimes told that infant deaths result from vaccine-linked immune system overload, because it “is widely recognized that newborns have under-developed immune systems, which can be overwhelmed or shocked” (Belkin, 2012). Such stories, however, are not restricted to children, as AVN articles also frequently tell readers of adult mortalities, indicating, “More and more stories are emerging about babies, children and even adults dying within a short time after vaccination” (Australian Vaccination-Risks Network, 2019f). Many such Arousal of Fear statements overlap with Scarcity Principle cases, as they reference the censorship plotlines and NJNP/P complaints mentioned earlier. These messages communicate that BigPharma and government are actively covering up such frightening vaccine-related morbidities and deaths. One especially notable and withheld side effect includes autism spectrum disorder, which AVN blog posters continue to link directly to vaccine receipt. Worrisome stories are told about children who quickly displayed symptoms of autism following their immunizations (Australian Vaccination-Risks Network, 2017d), along with research indicating that vaccinated children present a “4.2× increased risk of autism” (Australian Vaccination- Risks Network, 2018f). References to autism (Australian Vaccination-Risks Network, 2012c) are also connected with recurrent AVN fear appeals involving “many of the toxic ingredients which most parents (and, let’s face it, most doctors) have no idea are in vaccines.” These ingredients include aluminum, along with potentially dangerous “toxins” that should be feared due to their unknown health consequences (Australian Vaccination-Risks Network, 2019c; Piesse, 2017).

In relation to such fear claims, an AVN blog post (Australian Vaccination-Risks Network, 2018b) asks, “How many more poorly tested, dangerous and useless vaccines will our children be forced to bear?” These sorts of queries relate to the message variable described as Asking Questions, which proves to be the third most common persuasive cue in the AVN sample.

Asking questions

In this study, Asking Questions is identified as the use of rhetorical queries, also known as eroteme, which involves asking a question without expecting an answer, because the answer itself is strongly implied within the question itself. These types of questions have been found to enhance message processing in audiences, especially in cases where individuals initially exhibit little interest in a communication’s claims (Petty and Cacioppo, 1986: 198–203). The rhetorical devices termed hypophora and anacoenosis are also integrated into this message variable. Hypophora entails asking a question and then immediately answering it, while anacoenosis involves asking the opinion of an audience in a way that implies common interest without requiring an answer (Aechtner, 2016: 85). Such queries (N = 230) can be identified in 32.46% of all AVN posts.

The very first blog post hosted on the AVN webpage begins with the following remarks: “Our children. Is there anything we wouldn’t do for them?” (Dorey, 2012g). This simple rhetorical question characterizes a major theme in AVN’s media, which stresses that one of the community’s primary goals is to keep children safe and to protect parents’ autonomy of healthcare choices. As another post (David, 2018a) hypophorically concludes,

You want to know the most important reason why I and many other parents don’t vaccinate their child? We do it because we love them and want to protect them, just like you love your child and no amount of legislation or shaming tactics will ever change that.

Asking Questions incidents like these frequently co-occur with other message variables. For instance, rhetorical questions often accent Scarcity Principle claims regarding Australia’s NJNP/P policies and a BigPharma-government conspiracy (Dorey, 2012b, 2019b). As one post (Australian Vaccination-Risks Network, 2016a) first notes of Malcom Turnbull, the Prime Minister who ushered in No Jab No Pay, “I think there is a conflict of interest in Malcolm Turnbull via his wife’s chairmanship of Prima BioMed.” The contributor (Australian Vaccination-Risks Network, 2016a) then asks knowingly, “Could that have influenced his decisions on No Jab No Pay? $5.5 million investment after the announcement. OMG.”

Similar questions punctuate scarcity claims about vaccine-rejecting parents being victimized by an authoritative, anti-choice government in league with BigPharma. “Never before has a small group been persecuted like this,” complains an AVN contributor (Australian Vaccination-Risks Network, 2019h) to the Western Australian Premier, Mark McGowan. With hypophora, the poster then asks, “WHY?? What is the reason from your perspective?? There is conflict of Interest. Industry is influencing decisions” (Australian Vaccination-Risks Network, 2019h). The expertise of Australian doctors is also questioned through rhetorical queries, while the impartiality and integrity of Australian journalists is drawn into question (Australian Vaccination-Risks Network, 2019b, 2019d). Rhetoricals also dovetail cases of Arousal of Fear that mention hazardous vaccine ingredients. This transpires in an article relating the apparent dangers of aluminum in vaccines, and refers to the work of Professor Chris Exley, described as “the world’s leading authority on the biological effects of aluminium and silicon” (Australian Vaccination-Risks Network, 2019e). Exley’s research is compared with the “utter rubbish” media produced by Australia’s National Centre for Immunisation Research and Surveillance. After striving to demonstrate the superiority of Exley’s work, the post concludes with the leading rhetorical questions, “Who would you trust?” and “Would you say the science is ‘settled’?” Of import is that this AVN post also appeals to the credentials and expertise of a scientist to support its position. Such references to qualifications correspond with the message variable described as Source Cues.

Source cues

In situations of low elaboration likelihood, the purported expertise and perceived credibility of communicators have been demonstrated to act as a significant peripheral cue. In short, a message’s persuasive arguments tend to be accepted far more readily when a communicator is described as possessing prestigious academic credentials (Petty and Cacioppo, 1986: 142–143). This study identifies Source Cues as displays of academic qualifications and expertise in persuasion attempts. While this message variable occurs less frequently than the three aforementioned cues (N = 209), it still appears in almost half (47.12%) of the sample articles.

Sources cues in AVN blog posts include references to academic degrees, as well as professional proficiencies and direct experiences with vaccine injury. Descriptions of academic knowledge and accreditation are often provided when apparent vaccine-skeptical experts are mentioned (Australian Vaccination-Risks Network, 2016b). In addition, the academic standing of pro-vaccine individuals who have questioned No Jab No Pay/Play policies is also referenced throughout AVN media (Australian Vaccination-Risks Network 2018h). Yet, most commonly, Source Cues feature as reports of personal expertise conveyed by vaccine-skeptical parents. These are often pithy references to professional training, university education, past experiences, claims of having completed one’s own extensive research, and firsthand exposure to vaccine injury that are employed as markers of credibility in personal narratives (Australian Vaccination-Risks Network, 2016d; Dorey, 2016). Such a Source Cues-enriched personal account is provided by one contributor who describes herself as a seasoned pediatric occupational therapist. This concerned mother explains that she “started to question vaccination because as an OT, the most severely disabled children I have ever worked with, both in Australia and abroad, had their disabilities openly attributed to vaccine damage” (Australian Vaccination-Risks Network, 2016d). She further clarifies of her own research that there is “ample scientific evidence that I have available to me as a health practitioner to support my choice as a parent not to vaccinate my children” (Australian Vaccination-Risks Network, 2016d).

Along with personal credibility statements, articles also provide more general references to the training, research, and firsthand experiences maintained by AVN members; the “majority of whom are tertiary-educated and many of whom have had children either killed or injured by vaccinations” (Australian Vaccination-Risks Network, 2013a). An important commonality across both personal and general Source Cues in AVN posts is the implication that these vaccine-hesitant parents are in fact more informed than pro-vaccination authorities. For it is the

experience of the AVN that parents who have studied the issue of vaccination by reading medical journal articles and texts and by speaking with a broad range of health professionals can be far more knowledgeable about this topic than the average GP. (Australian Vaccination-Risks Network, 2017b)

At the same time, posts refer to more general esteem-garnering references to scientific evidence and data that are said to substantiate vaccine-skepticism. Audiences are frequently told that the AVN uses data “backed by science” (Australian Vaccination-Risks Network, 2019a), while the group provides access to “cutting edge vaccination information and answers from acknowledged experts on vaccination science and policy” (Australian Vaccination-Risks Network, 2018e). This credibility can also be compared with the dubious expertise and scientific data tendered by pro-vaccine pundits or the average vaccine-supporting parent. Because unlike conscientious and diligently researching vaccine-skeptics, a “significant majority of people who are consenting to vaccination for themselves or on behalf of their children are doing so without the requisite knowledge and skills” (Australian Vaccination-Risks Network, 2018d). Such comparisons also correspond with the message variable described as the Contrast Principle and Negativity Effect.

The contrast principle and negativity effect

When two items or ideas are presented one after the other, the differences between the two are accentuated. This can be used to persuade audiences toward a concept more effectively than if no comparisons are made at all (Aechtner, 2016: 89). Within this study, contrast emphasizing the negative attributes of a competitor’s ideas or products is also associated with what has been described as the Negativity Effect. Bizer and Petty (2005) explain that “negative information is often more powerful in creating attitudes (i.e., it is weighted more heavily) than is positive information of equal extremity” (p. 554). Any comparison made between an advocated product or concept with those supported by a competitor are identified in this project as cases of the Contrast Principle, with attention paid to comparisons that invoke the Negativity Effect.

Contrast cues (N = 189) can be identified in 38.74% of AVN blog posts, as the knowledge, truthfulness, and policy ideas of vaccine-skeptics are compared with those advanced by vaccination supporters. Such comparisons include juxtaposing the “multiple falsehoods” (Australian Vaccination-Risks Network, 2018a) of pro-vaccine advocates with genuine scientific facts. For unlike AVN, which seeks to inform the Australian public about apparently unbiased facts concerning vaccine risks without corporate invested interests, their opponents use “the most cynical form of deceit to appeal to parents’ hard-wired biological instincts to protect their babies from harm by selling them a ‘magic forcefield’” (Australian Vaccination-Risks Network, 2017e). Comparisons are also made between No Jab No Pay/Play and alternative policies, as well as contrasting the treatment of vaccine-resistant parents under NJNP/P with the government’s position toward other communities (Dorey, 2012d).

Nevertheless, many of the most conspicuous contrast statements are found in detailed accounts of vaccine injuries. These stories characterize the Arousal of Fear cue detailed earlier, while providing comparisons of an individual’s health before-and-after receiving vaccinations. Such narratives emphasize the disparities between pre-vaccine health and post-vaccine morbidities or death in both children and adults; with the starkly negative adverse reactions stressed for audiences (Australian Vaccination-Risks Network, 2012b). Contrast cues are also expressed in posts comparing the newsmedia’s lack of research, dishonest “hate speech,” and parroting of “pharmaceutical propaganda,” with what is described as legitimate, scientific vaccine data emphasized by AVN’s truth-seeking community (David, 2016c). Within these reports, AVN contributors occasionally employ complex medical terminology and numerical information, which together are associated with the message variable Statistics and Technical Jargon.

Statistics and technical jargon

This message variable involves employing specialist language and the use of numerical data, which can act as markers of expertise that lead audiences to defer to the credibility of communicators (Aechtner, 2014: 193). In this sense, jargon and stats can trigger persuasion through Source Cues, while also being reciprocally dependent upon them (Cooper et al., 1996). It is, therefore, important to note that there are 1.55 occurrences of Source Cues in AVN media for every case of Statistics and Technical Jargon, which audiences can refer to for expertise validation. This variable (N = 136) appears in 30.37% of the examined sample, with complex language often co-occurring together with stats.

Statistics and jargon frequently appear within articles claiming that vaccines are ineffective, as well as posts underscoring alleged vaccine risks (Australian Vaccination-Risks Network, 2019g; Dorey, 2012a). This includes warning pregnant women against receiving the flu vaccine, for such vaccines “contain thiomersal—a preservative that is 49.6% mercury by weight” (Dorey, 2012c). Mercury is described as a “potent neurotoxin” contained in the vaccine at levels “200 times higher than the EPA safe limit for a foetus and almost 4 times higher than the safe limit for a 70 kg adult” (Dorey, 2012c). Statistics are also provided regarding illness rates in Australian children, which are either directly or indirectly linked to vaccines by AVN contributors (Australian Vaccination-Risks Network, 2017a, 2019a). Statistics and jargon are correspondingly a regular feature of articles discussing vaccine ingredients and autism-vaccine links, which can include complex chemistry and medical nomenclature alongside statistics (Australian Vaccination-Risks Network, 2013b, 2019d). Other posts employ poll figures to demonstrate the number of people, including medical professionals, who have vaccine hesitancies or who have firsthand experience with vaccine injuries. Accordingly, an article posted by Dorey (2012e) reports on an academic article published in

that bastion of vaccination-science, Vaccine, which shows that a large number of nurses (98% of them surveyed)—people who are trained to understand how vaccines are meant to work and how safe they are purported to be—are saying no to vaccination.

References to poll data citing either a preponderance, or important minority of individuals who might support an idea also coincide with the message variable defined as Social Consensus.

Social consensus

Social Consensus involves attempts to convince audiences that an important number of people endorse a marketed product or an advertised opinion. These bids can include appeals to multiple sources, which hinge upon the inclination to give more weight to ideas that are stated by numerous sources (Petty and Cacioppo, 1986: 212). In addition to multiple sources is the social proof approach, which is based upon the tendency for individuals to “use the opinions apparently held in their immediate social context to form judgments,” while most people “tend to align their beliefs with the opinions of those around them” (Lun et al., 2007: 957, 958). Finally, underdog effects involve purposefully stressing the seemingly underdog nature of an idea, action, or group, which can be influential when elaboration likelihood is low (Fleitas, 1971). An underdog group is often characterized as an ensemble of righteous dissenters or victims, contesting against a domineering majority.

Collectively, these three varieties of Social Consensus cues (N = 82) are exhibited in 24.08% of AVN articles. The majority of these cases appear as manifestations of social proof, which can involve mentioning how many people have apparently been negatively effected by vaccines. In these instances, the “tens of thousands of Australian families who have seen their perfectly healthy family members become ill or even die as a result of vaccines” (Australian Vaccination-Risks Network, 2017d) are referenced. In addition, social proof claims affirm the significant numbers of Australians who back the AVN (Australian Vaccination-Risks Network, 2016f). These statements are reinforced by numerous testimonials thanking the AVN for its activism (Australian Vaccination-Risks Network, 2016a, 2016d). Social Consensus is also articulated in AVN media through underdog messages and examples of multiple sources, though these appear comparatively infrequently relative to occurrences of social proof. Underdog accounts present the AVN as a stalwart band of “fighters who never give up no matter how much the government and vested pharmaceutical interests want us to” (David, 2016a). With multiple sources, numerous vaccine injury stories, or reports of NJNP/P-related hardships are recounted by several different individuals within a single post (Australian Vaccination-Risks Network, 2016e).

Persuasion themes

This study’s third research question asks what overall persuasion themes are collectively expressed by persuasive cues in AVN blog posts. Three themes were identified from patterns in the data that were derived in part by analyzing message variable co-occurrences detailed in Table 2. The themes, described as Distrust, Danger, and Confidence, each feature what can be described as a core persuasive cue, which co-occur with other message variables to express an overarching persuasion focus. Table 3 further outlines this trio of themes and their affiliated message variables. Distrust is primarily encapsulated in AVN’s recurring Scarcity Principle cues, but it is also communicated through co-occurring incidences of Asking Questions, the Contrast Principle and Negativity Effect, as well as Social Consensus. Altogether this persuasion theme relates that Australians’ health choices are being restricted through NJNP/P by an increasingly undemocratic and untrustworthy government, working in collusion with BigPharma, while counter-vaccine data and immunization injury reports are being suppressed worldwide. Danger, on the other hand, revolves around Arousal of Fear prompts, further buttressed by Asking Questions cases, the CPNE, overlaid with occurrences of Statistics and Technical Jargon as well as Social Consensus cues. In sum, this persuasion motif publicizes apparent vaccination risks ranging from autism to death, often communicated through firsthand parental narratives, while also focusing on seemingly toxic, untested vaccine ingredients. The Confidence theme emphasizes the personal expertise of skeptical individuals, the credentials of specialists as well as the science behind AVN claims, and the numbers of other, often similarly experienced people who also support counter-vaccine initiatives. Through Source Cues, Social Consensus indicators, plus STJ, this theme underlines who and what data audiences can be confident in.

Table 2.

Cue co-occurrences and AVN persuasion themes.

Persuasion theme
Core persuasive cue	Co-occurring cue	Co-occurrences	c-coefficient
Distrust
Scarcity principle	CPNE	82	.161
	Asking questions	53	.092
	Social consensus	35	.078
Danger
Arousal of fear	STJ	42	.104
	Asking questions	27	.053
	Social consensus	26	.071
	CPNE	24	.051
Confidence
Source cues	Social consensus	27	.102
	STJ	26	.082

CPNE: contrast principle and negativity effect; STJ: statistics and technical jargon.

Table 3.

AVN’s overarching persuasive themes.

Persuasion theme	Associated message variables
1. Distrust	Scarcity principle	• Government restricting medical autonomy and health choices through NJNP/P financial coercion.• Scientific data and vaccine risks are conspiratorially suppressed by government-BigPharma and media outlets.
	Asking questions	• Questioning government-BigPharma collusion.• Questioning why government is persecuting vaccine refusers.• Questioning one-sided, pro-vaccine news reporting.
	CPNE	• Contrasting suppressive pro-vaccine activities and media with counter-vaccine honesty and facts.• Comparing treatment of vaccine-refusing parents and NJNP/P policies to other communities and legislation options.
	Social consensus	• Hardship stories resulting from NJNP/P choice restrictions.
2. Danger	Arousal of fear	• Narratives of vaccine injury, including autism and death.• Toxic vaccine ingredients.
	Asking questions	• Questioning vaccine ingredient safety.
	CPNE	• Comparisons of pre- and post-vaccination health.
	STJ	• Statistics and jargon demonstrating vaccine risks.
	Social consensus	• Numbers of people who have experienced vaccine injuries, and who corroborate immunization risks.
3. Confidence	Source cues	• Personal expertise and firsthand experiences.• Credentials of experts.• AVN backed by empirical science.
	Social consensus	• Many Australians support AVN.• AVN as underdog resisting government-BigPharma.
	STJ	• Statistics demonstrating numbers of people with vaccine hesitancies.

AVN: Australian Vaccination-risks Network; CPNE: contrast principle and negativity effect; NJNP/P: no jab no pay/play; STJ: statistics and technical jargon.

4. Discussion

This study has identified and illustrated the most readily occurring message variables associated with the ELM of persuasion in an 8-year sample of AVN blog posts. The analysis also distinguished three persuasion themes that these cues collectively express. Many of this study’s observations coincide with previous analyses of antivaccine media and its rhetoric. Hence, articulations of the Scarcity Principle in AVN posts correlate with reports of antivaccination media claiming that BigPharma and governments are censoring incriminating data for financial gain, as well as counter-vaccine contentions that pro-vaccine policies violate civil liberties (Heller, 2016). Likewise, cases of Arousal of Fear in AVN articles parallel similar assertions about vaccine risks and toxic ingredients identified in other antivaccination media (Kata, 2010; Zimmerman et al., 2005).

Nevertheless, by integrating the ELM, this study draws attention to rhetorical devices not previously identified in research of antivaccination media, while disclosing additional insights into the persuasive mechanisms underlying such rhetoric. Identifying such persuasive cues is also valuable in relation to the Internet, because it has been found that individuals tend to rely upon cognitive mental shortcuts to quickly determine an online message’s apparent reliability and trustworthiness (Metzger and Flanagin, 2013). By enumerating message variables and ascertaining persuasion themes, this analysis also reinforces how antivaccination media can emphasize distrust narratives, while underscoring risk and credibility. Although these findings relate specifically to an AVN sample, they may also be instructive for non-Australian contexts. For example, it is worth investigating whether other antivaccination media also place greater emphases on Distrust messages than even fear appeals or credibility cues, while considering the import of such persuasion tactics as they relate to audience trust, vaccine confidence, and persuasion tendencies.

Regarding Australian audiences specifically, it is of further interest how the identified message variables correspond with Australian vaccine hesitancies and immunization contexts. For instance, as with other regions of the world, it has been observed that Australian vaccination anxieties are frequently associated with persistent fears over vaccine safety, including adverse side effects and toxic ingredients. These uncertainties coincide with distrust in Australia’s healthcare system and pro-immunization policies. This wariness accompanies Australian-specific apprehensions with, and reactance to, the country’s No Jab No Pay/Play legislation, tied to attendant perceptions of financial coercion and the limiting of medical choice. It is of note that the expression of persuasive cues in AVN blog posts, exemplified specifically through the themes Distrust and Danger, directly address these same Australian concerns. Distrust, notably characterized through the AVN’s widespread and rather conspiratorial cases of the Scarcity Principle, appertains to these same suspicions of Australia’s policies and health systems. Stakeholders have warned that NJNP/P may backfire by eroding civic trust and entrenching feelings about government coercion. Accordingly, AVN blog posts are, above all, disseminating scarcity claims that directly play into Australian qualms regarding diminished health choices, while speaking about public reactance and the reciprocative strengthening of counter-vaccine perspectives. At the same time, the Danger foci, centered primarily upon Arousal of Fear cues, persuasively links to enduring Australian worries about vaccine safety. Notably, such fear appeals are frequently communicated through personal stories about presumed vaccine injury, and in Australia, it has been observed that vaccination-damage narratives are often shared within the online and in-person networks of concerned parents (Helps et al., 2019: 4).

Finally, the Confidence theme matches up with fact-seeking tendencies observed in wary Australians. Although AVN blog posts insist that pro-vaccine authorities should be distrusted, the Confidence persuasion motif steers audiences toward what can apparently be depended upon. The theme is particularly linked with Source Cues; maintaining that hesitant parents can rely on their own expertise, firsthand experiences and ability to conduct thorough research, while the AVN’s counter-vaccine stance is supported by trained specialists and rigorous science. These claims match up with numerous AVN appeals (Australian Vaccination-Risks Network, 2012a) for people to investigate for themselves every available fact about vaccines, because “vaccination is a medical procedure and it carries with it risks and benefits so parents need to be aware of all of the information.” Such statements are made alongside affirmations that unlike government-BigPharma, AVN does not have vested financial interests around vaccines, and like parents Australia-wide, its members are simply concerned with the safety and health of their families.

These cumulative observations bring this study to its final conclusions. The first being that AVN blog posts from 2012 to 2019 feature seven readily occurring persuasive cues. Such message variables together express concerns about the suppression of medical autonomy and information, while also articulating fears about vaccine safety alongside various notions of personal and professional expertise. Building from this, the second conclusion is that these three persuasion foci parallel many of the leading apprehensions and inclinations denoted by Australians with vaccination doubts. The AVN blog, therefore, is not only harnessing numerous persuasive cues on the Internet, where many tentative individuals turn for information about vaccines. But it is doing so through persuasion themes that speak directly to the most central concerns voiced by vaccine hesitant individuals in Australia.

Supplemental Material

Supplemental_Material_1 – Supplemental material for Distrust, danger, and confidence: A content analysis of the Australian Vaccination-Risks Network Blog

Supplemental material, Supplemental_Material_1 for Distrust, danger, and confidence: A content analysis of the Australian Vaccination-Risks Network Blog by Thomas Aechtner in Public Understanding of Science

Footnotes

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The research was funded by the Westpac Scholars Trust.

ORCID iD

Thomas Aechtner

Supplemental material

Supplemental material for this article is available online.

Author biography

Thomas Aechtner is a senior lecturer in the School of Historical and Philosophical Inquiry at the University of Queensland, Australia. His research focuses on science and mass persuasion, including religiously motivated antievolutionism, vaccine hesitancy, scientism, and public perceptions of science.

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