Vaccine Communication and the Media Credibility in Addressing Vaccine Hesitancy: A Focus on Malaysia

Abstract

The resurgence of vaccine-preventable diseases such as polio, diphtheria, measles and the like shows that the anti-vaccine movement is gaining popularity and effectiveness in bolstering its views. Multiple studies have shown worrying trends of distrust towards vaccines, medical professionals, vaccine scientists and the government agencies that promote vaccination. It is observed that the current anti-vaccine discourses and misinformation about vaccines on social media are fuelling fear of vaccination among the public. To minimise the spread of vaccine-preventable diseases, the media has considerable potential to influence the public’s understanding of how vaccines function. Therefore, this chapter proposed the adoption of a media guide to assist media practitioners in reporting vaccination stories. It will highlight an influential role that the media can play by enlisting the assistance of experts and health professionals to dispel erroneous beliefs about vaccinations and aggressively promote vaccination among influential persons and the general public. This chapter argued that responsible and ethical reporting will aid in raising awareness of the public health implications of the anti-vaccine sentiment, thereby combating the transmission of messages that drive vaccine fear and rejection. The chapter also addressed how insights provided by Ihlen on rhetorical communication can enhance the effectiveness of delivering vaccine-related messages.

1. Introduction

Despite being closely monitored by the Ministry of Health (MOH) through national immunisation programme, Malaysia has continually observed a rise in vaccine-preventable illness outbreaks. This may be the result of misinformation and falsity spread by anti-vaccination activists worldwide. In Malaysia, the vaccine refusal and rejection scenario became known in 2012 due to its concealed approaches [1]. However, the advancement of social media has facilitated the groups to set a strong foothold [2], particularly in spreading the anti-vaccination sentiment and influencing the public. The trend should be concerning as 65% of vaccine information on the Internet cannot be trusted since they come from anti-vaccination groups [3]. In this situation, official media providers must intervene through good reporting and play a more specific role to increase vaccine acceptance and consequently, vaccine uptake. The official media in this chapter refers to TV, radio and newspapers, which includes all online platforms used to reach more audiences, including incidental social media users [4]. This chapter began with a discussion of vaccine hesitancy issues followed by journalistic roles in increasing vaccine acceptance and uptake and the strategic approach to reporting vaccination. The conclusion of the chapter emphasised the need to respond to concerns about potentially harmful anti-vaccination messaging on the Internet through responsible and transparent reporting on vaccination.

2. Vaccine reluctance among Malaysian parents

The World Health Organization (WHO) defined vaccine hesitancy as a delay in acceptance or refusal of vaccines despite the availability of vaccine services. The fact that availability of health information on the Internet has empowered the public in making decisions on health-related matters. This infers that the public is also exposed to unreliable and even false information that could affect their trust in vaccinations and health programmes. Many factors lead to vaccine refusals including distrust in vaccine content which refers to suspicious ingredients, fear of vaccine side effects, conspiracy theories and religious reasons [5].

In Malaysia, Abdullah et al. [6] revealed that parents who chose not to vaccinate their children gave ‘vaccinations are dangerous’ as their reason. While Mohd Azizi et al. [7] showed that parents who delayed and refused to vaccinate their children blamed vaccine side effects (40%), safety and efficiency (37.4%), the number of vaccines given to children (64%) and a preference for children to self-develop immunity by getting sick (52%). Other parents have stopped immunising their children due to concerns that vaccines cause autism and Facebook posts about vaccine side effects [8]. Some parents believed that there is a hidden agenda behind vaccination, where pharmaceutical companies produce vaccines for profit rather than for disease preventions [9]. Mohd Azizi et al. [7] also found that non-Muslim parents were more hesitant to vaccinate their children than Muslim parents, despite the fact that vaccine difficulties are always associated with a false belief regarding the presence of pig DNA, which affects the halal status of vaccines.

In addition, personal anecdotes shared by others have a significant impact on vaccine acceptance and rejection. A number of studies have reported the impact of social media on vaccination and the increase in anti-vaccination sentiment. According to Shelby and Ernst [10], sharing anecdotes on the so-called ‘vaccine injury’ narrative on social media can be emotionally impactful and, to some extent, accelerates vaccine hesitancy among parents. ‘Each “like” is an endorsement of the content of these anti-vaccine pages by an individual, often a parent, who has read through them’ (p. 1796, [10]). The effects of personal anecdotes on various social media platforms can be seen as consistent with the number of unvaccinated children reported. Ghazali et al. [11] concluded based on several studies reviewed that the majority of the social media content related to vaccination was skewed negatively that disfavoured vaccine uptake. More specifically, in their 2021 study of Anti-vaxxers on Facebook, Ghazali et al. [2] found that when using Facebook for anti-vaccine discourses, the anti-vaxxers can be grouped into four categories which are persistent, moderate, uncertain and non-active. While the majority of them are uncertain (59%), which meant that they were mostly following and consuming anti-vaccine messages but are not the ones producing the messages, the persistent (12.5%) and moderate (17.5%) anti-vaxxers who were actively producing and disseminating anti-vaccine messages were significant. The persistent type of anti-vaxxers manifest their opposition through the content sharing of negative vaccine information. Their posts range from exposing severe vaccine side effects to distrust towards vaccines, amongst others. Most of the contents were re-shared posts from other accounts accompanied by their own comments. Unfortunately, the study also found that anti-vaccination advocates may use dishonest strategies to discredit the scientific validity of vaccination, which may include emotionally driven arguments. This is supported by Kata [12], who found that those anti-vaccine groups have utilised a variety of convincing and effective online engagement strategies.

3. Media coverage of vaccination in Malaysia

Ghazali et al. [2, 11] examined how the Malaysian media reported on the anti-vaccination movement. By analysing news coverage on vaccinations in Malay (2020) and English newspapers (2021), the authors examine whether the Malaysian news media is fulfilling its responsibility to cover vaccination concerns effectively. The authors initially examined vaccination coverage in two Malay newspapers, Berita Harian and Harian Metro. From January 2019 to September 2019, a quantitative framing analysis was undertaken on a total of 131 vaccine-related news articles collected over 9 months. The news was analysed in order to determine the volume of coverage, types of frames and sources utilised while reporting on vaccination difficulties. The data revealed disparities in the amount and nature of vaccination coverage between the two newspapers. Despite variations, the study discovered that Malay publications continue to place inadequate attention on immunisation. Vaccination is primarily regarded as newsworthy rather than as a topic to be addressed and emphasised. Considering the present health conditions, it is vital that Malay publications play a greater role in promoting the significance of immunisation.

Similarly, the authors examined the coverage of vaccination in two English newspapers in Malaysia [13]. From January 2019 to March 2020, a framing analysis was performed on 308 vaccine-related news articles collected for 14 months. The results revealed that there are few differences between how the two publications covered immunisation. Vaccination is generally treated as news rather than as a problem to be solved. Based on the findings, the authors proposed stronger attention to vaccine concerns in the Malaysian media so that it can become a national priority. In particular, by giving more planned and deliberate coverage, the media can promote awareness about the necessity of vaccination while highlighting the dangers of anti-vaccination views. The authors made a specific suggestion that government, researchers and media professionals should collaborate to inform, educate and raise public understanding about the significance and repercussions of vaccination.

4. Journalism undertaking the role to improve vaccine acceptance and uptake

In relation to all the research findings that demand more purposive media coverage of vaccination, there is no doubt that journalists and other media professionals should take on the responsibility of addressing anti-vaccine messages, given their traits and power for pushing towards quality and credibility reporting. From a journalistic perspective, producing newsworthy media reports may come with specific procedures and guides, especially on facts and sources. According to Shapiro et al. [14], maintaining quality news reporting, such as fairness, accuracy and clarity, is essential because it reflects the professionalism of both the journalists and the media they represent. Prioritising the quality of news reporting extends beyond protecting the credibility of journalists and the media entity. What is important, society gets the true and quality information as the public may be unable to independently verify information [15].

Besides journalistic quality, media professionals often consider the societal implications of a story [16]. For instance, a news story with accuracy and clarity of fact may have a devastating impact on society. Therefore, journalists are responsible to minimise these effects while preserving accuracy when involving sensitive matters. This idea is in line with Wagemans et al. [17] who proposed that the public needs journalists to play a deeper role in reporting an incident, in which they think and act beyond the surface, such as following the development of an issue and its impact on society.

As a gatekeeper, the media can set an agenda for public discussion and shape public opinion and determine the public’s action on the issue. Happer and Philo’s [18] study on the role of media in building public trust found that media had created a state of uncertainty among the public on the issue of climate change and prevented any change in attitudes among the society members. Therefore, journalists, especially those on the editorial board, should be realistic and vigilant regarding the circumstances. Saldana et al. [19] suggested that realistic editorial decision-making is important. In dire situations, editors must adjust their traditional-ethical standards and be reflective of the surroundings in order to address certain matters. These studies exemplified that the decisive role of the news media is needed, but wrong decisions can be hazardous.

Quality reporting of critical issues such as health is no exception to the discussion. There have been several cases reported in the media that speak out about the misrepresentation of news reports on health issues. For instance, Lister [20] asserted that the Lancet media deceived the public into not receiving the MMR vaccine. The media disseminated inaccurate and imprecise information regarding vaccines, including potential risks and side effects. There are several plausible causes for this. One of them is journalists’ lack of expertise on health-related matters. This is reinforced by a study by Keshvari et al. [21] which found that most health journalists in Isfahan have minimal knowledge and were not well-trained in dealing with health issues. The study is in line with Safari et al. [22] which emphasised the importance of media getting appropriate training from experts in the medical field. The review saw that the lack of knowledge and training in health-related issues could result in incorrect or ambiguous information that steers society on the wrong path. In short, the media has to approach health issues a bit different from other issues as a wrong move might backfire on them. They should be aware of when it is appropriate to highlight, prioritise and emphasise specific issues to lead the agenda for the public.

Evidence from Pew Research Centre found that Americans who closely follow news reports about vaccines have more positive attitudes towards childhood immunisation. The media reports raised public awareness of the importance of vaccination, thereby promoting free choice [23]. Media, in this sense, assists to educate people on the importance of vaccination. However, media can sometimes have the opposite effect. According to Tran et al. [24], media portrayal of vaccine side effects could also cause individuals to hesitate or even refuse vaccinations. Yu et al. [25] argued that media coverage of potential adverse side effects of the hepatitis B vaccine caused people’s confidence in the vaccine to wane. While Bodemer et al. [26] expressed concern that balanced media coverage, such as stories that contradict scientific evidence, may actually provide an unbalanced portrayal of the HPV vaccine. These findings corroborated a claim that the media could be ‘a poor vehicle for the communication of scientifically accurate information about health and medicine, prone to sensationalism, sins of omission, and sheer inaccuracy’ ([27], p. 2).

In view of these discussions, systematic and conscientious means of reporting health issues should be standardised and endorsed within media organisations. As the world fights Covid-19 misinformation, the relevance of this measure increases. The use of a specific media guide could promote accurate, responsible and appropriate reporting on health matters, particularly vaccination. The guide is not a kind of censorship, but rather a methodology to ensure that all pertinent information is clear and thoroughly presented. The guide should also be viewed as a standard in maintaining news credibility and restoring the public’s faith in the media. Standards, as suggested by [26] (p. 3754), ‘will help consumers identify reliable and balanced information sources and will support the use of transparent formats to translate scientific knowledge’.

5. Providing strategic reporting

Studies have shown that reporting on vaccination could lead to a mix of responses on vaccination programmes. As pointed out earlier, while some people will take vaccines, others might be discouraged by vaccination misinformation and misleading news reporting. Therefore, this chapter suggested that the media professionals should adopt a strategic approach to report vaccination by using a standard media guideline. In journalism, the use of a media guide to report on issues is not uncommon. Several guidelines have been developed to ensure different topics are accurately and responsibly reported.

For example, the guideline for suicide reporting. Research explored that media reporting of suicide can encourage suicidal thought, thus leading to the act. To overcome the impact, the media professionals have been informed to follow a guideline to responsible suicide reporting. The guide recognised ‘that there will be occasions when an individual’s suicide will be newsworthy, and offer evidence-informed suggestions as to how to report such deaths in a way that raises public awareness about the issue of suicide without leading to a risk of imitation’, ([28], p. 46). Machlin and colleagues suggested two key issues to avoid when reporting suicide: sensationalism and complete details of how the act of suicide. The reports should rather focus on providing information that offers help and support.

A second illustration is a guideline for reporting children. Children are seen vulnerable whose rights need special protection from the media. According to Gordon, McAlister and Scraton [29], negative labeling on children and young people has been found to produce a long-lasting poor reputation and negative stereotypes. Therefore, media professionals are reminded through Reynolds Journalism Institute [30] to perform responsible reporting by pointing out several concerns. This includes, but is not limited to, considering a positive portrayal of children and their rights interests, respecting their privacy, confidentiality and consensus during interviews, including their perspectives in issues pertaining to them and protecting their identity if disclosure is likely to cause harm. The guide is primarily viewed as a resource for media professionals to monitor how to generate ethical and high-quality reporting regarding children. The guide on reporting children also emphasises the significance of addressing children’s rights, as poor media portrayals have harmful effects on their life.

In relation to the news treatment on health matters, Schwitzer et al. [16] pointed out that accurate and clear coverage is not adequate. They argued that the media should correspondingly and comprehensively reflect society’s needs and issues when covering health news. The media should assume an educational function with the goal of imparting a comprehensive understanding on scientific knowledge [16] and influencing the attitudes and behaviours of the public towards an issue [31]. The argument is linked with Ihlen’s [32] view that to effectively persuade people on certain matters, the messages created should be significant to their belief and values. Discussed through the lens of strategic communication and rhetorical theory, Ihlen [32] suggested that in ensuring effective messages can be formulated, target groups and their values should be first identified. Once a clear connection is established, messages can be better comprehended as meaning is co-created between the audience and the sender. Therefore, a guide which specifies messages and addresses particular concerns could aid media professionals in deciding how vaccination stories should be reported. In order to accomplish this, it is essential to comprehend the public’s issues and develop relationships with relevant stakeholders.

Experts in medical, public health, social science and computer science fields as well as the public could provide insights on what matters the most to stop health and vaccine misinformation from aggravating. Efforts by health communicators to neutralise misinformation on vaccination through audience engagement are evident. Some of them used social media to build trust, give feedbacks to audience concerns, use evidence-based information, carefully refute information and collaborate with like-minded organisation [33]. In Malaysia, among the measures taken by the government include organising campaigns and providing complete information on vaccine and immunisation programmes on the Health Ministry website and its social media platforms. Medical personnel such as doctors, nurses, pharmacists and scientists similarly have been using a more amicable method to communicate with the public using social media platforms either personally or in teams such as Medical Mythbusters Malaysia, MedTweetMY and ML Studios.

Though, operating in isolation might be ineffective to combat anti-vaccination messages. This is true as some corrective strategy may backfire while some factual information may be incorrectly recalled over time [34]. Therefore, this chapter argued that media and various stakeholders must build intentional linkages. Through strategic engagement, input could be drawn, and initiatives could be made to develop a standard media guide to be used by media professionals.

6. Conclusion

Given the current characteristics of vaccine refusal and anti-vaccine sentiments, suggestions in this chapter are timely. This chapter argued that a media standard is necessary for reporting and correcting vaccination misinformation. The aim of the media guideline is not to censor and control, rather to help news producers, editors and journalists alike to have a clear idea of what constitutes reliable, responsible and ethical reporting pertaining to vaccines. In turn, this will improve awareness of the effects anti-vaccine views may have on public health. A reference to a transparent standard could increase the credibility and authority of mass media providers in Malaysia in comparison to social media networks that share the same content but cite unreliable sources.

In line with rhetoric and strategic communication discussed by Ihlen [32], the media guide should consider issues such as defining a target audience, setting specific purposes of writing, tackling facts, risk and benefits related to vaccines, identifying specific contents or themes and verifying with the right authority in reporting vaccination stories. This will ensure that the media reporting will not only revolve around events and incidents but deeper analysis on vaccination.

Though, it is uncertain as to how far the media guide is effective to report vaccination stories. One clear reason is that the communication of information about vaccination as a social phenomenon might not always fit easily with expectations of what makes news. As Machlin et al. [28] argued that some elements in media guidelines are not always easy to interpret. Hence, its use might be inhibited. Prescriptive media guidelines might not be fully accepted by the media professionals that would see it as a regulative norm. Admittedly, the adherence to the guideline might be challenging (e.g. [28, 29, 35]), but its adoption could help to improve media social responsible roles especially on vaccine-related matters.

Therefore, this chapter suggested that a long-term engagement between the media players and health authorities is a way forward to ensure voluntary adoption and effective use of the media guideline. Collaboration, consultation and training could be among the systematic strategies that the media could adopt. For example, health practitioners could provide information and expertise so the media could have a repository of significant and persuasive vaccine-related messages to counter anti-vaccination attitude in the community. The guideline could further provide insightful suggestions to both parties in planning and promoting effective policies and health programmes that support immunisation.

In this chapter, the proposal to improve journalistic practices through the use of a specific media guideline dealing with vaccination topics is significant in the field of health communication. The authors perceived that this effort would help counter pseudo journalism activities in the long run. As vaccine refusal individuals are ‘highly media-savvy and unafraid to push their opinions that vaccines are dangerous’ ([36], p. 6), strategic approaches are pertinent. Through these efforts, the authors recommended that the Malaysia media providers to be more pronounced in their attitudes to approach anti-vaxxers and combat anti-vaccination phenomenon with the aim of moving towards literate society.

Acknowledgments

This research is supported by Islamic Advisory Group entitled ‘Developing a Strategic Communication Intervention Manual to Inform and Correct Misinformation and Misconception about Vaccination using Islamic Evidence’ (Project ID: SPI22-122-0122).