Ii ABSTRACT Vaccine Hesitancy Is As Old As the Vaccine Itself, Yet This

Home , Del Bigtree, Frank DeStefano, Loving Lampposts, MMR vaccine and autism, Vaxxed

ABSTRACT

Vaccine hesitancy is as old as the vaccine itself, yet this issue has been historically difficult for public health measures to effectively address, particularly after the advent of Web 2.0.

The most recent wave of vaccine hesitancy comes from a purported link between the measles, mumps, and rubella vaccine and autism, and has led to the release of a documentary-style film entitled Vaxxed: from Cover-Up to Catastrophe in 2016. To better understand vaccine rhetoric and its implications for informing future interventions, this project uses a novel analytic framework that identifies key narratives of vaccine hesitancy and traces the ways that they are subsequently disrupted or bolstered in vaccine conversations. Specifically, the narratives of conspiracy, injustice, victimization, and enlightenment that are presented in Vaxxed are followed as they are rebutted in mainstream newspaper articles, and then further evoked or contested in the comment sections that follow. Ultimately, this project suggests that public health, physician, and layperson efforts that take into account the sophistication of vaccine skeptic epistemologies and knowledge are better able to disrupt the central narrative of enlightenment to reduce the spread of vaccine hesitancy. Furthermore, increased autistic representation on platforms that engage with the vaccine conversation could undermine victimization narratives and ensure pro-vaccine discourse that respects people with autism.

ACKNOWLEDGMENTS

First and foremost, I would like to thank my thesis advisor Prof. Jordynn Jack of the

Department of English and Comparative Literature at the University of North Carolina at Chapel

Hill. Prof. Jack was endlessly patient with the bumbling beginnings of this project, as well as all of the muddled middle parts, and I am incredibly grateful for her guidance throughout this process.

I would also like to thank the members of my committee, Prof. Jane Thrailkill and Dr.

Melissa Geil of the Department of English and Comparative Literature at the University of North

Carolina at Chapel Hill, for their valuable comments on this thesis.

Finally, I would like to express my gratitude to my family, friends, and fellow members of the HHIVE Lab at the University of North Carolina at Chapel Hill for their kindness and support throughout this process. Without all of you, this thesis never would have come to be.

iii

TABLE OF CONTENTS

INTRODUCTION...... 1

The History...... 1

The Problem...... 3

The Potential Solution...... 7

The Project...... 9

CHAPTER 1: THE VAXXED NARRATIVE...... 13

A Claim of Conspiracy...... 15

An Indictment of Injustice...... 19

The Charges and the Evidence...... 19

The Direct Examination...... 20

The Mistrial...... 23

The Closing Statement...... 24

A Verdict of Victimization...... 25

Autistic Children...... 25

Autism Families...... 27

Society at Large...... 29

Conclusion...... 30

CHAPTER TWO: THE PRESS RESPONSE...... 34

The Question of Credentials: Reframing Allegations of Injustice...... 38

The Series of Scandals: Burying the Conspiracy Narrative...... 39

The Quiet Claims: A Motion to Dismiss...... 41

The Advocate for Alternatives: Complicating the Forces of Victimization...... 42

Conclusion...... 44

CHAPTER THREE: THE PUBLIC EXCHANGE...... 48

A Question of Epistemology...... 50

Science (as a Segue to Skepticism)...... 52

Skepticism (as a Segue to Science)...... 53

Testimonies of Terror...... 56

Saviors or Charlatans?...... 58

“Anti-Vax Trolls” vs. “Pro-Vax Shills”...... 60

Is Autism the Real Victimizer?...... 61

Conclusion...... 64

CONCLUSION...... 68

REFERENCES...... 79

INTRODUCTION

Vaccine hesitancy, or an intentional delay or refusal of vaccination despite readily available access, is not a new phenomenon; in fact, it technically predates vaccination itself

(Dubé et al., “Vaccine Hesitancy, Vaccine Refusal…” 100). Concerns about vaccines trace their roots to the late nineteenth century practice of variolation, or the intentional inoculation of healthy individuals with smallpox cultures from ill patients to produce a controlled infection that confers later immunity (Wolfe and Sharp 430). During that age of rampant quackery, the practice was met with skepticism, particularly due to the dangers associated the intentional smallpox infection.

The History

In 1796, British physician Edward Jenner developed the first true vaccine, which instead used cultures from the far less dangerous cowpox to confer immunity for smallpox (Stern and

Markel 612). This finding resulted in mandated vaccinations to control smallpox transmission in both the United Kingdom and later, the United States. In turn, during the following decades, various AV organizations were formed in both nations by those who questioned the safety and efficacy of vaccination or resented the government oversight. After extensive lobbying, the

United Kingdom relaxed policies that criminalized parents who refused to vaccinate their children.

In the United States, however, the landmark Jacobson v. Massachusetts ruling in 1905 following the 1901 smallpox epidemic set a new precedent allowing for government intervention in private matters in the interest of maintaining public health (Albert et al. 375; Stern and Markel 617).

This ruling, however, would not prove to be the end of vaccine skepticism. Despite a period of relative vaccine confidence during the mid-twentieth century, by the 1970s, the diphtheria, pertussis, and tetanus vaccine (DPT) was called into question. A 1974 London report described 56 children who developed neurological complications after receiving pertussis vaccine.

This report led to the 1982 WRC-TV broadcast of the film DPT: Vaccine Roulette, thereby spreading anti-DPT sentiments to the United States. Such sentiments were further exacerbated by a American Academy of Neurology meeting presentation in the same year suggesting that DPT vaccine causes sudden infant death syndrome (Fenichel 193). Although both associations were later disproven, lawsuits by concerned parents against pharmaceutical companies reduced their willingness to manufacture vaccines, driving up prices. Consequently, the United States Congress passed the National Childhood Vaccine Injury Act (NCVIA) in 1986, allowing parents to obtain compensation for vaccine-induced injuries while protecting vaccine manufacturers from litigation and establishing the Vaccine Adverse Event Report System, through which providers could officially record suspected injuries reported by parents (Dubé et al., “Vaccine Hesitancy, Vaccine

Refusal…” 104, Smith 267). Unfortunately, the compensation mechanism created by NCVIA, colloquially known as “Vaccine Court,” has been interpreted among vaccine skeptics as evidence that a corrupt government is enabling vaccine manufacturers to freely produce harmful vaccines without due punishment, rather than an attempt to incentivize pharmaceutical companies to continue producing vaccines while ensuring proper repayment for children affected by adverse side effects (Vaxxed). This perception has galvanized current vaccine hesitant activists to cite cases ruled in favor of the petitioning parents as evidence for vaccine dangers.

More recently, vaccine hesitancy has turned against the measles, mumps, and rubella vaccine (MMR). In 1998, then pediatric gastroenterologist Andrew Wakefield published a report in the prestigious medical journal Lancet suggesting a causal link between the MMR vaccine and autism. He followed this report with a public statement that the MMR combined vaccine, in contrast to individual measles, mumps, and rubella vaccines, should not be administered to

2 children until more evidence was available to ascertain its safety (Mnookin). Although the paper was later retracted and this link has long since been disproven, the enormous media firestorm along with extensive propagation of the accusation among vaccine hesitant groups that followed his shocking announcement ensured that anti-MMR attitudes persist even today.

Thus, the historical evidence suggests that this anti-MMR flavor of vaccine hesitancy is part of a broader trend rather than an anomaly. Unfortunately, it is a trend with real consequences for public health. Low vaccination rates have been linked to epidemics of otherwise low- prevalence vaccine preventable diseases. For instance, the 2017 measles outbreak in a Somali-

American community in Minnesota has been linked to anomalously low vaccination rates following talks by vaccine skeptical activists (Dyer j2378). During the same year, measles rates in

Europe quadrupled, a phenomenon attributed to “anti-vaccine hysteria” (McNeil D3).

Additionally, from an economic standpoint, the financial burden of a 5% reduction in MMR vaccination coverage is projected to result in a 3-fold increase in annual measles cases and cost

$2.1 million for the public sector (Lo and Hotez 887). As a result, vaccine hesitancy has become a subject of study across multiple disciplines, generating a body of literature that characterizes vaccine hesitant communities, their discourses, and efforts made to alter their attitudes.

The Problem

Unfortunately, the literature surrounding vaccine hesitancy reveals certain characteristics of vaccine skeptics that are both surprising and disconcerting. In this thesis, I use the terms

“vaccine hesitancy” and “vaccine skepticism” interchangeably to indicate any negative attitudes, including concern or doubt, toward the safety or efficacy of vaccines. Thus, this definition captures not only parents who refuse vaccination or encourage others to refuse vaccination, but also ambivalence experienced by parents who reluctantly accepted vaccines or are debating whether they will vaccinate in the future. Of note, I avoid the colloquial term “anti-vaccination attitude,” which has largely been rejected by vaccine hesitant communities, which instead

3 describe themselves as “pro-safe vaccine” (McCarthy). To parallel these alternative terms, as stand-ins for “pro-vaccination attitude,” I use “vaccine confidence,” which refers to positive attitudes toward vaccines, and “vaccine advocacy,” or active efforts to promote vaccine confidence. All four terms pertain to attitudes toward vaccines, but are distinct from “vaccine uptake” and “vaccine refusal,” which refers to the actual behavior of obtaining or rejecting vaccination.

Meta-analyses of the digital discourse of vaccine hesitant parents have elucidated the common motivating factors for vaccine hesitancy, including: distrust toward medical and scientific institutions, which can manifest in conspiracy theories; emphasis on parental autonomy, authority, and responsibility over physician recommendations; risk-benefit analyses that emphasize potential vaccine dangers over efficacy in preventing vaccine-preventable diseases; reliance upon alternative medicine and alternative models of healthcare due to perceived failure by conventional medicine; group affiliation with communities that are vaccine hesitant, including religious communities; and inadequate primary care physician support (Kata; Mitra et al. 269;

Wolfe and Sharp).

Yet despite their distrust in scientific institutions and disagreement with their vaccination recommendations, vaccine skeptics are not necessarily “unscientific.” Rather, selective and delayed vaccinators tend to be the most well-informed about vaccination and exhibit a preference for the sorts of statistical evidence favored in scientific inquiry rather than anecdotal evidence; by contrast, vaccine acceptors tend to be the least informed (Leask et al. 154). Consequently, while certain vaccine skeptic arguments stem from misinformation, vaccine hesitancy as a whole is unlikely to be reduced simply by providing more information.

Moreover, analyses of vaccine rhetoric reveal that the ideological roots of vaccine hesitancy are difficult to dismantle. One study comparing tweets made by longtime vaccine skeptics against those made by newly converted vaccine skeptics suggests that the spread of vaccine hesitancy over digital media is a process through which “susceptibles,” or people with

4 pre-existing tendencies toward conspiracy ideation, are converted to vaccine hesitant viewpoints

(Mitra et al. 277). While this finding points toward populations who need to be particularly targeted by efforts to improve vaccine confidence, the notion of a pre-existing susceptibility also feeds a narrative of inevitability, through which certain people are doomed to be converted regardless of public health and physician efforts. Additionally, meta-analyses have noted that vaccine skeptics’ distrust in authority, insistence upon autonomy, and emphasis of risks over benefits are all characteristic of broader trends toward consumerism in healthcare and postmodernism in our ideological environment (Kata 1715). Unfortunately, this consistency with broader frameworks makes these beliefs even more resistant to change, since they are bolstered by analogous belief systems in other arenas like politics and perceptions of media.

The complications of postmodernism are exacerbated by the influence of Web 2.0, which refers to the current iteration of the World Wide Web that allows for dynamic interactions between multiple users via comment threads, forums, and social media; such platforms stand in contrast to earlier static web pages that facilitated only a one-way transmission of information from producer to consumer. Web 2.0 has been characterized as a Pandora’s box of vaccine misinformation, allowing free propagation of opinions about vaccine safety unchecked by obligations to accuracy (Kata 1715).

These difficulties are reflected in the poor efficacy of interventions to increase vaccination. According to a 2013 systematic review of such approaches,

[There exists] a large number of studies that evaluated interventions for increasing

immunization coverage rates such as the use of reminder/recall systems, parent,

community-wide, and provider-based education and incentives as well as the effect

of government and school immunization policies. However, very few intervention

studies measured outcomes linked to vaccine refusal such as vaccination rates in

refusing parents, intent to vaccinate, or change in attitudes toward vaccines. (Sadaf et

al. 4297)

Nevertheless, some studies have shown that physician intervention does sometimes improve vaccine uptake, resulting in official guidelines issued by bodies like the American Academy of

Pediatrics regarding how physicians ought to counsel parents with varying degrees of hesitancy toward vaccine acceptance (Edwards et al. e9). Unfortunately, as critics have noted, such measures are difficult to execute in light of busy medical practices (Wells).

In light of the diversity and informedness of the vaccine hesitant community, the efficacy and ideological timeliness of their rhetoric, and the challenges facing interventions, the outlook for promoting vaccine confidence seems rather bleak. However, despite the vast breadth of existing literature, there still exist opportunities for new findings to inform alternative approaches.

For instance, little information currently exists about characteristics and impact of layperson vaccine advocacy (Brewer et al., “Understanding and Increasing Vaccination...” 23). However, with the rise of Web 2.0 and an increasing reliance on social media for healthcare advice (Kata

1709), citizen advocates on both sides of the vaccine conversation now possess ample opportunity to influence vaccine opinions. Additionally, existing studies of lay rhetoric tend to perform an aggregate, de-contextualized content analysis. Thus, each remark is removed from the conversation in which it was made, isolating it from the rhetorical microenvironment that generated its exigence and the exigences for follow-up that it generates. With such gaps in our understanding of vaccine rhetoric, several questions arise. For instance, how does layperson advocacy engage with vaccine skeptic efforts? How do the contexts of vaccine advocate and vaccine skeptic remarks influence their efficacy in shifting public opinion? Most importantly, how could a better understanding of these emergent qualities of the organic exchange between layperson vaccine advocates and skeptics capture a dimension of the vaccine conversation that eludes current efforts to improve vaccine confidence?

The Potential Solution

In light of these questions, I focused this thesis on the conversation that occurs between vaccine skeptics and vaccine advocates. This approach stands in contrast to existing studies of

Web 2.0 vaccine discourse, which treat tweets, comments, and the like as discrete remarks rather than snippets situated within longer back-and-forth exchanges. It is also distinct from efficacy studies or proposed strategies for provider-patient discourse, which assume that vaccine advocates possess the characteristics of professionals, including sophisticated expertise and an obligation to engage in respectful discourse in adherence to guidelines issued by regulatory institutions. Instead, I focus on organic conversation that arises via both the press and Web 2.0, gleaning insights from how comments react to the content and rhetoric of preceding ones in the thread.

To do so, I use the framework of narrative transportation theory, which posits that readers immerse themselves within the stories that they are told. According to Mazzocco et al., “narrative transportation can increase attitudinal yielding either by decreasing the natural response to argue against persuasive communications or by fostering emotional, empathetic connections with characters in the story” (361). Consequently, narratives function rhetorically by drawing in the audience to follow trajectories that bring them from assumptions to conclusions. As such, in this thesis, I trace narratives constructed by vaccine skeptics and advocates as a rhetorical device as they are complicated through disagreement from the opposing side.

Additionally, I attempt to go beyond discerning trends in subject, sentiment, and strategy in order to attempt to capture anomalous moments of productive conversation and better understand the conditions that generate such exchanges. Productive conversation, however, is an elusive concept to define. For example, from a utilitarian public health standpoint, an ideal exchange is that which induces the maximum number of people, whether active participants in the conversation or readers and other bystanders, to subsequently vaccinate their children, preferably in a timely fashion according to the vaccine schedule recommended by the United

States Centers for Disease Control and Prevention (CDC). Unfortunately, commenters rarely keep a running commentary of the precise state of their vaccine confidence and intent to vaccinate over the course of an Internet debate. Even if they did, positive intention does not always result in actual vaccine uptake (Brewer et al., “Longitudinal Predictors...” 197), and thus the behavioral outcome of digital discourse becomes even more difficult to elucidate.

As such, in subsequent analyses, an operational definition of “productive conversation” draws from the writings of American literary theorist Kenneth Burke and ancient Chinese rhetorician Guiguzi, as well as the principles of improvisational theatre. From Burke comes the notion of identification, which he explains as the phenomenon by which “you persuade a man only insofar as you can talk his language by speech, gesture, tonality, order, image, attitude, idea, identifying your ways with his” (A Rhetoric of Motives 55). Interpreted more broadly, identification suggests that persuaders ought to start by finding common ground with their audience. From Guiguzi come the philosophy of open-shut rhetoric, through which he recommends the following:

Carefully examine what people on the other side hold to know truths and untruths

about them. Learn about their wishes and desires to understand their ambition and

intent. Subtly critique their statements to make them open up with disagreement and

seek the true meaning behind it to benefit from their point of view. (Guiguzi 39-40)

Again, the impetus is placed on listening the audience and responding appropriately. Finally, from improvisational theory comes the conventional wisdom of responding with “yes, and….” In other words, in order to further the dialogue and keep the conversation alive, one must begin by acknowledging some measure of agreement and then building upon that agreement, rather than merely refuting points of contention. Based upon these three notions, I define “productive conversation” as discourse in which parties acknowledge points of agreement with their opposition, then navigate through differences to distinguish their own reasoning and subsequent conclusions.

The Project

In order to glean insights from this analytic approach, I examine the 2016 Cinema Libre film Vaxxed: from Cover-Up to Catastrophe, along with its related media coverage and Web 2.0 commentary, as a case study. This film alleges that the CDC has attempted to hide data supporting a link between MMR and autism, per the evidence of a CDC whistleblower. It presents this evidence in the form of documentary-style interviews with autism parents, scientists, politicians, physicians, and other experts and stakeholders in the purported consequences of the conspiracy. Ultimately, it attempts to persuade the audience to take action by demanding more rigorous vaccine testing and an Congressional hearing to investigate the potential CDC fraud.

Aside from its emphasis on promoting vaccine hesitancy and its relatively recent release,

I have selected this film because it represents the directorial debut of Andrew Wakefield, who has become synonymous with his allegations of the MMR-autism link since his 1998 study. This connection has lent the film instantaneous credence and notoriety among vaccine skeptics and advocates, respectively. Beyond Wakefield, the cast also features other high profile vaccine hesitant activists in the MMR-autism iteration of vaccine hesitancy, including producer Del

Bigtree, who also produced The Doctors, an American daytime talk show featuring medical advice generally ungrounded by scientific evidence (Korownyk et al. g7346), and interview subject Polly Tommey, who created The Autism File, a British magazine promoting alternative explanations and treatments for autism that fall outside of the scientific mainstream (“About Us”).

Furthermore, Vaxxed has enjoyed exposure even outside of more niche vaccine discourse circles through its brief association with the prestigious Tribeca Film Festival. Less than a month prior to its release, the film was selected and then later removed from the line-up within days; these events have been attributed in part to outcry from vaccine advocates over its acceptance to such a renowned platform (Tarkan).

Between its affiliation with the key vaccine skeptics and its brief foray into the attention of a broader audience, Vaxxed has become the “anti-vaccine” film. As I write this introduction

9 nearly two years after the release of this independent film, the hashtag #Vaxxed has been used in nearly 70 vaccine hesitant tweets over the past twenty-four hours. Meanwhile, “the Vaxxed crowd” has been adopted as a pejorative term by the vaccine advocate community toward their vaccine skeptic counterparts (Willingham). As such, particularly among individuals invested in the vaccine conversations, expressing an opinion toward Vaxxed continues to be a widely understood means of taking a side. Consequently, the film holds rhetorical significance as a source of exigence, or “imperative stimulus” to continue the vaccine conversation (Bitzer 5); this notion derives from Lloyd Bitzer’s factors of rhetorical situations, or “contexts in which speakers or writers create rhetorical discourse” (1).

The following thesis is organized such that each chapter is devoted to a specific level of conversation initiated by the release of Vaxxed. In doing so, I attempt to trace the rhetorical moves used to support or discredit narratives promoted in the film and evaluate whether such measures generate the types of productive conversation needed to improve vaccine confidence and increase vaccine uptake.

Chapter One introduces the three major narratives that are presented in Vaxxed: the conspiracy narrative, which alleges a secret scheme designed by pharmaceutical companies and government entities to hide a link between MMR and autism; the injustice narrative, which suggests that vaccine skeptics have been wrongfully persecuted for their attempts to expose this link while institutions like the CDC that have colluded in the conspiracy have eluded rightful retribution; and the victimization narrative, which claims that autistic children, autism parents, and society at large are all made victims by autism, which is in turn caused by the MMR vaccine and those who hide its potential for injury. These three narratives combine into a meta-narrative of enlightenment, which argues that if anyone were to become aware of the facts supporting the conspiracy and the injustice, then they too would become vaccine skeptics, pinning the blame of victimization on the CDC, pharmaceutical companies, and other healthcare institutions. Through this analysis, I argue that Vaxxed is effective at promoting vaccine hesitancy because its

10 enlightenment narrative appeals to a basic desire to be among the enlightened rather than the ignorant.

Chapter Two then discusses how the mainstream press coverage of the film largely attempts to counter these narratives. To question the injustice narrative, journalists disclose the retraction of Wakefield’s report to discredit his claims. To remove emphasis from the conspiracy narrative, articles redirect focus to controversies surrounding the vaccine conversation and the film’s unusual dalliance with Tribeca. To further dismiss the conspiracy narrative, most articles also avoid legitimizing language toward the film and the vaccine conversation. Finally, to question the victimization narrative, one article presents the testimony of an autism father who promotes views of autism as a difference rather than a disability. Collectively I argue that the press attempts to discredit the injustice, conspiracy, and victimization narratives of Vaxxed to varying degrees, but their success is limited by low engagement with the enlightenment metanarrative and efforts to bury rather than confront the conspiracy narrative.

Chapter Three explores how comment sections associated with the articles reviewed in the previous chapter further complicate the existing narratives and introduce new perspectives that were excluded from previous modes of discourse. To further strengthen the enlightenment narrative, vaccine skeptics critique vaccine safety study designs, suggest conflicts of interest among vaccine scientists, reference bodies of anecdotal evidence about vaccine safety that are ignored by mainstream physicians, and promote alternative experts who acknowledge their claims.

Although incivility initiated by vaccine proponents sometimes disrupts productive conversation, there do exist moments during which they acknowledge the concerns of and insights from vaccine skeptics and then build upon them to make a case for vaccine safety. Additionally, autistic voices arise for the first time on this platform, allowing a new opportunity to disrupt the victimization narrative by suggesting that autism is not truly a victimizer. Thus, I argue that although ad hominem attacks occasionally derail the vaccine conversation, comment sections nevertheless act as a window into vaccine skeptic beliefs that fail to be addressed by vaccine advocate

11 counterarguments. Therefore, they present an opportunity to amend future efforts to better promote vaccine confidence.

Finally, the last chapter concludes with implications of these narratives. Ultimately, I argue that across multiple platforms, vaccine hesitant arguments are effective because they collectively construct a meta-narrative of enlightenment. Because this narrative relies upon an assumption of vaccine advocate ignorance, refuting the narrative requires a commitment to productive conversation that requires two key components. Vaccine proponents must first acknowledge their understanding of vaccine skeptic concerns and then subsequently justify their confidence in vaccines even in light of this understanding. Additionally, I further argue that such endeavors must take care to avoid inadvertently marginalizing the autistic population as a mere rhetorical tool. Rather, I suggest that increased representation of autistic vaccine advocates upstream of article comment sections may instead further counter the enlightenment narrative by undermining the underlying victimization narrative. I end with practical interventions to reduce vaccine hesitancy that are suggested by the findings of this rhetorical analysis, with the ultimate goal of improving vaccine uptake to reduce unnecessary future outbreaks of vaccine-preventable diseases.

CHAPTER 1

THE VAXXED NARRATIVE

In 1998, British pediatric gastroenterologist Andrew Wakefield and his colleagues published a paper in the Lancet entitled, “Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children.” Within the last paragraph of the discussion section were two sentences that would kindle the newest iteration of the centuries’ old debate about vaccine safety:

We have identified a chronic enterocolitis in children that may be related to

neuropsychiatric dysfunction. In most cases, onset of symptoms was after measles,

mumps, and rubella immunisation. (Wakefield et al. 641)

Following this allegation came numerous experiments by other members of the scientific community aimed to further investigate this claim. By 2004, the Immunization Safety Review

Committee of the United States Institute of Medicine released its eighth and final report, concluding that existing evidence rejects any link between the MMR vaccine and autism. In the same year, British investigative journalist Brian Deer published the first installment in his series of reports in The Times that revealed undisclosed conflicts of interest by Wakefield in association with his 1998 Lancet publication. Specifically, his study was partially funded by prosecutors in an anti-MMR legal case. The reports also indicated fraudulent manipulations of data. Deer’s publications, which continued through 2012, later led to the partial then full retraction of the paper by the Lancet and Wakefield’s removal from the British medical register by 2010 (Boseley).

Four years later, CDC researcher William Thompson contacted autism parent Brian

Hooker. In this phone call, Thompson claimed that he possessed evidence of wrongdoing and

13 fraud by CDC scientists including himself who investigated the safety of the MMR vaccine

(Hooker). The CDC had attributed the small observed linkage between MMR and autism to an artifact of the data set, stating that early vaccination is slightly more common among autistic children because they are required to be vaccinated for special education programs (DeStefano et al. 264). Nevertheless, Thompson would be dubbed the “CDC whistleblower,” which subsequently became a rallying cry among vaccine skeptics and activists (DiResta and Lotan).

On April 1st, 2016, the film Vaxxed: From Cover-Up to Catastrophe, which details the story of the CDC whistleblower and attempts to present a case for conspiracy and fraud, was first released at the Angelika Film Center in New York City (Ryzik, “Anti-Vaccine Film…” A14).

The ostensible documentary was directed by Wakefield and produced by journalist Del Bigtree. It features phone recordings and emails from Thompson, the former of which were obtained without his consent, along with testimonies from autism parents, psychologists, scientists, politicians, and physicians advocating for refusal of the MMR vaccine due to its purported association with the onset of autism. Since its release, the film has risen to prominence among vaccine skeptics whose concerns primarily relate to issues of vaccine safety and efficacy. Among vaccine advocates, “the

Vaxxed crowd” has become shorthand for the vaccine hesitant community (Willingham).

In this chapter, I analyze the rhetoric of the film, focusing on the central narratives presented. A narrative of conspiracy is conveyed through the chosen form and genre of the conspiracy thriller. The narrative of injustice is established by portraying the conversation surrounding Wakefield and his alleged MMR-vaccine conversation as a misadministration of justice, using a metaphorical courtroom in which the audience serves as judge and jury as the framing device. Finally, a narrative of victimization identifies autistic children, their families, and society at large as the casualties of purported institutional wrongdoings, generating sympathy in the audience for these victims through identification. Through these tactics, I argue that the film establishes a broader metanarrative of enlightenment that entices potential converts to vaccine hesitancy by appealing to their desire to be in the know. This metanarrative therefore also

14 becomes a point of contention upon which future vaccine skeptic arguments and vaccine advocate counter-arguments will build, as explored in later chapters.

A Claim of Conspiracy

The primary message of the film centers around an accusation of conspiracy. Specifically,

Vaxxed alleges that the CDC and a conglomeration of pharmaceutical companies conspired against the public, which includes patients and individual healthcare practitioners alike, to hide a real MMR-autism link in the whistleblower case specifically and to prevent adequate vaccine safety testing in general. This invocation of conspiracy is established through techniques of identification and form.

According to rhetorical theorist Kenneth Burke, identification occurs both through the literal act of naming a phenomenon and through accompanying social affiliations that necessarily ally the target in question with certain ingroups and against other outgroups. In other words, to identify something is to give it a label and to note what sorts of things it is and is not. Consider, for example, the act of calling a woman with a stethoscope and a white coat a “doctor.” In doing so, she is issued a label: “doctor.” At the same time, she is situated within existing systems of social relationships, using the label “doctor” to group her with her ingroups: other doctors and, by extension, other healthcare providers. Furthermore, she is grouped away from her outgroups, which include “non-doctors,” such as nurses, and “non-healthcare providers,” such as patients or administrators. As a rhetorical tool, identification can persuade a listener to accept the speaker’s narrative when the speaker situates the protagonist in the listener’s ingroup (de Graaf et al. 802).

Related to identification is the act of scapegoating. As a rhetorical tactic, it acts similarly to identification in that relies upon labels situated within networks of ingroups and outgroups.

The critical difference, however, is that while identification emphasizes ingroup ties, scapegoating emphasizes outgroup status in order to establish blame and justify actions against the outgroup in the name of rightful retribution. As Burke puts it, “the scapegoat represents the

15 principle of division in that its persecutors would alienate from themselves to it their own uncleanliness” (A Grammar of Motives 406).

Meanwhile, Burke also argues that “form is the creation of an appetite in the mind of the auditor, and the adequate satisfying of that appetite” (Counter-Statement 31). For instance, one example of a form is the traffic light pattern, which consistently transitions from red to green to yellow and back to red. Once somebody understands this pattern, or the form of the traffic light, they know what to expect, hence the “creation of an appetite” for the fulfillment of their expectations. When they see a yellow light, they expect that a red light is coming and make their driving decisions accordingly. At the same time, when form is used rhetorically, they also require an “adequate satisfying of that appetite,” meaning that expectations must be fulfilled for the argument to be accepted. If someone attempted to craft an argument based on an underlying assumption that a light following the pattern red to yellow to green is a traffic light, people would likely be more resistant to their claims because they know that “real” traffic lights do not operate in that manner.

When analyzing the rhetoric of Vaxxed, two concepts of form and identification are closely tied. One specific type of form, the genre, brings about archetypal systems of identification (and by extension, scapegoating) that are associated with the particular genre. For instance, when someone reads “Little Red Riding Hood,” they know that they are “supposed to” identify with Little Red Riding Hood rather than the Big Bad Wolf because they understand who traditionally make up the ingroups and outgroups of the reader in the context of fairy tales.

In Vaxxed, the specific form and genre employed is the conspiracy thriller. According to

Paul Lynch, “conspiracy thriller narratives present a David and Goliath struggle” between an everyman individual and an “enigmatic and impenetrable” institution (1). The individual is the protagonist, a sympathetic and ordinary character who is suddenly confronted by the emergence of new threats in previously familiar circumstances following their anagnorisis, or the critical moment at which they stumble upon the institution’s scheme and are irreversibly set upon their

16 journey ahead. The institution is the antagonist, “a potentially infinite network [presented] with a plausible explanation of its invisibility” (Jameson 9). The central narrative often concludes with the protagonist foiling the immediate plot of the nefarious institution. However, this victory tends to be tempered by some ominous indication that the conspiracy itself will carry on and re-emerge again someday. As Lynch summarizes, “the enduring message of the conspiracy thriller is that the antagonist is ultimately more enduring than the power of individual agency” (1).

Vaxxed invokes conspiracy even before the film begins; the promotional poster features the title and credit information along with an ominous syringe and a single tagline, “The film they don’t want you to see” (Vaxxed). In this pithy sentence, the audience is situated within a complex network of identification and form. First, the use of “they” establishes and scapegoats the yet unnamed other: an enemy of the viewer, the filmmakers, and their implied “us” that attempts to hide some truth for presumably nefarious purposes. Secondly, by creating this film that “they don’t want you to see,” those involved in the film situate themselves on the viewer’s team as an unveiler of truth. Finally, by choosing a stock phrase of the conspiracy genre, the poster situates

Vaxxed within a larger genre of the conspiracy thriller. In doing so, it uses conspiracy as what

Kenneth Burke would consider a “terministic screen,” which is a rhetorical concept based on the notion that “any nomenclature necessarily directs the attention into some channels rather than others” (Language as Symbolic Action 45). Simply put, by using a specific phrase to describe an object or phenomenon, a speaker cues their audience toward one specific interpretation of that object or phenomenon. In this case, by suggesting that Vaxxed is a conspiracy film, the poster tints all allegations with a sense of credibility. Otherwise innocuous events are viewed through this screen as evidence of wrongdoing that are consistent with the conspiracy genre.

Because Vaxxed presents its version of the vaccine story as the objective truth, its predominant message is largely presented as a fact-driven, logos-based argument. Each point of suspicion is raised, examined, and asserted as irrefutable evidence of wrongdoing. In an early scene, Representative David Weldon observes that scientists and doctors cycle through an

17 industry-government-academia complex. This observation is cited as evidence for collusion, since promotion to a higher position in another organization involved in the conspiracy suggests an effort to reaffirm the alliance of these institutions and to reward the professional for keeping their silence. Additionally, Vaxxed presents a memo sent by Frank DeStefano, one of the scientists involved in Thompson’s whistleblower study. The note encourages the other collaborators to keep their heads down and brace themselves for an upcoming investigation. According to the filmmakers’ reading of these pieces of evidence, all signs point toward secrecy.

However, regardless of these claims, the case for conspiracy is not exactly air-tight; certain assumptions must be made by the audience in order for them to believe. In the case of

Weldon’s observation of cycling scientists, a limited pool of experienced professionals and opportunities for lateral mobility could just as easily explain the re-shuffling of scientists between their three primary career options as malicious intent to cover up wrongdoing. Regarding the memo, refusal to spark rumors in the press during a potential investigation is sound advice regardless of guilt or innocence. Yet the audience is prompted to make the logical leaps and believe in the conspiracy as a consequence of genre. Because they know the narrative of collusion by mass complexes of authority whose wrongdoing is revealed by a motley crew of outsiders determined to find the truth, viewers suspend their disbelief and buy into the story.

Other elements of conspiracy fiction also come into play. The shadowy figure of whistleblower William Thompson lingers throughout the film without a formal presence among the cast. In lieu of a traditional interview, he is present only through voiceovers collected from snippets of recorded telephone conversations and emails from his correspondence with members of the CDC. It remains unclear whether Thompson truly consented to his inclusion in the film; after all, the calls were recorded without his knowledge or permission. Nevertheless, the inherent dodginess of an absent and singular key witness is smoothed over by naming him a

“whistleblower,” conferring the understandable risks of the role. Viewers may accept and even expect this stock character of conspiracy fiction as a shadowy person who confers “the files” to

18 the protagonist yet chooses not to risk too much by exposing his own name. The whistleblower stands alone as the single insider willing to speak the truth, but his identity is more or less irrelevant. Thompson is only important as a way into an otherwise impenetrable institution of authority; as the plucky journalist, producer Del Bigtree is the real star.

An Indictment of Injustice

Intertwined with conspiracy is a narrative of injustice. To ameliorate this transgression,

Vaxxed brings the alleged wrongdoers to a legal court of its own creation. The latter half of the film focuses on two complementary arguments: first, that whistleblowers like Thompson and

Wakefield are wrongfully persecuted for exposing the truth, and second, that perpetrators of fraud like the CDC and pharmaceutical companies are wrongfully exonerated of their crimes without investigation. By framing their arguments as components of a legal trial, Vaxxed leads the viewer down a trail of breadcrumbs that attempts to overturn the existing narrative with a conclusion that supports vaccine hesitancy.

The Charges and the Evidence

In modern American society, courts and trials emerge in the popular consciousness as the primary arbitrators of justice. Therefore, it is logical that Vaxxed’s narrative of injustice correspondingly utilizes motifs from the justice system. Most notably, the framing device for the second half of the film begins by presenting a central question: “Did the CDC commit fraud?” It then divides this segment into a numbered series of exhibits much like the evidence that is presented in a court of law. The four exhibits and corresponding allegations are directed toward alleged whistleblower William Thompson’s collaborators in his 2004 study and are attributed to a desire to conceal a link between MMR and autism that is evident in their unaltered data. The exhibits are as follows: 1) deviation from analysis plan by retroactively altering exclusion criteria to reduce statistical power; 2) omission of data by deliberately erasing data contrary to their

19 conclusion; 3) destruction of document by holding “secret meetings behind closed doors” to dispose of evidence of their fraud; 4) obstruction of justice by committing fraud to avoid paying reparations for vaccine injuries and colluding with mainstream media to hush the whistleblower.

Despite the central focus of the film on conspiracy, which is itself grounds for legal prosecution, the filmmakers instead focus the pseudo-investigation on allegations of fraud. The choice to pursue a charge with fewer associations with paranoia lends legitimacy to the claims of wrongdoing, even among moderates who may not identify themselves as "conspiracy theorists."

Additionally, "fraud" carries both scientific and legal connotations, rather than merely the latter.

Because the rhetoric of science casts the discipline as an unbiased pursuit of objective truth, fraud becomes a violation of the concept of science because it is a manipulation of truth in order to fulfill a selfish agenda. As a result, within this particular arena, fraud is a more plausible yet also a more egregious crime. In the case presented in the film, vaccine hesitant parents and activists are cast as plaintiffs who bring forth charges against the producers and testers of vaccines, while mainstream media and the scientific community are collectively the judicial system that has failed them by dismissing their concerns rather than calling them to provide their body of evidence.

Consequently, the trial metaphor allows Wakefield and his compatriots to create a new court in which they present the evidence on their own terms to a receptive judge and jury in the public viewership. It acts as their opportunity to press charges and present evidence that existing organizations of governance and mainstream channels to the public have simply dismissed.

The Direct Examination

Despite an aversion toward the label "anti-vaccine," vaccine hesitancy is inherently reactionary because it presents a counter-narrative. Therefore, even while presenting a remarkably partisan perspective, Vaxxed cannot avoid addressing and responding to the mainstream narrative of vaccines as an effective public health achievement. Consequently, the film begins with a rapid-fire series of news clips describing a then recent measles outbreak in

California’s Disneyland that was “all basically because of the anti-vaccination movement,” despite overwhelming evidence toward the safety of vaccines according to the reliable authority of the CDC (Vaxxed). In doing so, it establishes that this narrative is the one championed pervasively by mainstream media. Next, a man types a letter as he narrates the words that appear on the screen: “I have waited a long time to tell my story and I want to tell it truthfully” (Vaxxed).

While this opening sequence implies a hidden message absent from major news channels, Vaxxed does not outright accuse them of deliberately refusing to publicize the whistleblower story until later in the film. In that segment, Bigtree explains that Wakefield and Hooker eventually released a joint statement about the CDC whistleblower. However, to his bewilderment and outrage, mainstream news sources simply ignored the story. The silence signified to him a deliberate collusion between news networks and pharmaceutical companies to hide the truth.

Wakefield's story also presents a point of contention between the mainstream and vaccine skeptic narratives. As director and cast member, Wakefield uses the film as a platform to address perceived misconceptions about his motivations and assertions. Most notably, he emphasizes that he is not "anti-vaccine," nor did he initially claim to prove a link between MMR and autism; rather, he merely suggested a potential causative relationship and therefore urged caution by administering the single vaccines for measles, mumps, and rubella rather than the combined version. By fleshing out the story of his discovery and allowing him to claim a more moderate opinion, Vaxxed makes a case for the ethos of Wakefield, supporting the credibility of one of the most prominent figures of the vaccine hesitant cause.

However, in creating a favorable image of Wakefield, the film also excludes major missteps in Wakefield's career history in favor of correcting the nuances of his mischaracterization by vaccine advocates. As mentioned at the beginning of the chapter,

Wakefield’s medical license was revoked six years before the release of Vaxxed after undisclosed funding and data manipulation were uncovered and reported by journalist Brian Deer.

Nevertheless, the loss of his license and his financial conflicts of interest were bypassed entirely

21 in the film. Thus, while capturing the untold narrative of an alleged victim to defamation and scapegoating by mass media, Vaxxed also sidesteps any discussion of potentially rightful blame.

Nevertheless, the juxtapositions illustrate the alternative narrative that is championed in this film, standing against powerful and prevalent voices that perpetuate the mainstream narrative. In doing so, the film appeals to the justice of focusing on the anti-MMR and anti-CDC viewpoint since the opposing view is already widely and allegedly deliberately represented as the only side of the story in the media at large. The vaccine hesitant creators use Vaxxed as an opportunity to express frustration that their opinion has not been offered its due exposure and investigation. The final segment of the film acts as a call to action, and features the key players presented in the earlier in the film pleading for William Thompson to be subpoenaed in a formalized trial to investigate potential CDC wrongdoing. In a series of back-to-back documentary-style interview responses, autism parent and whistleblower contact Brian Hooker, family physician and newly converted vaccine skeptic Dr. Rachael Ross, and vaccine hesitant congressman David Weldon respectively make the following remarks: “Bill Thompson wants to be subpoenaed by Congress”; “Absolutely

William Thompson needs to go before Congress. He needs to go before the whole nation.

Everybody needs to see what he has to say”; “[Thompson] needs to be deposed in front of a committee in Congress.”

Through their repeated plea for a highly public trial, they frame their eagerness for publicity to bolster their ethos as an entity with nothing to hide and a willingness to go to the platforms traditionally occupied by vaccine advocates to further their cause. By contrast, the second-to-last line preceding the closing credits states that the CDC scientists involved in the study were invited to interview but declined to do so, implying guilt because their lack of openness suggests that they have something to hide. By exploiting the frame and form of the legal trial, secrecy is easily cast as evidence of guilt since court cases require evidence obtained through disclosure to allow the determination of innocence and guilt.

The Mistrial

Although the second half of the film is largely spent exploring the four exhibits of evidence, it nevertheless splices in related clips that bolster the central claim of CDC wrongdoing.

One of such clips is a cartoon that describes “Vaccine Court,” a subdivision of the U.S. Claims

Court established by the 1986 National Childhood Vaccine Injury Act that evaluates parental claims of injuries caused by vaccines and dispenses compensation accordingly (Vaxxed; LaRussa).

The format of the segment is itself a rhetorical tactic: by using a visual medium associated with children, it draws upon the ethos of truthfulness in simplicity and the pathos of children in distress. The no-frills version of the story ostensibly cuts out distracting elevated language that distorts the truth; therefore, its arguments can be taken at face value.

In this segment, Vaxxed claims that the 1986 legislation "shields drug companies from liability for injuries and deaths caused by the vaccines they manufacture" due to pharmaceutical lobbying. By using the language of liability and lobbying, two claims of injustice are implicitly asserted. Not only are these corporations evading rightful punishment for their misdeeds, they do so as a result of a practice that represents unregulated corruption. Money passes from wealthy interest groups to officials elected by the people in order to influence them to act against the interests of the people, grating against American conceptions of rightful democracy.

The outcomes of this collusion are summarized in two “shocking facts”:

Pharmaceutical companies do not have to participate in the proceedings at all.

Taxpayers pay for all damages. The U.S. Department of Justice acts as a

government's lawyer with taxpayers footing the bill for their defense. (Vaxxed)

The appeal to righteous indignation is elevated by adding another player to this complex dynamic: the taxpayers. Throughout the film, appeals to the viewer casts them as a potential victim. Repeated claims that all children are at risk, regardless of their race or their otherwise healthy status, draws upon pathos to suggest that everyone should be wary of vaccine risks. By introducing the taxpayer as collateral damage in the government-pharmaceutical collusion,

23 however, the viewer gains another reason to demand justice. Not only are they potential victims, they are already actual victims because they are literally paying the price of unsafe vaccines while pharmaceutical companies escape unscathed, a notion that is further explored in the next section.

The Closing Statement

The final segment of Vaxxed is a call to action. Specifically, four demands are listed, all of which pertain to attempts to restore the violations of justice as described earlier in the film. The demands are as follows:

1) That Congress subpoena Dr. William Thompson and investigate the CDC fraud.

2) That Congress repeal the 1986 National Childhood Vaccine Injury Act and hold

manufacturers liable for injury caused by their vaccines.

3) That the single measles, mumps, and rubella vaccines be made available

immediately.

4) That all vaccines be classified as pharmaceutical drugs and tested accordingly.

The first two of these demands directly address the two primary issues of injustice presented in Vaxxed: undue sanctions against those who unmask the conspiracy and inadequate punishment for those who perpetuate it. The former demands for Thompson’s allegations to be given a platform for serious investigation while the latter demands that the “rightful parties” receive due punishment for the production of allegedly risky vaccines. The final demand is also a relatively straight-forward appeal to justice: it appeals to a common-sense demand for vaccines to be classified and tested like any other analogous product in the industry. That they are not currently evaluated as such appears to be an unjustified double standard, and ought to be remedied in order to restore fair practice.

The third serves as a nod to justice for the director: by supporting Wakefield’s initial recommendation after his assertion of an MMR-autism link in 1998, the remainder of

Wakefield’s claims are legitimized by association as they serve as the justification for single

24 vaccines. Consequently, the third demand gestures toward without making an outright demand for reparations to Wakefield (which would appear self-serving and therefore less legitimate given his status as interview subject and director) by simply calling for a sort of intellectual reparation.

Even if his career is not returned to its previous trajectory, his new role as martyr is solidified when policy reflects the very claims that led to his fall from grace.

A Verdict of Victimization

The argument for injustice inherently brings about a claim of victimization, the third narrative presented in this film. Injustice fundamentally occurs when the costs and benefits of an action are shouldered and received to different degrees by different parties, and the party that disproportionately takes on cost rather than benefit can be construed as the victim. Vaxxed therefore establishes the victims of the conspiracy and injustice created through the alleged CDC cover-up. In particular, three parties are identified as victims: autistic children, their families, and society at large. Autistic children are framed as victims of a complex that forces them to receive dangerous vaccines. Their families suffer because they must endure the emotional traumas associated with raising a child with the condition. Finally, society at large shoulders the burden of financially and socially supporting autistic children, who are depicted as a needless drain to the resources that are otherwise available and plentiful for non-autistic children.

Autistic Children

The most overt victims that Vaxxed attempts to establish are the autistic children themselves, most often through the visual rhetoric of video clips. This tactic is evidenced in the parent testimonies that prominently feature in the first half of the film. One of the most visceral images occurs as producer Del Bigtree introduces the central recurrent narrative presented by these parents; as he narrates a progression from healthy child to suffering child following the

MMR vaccine, the viewer sees a bright image of a child whose face screws up and begins to

25 scream in distress. The cries continue to echo even as the scene fades to black, cuing to the persistence of their affliction and drawing upon the pathos of an aversion to children in pain.

Furthermore, even normal childhood events are framed as evidence of decline in an effort to create pity for the autistic child. Nurse Jeanna Reed claims that her son had been walking and running only to regress from this developmental milestone following his MMR vaccine. Her testimony accompanies video footage of her toddler attempting to run only to fall down over and over again. Out of context, such footage is fairly innocuous: that small children fall and fall often prior to the age of two is hardly a newsworthy observation, particularly because the recommended age for the MMR vaccine per the CDC vaccination schedule almost perfectly coincides with typical age for walking as a developmental milestone (“Recommended

Immunization Schedule...”; “Important Milestones...”). However, by presenting the footage with the narrative of decline, the audience is perceptually primed to reframe the trial and error of learning a new motor skill as visual evidence of vaccine danger.

Furthermore, the rhetoric of science is co-opted to further establish a chain of causality between MMR and autism through the Ealey twins, a pair of African American teenagers whose mother, Sheila, is interviewed as part of the film. While Sheila’s narrative begins by following the pattern of happy, energetic child to sad, despondent child following MMR (in this case, a double dose of the first vaccine in the sequence), this testimony further juxtaposes the autistic Temple and his non-autistic twin sister, Lucinda, showing the former watching Blue’s Clues next to his mother during her interview while the latter performs a virtuosic classical piano piece in the background. In doing so, this example harkens to scientific twin studies, which are particularly favored because they control for genetic and environmental differences, thereby isolating a single point of divergence to establish causality. By generating an illusion of scientific rigor, the film borrows the ethos of science to cast MMR as the critical difference.

However, this narrative relies upon a concerning conceptualization of autistic children as objects of both pity and scorn. They are framed as both hapless victims of a nefarious cover-up

26 and hopeless disasters who fail to achieve developmental milestones as good, normal children ought to. Consequently, they are only regarded through the lens of their disabilities (or different abilities) and are leveraged purely as rhetorical tools rather than regarded as full persons with merits and agency. Such a characterization is consistent with Melanie Yergeau’s notion of the difference between “autism-as-modifier and autistic-as-modifier,” whereby she argues that the former, which is more commonly represented, “relates to broader discourse on autism that is typically authored by nonautistic people, whereas the latter imparts that which is autistically created” (2). Thus, even beyond this film, narratives and other works pertaining to the autistic experience tend to be “autism narratives” written by nonautistic people with a vested interest in autism rather than “autistic narratives” written by autistic people themselves. In the case of

Vaxxed, the reduced agency of this population to tell autistic rather than autism stories is further compounded by the power dynamics of their identities as both "autistic" and "children," receiving a dual disadvantage at this intersection of disability and youth.

Autism Families

The narrative of loss surrounding the alleged plight of autistic children is echoed from the perspective of the parents and is first introduced by Polly Tommey. In this interview, Tommey appears as a sympathetic figure with an understandable desire to be a perfect mother for her children, Bella and Billy. Idyllic shots of the Tommey family’s pastoral property and clips of the young children accompanying Tommey’s voiceover as she reminisces about the days when “life was just amazing” (Vaxxed). However, after receiving his MMR vaccine, Billy began to exhibit seizures, after which he was immediately sent to the hospital by his horrified parents. When they arrived, the Tommeys were informed by the physicians that his symptoms were perfectly normal.

Nevertheless, Tommey laments that after he went to bed that night, “he didn't really ever wake up to the Billy that we had before" (Vaxxed).

Similarly, each subsequent family begins with the expectation of a perfect child to complete their perfect family. Following the vaccine, they lose their promised child and are cheated of their destiny. The diagnosis and the family's subsequent experience with their autistic child is framed as a cautionary tale. Most notably, Tommey claims that they are sharing their message because “[their] kid's already damaged,” establishing a unique threefold ethos (Vaxxed).

Firstly, as a parent of an autistic child, she possesses experiential knowledge of the narrative of decline as seen through her own eyes. Secondly, in a film that seeks to establish everyone as a potential victim, this statement removes the speaker from this risk pool. She has no stake in lying to protect herself or her interests because she is already a victim, so she must be telling the truth.

Finally, her child’s illness is established as a moment of exigence to warn others and to protect them from the same pain; therefore, she must be working in the interest of her audience. The viewer is therefore drawn to identify with Tommey through her emotional plea and distressing experience, both of which represent their own possible future in a world where the alleged truth about vaccines is kept in the dark.

However, because the film features only the voices of such autism parents rather than the autistic individuals themselves, the viewer is moved to identify with the experience of the parent as victim rather than the child as victim. Given the audience, who are presumably adults who know such children (or will know such children) rather than children who may someday present with signs of autism, this rhetorical move makes logical sense since the viewer is likely more able to visualize these parents as their potential future selves. Yet despite the efficacy of this move, it allows a continued objectification and othering of the autistic children, reinforcing a troubling narrative of autism as abhorrent disability. The consequences of this omission are further explored at the end of this chapter.

Society at Large

Finally, society is constructed as a tertiary victim that is nevertheless profoundly impacted by the alleged MMR-autism association. This form of victimization begins with language of autism as an epidemic, thereby framing autism as a population rather than simply individual health problem. To support this claim, Vaxxed presents an MIT scientist who presents alarming projections that by the year 2032, 50% of children and 80% of boys will be diagnosed with autism in the United States. Although Stephanie Seneff is a computer scientist at MIT with only undergraduate training in biology, the film nevertheless calls upon the ethos of the scientist and of her prestigious institution, allowing the viewer to presume authority. This logical leap is facilitated by low public awareness of the specificity and limitations of individual scientists and fields, which is in turn partially due to the popular entertainment notion of the "omnidisciplinary scientist" as coined by the user-generated trope catalogue TVTropes. Despite the relatively niche knowledge of real world scientists, this archetypal figure notoriously addresses all scientifically- related matters of inquiry regardless of their actual field of expertise (“Omnidisciplinary

Scientist”). To further bolster the legitimacy of the statistic, Vaxxed also supplies animated graphs to illustrate an alarming yet ostensibly logical extrapolation of existing data, drawing upon the visual rhetoric of a trend line extending beyond the existing axes as evidence for imminent disaster. Because of this predicted proportion, Seneff argues that “healthy” children will be neglected as energy and resources of their educators are diverted toward the children with special needs instead. In a similar appeal toward resource allocation, Congressman Dan Burton emphasizes the financial costs associated with supporting an autistic population. Most notably, he argues that an autism epidemic is a particularly pressing concern because the condition is compatible with survival to old age, and therefore ensures that autistic individuals remain burdens to the taxpayers because they do not simply "drop dead" (Vaxxed). Consequently, Vaxxed creates an inevitability of victimhood that ensures the viewer has a stake in its cause. If you are or will be a parent of a child who needs their vaccines, your child could develop autism following

29 vaccination. If your child escapes the experience unscathed, then they are potentially neglected by an education system and social support networks overburdened by caring for the increased needs of autistic children. And if even you never have children, you will still be victimized by this alleged MMR-induced autism epidemic because everyone pays the taxes to support this population. By identifying victims and identifying the audience with and as victims, Vaxxed creates stakes and generates fear, propelling their agenda of conversion to and action toward their cause.

Conclusion

Throughout the film, three intertwining narratives are explored through three dominant rhetorical tactics. First, a narrative of conspiracy is reinforced through the form and genre of the conspiracy thriller, which evokes the terministic screen necessary for the audience to perceive the events presented as incontrovertible evidence for CDC wrongdoing. Secondly, a narrative of injustice is framed in the context of a legal trial in which alleged wrongdoers are brought before the judge and jury of the audience with the parties involved in the film as both plaintiff and prosecution. Specifically, Vaxxed presents charges against the CDC scientists involved in the

2004 MMR-autism study, brings in its own witnesses to demand a subpoena for Thompson, suggests a previous miscarriage of justice during the creation of the vaccine court, and concludes with an explicit call to punish the alleged perpetrators of fraud and an implicit call exonerate

Wakefield and Thompson for reporting an MMR-autism link. Finally, victimization by autism and the sinister collusion that has allegedly produced its epidemic calls the audience to pick sides and identify with the victims by accepting the MMR vaccine and its supporters as scapegoats.

The film creates sympathetic figures in the autistic children portrayed with visceral imagery of distress, autism parents with emotional tales about the regression of their beloved child, and society as a whole, for which cited experts anticipate increasing financial costs and resource depletion as a result of efforts to support autistic children.

These three narratives coalesce into a single narrative of enlightenment. By virtue of their very definition, conspiracies are secretive, but according to this narrative, once parents stumble upon this secret, then they come to see the injustice in the punishment of Wakefield and

Thompson while allegedly corrupt healthcare institutions face no consequences. They then become righteously indignant because they see how autistic children and autism parents are directly victimized by the autism caused by this conspiracy, and further believe that they are not only potential future victims if their children develop autism, but also already indirect victimized because they participate in a society that must support the needs of its autistic members.

Consequently, Vaxxed carries a strong undercurrent of evangelism, arguing that when rational people are exposed to the truth, they convert to vaccine skepticism as the rightful cause.

Such a trajectory is portrayed by parents and physicians alike who are interviewed in the film. As described previously, The Autism Files founder Polly Tommey claims to have trusted in the authority of health agencies, protesting when her mother warned her against the MMR vaccine, before her eyes were opened to the truth of vaccine dangers with the seizures and later diagnosis of autism in her son Billy. In later scenes, pediatricians Jim Sears and Rachel Ross, both of whom believed in and counseled their patients to adhere to the CDC-recommended vaccine schedule, are presented with the data from the 2004 CDC study. Following their examination, both physicians are shown to be aghast by the associations between MMR and autism that these documents allegedly reveal. Thus, through the narrative of enlightenment, vaccine skeptics are former vaccine advocates who now know better. They represent what Vaxxed argues that every person ought to become when they inform themselves on the issues. Thus, when any rational individual comes to possess the secret knowledge about the conspiracy, the injustice, and the victimization, they too ought to pin the blame for these wrongdoings squarely on vaccines and those involved in their creation.

The analysis of these narratives reveals insights into the efficacy of Vaxxed in propagating vaccine hesitant attitudes. Through form and genre, a message of propaganda is

31 disguised as a conspiracy thriller documentary, lending legitimacy through ostensible objectivity.

Their arguments are furthered by the framing of vaccine hesitancy as the logical conclusion of insider knowledge. After exposure to the secret of the cover-up, the viewer is urged to identify with their fellow insiders and defy the mainstream message of support for vaccines. Consequently, the enlightenment narrative is effective because it situates vaccine hesitancy and refusal as behaviors indicative of learnedness.

While these narratives are troubling because of their potential for persuading parents away from vaccination, the notable and often shocking portrayal of autism and autistic children with an attitude of immense prejudice and fear is also concerning. The Ealey interviews were filmed with the autistic son watching children’s programs and sitting next to his mother while she explains her remorse that he would never live a fulfilling life as a happy man. Tommey justifies her crusade and her credibility by asserting that her sole purpose is to prevent the suffering of other parents because her “kid’s already damaged” (Vaxxed). Most disturbingly, Republican

Congressman Burton argues that autism is particularly costly because the children affected must be sustained by taxpayer money since autism is “not like a lot of diseases where they get infected and they drop dead” (Vaxxed). Despite extensive testimony by families of autistic children, who perceive themselves to be victims of an unfair exchange of their perfect, “undamaged” child with one who is autistic, no autistic person is ever interviewed. Because of this missing voice, Vaxxed leverages autism as a source of fear-mongering without considering the self-perceived quality of life or the implications of such disparaging arguments for autistic people. Such potentially damaging arguments are not exclusive to vaccine skeptics, a phenomenon that will be discussed in chapter three.

Yet despite the problems that it presents for vaccine confidence, the rhetoric of Vaxxed reveals surprising insights into beliefs of the vaccine hesitant community. Firstly, it elucidates perceptions by vaccine skeptics about vaccine advocate attitudes about vaccine skeptics and vice versa. As evidenced by the splicing of disparaging news clips, vaccine advocates are viewed as

32 dismissive toward vaccine hesitancy and its associated concerns. By contrast, vaccine skeptics do not necessarily disdain vaccine proponents; rather, aside from parties perceived actively involved in fraud, the latter are considered ignorant potential converts. Testimonies like those of Tommey,

Sears, and Ross illustrate that even key vaccine hesitant figures began as vaccine advocates who were brought out of the proverbial cave to champion the true cause. Secondly, contrary to more traditional conceptualizations of ingroup and outgroup psychology, which include perceptions of outgroup homogeneity (Mullen and Hu 233), Vaxxed provides evidence that vaccine hesitant individuals like the creators of this film possess a nuanced perception of pro-vaccinators, dividing them between the colluders and the ignorant even among parties involved in the healthcare system. The film clearly illustrates that vaccine hesitancy can be partially attributed to distrust in the colluders: institutions of authority like the CDC and pharmaceutical companies. However, not all purveyors of healthcare are vilified; individual practitioners are perceived as equal victims of duplicitous lobbying by a conspiracy to hide vaccine dangers. Doctors, nurses, and other such providers are cast as misguided but trustworthy and fundamentally interested in children’s wellbeing. This revelation points toward implications for endeavors to correct deleterious vaccine hesitant attitudes, which are further explored in the final chapter.

In the context of the broader vaccine conversation, Vaxxed presents a carefully crafted set of narratives that have been assembled to sway potential converts toward vaccine hesitancy by appealing to their desire to be knowledgeable insiders. They are packaged into a message that is issued by the celebrities of the vaccine skeptic community, including Wakefield, Tommey, and

Bigtree. Thus, Vaxxed acts as an “official statement” from the “authorities” of vaccine hesitancy and represents an effort for that party to control or at least sway the direction of the subsequent conversation. However, just like any other official statement, upon its release, it is immediately subject to commentary from the press, which in this case happens to be allied with the side of public health and vaccine advocacy. Therefore, the next phase of the conversation generated by the film occurs through this ensuing press response, which is explored in the next chapter.

CHAPTER 2

THE PRESS RESPONSE

Even before its debut, Vaxxed was generating buzz in even major newspapers for its role at the center of a minor debacle in the film industry. On March 21, 2016, The New York Times announced that Vaxxed was to be premiered at the illustrious Tribeca Film Festival (Belluck and

Ryzik A11). Four days later, Robert De Niro, award-winning actor and co-founder of the festival, issued a statement via Facebook supporting the decision to screen this film at Tribeca as follows:

[My wife] and I have a child with autism...and we believe it is critical that all of the

issues surrounding the causes of autism be openly discussed and examined. In the 15

years since the Tribeca Film Festival was founded, I have never asked for a film to be

screened or gotten involved in the programming. However this is very personal to me

and my family and I want there to be a discussion, which is why we will be screening

VAXXED. (Belluck and Ryzik A11)

However, by the next day, Vaxxed was removed from the Tribeca line-up, partly due to enormous outrage both by the medical and scientific communities and by layperson vaccine advocates (Welch). To explain this rapid reversal, De Niro issued a second statement:

My intent in screening this film was to provide an opportunity for conversation

around an issue that is deeply personal to me and my family. But after reviewing it

over the past few days with the Tribeca Film Festival team and others from the

scientific community, we do not believe it contributes to or furthers the discussion I

had hoped for. (Goodman A17)

Both the initial announcement and its rapid subsequent reversal were extensively covered by major news outlets; The New York Times, for example, issued a series of four articles over the span of a single week discussing each turn of events up until the Angelika Film Center premiere on April 1 (Brodwin). The third in this series features an interview of Philippe Diaz, French producer and founder of Cinema Libre, the California-based company that acquired Vaxxed for distribution and submitted the film to Tribeca in the first place (Ryzik, “Pulled From Festival…”

C3; McNary). Diaz claimed that Cinema Libre’s intentions in acquiring the film stem from an interest in a potential CDC conspiracy and hopes for spurring further investigation via

Congressional hearing. In his own words, “Ultimately, the idea of a government cover-up seemed a convincingly meaty topic for a film” (Ryzik, “Pulled From Festival…” C3).

The press, however, disagreed in their primary point of interest. The initial coverage of

Vaxxed prior to its release set the tone for subsequent articles surrounding the film; the press latched onto controversy, albeit not the one that the creators of Vaxxed had ostensibly intended to generate. The tumultuous happenings surrounding the film became a more consistent feature than those it attempts to bring to the people’s court.

In this chapter, I will analyze six articles released by major news organizations to understand the response to Vaxxed by the mainstream press. To mimic the typical digital search results obtained by a layperson interested in learning more about the film, a web search was conducted using a cookie-free Google search engine and the search term “Vaxxed.” The first two pages of search results generated twenty-one links, which included exactly seven articles from major news websites. Of these articles, one was omitted because it centered around a protestor of the film rather than the film itself (Robbins). The remaining six were selected for analysis as a representative sample of the most influential press articles covering the film. Specifically, they were examined for evidence of engagement, or a deliberate absence of engagement, with the narratives of conspiracy, injustice, victimization, and enlightenment as presented in the film.

The first two articles describe the screening and distribution of Vaxxed. Melena Ryzik of

The New York Times focuses on its premiere at the Angelika Film Center in Manhattan, framing the screening event in the context of the Tribeca Film Festival controversy and Wakefield’s tumultuous professional history and describing reactions from both viewers and reviewers (“Anti-

Vaccine Film…” A14). It also discusses Thompson’s relatively low degree of involvement in the film, then ends by discussing Cinema Libre’s other projects, including an earlier documentary about the producer’s autistic son that denounced the relationship between autism and vaccines.

By contrast, Tatiana Siegel’s The Hollywood Reporter piece announces a secret screening of the film at the prestigious French Cannes Film Festival nearly two months after the Angelika premiere. While the article also nods to the Tribeca controversy and the discredited Lancet study, it focuses primarily on the business prospects of Vaxxed, describing distribution plans outside of

North America, particularly in the European market, gross earnings, and the subsequent acquisition of another film questioning vaccine safety by Cinema Libre. In both cases, little evidence indicates that either author has actually seen the film; for instance, Ryzik quotes the producer in noting that William Thompson does not appear in the footage of the film rather than independently making the claim.

The next two articles were written to debunk myths and supply outside facts omitted from the film. In The Washington Post, Ariana Eunjung Cha discusses seven facts and events that are excluded from but provide context for the arguments presented in Vaxxed. These include the details of the Lancet retraction, the Tribeca controversy, Thompson’s involvement, scientific consensus regarding causes and trends in diagnosis of autism, and reviewer opinions. The

Guardian’s Jessica Glenza provides an edited transcript of her interview with pediatrician Dr.

Philip LaRussa, in which he discusses Wakefield's history and its absence from Vaxxed, his own sympathy toward parental frustrations regarding the unclear causes of autism, the misrepresentation of the Vaccine Injury Compensation Board in the film, and the omission of

36 myriad other studies that verify the safety of vaccines, regardless of how the CDC addresses

Thompson’s situation.

The remaining two articles are reviews. The Hollywood Reporter invited Dr. Paul Offit, pediatrician and outspoken critic of anti-vaccine efforts, to write a scathing review of not only

Vaxxed but also its director. He begins by detailing the infamous Lancet article and the subsequent fall out. Next, he questions the logic of the purported MMR-autism link and the alleged CDC wrongdoing. Finally, he describes Wakefield as a conspiracy theorist and fearmonger, portraying Vaxxed as the work of a delusional man. Eric Kohn’s review in IndieWire, which was quoted in Ryzik’s piece, similarly decries both Vaxxed and Wakefield, claiming the former uses dramatic storytelling to obfuscate an absence of “real science” and the latter merely leverages the film as an opportunity to further his anti-vaccine agenda. He ends by grading

Vaxxed with a “D.”

However, despite the specific differences in genre, all six articles manipulate the narratives presented in the original film, typically refuting them but occasionally also offering support. In order to discredit the injustice narrative, articles deliberately highlight Wakefield’s conveniently excluded wrongdoings. To draw attention away from the conspiracy narrative, the press emphasizes the scandal associated with the broader vaccine conversation and the film’s brief appearance in the Tribeca line-up. Furthermore, although concluding remarks impart mixed messages regarding the validity of vaccine concerns, most articles also attempt to dismiss the relevance of the conspiracy narrative by avoiding the use of legitimizing language toward the film and the vaccine conversation. Finally, by featuring the voice of an autism parent who does not bemoan his child’s condition, one article works to question the victimization narrative by presenting an alternative perspective on autism. Thus, I argue that the press coverage of Vaxxed generally attempts to undermine the central narratives of conspiracy, injustice, and victimization originally presented in the film in order to counter vaccine skeptic efforts. However, the success of these efforts is tempered by inadequate direct engagement with the conspiracy narrative and

37 low reliance upon logos-driven arguments, which present a key potential mode of disrupting the enlightenment metanarrative.

The Question of Credentials: Reframing Allegations of Injustice

In light of the apparent uncertainty that shrouds the film, the journalists placed an emphasis on establishing credentials, or a lack thereof, for each agent who participates in the conversation. In both cases in which a physician is asked to contribute to the article, the piece either begins or ends with a stand-alone description of their field of expertise. For instance, the

LaRussa interview is preceded by a two sentence description that provides his position as a professor of pediatrics at the Columbia University Medical Center, his expertise as an immunization specialist, and his experience as a member of the National Vaccine Advisory

Committee (LaRussa). Beyond conveying credibility of their own writers and informants, the press also presents outside context to question the credibility of the figures in the film. As such, ethos of the claimant becomes a primary source of evidence for validity of the claim.

Among the individuals quoted in Vaxxed, journalists largely focus upon scrutinizing

Wakefield and Thompson. While the loss of Wakefield’s medical license and the retraction of his article are both conveniently excluded from Vaxxed, journalists and review writers waste no time in remarking upon both strikes against the reliability of Wakefield as director of the film and champion of the MMR-autism narrative. Offit’s review in particular contains a detailed account of Wakefield’s ethical missteps:

He was found to have falsified biological and clinical data, drawn blood from

children who had attended his son’s birthday party, and neglected to mention to his

colleagues that he had been paid more than $800,000 on behalf of several children in

his study whose parents were in the midst of suing vaccine makers, essentially

laundering legal claims through a medical journal.

Meanwhile, in the case of Thompson, several articles note that he is present only through

“phone conversations [he] had with another researcher who secretly recorded the calls” and excerpts of emails to his colleagues (Cha). The New York Times reports that “Thompson does not appear in person in the film, nor has he seen it” (Ryzik). As such, although championed as a whistleblower, Thompson is hardly doing much of the whistle blowing; rather, it is done for him by the producers of Vaxxed.

In doing so, to continue the trial metaphor established in the film, the press acts to cross- examine the witnesses presented by the prosecution. They supply the outside context of

Wakefield’s history and Thompson’s lack of commitment to the cause to suggest to their readers, the jury, that the evidence presented by these two witnesses is unreliable. Moreover, they suggest that the prosecution is attempting to manipulate the jury by presenting a partial truth that deliberately excludes Wakefield’s contentious background. In response to a narrative that attempts to establish perceptions of injustice in the audience, these articles present evidence that justice has indeed been served.

The Series of Scandals: Burying the Conspiracy Narrative

As discussed in the previous chapter, the ostensible central narrative of Vaxxed is one about an alleged cover-up by the CDC. In its acquisition and following press release, Cinema

Libre homed in on this claim, declaring an interest in the film as a revelation of potential governmental wrongdoing. Nevertheless, this purported fraud is only briefly mentioned in most of the articles sampled. If anything, they tend to comment on Thompson’s notable absence as a direct cast member in the film, despite his centrality to the whistleblower narrative.

Instead, Vaxxed is predominantly summarized in the press as a film that addresses the purported link between the MMR vaccine and autism. The film is therefore primarily situated within a discussion of the larger controversy regarding the veracity of this claim. In all cases, the claim is also subsequently referred to as a “debunked theory” or otherwise noted for its lack of

39 consistency with mainstream scientific understandings. Additionally, all but one of the articles analyzed further established a secondary controversy stemming from the larger vaccine debate: its acceptance into the Tribeca Film Festival line-up and the subsequent reversal of this decision.

By emphasizing these two controversies, the press highlights the film’s two greatest claims to fame among the mainstream audience. The first is its relation to vaccine hesitancy, an unpopular but prominent opinion that periodically becomes salient in the media with each vaccine-preventable disease outbreak. Furthermore, its transient presence in Tribeca not only associates the film with a renowned film festival but also raises questions about the role of public outcry in generating its lineups and whether the incident constitutes evidence of censorship. By contrast, the more extreme accusations of conspiracy are carefully skirted.

The likely net effect of these choices on public perceptions of vaccine safety is unclear.

By excluding the conspiracy narrative, this claim is implicitly deemed so unreasonable that it is unworthy of further examination. However, the remaining arguments regarding potential dangers of the MMR vaccine become more credible when they are no longer associated with the connotations of paranoia from the government cover-up accusation. Furthermore, by highlighting omitted context, these articles provide evidence that discredits central claims regarding purported dangers of the MMR vaccine. However, their very existence nevertheless increases the salience of the film and by association, concerns about vaccine safety, in the public consciousness.

Increased references to the minority opinion create the impression that something of concern ought to be debated. The mere association with Tribeca improves the reputability of the film as something worth seeing, regardless of whether it was later pulled for failing to “further the

[hoped-for] discussion” (Goodman A17).

For an underdog movement that attempts to question mainstream beliefs and understandings, all publicity is good publicity because it raises awareness of an otherwise overlooked argument. Vaxxed becomes an attractive commodity when “controversial” becomes a part of its brand, even as the specific conspiracy narrative promoted by the film is largely

40 overlooked or even intentionally buried. As one theatregoer remarks, “It makes me want to see it all the more, if the scientific community is that scared” (Ryzik, “Anti-Vaccine Film…” A14).

The Quiet Claims: A Motion to Dismiss

Because of expectations for objectivity in the press, these accusations are often suggested rather than directly stated. Nevertheless, across the articles surveyed, press attitudes toward

Vaxxed and its claims clearly lean negative. In cases of both reviews and the interview, which fall within genres that allow and even encourage the expression of subjective opinions and evaluations, strong, direct statements were made to verbally eviscerate the work. Of note, Offit’s review concludes with a note of derision, comparing those who appreciate the film to “people who believe that President Barack Obama is not a U.S. citizen, that the moon landing was filmed on a Hollywood soundstage and that an intergalactic board of elves and fairies are trying to get the IRS out of Puerto Rico.”

In the more traditionally journalistic articles, which are limited by an ostensible adherence to professional standards of objectivity, evaluative judgments are nevertheless quietly conveyed. For example, questions regarding the validity of claims made by Vaxxed and by vaccine skeptics in general were covertly raised by the specific terms selected to characterize the film and the conversation surrounding its central premise. For instance, “debate” was used only once to describe the vaccine conversation. Similarly, articles tend to use the terms “film” or

“movie” to describe Vaxxed rather than “documentary.” The latter is used only twice, one of which was part of an attempt to build a strawman argument against the film. The act of foregoing terms such as “debate” and “documentary” reflects implicit efforts to undermining the legitimacy of vaccine skeptic arguments and of Vaxxed’s central accusations.

Additionally, the closing statements in each piece deliver additional insight into the ultimate attitude of the work toward Vaxxed. Each is able to impart a covert value judgment through the quotation that is selected to conclude each piece. By choosing a quotation that is

41 either anti- or pro-Vaxxed, authors provide the reader with a final take-away message as expressed through the words of an interview subject who is unfettered by the journalist’s restrictions in conveying a direct opinion. Such is the case in two of the remaining articles. The

Washington post piece ends on a series of negative reviews, culminating in the following:

The Age’s Sarah Gill warned: “Don't be fooled — Wakefield's story is not the tale of

a man wronged by powerful corporations or the medical establishment, which, in fact,

closed ranks to protect him. It’s the story of a physician who set out to cast doubt on

vaccine safety before he’d even gathered the evidence, and he did so not for the

public good, but for private gain. (Cha)

By contrast, the Siegel piece in The Hollywood Reporter presents a more charitable view toward potential merits of the film. It quotes Robert DeNiro, who remarks, despite his choice to remove the film from Tribeca, “I think the movie is something that people should see.”

The final article stands as an outlier because it does not end with a direct evaluation of

Vaxxed. Rather, it segues away from the film toward an conversation with Todd Drezner, the creator of a documentary that argues against an MMR-autism link. Surprisingly, his film had also been acquired and distributed by Cinema Libre in 2011. In his interview, Drezner discusses how the alleged MMR-autism connection detracts from conversations about autism. The article then ends with his critique of the vaccine hesitant efforts promoted by Vaxxed. Drezner notes, “[all] the energy we spend fighting over a debunked vaccine conspiracy theory is energy we're not spending on working with autistic people to help them better thrive in the world today,” leaving the reader to ponder the implications of the film for this community (Ryzik).

The Advocate for Alternatives: Complicating the Forces of Victimization

Nevertheless, aside from a decreased emphasis on the alleged cover-up, the press also largely avoids discussing the myriad parental testimonials about their experiences caring for children with autism. Such stories comprise the bulk of the victimization narrative in the film.

Instead, autism lies at the periphery of the narrative about controversy. For example, the Tribeca debacle and in turn, De Niro's involvement as the primary spokesperson for the decision to include and then later remove Vaxxed from the line-up, are discussed in most of the articles.

However, De Niro's personal stake in the conversation is mentioned only in the Washington Post piece; he is otherwise represented merely as a festival founder rather than the father of an autistic son.

The experiences of parents of autistic children are discussed in two of the articles. Dr.

LaRussa in the piece from The Guardian acknowledges “the really compelling story of parents with children with autism” without delving into the details of their distress. He further sympathizes with their frustrations that no conclusive single genetic cause for autism has been discovered, driving them to seek more specific alternative explanations such as those presented in

Vaxxed. Additionally, as described previously, The New York Times article concludes with a quotation from Todd Drezner, filmmaker and father of an autistic son, that describe the negative consequences of vaccine hesitant efforts on the autistic community. Here, Drezner acts as a foil to the parents in Vaxxed. Although he too is the father of an autistic child, he does not champion attempts to elucidate causes of autism to prevent them. Instead, he advocates alternative efforts to improve quality of life for people who are already autistic. This approach mirrors a larger effort by the autistic community to support neurodiversity, a framework that posits that autism is simply a type of normal human variation that happens to pertain to neurological function (Ryzik, “Anti-

Vaccine Film…” A14). Consequently, autism ought not be pathologized but rather supported and accepted like any other form of diversity. Thus, Drezner and other adherents to neurodiversity complicate the victimization narrative by suggesting that efforts for justice as promoted in the film may instead further victimize already vulnerable autistic children.

However, while the voices of physicians, viewers, reviewers, and autism parents are present, like in the film, no autistic individual is quoted in any of the articles reviewed. Thus, the

43 lack of autistic representation is not a problem that is limited to vaccine skeptics alone; the largely vaccine-positive media similarly neglects this perspective.

Conclusion

This chapter analyzes how the press responds to the central narratives presented in

Vaxxed and generates new narratives surrounding vaccine hesitancy. Specifically, the injustice narrative is undermined by questions regarding the credentials of witnesses to the CDC’s alleged wrongdoing. In particular, the articles emphasize the absence of alleged whistleblower William

Thompson and conflicts of interest by figures such as Wakefield, who in one article is described to “[not] just have a dog in this fight; he is the dog” (Kohn). The conspiracy narrative is largely ignored in favor of other the broader MMR-autism discussion as well as the acceptance and subsequent removal of Vaxxed from the Tribeca Film Festival lineup, ostensibly on grounds of its inability to “further the discussion” but also potentially influenced by allegations of factual inaccuracy (Goodman A17). Additionally, journalists further attempt to dismiss the significance of the conspiracy narrative by deliberately excluding legitimizing terms like “debate” and

“documentary.” Finally, the victimhood narrative is briefly complicated by one article that references neurodiversity and the adverse impact of efforts to champion a disproven cause of autism. However, by and large, any distress experienced by autistic individuals and their families in response to either the film or its central premise is not addressed.

The leaning toward anti-Vaxxed sentiment by the press serves to affirm the alliance between the mainstream press and the mainstream scientific and medical communities. The press provides a platform for physicians who denounce the MMR-autism link and generates independent articles that cite scientific consensus and imply doubt toward the veracity of claims that stand at odds with it. However, certain intrinsic qualities of the genre of journalism nevertheless undermine efforts to reduce vaccine hesitant sentiment. For example, the need to hook the reader’s attention to inspire interest in an article about a fringe film leads to an emphasis

44 on the drama of the controversy, creating undue exposure for an emotionally compelling but rather one-sided production.

In this regard, attempts to undermine the legitimacy of vaccine hesitancy may backfire.

For instance, implicit efforts to dismiss the credibility of vaccine skeptics by avoiding language such as “debate” and “documentary” as observed in these articles can bolster beliefs in a biased media since conspiratorial thinking is inherently self-sealing. This quality means that efforts to negate the existence of the conspiracy can paradoxically be interpreted by its subscribers as evidence that the conspiracy is real (Sunstein and Vermeule 207). Also, while vaccine hesitant arguments are generally unsupported by existing scientific evidence, vaccine hesitancy is still real enough to persist and influence vaccination behavior. By erasing the terms “debate” and

“documentary” from their vernacular, the press erases the possibility of discussion rather than adherence to the undesirable stance. Instead of discouraging, it may merely prevent efforts to find common ground and initiate conversations to potentially alter perceptions of vaccine dangers.

Additionally, scientific authority is both supported and undermined by a disconnect between the epistemologies of different forces within vaccine advocate efforts. Vaccine proponents typically defend vaccination as an objective, evidence-based preventive measure that is strongly supported by well-designed experimental studies. Such studies, however, are not cited to defend claims made by the press. Instead, these articles reveal a dependence on establishing or dismantling credentials of alleged experts and informants. Therefore, the credibility of the story is instead evaluated by the credibility of the person who tells it. This tactic is far more consistent with vaccine skepticism, which bases its claims on the interpretations of lived experiences by families of autistic children, whose qualifications arise from their lived experiences.

The scientific community derives its authority from an adherence to unbiased inquiry and attempts to divorce itself as a subjective participant from the objects of their study. However, the press response reveals that pro-vaccine efforts do not all align with this adherence to objectivity.

Based on this analysis, the press attempts to bolster vaccine confidence by citing physicians,

45 thereby evoking their ethos as scientific experts. However, science itself is actually driven by logos; therefore, to truly employ a “scientific argument,” the press ought to instead have created a logical chain of arguments each supported by statistical evidence. Unfortunately, such writing can be rather daunting and difficult to comprehend without specialized training, so rather than persuading layperson readers through true logos, articles instead rely upon an ethos of logos, which in this case is the perceived “scientific-ness” of interview subjects. In doing so, the press ironically subverts any claims to intellectual superiority that come from a strict reliance on logos, even though the ethos of its informants comes from their expertise in the logos-driven field of science. In other words, rather than directly citing rigorous, well-designed studies, journalists quote scientists who are considered authorities because they conduct such studies. Consequently, the intellectual high ground that may otherwise be occupied by a true “science-based perspective” is compromised.

This compromised authority is concerning because it presents a barrier to engaging productively with the enlightenment narrative. The notion of enlightenment among vaccine skeptics inherently implies a perceived ignorance among vaccine advocates. When the press largely quotes the conclusions of vaccine experts rather than presenting the entirety of an evidence-based argument countering vaccine hesitant claims, they support the notion that vaccine advocates merely parrot messages of vaccine safety issued by allegedly corrupt institutions like the CDC. Without proper acknowledgment of vaccine skeptic concerns, articles fail to challenge conceptions of vaccine proponent ignorance. Despite the press’s overall pro-vaccine intentions, their approach can reinforce rather than undermine the enlightenment metanarrative.

As such, while journalists generally attempt to counter the narratives of conspiracy, injustice, and victimization, their efforts nevertheless fail to engage productively with the conspiracy allegations or the enlightenment metanarrative. However, regardless of its efficacy as a vaccine advocacy entity, the press does not receive the final word. With the rising popularity of comment sections at the end of online news articles, the digital conversation continues even after

46 professional journalists have said their piece because publication has become democratized by

Web 2.0. Layperson vaccine skeptics and advocates alike take to this platform to continue bolstering or compromising the narratives of vaccine hesitancy, particularly the ones perceived to be neglected by the press. These efforts are examined and analyzed in the next chapter.

CHAPTER 3

THE PUBLIC EXCHANGE

Before the age of Internet 2.0, published letters to the editor were the means by which ordinary citizens publicly expressed their responses to articles written by professional journalists.

With social media and post-article comment sections came new opportunities for almost everyone rather than just the selected few to have their opinions heard. Theoretically, by democratizing the dissemination of ideas, readers are exposed to new viewpoints, which in some cases leads to more nuanced understandings of the situation at hand (Smets and Iserna 389). At their best, comment sections have the potential to generate discussions influenced by perspectives typically lost on other platforms, shifting conversations to become more inclusive. Unfortunately, they have also brought new challenges to civil, productive discourse.

One of such difficulties is the emergence of the troll. Per Merriam-Webster, to troll is “to antagonize (others) online by deliberately posting inflammatory, irrelevant, or offensive comments or other disruptive content” (“troll”). Behaviors like trolling fall under a broader umbrella of incivility in digital discourse, which “limits the deliberative potential of online interactions” (Gervais 167). It does so by creating a self-sustaining cycle whereby incivility from opposing parties leads to aversion and reduced satisfaction toward the conversation while incivility from like-minded posters increases the acceptability and therefore the likelihood of further incivility.

However, motivations for incivility are complex and go beyond spiteful misbehavior.

Journalist Gavin Bell suggests that trolling is in the eye of the beholder, noting that “[on] an emotive issue, someone from the other side might seem to be a troll to you, but from his point of

48 view he is behaving appropriately” (270). Nevertheless, by definition, trolls derail civil discourse.

A cursory web search using the query “pro-vaccine trolls” or “anti-vaccine trolls” yields myriad blog posts and reports on niche news sites referring to adherents to the opposing perspective on vaccine safety as “trolls.” Thus, these terms have entered the vernacular of the vaccine conversation and, regardless of the intentions of the alleged trolls, have contributed to divisiveness between the two sides.

Even despite challenges presented by trolling, incivility, and other forms of disruption, in the context of Vaxxed, comment sections create an opportunity for the discussion to continue beyond claims made in the articles, which tend to act as vaccine advocate counterarguments to vaccine skeptic allegations. For vaccine skeptics, this opportunity is a chance to rebut the rebuttal, prompting subsequent back-and-forth responses between skeptics and advocates until the replies stop or the trolls successfully derail the discussion. This chapter explores the dynamics of these interactions through posts sampled from the comment sections following four of the articles analyzed in the previous chapter: the pieces written by Siegel, Cha, and Kohn, and Glenza’s interview with LaRussa. Of the remaining two articles, the Ryzik piece did not support a comment feature. Additionally, the Offit piece featured comments with characteristics that were largely redundant with those from the Siegel article and was therefore excluded since this thesis is intended to focus on close readings of unique characteristics rather than trends.

In this chapter, I examine how the four narratives presented in Vaxxed and rebutted in the mainstream press continue to be manipulated by vaccine skeptics and advocates in these comment sections. To strengthen the enlightenment narrative, vaccine skeptics link critiques of science to allegations of conspiracy; they point out flaws in study design to segue into accusations of collusion while suggesting conflicts of interest as a motivator for fraudulent science.

Additionally, they allege that mainstream physicians are either ignorant of or deliberately ignore a vast body of anecdotal evidence about vaccine injuries, contrasting them to vaccine hesitant physicians who are willing to listen and therefore possess this purported insider knowledge.

Additionally, unproductive incivility initiated by frustrated vaccine advocates undermines the potential for effective discourse that effectively counters vaccine hesitant narratives by derailing the conversation to attacks on vaccine skeptic ethos. Despite this shortcoming, autistic vaccine proponents argue for a reframing of autism discourse in the vaccine conversation that acknowledges neurodiversity and the social factors that contribute to the difficulties associated with their condition. Thus, such autistic voices undermine the victimization narrative by suggesting that autism itself does not necessarily victimize. Furthermore, autistic and non-autistic lay vaccine advocates alike exhibit moments of productive discourse during which they acknowledge valid arguments made by vaccine skeptics while explaining the reasons for their continued support for vaccines. As such, I argue that although incivility can reduce the efficacy of this platform, comment sections present an opportunity for vaccine proponents to better understand which portions of vaccine hesitant narratives fail to be disrupted by existing vaccine advocate arguments and to respond directly to these concerns.

A Question of Epistemology

Toward the end of Vaxxed, producer Del Bigtree expresses his belief that mainstream media and nefarious government forces are actively suppressing information about vaccine dangers on official channels. While the omission of the whistleblower story may not be driven by a desire to obfuscate the truth about vaccines, analyses from does indicate that the press avoids engaging with these allegations. Consequently, several vaccine skeptical commenters critique this perceived one-sided news coverage, asking for an unbiased presentation of “both sides” of the issue to allow the audience to make a decision for themselves. Despite the ostensible fairness of this journalistic approach, one vaccine advocate points out its key flaw:

[Wakefield’s] opinion doesn’t count for 50% of evidence. So for a balanced article

using all of the available evidence, it would mean the findings of the rest of the

scientific world versus Andrew Wakefield. I’m not sure now [sic] many thousands of

conclusions that would be, but that would make a more scientific balance. (LaRussa)

Because there are so many more studies favoring vaccine safety, almost any mention of vaccine dangers would be unrepresentative of the evidence pool, skewing the perceived ratio toward the latter. It would simply be wildly impractical to include the sufficient number of examples to reflect the number of pro-vaccine findings that exist for every one anti-vaccine finding. Yet despite perceptions of biased media coverage, vaccine skeptics exhibit a belief that evidence supporting their cause is ample and readily accessible via amateur web search. As they allude to prominent, oft-cited bodies of evidence, such as alleged lies by pharmaceutical companies, they call their potential future converts to “Google it” or to “look it up” rather than citing specific sources. One commenter claims that cases of serious vaccine injuries are more common than they seem, so “if you cared enough to look you would find thousands more”

(LaRussa).

This attitude, however, is not exclusive to vaccine hesitant commenters. Vaccine advocates similarly echo the need to approach evidence with skepticism and an eye for independent fact-checking, focusing instead on the faulty claims made by high profile vaccine skeptics. As one commenter bemoans, “One wonders why the audiences don’t bother to verify the claims made in the film?” (Siegel).

Although this adherence to skeptical inquiry is admirable on both sides, it also creates situations in which laypersons without the tools to properly analyze study design and reputability attempt to navigate large amounts of well-disguised misinformation in order to parse out the truth

(Kata 1709). When the difference between information and misinformation become unclear, readers deal with a question of epistemology: they must determine which types of evidence are most valid. In the comments surveyed, four predominant justifications are employed by vaccine skeptics: science, which both works to validate criticism for study design and legitimize conspiracy allegations; skepticism toward authority, which goes largely uncontested and further

51 bolsters doubts concerning study validity; stories of vaccine injury that encompass both individual testimonies and collective understandings that “thousands” share the same negative experiences; characteristics of the professionals and figureheads of each side that drive skeptics to cast charlatans as saviors, and vice versa.

Science (as a Segue to Skepticism)

As mentioned in the introduction, vaccine skeptics are not necessarily anti-scientific inquiry. They hyperlink to studies and demand citations just as vaccine advocates do, pasting in abstracts from their favored texts. They champion the importance of a double-blinded study design in which fully unvaccinated children are compared against fully vaccinated children to assess health consequences of vaccines. The ethics of intentionally withholding a known and effective prophylactic from a large population of children aside, such a study would theoretically be the gold standard for establishing causation or lack-thereof. As such, vaccine skeptics are able to continually rebuff attempts by vaccine advocates to plead a case for vaccine safety in the absence of such a study. In one case, a vaccine skeptic critiques the study cited within the article as inadequate proof of vaccine safety:

The article leaves out the fact that they did not compare completely unvaccinated

children. They only compared children who did not receive the MMR vaccine - and

called them unvaccinated - when in fact, they received other vaccines. Also they

included the *unvaccinated* if they did not receive BOTH doses of MMR (but

indeed received the first MMR dosage) (Cha).

In doing so, this comment issues a valid critique in response to a study design that would be useful for verifying the importance of completing the vaccine series but is flawed when cited as evidence for MMR safety. However, it is also followed by more extremist allegations of collusion and undisclosed interest: “Perhaps the biggest red flag with the Lewin Group [which

52 conducted the study], though, is its owner: UnitedHealth Group, another major promoter of vaccines” (Cha).

This comment, therefore, reveals two insights into vaccine hesitancy arguments. It reinforces the notion that vaccine hesitancy cannot be resolved simply by correcting misinformation because it is not unilaterally misinformed (Leask et al. 154). From a solutions standpoint, it would not be terribly feasible to conduct ethically dubious studies simply to assuage vaccine skeptic fears; however, comments like this one provide insight into why they are intellectually dissatisfied by vaccine advocate explanations. This dissatisfaction, in turn, bolsters their enlightenment narrative; since vaccine proponents are unable to provide adequate evidence that their opinion is grounded on better science, vaccine skeptics default to their belief that their

“insider knowledge” about bad study design justifies their stance. Additionally, these comments also shed light onto how neutral third party readers can be galvanized toward vaccine hesitant attitudes. Fairly moderate remarks, such as a non-controversial logos driven comment on study design that does not fit the desired research question, are yoked to the more extremist collusion allegation. Much like in the fable of the boiling frog, naive readers are eased into tepid waters of legitimate critique which heat up into full-blown conspiracy theories.

Skepticism (as a Segue to Science)

A concern about government collusion in hiding evidence of vaccine danger is among the most extreme allegations made by hardcore vaccine skeptics. However, it stems from a more fundamental form of skepticism. Specifically, they believe the official claims regarding vaccine safety cannot be trusted, either because these parties have failed to conduct the appropriate studies and therefore do not yet know the truth, or because they have already discovered vaccine dangers and choose to intentionally hide them, as claimed in Vaxxed. Because public health organizations and the scientific community have repeatedly and emphatically insisted that

53 vaccines do not cause autism, to believe that vaccines do cause autism is to believe that these institutions must be wrong.

Although the central cover-up narrative of the film is largely ignored by the mainstream media, this allegation resurfaces in the subsequent layperson discourse. Few comments directly address the purported whistleblowing and accusations surrounding the specific 2004 study explored in Vaxxed. Instead, they tend to accuse the CDC more broadly of being a “cesspool of corruption” caused by “financial conflicts of interest between people who work at the vaccine division and the vaccine industry” (Kohn). They also discuss perceived bias in the press coverage.

A commenter claiming to be Cinema Libre founder Phillippe Diaz remarks in response to the

IndieWire review, “This is not a review, this is a piece of propaganda going for the kill” (Kohn).

Additionally, concerns about potential vaccine dangers extend beyond autism; several comments discuss skepticism about the safety of potential “toxins” contained in these vaccines.

As discussed in the previous chapter, the articles themselves may not be the ideal venue for addressing conspiracy accusations because their very presence as a topic of conversation imbues the claims with credibility. By allotting space to address an alleged conspiracy, journalists would imply that such accusations are an adequate threat to merit discussion. Unfortunately, this quandary also means that there currently exists no official, mainstream platform to address the collusion concerns that underlie vaccine hesitant arguments. This key component of their narrative therefore becomes very difficult to convincingly refute. Additionally, because comments can supply outside information missing from the article, perceptions of inadequate discussion of the conspiracy allegations within the article may contribute to the prolific presence of vaccine hesitant sentiment in the comment chain. In other words, because articles are not generally vaccine hesitant, skeptics become more vocal in the comments to compensate. Thus, layperson vaccine advocates are important sources of rebuttals for prolific vaccine hesitant claims in that medium.

Among the comments surveyed, propaganda claims are generally addressed in four different ways. The most common is a complete absence of response. Since rebuttal comments are not required to address every accusation made, conspiracy implications and allegations are often ignored entirely. Other times, vaccine advocates assert the absurdity of their claims or disparage their opponents for their “lack of reflexivity” without providing further justification

(LaRussa). More argument-based responses attempt to disrupt the ethos of alternative authorities, noting that Wakefield was hardly an impartial third party investigator of MMR since he “was originally trying to sell another vaccine” (LaRussa). Finally, occasional comments acknowledge that portions of vaccine skeptic critiques are accurate, yet reaffirm faith in the scientific institution to discover the truth in spite of its flaws. In one example of such an exchange, one vaccine advocate begins by remarking that “very good evidence” is provided by an earlier comment that asserts, “Vaccines obviously don’t cause autism, because the unvaccinated develop autism at the same rate as the vaccinated” (Cha).

The next reply, which is made by a vaccine skeptic, attempts to engage in productive discourse by emphasizing the point of divergence in their belief in otherwise reliable evidence for vaccine safety: “The problem with your “good evidence” is the deceit and fraud in medical research and the criminal activity of the manufactures [sic] of vaccines, how do we really know which studies are real?” (Cha).

In response, a vaccine advocate continues this thread of productive discourse, remarking upon the limitations of science while reinforcing the need to continue scientific inquiry, even as it is conducted by an institution that sometimes arrives at incorrect conclusions with dubious interests:

[S]cience isn’t perfect, and there is research motivated by non-scientific motives, but

that doesn’t mean you can just discount every piece of science. Science eventually

gets it right, even if it started with the wrong ideas… I’m well aware of bad actors in

the pharmaceutical arena. Glaxo had a drug that caused 100,000 heart attacks and

they tried to keep the information secret. But MORE science, not less, was the

solution. (Cha)

These sorts of comments are unusual but promising because they challenge the ways in which vaccine skeptics understand and define science. Rather than assuming that vaccine skeptics are simply “unscientific,” they implicitly acknowledge a mutual respect for scientific inquiry as common ground. Consequently, the commenters are able to bypass fruitless discussions about whether vaccine skeptics believe in science. Such debates derail the conversation by generating unnecessary points of disagreement. They split hairs over whether vaccine skeptic behavior properly reflects a belief in science when both skeptics and advocates already agree that science is important. Continued discussion wastes time by arguing a bygone conclusion; in fact, it represents the sort of behavior that vaccine advocates critique when they complain that vaccine skeptics refuse to accept the body of literature disproving the link between vaccines and autism.

Testimonies of Terror

Because scientific evidence is regarded as contentious due to conspiracy concerns, anecdotal evidence is quite prominent in comment thread discourse. While the former use personal narratives far more frequently, anecdotal evidence is leveraged by both vaccine skeptics and advocates. These testimonies tend to be consistently negative, regardless of which party tells the stories. Vaccine-positive narratives emphasize the dangers of vaccine-preventable diseases.

For example, one vaccine advocate describes a parent who contracted poliomyelitis as a child and ultimately passed away from post-polio syndrome, citing their father’s experience as evidence for the perils of forgoing vaccination. As is consistent with the literature and the testimonies presented in Vaxxed, vaccine hesitant comments tend to feature anecdotes of developmental decline, injury, or death attributed to a vaccine (Dubé et al., “Vaccine Hesitancy: An Overview”

1767; Vaxxed: From Cover-Up to Catastrophe). One autism parent testifies,

Here is what I can tell you. My son was developing normally. We took him in for his

booster shots and within hours he started to show signs of distress. He started having

seizures, lost all his learned vocabulary and regressed into autism almost immediately.

Two weeks later he was diagnosed autistic. (Cha)

Positive narratives are rarer and typically provided by vaccine skeptics. In some cases, parents note that their children, or the children around them, have foregone vaccines and yet are perfectly healthy. Others go on to claim that no unvaccinated child has ever been diagnosed with autism, although, as vaccine advocates are quick to point out, this claim is false. Positive vaccine advocate narratives were not observed in the comments sampled. Their absence is understandable since such stories are unlikely to contribute to the conversation. Even vaccine skeptics acknowledge that vaccine injuries are a relatively rare phenomenon; one commenter notes that

“vaccines DO cause problems...but [manufacturers] justify it because so many more are helped…[whether] or not a small percentage being harmed for the greater good is justifiable is the real question” (Cha). Furthermore, their lack of concern about vaccine-preventable diseases is partially attributed to their low prevalence in the general population (Kata 1710). Consequently, anecdotal evidence that a child received a vaccine and subsequently did not contract a vaccine- preventable disease would hardly be surprising to anyone in the conversation.

Additionally, aside from firsthand or even secondhand accounts, during which a single individual with whom the writer is familiar has purportedly witnessed “vaccine injuries,” vaccine hesitant comments also referred to broader metanarratives, claiming that they have heard of

“thousands of children” affected by the alleged vaccine-induced harm. It is the repetition of such claims that allows vaccine skeptics to perform a sort of lay epidemiology that is more credible in their own circles for several reasons.

First, it echoes sentiments about doing one’s own research and data analysis. Ultimately, the goal of such analyses is to discern patterns, which is precisely what vaccine skeptics believe that they have unearthed. As one vaccine skeptic explains, “I personally take notice when

57 thousands and thousands of parents from around the world claim that their babies were perfectly healthy until vaccination” (LaRussa). This remark echoes the sentiment expressed by Vaxxed producer Del Bigtree when he explains in the film why he found the purported MMR-autism link to be such a compelling accusation. Secondly, it relies upon data obtained from parents, who are perceived to be reputable because they are presumably motivated by their children’s wellbeing rather than financial gain. This focus on protection of one’s children as a value and therefore as proof of reliability extends to its converse; one vaccine hesitant commenter suggests, “I suspect some of the best provaxx arguments are coming from childless people” (LaRussa).

Saviors or Charlatans?

Ultimately, vaccine skeptics tend to mentally weigh trustworthiness, or a lack-thereof due to association with a tainted institution, against traditional notions of expertise that come through formal training. They do not operate under the assumption that training necessarily equates to trustworthiness. This belief is not because they see the training process as inadequate for conferring the analytical knowledge necessary to discern the truth about vaccines; rather, they perceive that scientists and other experts are willing to lie in order to uphold the status quo.

This skepticism does not mean that they are skeptical of the authority of scientific inquiry.

They link to abstracts in albeit fringe journals that support their cause. They demand large-scale, double-blinded, controlled studies, which are the gold standard of experimental design, to validate the safety of the MMR vaccine once and for all. They, too, cite scientists and physicians, following their names and titles with parenthetical epithets that describe their accomplishments.

On a superficial level, despite their intrinsic affiliation with the biomedical complex by way of their professions, these authorities are clearly “different” owing to their alliance with vaccine skepticism. However, several comments also reveal a less obvious point in their favor: they listen.

After one mother reveals that her child passed away from adverse effects of a vaccine administered without her consent, another parent passes on the name of an Italian physician who

58 recently published a study linking that vaccine to sudden infant death syndrome. To follow up, the original poster replied, “Dr. Pulliyel kindly reviewed my child’s medical records pro-bono and gave evidence via video link during the inquest” (LaRussa).

As such, parents who attribute their children’s symptoms to vaccines trust Wakefield,

Pulliyel, and their ilk because these doctors are willing to acknowledge their experiences. The readiness with which vaccine skeptics accept such professionals as saviors rather than charlatans suggests a dearth of mainstream physicians who listen to their concerns. This unfilled need in turn points toward a potential point of intervention in countering vaccine skepticism, which is further explored in the final chapter.

Regardless of the specific type of evidence used, all four approaches work to strengthen the enlightenment narrative that is first presented in Vaxxed. Allegations of poor study design and skepticism toward the institutions that conduct these studies discredit vaccine advocate efforts to introduce evidence that contradicts their “enlightened” conclusion. Personal anecdotes suggest that there may exist examples of “vaccine damage” that fail to be accounted for by existing vaccine advocate understandings of vaccine safety. The absence of doctors who listen means that physicians are not incorporating the experiential evidence of parents when they evaluate whether to counsel their future patients to receive vaccines. Ultimately, vaccine hesitant parents view themselves as enlightened from their ignorant default trust in the pharmaceutical industry and the limitations of closed-mindedness in the medical and scientific communities. Furthermore, they also believe that if other parents were to know what they knew, then these parents would also refuse vaccines.

The converse to this corollary is also regarded as truth; if one learns the “truth” about the pharmaceutical industry and yet still champions vaccine usage, then they must be a shill for corrupt interests. Vaccine advocates on one thread are accused of acting as a “mercenary army fighting against healthy outcomes for children” because they use claims consistent with vaccine

59 industry defenses against vaccine skeptic allegations (Cha). The implication here is that if a parent supports vaccination, then they must be among the naive uninitiated; once a parent is made aware of the alleged wrongdoing and yet supports vaccines anyway, they must be mouthpieces for more nefarious purposes. In this commenter’s words, “real parents make spelling mistakes and don't happen to have an encyclopedic knowledge of how industry tried to silence Wakefield”

(Cha). The part left unsaid is that if they had this knowledge, then they would believe the conspiracy claims.

“Anti-Vax Trolls” vs. “Pro-Vax Shills”

Unsurprisingly, vaccine lay discourse is not exempt from the broader trend of incivility in comment threads. Conduct varies across different articles, with the greatest degree of incivility occurring in The Hollywood Reporter. The most obvious form of incivility observed was name- calling, a practice that is sometimes rhetorically meaningful. For example, repeated accusations that vaccine advocate commenters are “shills,” a term referring to confederates of a swindler who facetiously play the role of an enthusiastic consumer, reflects reinforcement of the conspiracy narrative. Other instances are closer to schoolyard insults, including a five day long series of comments from two users who repeatedly accuse one another of a fixation with excrement.

Moreover, if trolling is defined broadly as any effort to derail conversation, then the accusation of trolling is itself a form of trolling, detracting from attempts to earnestly engage with and respond to concerns raised by the alleged troll. In one of the examples explored previously in this chapter, in which a vaccine advocate explains why one ought to maintain their faith in scientific inquiry even in spite of past missteps, another vaccine advocate subsequently asserts that the vaccine skeptic to whom this explanation is directed is a “dishonest anti-vaccine poster who has been caught pretending to be a 15-yr-old girl on one thread and a middle-age person on the other” (Cha).

Whether the preferred term is “shill” or “troll,” such pejoratives ultimately evoke the same sort of reasoning: the conversation partner is being disingenuous about their intentions, so their claims are also illegitimate. The specific accusation of “troll” both evokes and follows the conventional wisdom of “Don’t feed the trolls!” The naming draws to mind this advice while attempting to discredit the commenter as a troll rather than engaging, or “feeding” them. Instead, on the vaccine proponent end, it feeds a narrative of vaccine skeptics as trolls who should not be brought into intelligent discourse, and vice versa. Therefore, it necessarily shuts down conversation, which requires continued engagement.

At the same time, naming does not necessarily undermine the influence of misinformation from alleged trolls presenting vaccine hesitant messages. According to social psychology, the recency effect causes the last piece of information presented to a consumer to be remembered most readily (Murdock 484). Additionally, the source misattribution error dictates that information from unreliable sources may be retained even when the source of this information is forgotten, thereby allowing even content recognized as misinformation to be misremembered as credible fact (Zaragoza and Lane 935). Although the exact consequences of naming on vaccine confidence are unclear, the interaction of these two effects suggests that when vaccine proponents derail a conversation by calling out trolls, these call-outs may paradoxically cause the last message, which is vaccine hesitant, to be most strongly retained by readers of the comment thread regardless of its credibility. Thus, by defaulting to such ad hominem attacks, vaccine proponents fail to disrupt vaccine hesitant narratives, allowing them to retain their persuasive power.

Is Autism the Real Victimizer?

Paradoxically, as the focus of vaccine injury allegations shifts away from autism specifically, the voices of autistic people begin to arise in the comments. This phenomenon may

61 partially be attributed to the fact that comments cast a broader net for contributors, thereby allowing underrepresented populations to make their voice heard.

Aside from the quotes from the producer of Loving Lampposts, the use of autism and autistic children as a rhetorical device to conjure fear is not problematized in either Vaxxed or the subsequent media response. Even within that article, the exploitive portrayal is overlooked, and while neurodiversity is mentioned as one of the focuses of Loving Lampposts, it is neither defined nor truly explored. By contrast, non-autistic and self-identified autistic vaccine proponents alike criticize the notion of autism as “damage” or as comparable to debilitating vaccine-preventable diseases. One non-autistic commenter quotes an op-ed written by an autistic blogger to support their claim that “[vaccine skeptics] represent an ideology that is harmful to everyone, especially those with autism” (Siegel). Similarly, an autistic commenter describes a vaccine skeptic’s claims about autism as “misleading and insulting,” providing their own anecdotal evidence that autism is not “something wrong”:

I’m autistic. And the combination of being autistic so my senses are a bit different,

having some kind of chronic illness where they’re turned up to one hundred and

eleven, and being hit with sensory bombardment is very disabling...This isn’t

something wrong with us. In the right circumstances, we can excell [sic]. This is

something wrong with the way neurotypicals treat us. (Siegel)

However, these critiques are met with resistance. In both cases, subsequent replies by vaccine skeptics note a difference between “high functioning” and “low functioning” autism, claiming that those who are coherent and eloquent enough to pen such responses to vaccine hesitant concerns are unrepresentative of the “barely functioning who have greater harm done to them,” describing their existence as a “void” (Siegel). Nevertheless, the autistic commenter offers a rebuttal to this claim:

I’m in unrelenting pain due to the chronic illness nd [sic] the sensory bombardment.

I’m no longer “high-functioning.” But autism is not the source of the problem. An

ableist, anti-disabled, anti-autistic society, which uses strobe lights everywhere,

among other absurd sensory bombardment, is the source of the problem. (Siegel)

This description of a so-called “high-functioning” autistic person’s experience resonates with the social model of disability as proposed by Michael Oliver in 1983, which conceptualizes disability as the product of a disabling environment rather than an intrinsic property of a disabled individual (1024). Such a framework thoroughly upsets the victimization narrative because it posits that autism is not a victimizer. Through a social model lens, autism itself does not victimize autistic children; rather, they become victims in certain environments in ways that their neurotypical counterparts do not because these environments fail to facilitate their needs. Autism itself does not victimize parents of autistic children; rather, a lack of readily available resources ensures that these parents must devote disproportionate amounts of their time and energy to fight for the level of support needed for their children to thrive. Autism itself does not victimize society; rather, the absence of suitable employment opportunities for autistic adults result in the financial contributions that society must make to support their daily needs.

However, vaccine advocates are not all neurodiversity advocates. They too make anti- autism remarks. For instance, one commenter acerbically declares,

Show me a parent of an autistic teen who smears his feces all over the wall and I’ll

show you a shitty parent. It has nothing to do with vaccination...For a tiny number of

the severely impacted who may [exhibit that behavior], it can be modified before

school age. However, that requires a parent with a little bit of patience and a

willingness to use therapies that work. (Siegel)

Such remarks are troubling because they show that while anti-autism sentiment is tied to many vaccine skeptic arguments, vaccine advocates also allow damaging sentiments about the autistic community to continue unfettered. While anti-autism attitudes long predate Wakefield’s proposed association between MMR and autism, autism-related comments reflect the ways that prejudice has been leveraged in efforts to influence vaccine confidence and hesitancy. As such,

63 they attempt to counter the victimization narrative by shifting the identity of the victimizer from institutions that hid the cause of autism to the condition itself, regardless of its causative factors.

Thus, while this approach undermines the narrative presented by vaccine skeptics, it also contradicts the ideals of neurodiversity that are championed by many autism activists.

Conclusion

This chapter studies Web 2.0 vaccine discourse by discussing rhetorical tactics employed by vaccine skeptics and how layperson vaccine advocates respond to them. It also analyzes how these interactions influence vaccine hesitant narratives. In doing so, it aims to find exchanges that either attempt or suggest opportunities to establish common ground. While rarer than condescending insults or references to studies that are greeted with skepticism by the opposing parties, such comments help elucidate the most fundamental points of divergence between vaccine skeptic and vaccine advocate understandings of vaccine safety and efficacy.

Identification of these subjects in turn informs strategies for bridge these early gaps, much like a zipper works to bring together two ends by starting from a point at the bottom where the two sides are already joined.

Through this analysis, we see that vaccine skeptics use a variety of strategies to legitimize their evidence. Valid methodology critiques of vaccine safety studies ease readers into believing in more conjecture-based conspiracy theories, which in turn detract from the validity of other studies. An emphasis on anecdotal evidence from parents works to question vaccine advocate arguments that fail to account for such experiences, as well as the advice of healthcare professionals who do not seem to listen to these testimonies. Vaccine skeptics use these efforts to sustain their narrative of enlightenment, arguing that vaccine advocates fail to provide untainted scientific evidence or account for anecdotal counter-evidence. Consequently, arguments that support vaccine safety fail to disrupt perceptions that vaccine skeptics know more and therefore know better, thereby supporting the enlightenment narrative.

Furthermore, allegations of trolling and shillery derail the conversation, allowing vaccine skeptics to have the last word even as vaccine advocates attempt to call out their perceived irrational or off-topic remarks. When the conversations devolve as such, vaccine proponents fail to disrupt any vaccine hesitant narratives.

Finally, the comment sections mark the first occasion in which autistic vaccine advocates are granted a platform for arguing their case. Unsurprisingly, those who identify themselves as autistic work to disrupt the victimization narrative, particularly by drawing on the social model of disability to argue that even independent of any association with MMR or lack thereof, autism is not the victimizer. However, vaccine advocates seem split on their approach to countering claims of victimization, since others argue against an MMR-autism association while maintaining the notion that autism is inherently bad.

From examining the understandings of vaccine safety presented in these comments, we can see that one key point of divergence occurs in the definition of scientific inquiry. When the limitations of science are misunderstood, unrealistic expectations are created. Although both parties generally agree that the scientific method is a good way to obtain truth about natural processes, vaccine skeptics demand experimental conditions that are ideal but virtually impossible to execute in order to accept conclusions favoring vaccine safety. Unfortunately, as one departs from disposable and easily manipulated cell cultures, it becomes more and more difficult, both logistically and ethically, to design and execute controlled experiments.

Consequently, much of the existing body of scientific evidence is not actually based ideal experimental designs and is therefore rife with uncertainty. However, sufficiently large bodies of correlative evidence and pseudo-experiments based on serendipitous outside events that act to manipulate a target variable can be used in lieu of double blinded, fully controlled studies to generate meaningful and useful findings. One such example is epidemiology, which tracks the prevalence of risk factors and maps them to disease incidence. Although comments that attempt to address such misconceptions are rare, they do occur. In one case, a vaccine advocate notes,

It is true that there has never been a large-scale placebo controlled, double-blinded

study of the relationship between vaccination and autism…[but,] if vaccines were

causing the massive rise in autism diagnoses, it would be obvious from the

epidemiology; you wouldn’t need a large-scale double-blinded study. (Cha)

Since no further replies were observed, the efficacy of this explanation in altering vaccine misconceptions is unclear. Nevertheless, it serves as an example for ways in which vaccine advocates can leverage Web 2.0 to start bridging gaps in understandings, an approach that is discussed more extensively in the final chapter.

Beyond misconceptions regarding the practice of science, there exists a complex dynamic in which vaccine skeptics believe in scientific methodology while remaining frosty toward the scientific institution. Consequently, potentially effective responses must remain conscious of these underlying assumptions about ethos. For example, in one discussion of why Hooker’s data analysis as presented in Vaxxed was flawed, a vaccine advocate cites “a PhD in physics who can explain to you why the PhD in engineering did a really bad job,” noting that they were “both autism dads, so no conflict” (Siegel). In this remark, the commenter seamlessly incorporates parental authority, particularly among parents perceived to have a vested interest in discovering the true cause of autism, scientific authority without affiliation with institutional interests, and the do-it-yourself approach to science.

Unfortunately, citing such authorities requires the ready availability of sound bites or quotable text, along with rigorous critical analyses of a large body of flawed studies, from a very specific subset of the population. Moreover, this subset of the population is already quite occupied by the logistical challenges of caring for autistic children in a society that provides little ready support. As individuals who hold doctorates in science, they are likely also balancing intellectually demanding careers with these complicated childcare needs. To create an additional imposed moral impetus in their caretaker role seems unnecessarily burdensome. Hence, comments that evoke the optimal ethos rely upon the cited source equivalent of the controlled vax

66 versus no-vax study: theoretically satisfying on intellectual grounds but practically difficult on moral grounds.

When valid points that are raised by vaccine skeptics are not acknowledged as such, their enlightenment narrative is bolstered. By and large, vaccine hesitancy operates as a reactionary force; official channels make vaccine-positive claims, and skeptics provide their rebuttals of perceived lies and oversimplifications. Without a subsequent reply from vaccine advocates, these skeptics are able to continue believing that their specialized knowledge and superior logic have not been accounted for in even the most sophisticated vaccine advocate arguments. Comments allow an opportunity to provide that reply. Based on this analysis, comment sections have the potential to emerge as a platform upon which advocates acknowledge the ways in which vaccine skeptics are correct, and then provide additional rationale for why they continue to support vaccines even when they share the specialized knowledge. When utilized carefully, comment threads allow a reframing of the enlightenment narrative, placing advocacy as a peak level of enlightenment above the skepticism that can come from the initial stages of personal research.

CONCLUSION

In a way, Vaxxed is a film about a conspiracy that is not really about that conspiracy at all.

Rather, it initiates a new skirmish in a larger pseudo-legal battle. It is a lawsuit in the court of public opinion through which Andrew Wakefield and his associates attempt to undermine the general trend of vaccine confidence. To do so, the film presents four central narratives as charges laid against institutions perceived to have deliberately obfuscated vaccine dangers. The first narrative is one of conspiracy, which attempts to establish that CDC officials colluded to hide and alter data that would have proven a link between vaccines and autism. Next is a narrative of injustice, which claims that vaccine skeptical activists are victims of institutions that actively seek to hide the truth. Third is a narrative of victimization, which casts autistic children, their families, and society at large as victims to the scourge of autism, which has risen to become an epidemic due to the machinations of health institutions. Ultimately, these three narratives merge to generate a metanarrative of enlightenment, which encapsulates the underlying purpose of the film and the reason why its vaccine hesitant creators believe that it will be effective: vaccine skeptics distrust vaccines not because they are deluded but because the possess insider information that the population at large does not, so if they spread their knowledge to the public, then the public would begin to side with them.

On the level of the press, however, writers home in their efforts on discrediting the injustice narrative. Rather than engaging with the possibility of a government cover-up, they aim straight for the veracity of MMR-autism claims. They dismiss Wakefield as a credible source and cite outside witnesses deliberately excluded from the vaccine skeptics' opening statement. As a result, they discredit the injustice narrative by showing that Wakefield likely received precisely

68 what he deserved. Moreover, they suggest that the real story is in the film’s brief engagement with Tribeca and the persistence of vaccine skepticism, further drawing attention away from the conspiracy narrative. They further dismiss this narrative by avoiding the use of legitimizing terms like “debate” and “documentary” when discussing the vaccine conversation and Vaxxed, respectively. Finally, they introduce the voice of an autistic parent who does not blame vaccines but rather encourages the energy spent investigating them to be redirected toward measures that improve quality of life for autistic children. Consequently, not all parents perceive themselves to be victims of the pharmaceutical industry, thus countering the victimization narrative. However, by relying upon distraction and language choice to address the conspiracy narrative, they fail to truly argue against the conspiracy concerns. Additionally, without due acknowledgment of any valid critiques and concerns expressed in Vaxxed, the press fails to counter the enlightenment narrative, allowing a continued perception of vaccine skeptics on the intellectual high ground.

When we move below the line to the comments that ensue, we see that these narratives continue to be referenced and manipulated. The enlightenment narrative is bolstered by vaccine skeptic efforts to establish the credibility of their evidence. They poke holes in the ethos of parties who conduct studies and in the designs of the studies themselves while referencing a corpus of anecdotal evidence about vaccine danger that is ostensibly ignored by mainstream physicians, suggesting that vaccine skeptics really do know more. Furthermore, unproductive moments of incivility initiated by well-meaning lay vaccine advocates work to derail productive discourse, preventing efforts to refute vaccine hesitant narratives. However, lay vaccine advocates are not without their merits. Autistic voices in the comment thread promote notions of neurodiversity and a social model for their condition, suggesting that autism does not really victimize. Furthermore, there do appear to be moments of productive exchange, during which vaccine advocates listen to determine why skeptics are skeptical and respond accordingly. Consequently, despite being plagued by incivility effects, comment sections serve as an opportunity for vaccine advocates to

69 elucidate how vaccine hesitant narratives persist despite existing vaccine advocate arguments, and to tailor their subsequent arguments accordingly.

Ultimately, these narratives are more than just stories that are told to explain and complicate understandings vaccine safety. They also point toward the anxieties held by the parties who subscribe to these narratives and the reasons for their stake in the issue. In particular, the moves made by vaccine skeptics to present and redirect the narratives of the vaccine conversation indicate three predominant concerns: 1) that MMR causes adverse symptoms, including autism; 2) that institutions are not acting in their best interest; and 3) that alleged vaccine injuries, including autism, are the worst things that could happen to their children. Ultimately, they show why vaccine hesitant beliefs and actions are so difficult to change, and why vaccine hesitant activists are so zealous in persuading other parents to become vaccine skeptics as well.

The first of these concerns is the primary focus of press and layperson comment interventions. Attempts are repeatedly made to disrupt this chain of causation by presenting counter-evidence from outside sources and by discrediting those who provide supporting evidence. However, the success of these measures is limited by the absence of efforts to address the other two concerns that interact with misinformation to generate vaccine hesitancy.

The second concern is ignored by the press and generally dismissed in the comments without any real engagement. In rare cases, efforts are made to question whether vaccine hesitant authorities are any more trustworthy than vaccine advocates, but in general, it is difficult to craft arguments supporting the authority of the scientists involved in vaccine science. First, the availability of funding sources ensures that scientists investigating vaccine safety are backed by either government health organizations or pharmaceutical companies because these are the only reputable grant-sponsoring entities with enough of a stake in vaccine safety and enough money to fund such studies. As such, it would be extremely difficult for vaccine advocates to find a well- designed study funded by an outside party to support their arguments. Furthermore, it would be inaccurate to claim that the parties criticized by vaccine skeptics are always trustworthy. As

70 vaccine skeptics so often remark, the tobacco lobby successfully pressured the government to forestall confirming the link between tobacco products and lung cancer, indicating that this institution is corruptible. Fraud does happen, even in the midst of generally good science. Even several vaccine advocates concede that pharmaceutical companies hardly possess a spotless track record for ethical practice. Thus, it is difficult to persuade skeptics about the overall integrity of studies verifying vaccine safety because such a belief requires some underlying level of faith that scientists, government agencies, and pharmaceutical companies generally act with integrity, even if they sometimes do not.

The third concern may be the most complex of these issues because it is not directly relevant to vaccine danger. Autism had no business in being dragged into the vaccine conversation; after all, it has no biological relationship with vaccination. However, through a confluence of correlation, coincidence, and fraud, autism is in this conversation whether it ought to be or not. A rhetorical, if not physiological, relationship between MMR and autism was established the moment Wakefield made his claim, and it has snowballed into acceptance by a broader audience. Since this belief persists even twenty years after its inception, it is clear that we have moved past the point at which it may be a reasonable approach to avoid talking about this allegation in hopes that lack of official recognition will make it disappear. Instead, because autism brings with it the convoluted baggage of other conversations on ableism and neurodiversity, vaccine advocates must seriously grapple with the notion that their discourse is perfectly capable of simultaneously advancing vaccine confidence while perpetuating harmful views about autism if navigated improperly.

Admittedly, based on our definition of “productive conversation,” it would make sense to suggest that vaccine advocates ought to pick their battles rather than rock the boat too much. If common ground is necessary to facilitate discourse that leads to informed consensus, then breaking up the pre-existing common belief that autism is generally undesirable seems

71 counterproductive. However, the boat needs to be rocked if underlying assumptions held by both sides are damaging to a vulnerable population. As blogger bellejarblog argues,

At the end of the day, words matter and how we talk about issues matters. And when

those of us who believe it’s important for children to be vaccinated keep pulling out

“but vaccines don’t cause autism” without following it up with some kind of

explanation that also autism isn’t a tragedy, we need to consider the impact our

words might have. Because of course the end goal is to vaccinate every child eligible

for vaccination, but we don’t need to throw autistic people under the bus to

accomplish that goal.

Whether they ever should have been or not, autism and by extension, autistic people, are now inextricably tied to issues of vaccine confidence. As such, this population deserves a voice in the conversation so that they can be rightly seen as a vibrant community of actual human beings who cannot be merely leveraged as a worst case scenario against which parental fears ought to be assuaged to prevent vaccine preventable disease outbreaks. This analysis supports existing claims within the autistic community that marginalizing language is a problem even among vaccine proponents and suggests that it ought to be further investigated and ameliorated.

Because this project acts as a pilot study, it draws from one film, six articles responding to the film, and approximately 300 comments from around 60 comment threads, thereby limiting its scope of inference. Nevertheless, by taking a small-scale, qualitative approach, this project has generated unique insights, which suggests the value of extending this approach to a larger scale by examining other interactions between lay vaccine advocates and skeptics to better understand this conversation. Additionally, these insights suggest certain directions for future interventions to improve vaccine confidence. These include strategically reactionary engagement with Web 2.0 debates that questions traditional conceptions of “trolling,” measures to better address parental concerns following vaccination, and more sophisticated logos-driven Web 1.0 counter-arguments.

First, the conversations present in comment threads are rather unusual in that they force vaccine advocates to become reactionary, which can be a positive characteristic. Rather than blindly producing flyers and public service announcements meant to persuade the general public to vaccinate, vaccine proponents must instead address concerns that are conveyed by vaccine skeptics earlier in the thread. Such an approach describes precisely why vaccine hesitant arguments are so effective via Web 2.0; they are allowed the last word because Web 1.0-style public health measures do not necessarily provide a counter-argument for every point raised by vaccine skeptics. However, if comment threads and forums are instead strategically utilized by vaccine proponents, they have the potential to allow direct rebuttals of vaccine skeptics in replies that are conveniently nested directly under their initial claims. Consequently, interactions on these typically layperson-driven platforms should be considered as a potential intervention even for public health organizations.

When engaging in these interactions, it is also important to reframe perspectives on “anti- vaccine trolls.” While trolls are traditionally conceptualized as purely disruptive, journalist Gavin

Bell instead argues that “[t]roll is a pejorative term and often used to color other people's reactions to a new voice or a contentious point of view that disagrees with the commonly held view of the community” (270). Allegations of trolling discredit the real underlying concerns that drive such “trolls” to target comment threads focused on particular issues. In other words, the supposed trolls do in fact have some stake in the topic of vaccine safety simply because they chose to “troll” this thread, and therefore this “trolling” marks an attempt to redirect the conversation to address their worries, albeit in an abrasive manner. Because they have agendas aside from disruption, it is then possible for other participants and readers of the thread to begin identifying with these agendas and therefore with the extreme narratives that they peddle.

Therefore, rather than following advice to avoid feeding the troll, efforts to earnestly engage with potential trolls may make some ground in shifting existing vaccine hesitant attitudes and preventing new ones.

Moreover, testimonies from parents of children with alleged vaccine injuries indicate that these parties trust vaccine skeptical physicians because they listened, thereby implying that mainstream pro-vaccine physicians did not. Through my review of the literature, while I found many articles suggesting ways to handle vaccine hesitation in order to persuade parents to vaccinate, there appear to be few, if any, recommendations for situations when a parent comes to the clinic post-vaccination claiming that their child had been injured by the vaccine. These two observations suggest a generally overlooked point of intervention in preventing the spread of vaccine hesitancy. If parents feel that their concerns have not been acknowledged, it is understandable that they would turn to vaccine skeptical parties that are willing to listen, thereby identifying with this community and attempting to further its cause by adding their own testimonies to the existing body of anecdotal evidence. As such stories accumulate, they lend further credence to claims that vaccine injuries are a common occurrence that ought to raise concern in future parents making vaccination decisions. However, by incorporating post- vaccination counseling as a continuation of pre-vaccination counseling when needed, healthcare providers can help disrupt the dissemination of such stories by acknowledging the presence and coincidental timing of these symptoms while pointing parents toward their true causes.

Finally, responses to vaccine skeptic claims work by disrupting the narratives that they attempt to portray in order to transport the reader to their conclusion of disproportionate vaccine risk. One major pillar to disrupt is the enlightenment narrative. Vaccine skeptics view their perceptions of vaccine dangers as the inevitable consequence of a more sophisticated understanding of the science underlying vaccines. In a way, they are correct; vaccine skeptics do tend to be more informed about vaccines than their vaccine advocate counterparts (Leask et al.

154), and many of the concerns that they raise about suboptimal study designs are valid. However, scores of scientists and medical professionals are equally if not more informed about vaccine safety and scientific inquiry than vaccine skeptics and yet nevertheless believe in vaccination. It is through them that vaccine advocates can undermine the idea of vaccine hesitancy as

74 enlightenment. Despite what vaccine hesitant activists have argued, these individuals are neither ignorant to the inherent limitations of scientific inquiry nor shills paid off by nefarious pharmaceutical industries to intentionally mislead the public. Rather, they are aware of uncertainties inevitable to the practical execution of the scientific process, and yet are able to believe in the findings that it produces in spite of them.

As such, their existence inherently complicates the enlightenment narrative. If one can know what the vaccine skeptics know, and yet provide a well justified answer without a hidden agenda for why they nevertheless support vaccination, then vaccine hesitancy must not represent the pinnacle of enlightenment. This argument has the potential to be particularly powerful because it does directly refute the notion that vaccine skeptics have some measure of “insider knowledge.” Rather, this alternative pro-vaccine enlightenment narrative instead jump-starts the cognitive process of accommodation by suggesting that the story continues, incorporating support for vaccination into existing schemas of vaccine safety awareness. One does not need either to return to Plato’s cave or insidiously enforce bars upon its opening in order to support vaccination.

Rather, for reasons that well-informed vaccine components can articulate, vaccine advocacy can be a thoughtful, agenda-less stance to take.

For instance, while misinformation is not the root problem in debates that center upon differences in trust, efforts can still be made to prevent misinformation from misleading parents who are generally trustful toward public health agencies. In an effort to address the ethos-based critique presented by vaccine skeptics, vaccine advocates have also turned to ethos-based attempts to discredit the heroes of the vaccine hesitant narrative. Unfortunately, such ethos vs. ethos debates make for value-driven competitions in which neither side can readily challenge the other’s weighing of strengths and weaknesses in their authorities. Nevertheless, vaccine skeptics do not resort to ethos alone, presenting logos-based critiques of study design and the like; such arguments are an ideal point of intervention for vaccine advocates because scientific evidence produced by well-designed studies sides with vaccine confidence. That they are capable of

75 pointing out valid problems in existing studies suggests a level of sophistication in vaccine skeptics that is often overlooked in relatively simplistic public health campaigns. As such, perhaps a return to logos, through which public health officials explore nuances of why vaccine skeptic arguments are faulty using logical, factually accurate language, could be beneficial.

Admittedly, such an approach may introduce unnecessary confusion for the cursory web searcher with little background knowledge, so the more straightforward flyers and public service announcements still have their place. Additionally, if public health institutions are to be held responsible for creating these rebuttals, then practicality dictates that they could only exist as static Web 1.0 content, which runs contrary to my overall argument for the importance of dynamic conversation. However, such static information sheets could act as “FAQ” sections, which blur the line between Web 1.0 style unidirectional information transmission and Web 2.0 style multi-party interactions by acting as a static response to arguments made by multiple voices from the public. They act to “further the conversation” just as reviews and press articles did with

Vaxxed. Consequently, the idea still holds merit because these resources could address potential new vaccine skeptics who have stumbled upon seemingly reasonable arguments against vaccination, yet still generally trust the authority of public health agencies enough to seek counter-arguments from these sources.

Ultimately, all of these measures work by contextualizing the vaccine skeptic enlightenment narrative in a vaccine proponent enlightenment narrative. The first two act to better ascertain the existing beliefs held by existing vaccine skeptics, and the third attempts to aggregate these concerns to inform more effective responses. While information alone cannot eliminate vaccine hesitancy, it can nevertheless aid in bridging the gap between vaccine skeptic and vaccine advocate evaluations of vaccine safety. Thus, they work to address vaccine skeptic concerns about vaccine risk.

Unfortunately, more fundamental ideas about the corruption of institutions and autism as a serious disability are harder to change. However, they are not impossible slowly erode over time. According to a recent social media study,

[Engaging] in cross-cutting political discussion [or discussion between individuals

who disagree] has a strong deliberation effect such that [people] are significantly

more likely to change their original views and get more involved in the issue of

discussion than those who are not engaged in cross-cutting discussion. (Lee and

Myers 94)

As such, repeated exposure to arguments about the trustworthiness of institutions, or at least the people who speak on behalf of these institutions, may work to slowly chip away at even strongly held convictions about conspiracy.

Additionally, negative attitudes about autism be addressed by a greater inclusion of autistic voices in popular media and press articles, since this analysis has revealed their notable absence on both platforms. Disabilities scholar Thomas Couser argues that “the very existence of first-person narratives makes its own point: that people with condition X are capable of self- representation,” ultimately allowing autistic narratives to act as “quality-of-life writing” (605). In other words, stories of positive autistic experiences evidence how fulfilling their lives can be. In this spirit, sharing testimonies of autistic people as whole, dynamic individuals who tell their own stories may reduce the pervasive fears surrounding the condition.

To conclude, let us realistically consider the potential impact of these measures. Can public health officials issue an official treatise that compels layperson vaccine proponents to drop their barbed comments, hold out olive branches, and engage exclusively in respectful, productive discourse with vaccine skeptics in a show of empathy and willingness to meet their opposition halfway? Probably not. Policing the Internet, no matter how unintentionally damaging the remarks made by well-meaning vaccine advocates can be, is not only virtually impossible from a

77 logistical standpoint but also unlikely to successfully de-escalate concerns about corruption within healthcare institutions to consolidate their authority. At the same time, will these efforts mean less to hardcore vaccine skeptics if they come from institutions like the CDC and other major public health organizations? Based on observed distrust toward such groups, most likely yes.

However, the vaccine conversation is more than just an exchange between dedicated vaccine proponents and skeptics. It is a performance that is observed by multitudes of parents who, per trends of consumerist healthcare behaviors, are turning to official and lay-generated web sources alike to inform their health behaviors. As one lay vaccine advocate declares,

[Efforts to argue are] only pointless if the goal is to change the mind of the

conspiracy theorists. But I'm arguing for the people who might not know much about

it and might think the fraud that Wakefield continues to perpetrate has merit.

Everyone is susceptible to conspiracy theories to some point...I'm trying to save more

people from falling down the rabbit hole. (Glenza)

Even if there will always exist vaccine skeptics, successful attempts to counter the enlightenment narrative via Web 1.0, Web 2.0, and clinical approaches may nevertheless serve to prevent the spread of vaccine hesitancy. Improved discourse may not eradicate vaccine skepticism, but this thesis shows that when analyses of vaccine discourse are studied from different angles, such as by mapping the conversations and exchanges, the new insights generated can nevertheless inform recommendations for practical interventions. As long as such interventions help clarify misconceptions endorsed by vaccine skeptic narratives and counsel parents toward better-informed decisions to vaccinate, then the effort to counter vaccine hesitancy to reduce vaccine-preventable disease outbreaks will have taken yet another step forward.

REFERENCES

“About Us.” The Autism File. The Autism File, n.d., http://www.autismfile.com/about-us. Accessed 7 March 2018.

Albert, Michael R., Kristen G. Ostheimer, and Joel G. Breman. “The Last Smallpox Epidemic in Boston and the Vaccination Controversy, 1901–1903.” New England Journal of Medicine, vol. 344, no. 5, 2001, pp. 375-379.

Bell, Gavin. Building Social Web Applications: Establishing Community at the Heart of Your Site. O’Reilly Media, Inc., 2009. bellejarblog. “Vaccines Don’t Cause Autism, But That’s Not The Point. Stop Being Ableist.” The Belle Jar, 5 February 2015, https://bellejar.ca/2015/02/05/vaccines-dont-cause-autism- but-thats-not-the-point-stop-being-ableist/. Accessed 20 March 2018.

Belluck, Pam and Melena Ryzik. “Robert De Niro Defends Screening of Anti-Vaccine Film at Tribeca Festival.” The New York Times, 25 March 2016, pp. A11.

Bitzer, Lloyd F. “The Rhetorical Situation.” Philosophy and Rhetoric, vol. 1, no. 1, 1968, pp. 1- 14.

Boseley, Sarah. “Andrew Wakefield Struck Off Register by General Medical Council.” The Guardian, 24 May 2010, https://www.theguardian.com/society/2010/may/24/andrew- wakefield-struck-off-gmc. Accessed 7 March 2018.

Brewer, Noel T., Gretchen B. Chapman, Alexander J. Rothman, Julie Leask, and Allison Kempe. “Understanding and Increasing Vaccination Behaviors: Putting Psychology into Action.” Forthcoming, pp. 1-150.

Brewer, Noel T., Sami L. Gottlieb, Paul L. Reiter, Annie-Laurie McRee, Nicole Liddon, Lauri Markowitz, and Jennifer S. Smith. “Longitudinal Predictors of HPV Vaccine Initiation among Adolescent Girls in a High-Risk Geographic Area.” Sexually Transmitted Diseases, vol. 38, no. 3, 2011, pp. 197-204.

Brodwin, Erin. “A 'Boutique' Film Company Is Debuting the Anti-Vaccine Film Yanked From Tribeca's Line-Up, and They're Starting in New York on April Fool's.” Business Insider, 30 March 2016, http://www.businessinsider.com/angelika-is-showing-vaxxed- documentary-that-tribeca-yanked-from-its-lineup-2016-3. Accessed 7 March 2018.

Burke, Kenneth. A Grammar of Motives. University of California Press, 1945.

Burke, Kenneth. A Rhetoric of Motives. University of California Press, 1969.

Burke, Kenneth. Counter-Statement. University of California Press, 1968.

Burke, Kenneth. Language As Symbolic Action: Essays on Life, Literature, and Method. University of California Press, 1966.

Cha, Ariana Eunjung. “7 Things About Vaccines and Autism that the Movie ‘Vaxxed’ Won’t Tell You.” The Washington Post, 25 May 2016, https://www.washingtonpost.com/news/to- your-health/wp/2016/05/25/7-things-about-vaccines-and-autism-that-the-movie-vaxxed- wont-tell-you/. Accessed 7 March 2018.

Couser, Thomas. “Disability, Life Narrative, and Representation.” Proceedings of the Modern Language Association, vol. 120, no. 2, 2005, pp. 602-606.

Deer, Brian. “Revealed: MMR Research Scandal.” The Times, 22 February 2004, https://www.thetimes.co.uk/article/revealed-mmr-research-scandal-7ncfntn8mjq. Accessed 7 March 2018. de Graaf, Anneke, Hans Hoeken, José Sanders, and Johannes W. J. Beentjes. "Identification as a Mechanism of Narrative Persuasion." Communications Research, vol. 39, no. 6, 2012, pp. 802-823.

DeStefano, Frank, Tanya Karapurkar Bhasin, William W. Thompson, Marshalyn Yeargin- Allsopp, Coleen Boyle. “Age at First Measles-Mumps-Rubella Vaccination in Children With Autism and School-Matched Control Subjects: A Population-Based Study in Metropolitan Atlanta.” Pediatrics, vol. 113, no. 2, 2004, pp. 259-266.

DiResta, Renee and Gilad Lotan. “Anti-Vaxxers Are Using Twitter to Manipulate a Vaccine Bill.” Wired, 8 June 2015, https://www.wired.com/2015/06/antivaxxers-influencing-legislation/. Accessed 7 March 2018.

Dubé, Eve, Caroline Laberge, Maryse Guay, Paul Bramadat, Réal Roy, and Julie A. Bittinger. “Vaccine Hesitancy: An Overview.” Human Vaccines & Immunotherapeutics, vol. 9, no. 8, pp. 1763-1773.

Dubé, Eve, Maryline Vivion, and Noni E. MacDonald. "Vaccine Hesitancy, Vaccine Refusal and the Anti-Vaccine Movement: Influence, Impact and Implications." Expert Review of Vaccines, vol. 14, no. 1, 2014, pp. 99-117.

Dyer, Owen. "Measles Outbreak in Somali American Community Follows Anti-Vaccine Talks." The BMJ, vol. 357, 2017, pp. j2378.

Edwards, Kathryn M., Jesse M. Hackell, The Committee on Infectious Diseases, and The Committee on Practice and Ambulatory Medicine. "Countering Vaccine Hesitancy." Pediatrics, vol. 138, no. 3, 2016, pp. e1-e14.

Fenichel, Gerald M. "The Pertussis Vaccine Controversy: The Danger of Case Reports." Jama Neurology, vol. 40, no. 4, 1983, pp. 193-194.

Gervais, Bryan T. “Incivility Online: Affective and Behavioral Reactions to Uncivil Political Posts in a Web-based Experiment.” Journal of Information Technology & Politics, vol. 2, pp. 167-185.

Goodman, Stephanie. “Robert De Niro Pulls Anti-Vaccine Documentary From Tribeca Film Festival.” The New York Times, 26 March 2016, pp. A17.

Guiguzi. Guiguzi, China’s First Treatise on Rhetoric. Translated by Hui Wu, Southern Illinois University Press, 2016.

Hooker, Brian S. “Dr. Brian Hooker’s official statement regarding William Thompson.” Focus for Health, 26 April 2016, https://www.focusforhealth.org/dr-brian-hooker-statement- william-thompson/. Accessed 7 March 2018.

“Important Milestones: Your Child By Eighteen Months.” Centers for Disease Control and Prevention. U.S. Department of Health & Human Services, 3 October 2017, https://www.cdc.gov/ncbddd/actearly/milestones/milestones-18mo.html. Accessed 7 March 2018.

Institute of Medicine. Immunization Safety Review: Vaccines and Autism. The National Academies Press, 2004.

Jameson, Fredric R. The Geopolitical Aesthetic: Cinema and Space in the World System. Indiana University Press, 1995, Bloomington, IN.

Kata, Anna. "A postmodern Pandora's box: Anti-vaccination misinformation on the Internet." Vaccine, vol. 28, no. 7, 2010, 1709-1716.

Kohn, Eric. “‘Vaxxed: From Cover-Up to Catastrophe’ is Designed to Trick You (Review).” IndieWire, 1 April 2016, http://www.indiewire.com/2016/04/vaxxed-from-cover-up-to- catastrophe-is-designed-to-trick-you-review-21896/. Accessed 7 March 2018.

Korownyk, Christina, Michael R. Kolber, James McCormack, Vanessa Lam, Kate Overbo, Candra Cotton, Caitlin Finley, Ricky D. Turgeon, Scott Garrison, Adrienne J. Lindblad, Hoan Linh Banh, Denise Campbell-Scherer, Ben Vandermeer, and G. Michael Allan. “Televised medical talk shows—what they recommend and the evidence to support their recommendations: a prospective observational study.” The BMJ, vol. 349, 349, pp. g7346.

LaRussa, Philip. Interview by Glenza, Jessica. “Vaxxed: An Expert View on Controversial Film about Vaccines and Autism.” The Guardian, 2 April 2016, https://www.theguardian.com/ film/2016/apr/02/vaxxed-film-scientist-interview-vaccines-autism. Accessed 7 March 2018.

Leask, Julie, Paul Kinnersley, Cath Jackson, Francine Cheater, Helen Bedford, and Greg Rowles. "Communicating with parents about vaccination: a framework for health professionals." BMC Pediatrics, vol. 12, 2012, pp. 154.

Lee, Jayeon and Teresa A. Myers. “Can Social Media Change Your Mind? SNS Use, Cross- cutting Exposure and Discussion, and Political View Change.” Social Media Studies, vol. 2, no. 2, 2016, pp. 87-97.

Lo, Nathan C. and Peter J. Hotez. "Public Health and Economic Consequences of Vaccine Hesitancy for Measles in the United States." JAMA Pediatrics, vol. 171, no. 9, 2017, pp. 887-892.

Lynch, Paul S. The Development of the British Conspiracy Thriller 1980-1990. Diss. University of Hertfordshire, 2017. Web. Accessed 12 March 2018.

Mazzocco, Philip J., Melanie C. Green, Jo A. Sasota, and Norman W. Jones. "This Story Is Not for Everyone: Transportability and Narrative Persuasion." Social Psychological and Personality Science, vol. 1, no. 4, 2010, pp. 361-368.

McCarthy, Jenny. “Jenny McCarthy: “We’re Not An Anti-Vaccine Movement … We’re Pro-Safe Vaccine.”” Frontline, 23 March 2015, https://www.pbs.org/wgbh/frontline/article/jenny- mccarthy-were-not-an-anti-vaccine-movement-were-pro-safe-vaccine/. Accessed 15 March 2018.

McNary, Dave. “Controversial Anti-Vaccination Documentary Gets Release From Cinema Libre (EXCLUSIVE).” Variety, 29 March 2016, http://variety.com/2016/film/news/vaxxed- anti-vaccine-documentary-cinema-libre-1201741603/. Accessed 7 March 2018.

McNeil, Donald G., Jr. "Measles Cases in Europe Quadrupled in 2017." The New York Times, 23 February 2018, pp. D3.

Mitra, Tanushree, Scott Counts, and James W. Pennebaker. "Understanding Anti-Vaccination Attitudes in Social Media." Proceedings of the Tenth International AAAI Conference on Web and Social Media, 2016, pp. 269-278.

Mnookin, Seth. Interview with Gwen Ifill. PBS Newshour. PBS. WUNC-TV, Chapel Hill, NC. 2 February 2015.

Mullen, Brian and Li-Tze Hu. “Perceptions of Ingroup and Outgroup Variability: A Meta- Analytic Integration.” Basic and Applied Social Psychology, vol. 10, no. 3, 1989, pp. 233-252.

Murdock, Bennet B., Jr. “The Serial Position Effect of Free Recall.” Journal of Experimental Psychology, vol. 64, no. 5, 1962, pp. 482-488.

Offit, Paul. “Anti-Vaccine Doc 'Vaxxed': A Doctor's Film Review.” The Hollywood Reporter, 11 April 2016, https://www.hollywoodreporter.com/news/anti-vaccine-doc-vaxxed-a- 882651. Accessed 7 March 2018.

Oliver, Mike. “The Social Model of Disability: Thirty Years On.” Disability and Society, vol. 28, no. 7, 2013, pp. 1024-1026.

“Omnidisciplinary Scientist.” TVTropes. TVTropes, 2018. Accessed 13 March 2018.

“Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger, United States, 2018.” Centers for Disease Control and Prevention. U.S. Department of Health & Human Services, 2 March 2018, https://www.cdc.gov/ vaccines/schedules/hcp/child-adolescent.html. Accessed 7 March 2018.

Robbins, Rebecca. “Meet the Uber Driver on a Mission to Troll the ‘Vaxxed’ Anti-Vaccine Road Trip.” STAT, 5 September 2017, https://www.statnews.com/2017/09/05/vaxxed-protests- road-trip/. Accessed 13 March 2018.

Ryzik, Melena. “Anti-Vaccine Film, Pulled From Tribeca Film Festival, Draws Crowd at Showing.” The New York Times, 1 April 2016, pp. A14.

Ryzik, Melena. “Pulled From Festival, Anti-Vaccination Film Will Run in Theater.” The New York Times, 30 March 2016, pp. C3.

Sadaf, Alina, Jennifer L. Richards, Jason Glanz, Daniel A. Salmon, and Saad B. Omer. "A Systematic Review of Interventions for Reducing Parental Vaccine Refusal and Vaccine Hesitancy." Vaccine, vol. 31, no. 40, 2013, pp. 4293-4304.

Siegel, Tatiana. “Controversial Anti-Vaccine Doc 'Vaxxed' Gets Secret Cannes Screening.” The Hollywood Reporter, 21 May 2017, https://www.hollywoodreporter.com/news/ controversial-anti-vaccine-doc-vaxxed-gets-secret-cannes-screening-1006018. Accessed 7 March 2018.

Smets, Kaat and Pierangelo Iserna. “The Role of Deliberation in Attitude Change: An Empirical Assessment of Three Theoretical Mechanisms.” European Union Politics, vol. 15, no. 3, 2014, pp. 389-409.

Smith, Martin H. "National Childhood Vaccine Injury Compensation Act." Pediatrics, vol. 82, no. 2, 1988, pp. 264-269.

Stern, Alexandra Minna and Howard Markel. "The History Of Vaccines And Immunization: Familiar Patterns, New Challenges." Health Affairs, vol. 24, no. 3, 2005, pp. 611-621.

Sunstein, Cass R. and Adrian Vermeule. “Conspiracy Theories: Causes and Cures.” Journal of Political Philosophy, vol. 17, no. 2, 2009, pp. 202-227.

Tarkan, Laurie. “Why Robert De Niro Promoted -- then Pulled -- Anti-Vaccine Documentary.” Fortune, 29 March 2016, http://fortune.com/2016/03/29/robert-de-niro-anti-vaccine- documentary/. Accessed 7 March 2018.

"troll." Merriam-Webster.com. Merriam-Webster, 2018. Accessed 7 March 2018.

Vaxxed: From Cover-Up to Catastrophe. Directed by Andrew J. Wakefield, Produced by Del Bigtree, Performance by Polly Tommey, Mark Blaxill, Michaela Blaxill, Francesco Lupica, and Brian Burrowes, Cinema Libre, 2016.

Wakefield, A.J., S.H. Murch, A. Anthony, J. Linnell, D.M. Casson, M. Malik, M. Berelowitz, A.P. Dhillon, M.A. Thomson, P. Harvey, A. Valentine, S.E. Davies, and J.A. Walker- Smith. "RETRACTED: Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children." Lancet, vol. 531, no. 9103, 1998, pp. 637- 641.

Wells, Jamie. "AAP Policy On Vaccine Hesitancy Glosses Over Real World Solutions." American Council on Science and Health, 31 August 2016, https://www.acsh.org/ news/2016/08/31/aap-policy-vaccine-hesitancy-glosses-over-real-world-solutions-9944. Accessed 7 March 2018.

Willingham, Emily. "Donald Trump Will Be a Disaster for Autistic People." Forbes, 12 January 2017, https://www.forbes.com/sites/emilywillingham/2017/01/12/donald-trump-is- waging-a-war-against-autistic-people/#ee681151c827. Accessed 7 March 2018.

Wolfe, Robert M. and Lisa K. Sharp. "Anti-Vaccinationists Past and Present." The BMJ, vol. 325, no. 7361, 2002, 430-432.

Yergeau, Melanie. Authoring Autism: On Rhetoric and Neurological Queerness. Duke University Press, 2018.

Zaragoza, Maria S. and Sean M. Lane. “Source Misattributions and the Suggestibility of Eyewitness Memory.” Journal of Experimental Psychology: Learning, Memory and Cognition, vol. 20, no. 4, 1994, pp. 934-945.