Injecting Doubt: Responding to the Naturopathic Anti-Vaccination Rhetoric

"Why is it that some communities in North America...are now turning their backs on vaccines in numbers large enough to threaten herd immunity?"

In light of research showing that over 25% of Canadian parents are concerned or uncertain about the association between vaccines and autism, and that a similar percentage of parents worry that vaccines could cause serious harm to their children, the authors of this paper ask: What are the social forces contributing to this rise in vaccine hesitancy? Though acknowledging that hesitancy to vaccinate is a complex phenomenon, they hypothesise that complementary and alternative medicine (CAM) providers have played a role. Their hope is that an exploration of how naturopaths represent the risks and benefits of vaccination can inform policies to correct the spread of misinformation about vaccination.

The study examined websites of naturopathic clinics and practitioners in the provinces of British Columbia and Alberta, looking for: (i) the presence of discourse that may contribute to vaccine hesitancy, and (ii) recommendations for "alternatives" to vaccines or flu shots. Of the 330 naturopath websites they analysed, 53 had either vaccine-hesitant language, suggested a vaccine alternative, or had both. (Text examples of vaccine hesitancy discourse are provided in Table 1 of the paper, and text examples of vaccine or flu shot alternatives in Table 2.) These websites presented information along a continuum - from examples of websites subtly raising issues over vaccine safety and effectiveness to those featuring explicit anti-vaccination perspectives raising suspicions and fears. "Vaccination alternatives offered by these naturopathic websites [e.g., homeopathic prophylaxes] are, without exception, unproven or disproven, and reliance on these products in lieu of vaccines creates a false sense of immunity while exposing both the individual and the surrounding community to potential harm."

Using these data, the researchers explored the potential impact such statements could have on the phenomenon of vaccine hesitancy. For example, research has found that mere exposure to anti-vaccination rhetoric - whether in the form of conspiracy theories or falsely balanced stories in the media - can impact attitudes and can play a role in the intention to vaccinate. For those who are already hesitant or hold anti-vaccination views, the existence of anti-vaccination or vaccination-hesitant rhetoric on naturopathic websites could serve as a source of validation (this is called "confirmation bias"). Coupled with a fairly significant presence of anti-vaccination sentiment on the internet, a channel that more and more people turn to for health-related information, a social media environment continually confirming and supporting one's views might play a substantial role in not only reinforcing anti-vaccination perspectives but also in heightening skepticism among those with doubts.

Next, the researchers examine approaches for changing public representations. Some of the strategies they advance include:

• Tightening advertising law - "Health Canada and the Competition Bureau should adopt proactive enforcement methods that actively identify and eliminate false and misleading claims and practices, using successes in other jurisdictions as a template."
• Reducing CAM practitioners' ability to self-regulate - "[I]ncreased regulatory restrictions, a related reduction in powers of self-regulation, and third party oversight of disciplinary functions could all contribute to curbing the harmful representations made by naturopaths about vaccination."
• Improving enforcement of existing common and criminal law standards - For example, "if a naturopath wishes to recommend a homeopathic vaccine instead of a real vaccine, he or she has a legal obligation to disclose existing evidence (known to him/her) that the homeopathic vaccine does not work, and that there is a highly efficacious alternative in the form of a vaccine. Where a naturopath does not make these disclosures, he or she may be guilty of negligence."

The researchers caution against arriving at the conclusion that all CAM practitiners are antivaxx. However, they conclude that it is important to recognise the presence of significant anti-vaccination sentiment in these communities and to explore ways to tackle myths and behaviours that contribute to vaccine hesitancy.