A guide to how and where to find accurate information about vaccinations online

1. Diagnosis by Dr Google
Dr Rachael A Dunlop PhD FSB

2. Why do parents fear vaccines?
1) Absence of visible vaccine preventable disease i.e., vaccines
are a victim of their own success
2) Without fear of disease the hypothetical vaccine risk or small
risk become elevated
3) Misinformation confuses parents, leads
to delaying vaccines and can have tragic consequences
Pineda D et al., Pediatrics, 2011 (free pdf here).

3. Why do parents fear vaccines?
Three main sources for information; health professionals, the media, the
Internet
1) Health stories constitute 11% of nightly news but many contain errors
that can harm viewers (1)
2) The media‟s favourite practice of “balance” in health and science stories
seeds doubt and confusion
3) BECAUSE CELEBRITIES
(1) Pineda D et al., Pediatrics, 2011 (free pdf here)

4. Can you trust the Internet?
• Dr. Google misdiagnosed 25% of women
• 50% wrongly self-medicated (2)
• 1/2 Australians use Internet to self-diagnose (3)
• 1/3 investigate medicines on the web (3)
• Online health information seekers
examine the first 10 search results
97.2% of the time
• Are they getting the right/accurate
information?
(2) UK health survey
(3) Bupa Health Survey, Aussies turning to cyberspace to self-diagnose, Feb 9th 2011

5. Is the Internet to blame?

6. Is the Internet to blame?

7. Is the Internet to blame?
• High quality information competes with equally available
misinformation
• “Current postmodern medical paradigm” – individuals play an active
role in their healthcare
• “Do your own research!” “Empower yourself!”
• Postmodernism allows for information to be interpreted in various
ways – not “wrong” but “another way of knowing”
Betsch and Sachse, Vaccine 30(25):3723-26 (2012)

8. Is the Internet to blame?
• An analysis of YouTube videos found that 32% opposed vaccination,
and that these had higher ratings and more views than pro-vaccine
videos
• As little as 5 mins on an anti-vaccine site could influence decisions
months down the track
• When you ring a bell, it can‟t be “unrung”
Kata, A. Vaccine, 2010 1709-1716.

9. Is the Internet to blame?
• Parents who exempt children from vaccination are more likely to have
obtained information from the Internet than parents who have their children
vaccinated
• McCarthy learned everything about autism from "the university of
Google."
• Parents empathize with her; she doesn't need science because she
observes her son, Evan, every day. "At home," she writes, "Evan is my
science."
“Evan is my science." –
Jenny McCarthy

11. Is the Internet to blame?
• Anti-vaccination web-sites express range of concerns related to vaccine safety and
varying levels of distrust in medicine.
• Rely heavily on emotional appeal to convey their message.
Issues raised % sites
safety and effectiveness 100
alternative medicine 88
civil liberties 88
conspiracies/search for
100
truth
misinformation/falsehoods 88
emotive appeals 88
Kata, A. Vaccine, 2010 1709-1716.

12. Kata, A. Vaccine, 2010 1709-1716.

13. Tactics and tropes used by anti-vax
movement
• “I‟m not anti-vaccine, I‟m pro-choice/safe”
• Cherry picking/skewing the science of vaccine safety and efficacy.
• Create legitimacy for unfounded or discredited theories of harm, pseudoscientific
conferences, (eg AutismOne) give veneer of legitimacy.
• Shifting the goal posts and the villain, MMR to thimerosal to other “toxins” and more
recently “too many, too soon”.
• Censoring dissent, delete comments or restrict access to events, creating virtual or real
echo chambers.
• Attack the opposition, e.g., lawsuits against physician Paul Offit or journalist Amy
Wallace.
Kata, A. Vaccine, 2012 May 28;30(25):3778-89.

14. Tactics and tropes used by the anti-vax
movement
• Anti-vaccine organisations also use names designed to obscure
their objectives, eg., Australian Vaccination Network,
Vaccine Information Service etc.

15. Because CELEBRITIES
“When people in the public eye give
opinions about causes of disease, cures, diets,
or products we should buy or avoid, that‟s it. Their opinion goes
worldwide in seconds. It gets public attention and appears in every
related google search for months. So if it‟s scientifically wrong,
we‟re stuck with the
fall-out from that.....We‟d like to see more celebrities checking out
the science
before they open their mouths and send
the wrong thing viral.”
Lindsay Hogg, Assistant Director, Sense About Science, UK.

16. The cult of celebrity
“I do believe sadly it's going to take some diseases
coming back to realize that we need to change and
develop vaccines that are safe. If the vaccine
companies are not listening to us, it's their f___ing
fault that the diseases are coming back. They're
making a product that's s___. If you give us a safe
vaccine, we'll use it. It shouldn't be polio versus
autism.”
Time Magazine, April 2009.

18. “I love botox, I absolutely
love it, I really do think
it‟s a savior”

20. The HON Code
• Health On the Net foundation founded to encourage
dissemination of quality health information for patients,
health professionals and public
• Certification is an ethical standard aimed to indicate
quality health information
• Oldest and most used code on the „Net
http://www.hon.ch/

22. Web of Trust
http://www.mywot.com/

23. Web of Trust

24. Web of Trust

25. What to look for
• Disclosure of ownership/source
• Transparency of sponsorship (who pays?)
• Quality of information
– Authority of sources; do experts review the info? What are their quals?
– Attribution; cite scientific evidence/references (beware misleading websites
can cite legitimate sources inaccurately)
– Accuracy; objective, scientific information
– Currency; is the info current?
– Stds of writing/editing should be high
• Completeness of information; cherry picking?
• Do anecdotes trump science? If yes, then less likely to be reliable.

26. What to look for
• The WHO conducted analysis called Vaccine Safety Net
• Websites providing information on vaccine safety which adhere to good
information practices were assessed
• Criteria were
Essential criteria i.e. with respect to credibility
Important criteria i.e. with respect to content
Practical criteria i.e. with respect to accessibility
Desired criteria i.e with respect to design
http://www.who.int/immunization_safety/safety_quality/approved_vaccine_safety_
websites/en/index.html
or http://tinyurl.com/7rkuskt

27. Vaccine safety web sites meeting credibility
and content good information practices criteria

28. Websites you can trust
• The CDC http://www.cdc.gov/vaccines/
• The WHO http://www.who.int/immunization/en/
• National Network for Immunization info (NNii)
http://www.immunizationinfo.org/ or nnii.org
• Vaccine education centre at the Children‟s Hospital of Philadelphia;
vaccine.chop.edu
• Immunization Action Coalition; www.immunize.org
Pineda D et al., Pediatrics, 2011 (free pdf here).

29. Websites you can trust
• WebMD
• Medline Plus - a combined effort of the National Library of Medicine and
the National Institute of Health.
• NHS Choices (UK site) – good general purpose site.
• Google Scholar (only issue is some papers are paywalled)
• PubMed (paywalls)
• xavfax.me

30. Contribute!
http://www.mamamia.com.au/news/vaccination-myths-
busted-by-science-cheat-sheet-on-immunisation/

31. Be skeptical!