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. ii 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 iv 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 v 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). 1 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,