BACKGROUND: In the United States, Western Europe and other areas, groups opposing universal childhood immunization are reported to be gaining political momentum.
METHODS: A review was done of Internet sites opposing childhood immunization, with the goal of describing the philosophies and strategies used by the groups presenting them. A random sample of antivaccination Web sites was obtained using standard Internet search engines and the search terms “vaccination” and “immunization.” These sites were analyzed for content, common themes, philosophy, affiliation with groups or organizations, and suggested strategies for avoiding vaccination.
RESULTS: Twenty-six of the 51 sites found were randomly selected for review. Fifteen of these were associated with groups promoting the use of alternative medicine for preventing or treating infectious disease. Groups concerned with civil liberties were also represented, as were conspiracy theorists.
CONCLUSIONS: Many groups have an interest in opposing universal childhood immunization, and some of them have a prominent presence on the Internet. Physicians and parents should be aware of the existence of these groups and their philosophies. Further research and educational efforts to counter their effects is necessary.
The first reported antivaccination groups formed in response to the vaccination acts that introduced compulsory immunization in 19th century England. At the time, a significant segment of public opinion opposed compulsory vaccination as an infringement on individual liberties and as interference with the will of God.
Among the most vocal groups in the movement to repeal the vaccination acts were practitioners and followers of natural and homeopathic therapies.1 Although the antivaccination groups were unsuccessful in repealing the acts, important concessions were achieved, including the right of exemption for individuals with philosophical objections to the procedure.
More recently, with major reductions in vaccine-preventable diseases and a decline in public knowledge about these illnesses, politically active antivaccination groups are gaining support, particularly in the United States and Western Europe.2 Beginning in the 1970s, antivaccination groups were successful in temporarily curtailing the use of pertussis vaccines in several industrialized countries, including Sweden, Japan, the United Kingdom, Italy, and Australia, resulting in significant public health consequences.3
One of the factors cited as contributing to the higher profile of antivaccination groups has been the increasing popularity of the Internet.2 For some parents, the Internet may be more accessible than specific literature or a health care professional. It has been estimated that 21% of the adults in the United States regularly access the Internet, and 42% of these individuals use the Internet to obtain medical information for themselves or their children.4 Some have called the problem of misleading or inaccurate information on the Internet a modern Pandora’s box.5
Methods
For this study, conducted from March 1999 through January 2000, Web sites were classified as being antivaccination if it expressed opposition to routine universal childhood vaccination for any reason. Web sites were found using standard search engines (Infoseek, Netscape, Lycos, and Excite) and the search terms “vaccination” and “immunization.” Links between Web pages were used to search for additional sites. Using this strategy, 51 antivaccination sites focusing primarily on routine childhood immunizations were identified. Four of the sites were excluded from the analysis because they were in a language other than English. Twenty-six of the remaining sites were chosen for closer study using a random number table. The sites were analyzed for content, common themes, philosophy, links, and strategies offered for avoiding routine immunization.
Results
From 2 to 5 of the first 10 “hits” from each search on each search engine were antivaccination sites ([Table 1]). The majority of the sites reviewed (16) were identified as belonging to groups in the United States. The others were in Australia (3), New Zealand (2), the United Kingdom (4), and Canada (1).
Fifteen of the 26 sites evaluated appear to be associated with groups or individuals practicing or promoting alternative medicine, as indicated by direct statements on the sites, promotion of alternative practices or products, or direct links to alternative medicine sites. Homeopathy and naturopathy were the alternative therapies most commonly cited, but others such as chiropractic and herbal medicine were also represented. At least 1 site6 is apparently operated by physicians.
All of the sites reviewed listed adverse effects due to immunization. The majority provided documented vaccine effects, and many claim chronic immunologic, psychiatric, or behavioral problems ranging from conditions such as Crohn’s disease to impulsive violence and attention deficit disorder. Several of the articles offer case histories of children who have died or been severely injured, presumably as a result of vaccination.
Several of the Web sites reviewed include speculation on reasons for the promotion of immunization by physicians and other health authorities. Theories include ignorance on the part of well-meaning physicians or the fear of exposure to legal or peer sanction for holding unconventional views. Some authors suggest that physicians purposely exaggerate the dangers of childhood illnesses to frighten parents into compliance. For example: “Doctors are known for using fear or pressure to get parents/guardians to vaccinate instead of giving them the chance to decide on their own after weighing the pros and cons.”7 Some sites suggest that pharmaceutical companies benefit from the illnesses brought about by their vaccines,8 and emphasis is placed on conflicts of interest that are said to exist between pharmaceutical companies, physicians, and the medical establishment.8-10 It is claimed that these conflicts result in physicians turning a blind eye to adverse reactions due to immunizations, nonreporting of adverse reactions to the Vaccine Adverse Effects Reporting System, and deliberate suppression of information regarding safe and effective alternatives to vaccination.