The European Journal of Public Health, Vol. 26, No. 4, 533–534 ß The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved...... Viewpoints ......

What are we told? A news media monitoring model for public health and the case of vaccines

How can we, the public health community, together with national screened by a priori selected key words. Details on the and international health authorities make sure effective health and complete list of selected indicators are available elsewhere.3 education messages reach the general population? We propose a news media monitoring model for public health and a of The case of immunization-related content in indicators that can be used to quantitatively assess health Downloaded from https://academic.oup.com/eurpub/article/26/4/533/2467322 by guest on 29 September 2021 education and communication messages delivered through news the media media. We piloted it to the case of vaccines on 1-year issues (n = 366) of the most read Italian newspaper. As done in We applied our set of indicators to immunization-related content marketing strategies, media monitoring is a valuable tool to retrieved from the media. inform health promotion interventions and communication During the study period, Italian words for ‘vaccine/s’ and strategies. synonyms were retrieved around 500 times, November being the period with the highest media coverage (23%), with progressive decline towards spring 2015 (March, April and May). Among News media play a crucial role in channelling relevant articles retrieved for the analysis >60% focused on a health-related specific vaccine (Influenza, HPV, measles and meningococcal vaccines ranking first), 16% focused on vaccines in general and Media play a crucial role in channelling health-related information: 23% approached health issues with mention to vaccines and they are powerful tools to deliver health education and promote immunization. disease prevention. However, if misused or exploited, they can On average, we estimate that around six articles per month are negatively influence general population’s health attitudes and published on vaccines and immunization and 3.5 articles/month behaviours. In previous work we reported on the detrimental when only considering those focusing on seasonal influenza. With impact that messages delivered through news media had on regard to articles’ approach towards immunization—although vaccine uptake in the last influenza season in Italy.1 Despite being around 70% have a positive approach and 23% a neutral/descriptive among the most effective primary prevention tools ever invented, approach—no less than 7% have a critical/negative approach vaccines are ‘victims of their own success’ and have recently towards immunization, some of them even reporting alarming lost public confidence. The World Health Organization has titles such as ‘deadly vaccines’ and ‘killer vaccines’. We calculated recently warned against the growing phenomenon of the ‘vaccine the median length of retrieved articles (around 450 words), noting hesitancy’ identifying effective communication as key tool to dispel its picking for selected months (November) and specific vaccines fears, address concerns and promote acceptance of vaccination.2 (influenza and HPV). The majority of articles are placed in the How can we—the public health community—together with national Health series section of the newspaper; however, three articles got and international health authorities make sure effective health the front page over the study period. Of particular note: only 26% of education messages reach the general population? total retrieved articles report official statements or data released by health authorities and institutions. When focusing on influenza-related content, e.g., we report little A news media monitoring model for public presence of positive messages promoting immunization at the start health of the flu immunization campaign; on the contrary, a relatively high number of articles, longer than the average, placed in the main As it has recently been reported by experts ‘for any communication sections of the newspapers (including the front page) and approach to be successful, it is critical that it is grounded not only in reporting alarming messages on the side effects of vaccines were theory but also in social data’.2 In this context, our aim is to propose published when two deaths were claimed to be associated with flu a ‘news media monitoring model’ for public health and to build a shot administration and before the Italian Institute of Health’s set of indicators that can be used to quantitatively assess health announcement that there was no evidence of causal association.1,3 education and communication messages delivered to the general population through news media. To explore the applicability and validity of the model and its indicators, we piloted them to monitor Need for a methodical and proactive the news media coverage of immunization-related topics on the communication strategy to respond to most read Italian newspaper, ‘Il Corriere della Sera’, over a 1-year misinformation study period.3 We a priori built a list of indicators to assess health-related We propose a news media monitoring model for public health, and content published on news media in terms of: (i) exposure/ we build a list of indicators that allow to quantitatively assess the visibility, (ii) relevance, (iii) approach and attitudes towards health public health content published on the popular press. If—as it has and prevention as well as (iv) presence of messages delivered by been recently reported in the scientific literature—social and health authorities and institutions. Indicators were selected during commercial marketing principles and strategies can be effectively focus groups with professional media monitoring consultants. We applied to promote health—detailed media monitoring data are to applied them to 1-year issues of the newspaper Il Corriere della Sera be systematically retrieved and analysed in order to plan, implement, (n = 366 issues, published between 15 May 2014 and 15 May 2015), monitor and evaluate health promotion interventions. The model it being the Italian newspaper ranking first in readership with an and indicators we developed could provide the technical support to average, 400 000 hard copies sold per day. Each newspaper issue was this process. 534 European Journal of Public Health

The WHO Strategic Advisory Group of Experts on Immunization a validated media monitoring model for public health. We suggest it recognized the need for a methodical and proactive communication could be ‘prospectively’ applied to relevant public health issues and strategy to respond to misinformation and anti-immunization used as a technical support tool for public institutions, health activities.2 When we apply our model and indicators to immuniza- authorities and representatives of the scientific community in a tion-related content published in the Italian press over a year time, strengthened effort to convey health education messages through we report that the amount and relevance of contents follow a media.6 seasonal trend. The example we describe on influenza vaccine show to which extent news media content can further widen the References discrepancy between scientific evidence and the population’s perception of risk. 1 Signorelli C, Odone A, Conversano M, Bonanni P. Deaths after Fluad flu vaccine Most importantly, we report that when immunization and the epidemic of in Italy. BMJ 2015;350:h116 programmes are mentioned in the press, less than one-third of 2 Goldstein S, MacDonald NE, Guirguis S. Health communication and vaccine times reference is made to national and international authorities’ hesitancy. Vaccine 2015;33:4212–4. positions and statements. As trust in vaccines and immunization is 3 Odone A, Chiesa V, Ciorba V, et al. Influenza and immunization: a quantitative 2 being increasingly undermined and anti-vaccination movements study of media coverage in the season of the Fluad case. Epidemiol Prev Downloaded from https://academic.oup.com/eurpub/article/26/4/533/2467322 by guest on 29 September 2021 capitalize the potential offered by the new means of communication, 2015;39:139–45. public institutions and scientific societies are called to confront such 4 Odone A, Ferrari A, Spagnoli F, et al. Effectiveness of interventions that apply new a growing public health concern and their positions should have media to improve vaccine uptake and vaccine coverage. Hum Vaccin Immunother higher media prominence. 2015;11:72–82. Few other studies carried out media monitoring analysis on 5 Fast I, Sorensen K, Brand H, Suggs LS. Social media for public health: an explora- selected relevant public health issues in different settings. Their tory policy analysis. Eur J Public Health 2015;25:162–6. models as well as ours had some limitations and could be further 6 Odone A, Fara GM, Giammaco G, et al. The future of immunization policies in Italy improved. For example it could be extended to assess other types of 4,5 and in the European Union: the Declaration of Erice. Hum Vaccin Immunother media, including social media. In addition, it could be further 2015;11:1268–71. developed by piloting it in other countries and on other fields of public health. Most importantly, it would be more informative if A. Odone1, and C. Signorelli1,2 applied to a control topic (both health-related topics and/or topics 1 Unit of Public Health. Department of Biomedical, Biotechnological and of general interest) in order to make meaningful comparisons. Translational Sciences. University of Parma, Parma, Italy, 2 School of Medicine, Universita´ Vita-Salute San Raffaele, Milan, Italy We call upon other research groups Correspondence: Anna Odone, Unita` di Sanita` Pubblica, Dipartimento di As the international scientific community recognizes the need for a Scienze Biomediche, Biotecnologiche e Traslazionali, Universita` degli Studi methodical and proactive communication strategy to respond to di Parma, Via Volturno 39, 43125 Parma, Italy, Fax: +39 0521 903832; misinformation, we hope this brief report will stimulate a fruitful Tel: +39 0521 903795; e-mail: [email protected] debate on effective communication strategies in public health. In this context, we call upon other research groups to collaborate to develop doi:10.1093/eurpub/ckw002

...... The European Journal of Public Health, Vol. 26, No. 4, 534–535 ß The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved......

Media researchers must understand the audience too

The impact of the media is undeniable. Its capacity to influence two schools later thought to be a event. confidence in vaccination is no exception. There are stark The program withstood the media attention and Australia rapidly examples where mass media amplification of unsubstantiated reached high levels of three dose uptake.1 claims about vaccines has led to a downturn in vaccination Even with the UK’s and vaccination scare, MMR coverage coverage. The mass media played a crucial role in response to for children took 4 years to decline from the 91% prior to publica- Italy’s temporary suspension of an influenza vaccine, the United tion of the original article to 2003–04 when coverage hit a trough of Kingdom’s measles-mumps-rubella (MMR) scare, Nigeria’s polio 80%. A range of factors amplified its effect with the media’s role vaccine , the United States’ thimerosal concerns and being one, albeit important one. Japan’s suspending of proactive human papillomavirus (HPV) Audience studies provide further explanation for this non-linear vaccine recommendations for female adolescents. Now, social effect. When exposing mothers of infants to negative media messages media gives an unprecedented capacity to spread misinformation about vaccination, our research found that most mothers actively about vaccines. A single rumor can spread rapidly before it can be wrestled with them.2 Their resilient beliefs in vaccination were refuted, leaving clinicians and health officials struggling to know reinforced by recourse to their wish to protect their children from where or when to respond. feared infectious diseases. Anti-vaccination rhetoric contained in the Viewed through this bleak lens, it would be easy to assume that media prompts was most potent when it came from medical sources vaccination rates are declining in many countries caused by this and/or included stories and images of allegedly vaccine-damaged increased exposure to misinformation, which in turn causes a parent not to vaccinate. But the evidence does not bear out this children. To reassure themselves and each other, mothers recalled simple linear relationship. There are instances where countries images and stories of children affected by vaccine preventable emerge unscathed from a mass-mediated safety scare. In Australia, diseases. They also spoke of their relationships with health profes- e.g. the introduction of the HPV vaccine program in adolescent sionals, the advice of family and friends and scepticism about the females saw widespread publicity surrounding adverse events in media as a source of information.