Vaccine Narratives and Public Health: Investigating Criticisms of H1N1 Pandemic Vaccination

"Vaccine hesitancy is often understood and explored on the level of individual decision-making. However, questions surrounding the risk and efficacy of vaccination are evident in wider public discourse; social narratives of vaccination inform and impact on the individual level."

This commentary takes a narrative analysis approach from the sociology of health to examine data drawn from a wider study on global public health responses to the H1N1 pandemic, focusing on criticisms to mass vaccination as recounted within the Council of Europe's debate of the handling of H1N1. The author, Sudeepa Abeysinghe, explains that "vaccine hesitancy is often examined on the scale of individual decision-making, or through referring to questions of ethics and freedom of choice. However, when considering the problem of vaccine hesitancy, social scientists of medicine would note that the public discourse surrounding vaccines - the way in which vaccines are represented and publicly understood - forms another important piece of the puzzle....Individual 'choices' are produced in the context of narratives and public conversations about the efficacy and safety of vaccine use."

As is explained here, in December 2009, Council of Europe parliamentarian and epidemiologist Wolfgang Wodarg presented a recommendation to the Council of Europe entitled Faked Pandemics: A Threat to Public Health. Following subsequent months of debate, the Council of Europe passed a motion decrying the World Health Organization (WHO)'s public health reaction to H1N1. "Criticism of the H1N1 vaccine was central to these findings. Such contestations can have an important effect on the public discourse, for example through media attention and public discussion of vaccination."

The commentary utilises data gleaned from the textual analysis of expert testimony, parliamentary debates, parliamentary reports, and documents produced by the Council of Europe during their examination of the WHO's management of the H1N1 Pandemic, focussing on statements concerning the use or misuse of vaccines in combating H1N1.

Abeysinghe finds that 3 narratives were particularly dominant in the ways in which vaccines were discussed and criticised: problematising the use of vaccination as a public health response; criticising the efficacy of the vaccines; and questioning the safety of the strategy. She notes that "Building trust, not just in terms of scientific objectivity but in terms of wider institutional structures, is...fundamental to perceptions surrounding vaccination." Furthermore, "In the case of H1N1, it was suggested that vaccines were a costly and ineffective strategy against the pandemic. This uptake of narratives serves to minimise the 'benefit' aspect of the risk-to-benefit estimate that is central to estimations of the utility of vaccination." Abeysinghe observes that "[c]ounter-vaccination movements are particularly prone to discourses of risk and uncertainty - vaccines are characterised as unsafe due to the risks of severe or lasting medical consequences."

She concludes that the Council of Europe's criticisms of the use of vaccines during the H1N1 pandemic "reflect many dominant discourses - lay understandings of vaccination and public representations of vaccination - that may inform vaccine hesitancy. Contestations such as this one, and the ways in which such debates are subsequently picked up by the media, have the potential to significantly shape the public discourse. Simultaneously, this debate mirrors and mobilises common sentiments surrounding vaccines."