Immunization and media coverage in Italy: an eleven-year analysis (2007-17)

ABSTRACT

Immunization polices in Italy has recently reached important milestones, including the approval of the National Immunization Prevention Plan and of a new law mandatory immunization; this stimulating a lively debate at the scientific, political and societal-level, reflected on the media. We applied a model previously published to quantitatively and qualitatively assess media coverage on vaccines and immunization-related topics on the most read Italian newspaper, “Corriere della Sera”, over an 11-year study period (2007-2017). We retrieved relevant key words and articles, reported on included articles’ topic, position, approach to immunization and on other selected indicators’ summary statistics, temporal trends and correspondence with key epidemiological and policy events. Over the study period the quote “vaccin*” was mentioned on average 325 times per year; with an increase of 150% after the approval of the new law on mandatory immunization in 2017. In the same year, on average, two first-page articles per week were published on the topic. We report a clear association between key events (i.e the H1N1 influenza pandemic, the “Fluad case”, the approval of the new law on mandatory immunization) and their media coverage. Overall, 84% of articles had a positive attitude towards immunization, this share decreasing to 79% when only considering articles published after the approval of the law on mandatory vaccination. Media play a crucial role in channelling health-related information and significantly influence health behaviours. We urge public institutions, health authorities and the scientific community not to underestimate the opportunity to monitor media coverage on key healthcare topics and to convey evidence-based health education messages through the media.

Introduction

Media play a crucial role in channelling health-related information and significantly influence health behaviours.^1,2 A considerable body of literature quantitatively and qualitatively explored health-related content delivered by media, over time,³ in relation to specific events,⁴ on selected health topics⁵ and assessed its association to knowledge, attitude and practices of care and prevention.⁶

The advent of new media, intended as means of mass communication developed at the time of the web, have drastically modified the way the general population look for, get access to, share and perceive health information.⁷ Nevertheless, traditional media such as national newspapers and television still play a crucial role in addressing health topics, even more so when they make headlines⁸ or are dealt with at the political level.⁹

We have previously developed a news media monitoring model for public health and applied it to case of vaccines¹⁰; in particular we have analytically reported on media coverage of the “Fluad case”^4,11 when in 2014 three deaths were blamed to be associated with influenza Fluad vaccine, this gathering large attention from the media and negative impact on influenza vaccine uptake.

The debate around vaccines and immunization polices has grown in Italy over the last five years. In particular, the growing phenomenon of the vaccine hesitancy,^12,13 the alarming decrease in coverage rates,^14,15 and the action taken by health authorities to contrast such trends, including the implementation of the new National Immunization Prevention Plan⁹" and the approval of a new law on mandatory vaccination^16,17 enhanced lively discussion both within the scientific community^9,18-21 and at the political and societal level.

In this context and building on previous work aim of the current study is to retrospectively analyse a 11-year period of newspaper media coverage on vaccines, reporting on temporal trends, content, form and other previously identified indicators⁴ likely to influence audience understanding, perception and ultimately behaviours towards vaccines.

We retrospectively monitored the reporting on vaccine-related topics, on all published issues of the most read Italian newspaper, “Corriere della Sera” (Corriere). In particular, specific objectives were: i) to quantitatively and qualitative analyse the media coverage of vaccine-related topics in absolute terms and in relation to key events, and ii) to classify the different articles’ approach towards immunization into favourable and neutral vs. hesitant and contrary, this applying a previously published media monitoring model.⁴

We considered a 11-year study period, from 1st January 2007 to 31st December 2017, for which we retrospectively retrieved all published Corriere issues (full digital version in portable document format).

Results

Between 2007 and 2017 the quote “vaccin*” was retrieved 3,570 times on Corriere, with an average of 325 times per year. No relevant trends over time were reported except for the last two years (2016-2017) which together accounted for 31% of total quotes (Fig. 1). In 2017, when the law on mandatory immunization was discussed and later approved, there was the highest number of quotes (n = 812), followed by 2009, the year of influenza A H1N1 pandemic. (n = 557 quotes). In 2014, when the “Fluad case” occurred, we report an annual increase in “vaccine*” quotes of 120%, as compared to the year before. Overall, we observe a clear association between the considered key events and their media coverage (Fig. 1).

Figure 1.

. Number of quotes “vaccin*” over time (2007-2017).

With regard to the sub-study period 2014–2017 we used single articles as our unit of analysis and we explored their characteristics and content by semester (Table 1). Overall, 635 articles on vaccine-related topics were published over the study period, with an average of 212 per year. The highest number of articles were published in 2017 (n = 436, this corresponding to 69% of all retrieved articles).

Table 1.

Distribution of vaccine-related articles, by semester and selected covariates of interest (2015-2017).

	Jan-Jun 2015		Jul-Dec 2015		Jan-Jun 2016		Jul-Dec 2016		Jan-Jun 2017		Jul-Dec 2017
	N	%	N	%	N	%	N	%	N	%	N	%
Total articles	35		60		33		71		221		215
Front page article	5	14,3	10	16,7	5	15,2	23	32,4	62	28,1	56	26,1
APPROACH TO IMMUNIZATION
Favorable/neutral	31	88,6	53	88,3	28	84,9	69	97,2	193	87,3	171	79,5
Hesitant/contrary	4	11,4	7	11,7	5	15,2	2	2,8	28	12,7	44	20,5
TOPICS
Influenza vaccine	12	34,3	12	20,0	4	12,1	9	12,7	6	2,7	11	5,1
Other specific vaccines	6	17,1	10	16,7	5	15,2	31	43,7	53	24,0	33	15,4
Policy: National Immunization Prevention Plan	5	14,3	15	25,0	6	18,2	7	9,9	21	9,5	9	4,2
Policy: Italian law on compulsory immunization	1	2,9	5	8,3	6	18,2	4	5,6	63	28,5	127	59,1
Immunization services	2	5,7	3	5,0	1	3,0	5	7,0	34	15,4	14	6,5
Other topics	9	25,7	15	25,0	11	33,3	15	21,1	44	19,9	21	9,8

We report a significant increase in first page articles (as percentage of total relevant articles, per semester) starting from the second semester of 2016 (32.4%) through the end of 2017 (28.1% and 26.1%). In fact, in this period – when the debate on mandatory immunization started and the law was eventually approved – nearly two times front page articles were published, as compared to previous years (2015-first semester 2016).

When focusing on articles’ approach to immunization, overall 86% of retrieved articles had a favorable or neutral approach to immunization but this distribution was not homogenous over time. In particular, we report an increase of articles having an hesitant approach to immunization in the second semester of 2017 (21%, as compared to 14% for the whole study period), this reflecting the debate around the approval of the law spreading at the political and societal level.

The distribution of articles’ specific topic is showed in table 1. Overall, most of articles focused on influenza and other specific vaccines (30%); however we report a relevant increase of articles focusing on immunization polices starting from 2016; indeed in the second semester of 2017 nearly 60% of articles focused on the recently approved law on mandatory immunization.

Discussion

We performed a media monitoring analysis to explore how the topic of vaccine and immunization policies has been dealt with in the news in the last eleven years. The relevance of this activity lays in the fact that media provides us with useful data on how the topic is perceived by the general population. This data can inform planning, implementation and evaluation of effective health promotion interventions, as well as influence general population's attitude and behaviour towards immunization uptake.

The current study sits on a broader platform; in fact, as representatives of the Italian public health community, we have extensively worked in recent years to support and inform immunization policies in Italy: systematically pooling data on different immunization programmes,²² monitoring regional and national-level vaccine coverage,^14,15 contrasting misinformation,¹⁹ and assessing the impact and potential of different communication tools and strategies.^23,24 As we report, political commitment to promote immunization has increased in recent years in Italy⁹ that has been reflected in media communication around vaccines on the popular press. As we demonstrate, in 2017 two first-page articles per week on average were published on the Corriere dealing with vaccines and immunization, underlining how the topic made headlines. Not only immunization has been the most discussed healthcare topic in 2017, but also it got high in the political and societal debate.²⁵ Interestingly enough, the distribution of relevant articles’ approach towards immunization changed over time.²⁵ The highest proportion of articles sceptical towards vaccine has been published after the approval of new law on mandatory immunization; however this has to be interpreted with caution as the majority of these articles reported or commented on criticisms to the legitimacy and usefulness of making immunization mandatory, rather than on criticisms to vaccines’ benefits or safety. Limitations include only having considered only one newspaper. However, the “Corriere della Sera” is the newspaper ranking first in readership in Italy (with a print run of 400,697 copies per day) and reaches a large and representative sample of the Italian population.²⁶

Similar media coverage analysis on vaccines have been carried out in other countries; in the UK researchers analysed the link between HPV and oral cancer in print and online newspaper coverage concluding that it is important not only to monitor media coverage, but also to work with journalists to ensure the content of articles is accurate and to influence health behaviours.²⁷ In Japan it was reported negative impact on vaccination acceptance when an important newspaper published the case of a high school student who suffered from adverse effects after HPV vaccination.² In Nigeria the association between press release content and Polio vaccine acceptance has been assessed; since the creation of the JAP (Journalists Initiatives on Immunisation Against Polio) in 2007, more than 500 reports have been published with consequent improvements in the acceptance of polio vaccine in northern Nigeria.²⁸

Immunization polices in Italy have been actively changing since 2015 reaching important milestones, including the National Immunization Prevention Plan⁹ and the new law on mandatory immunization.¹⁶ This process has been accompanied by a lively political and societal-level debate on the issue which has been reflected in large media coverage and general population access to correct and evidence-based information. How the new law has impacted on people knowledge attitudes and practice of immunization needs to be assessed with appropriate research in the near future. Meanwhile, we urge public institutions, health authorities and representatives of the scientific community not to underestimate the opportunity to monitor media coverage on key healthcare topics and to convey health education messages through the media.

Materials and methods

Each Corriere issue was screened to retrieve articles focusing on vaccines-related topics. The screening was independently conducted by two authors in an blinded manner, using the quote «vaccin*» as keyword. In case of disagreement between reviewers a third senior author was asked to give advice. Relevant data were selected using a pre-defined data extraction spread-sheet. The data extraction spreadsheet was piloted on all December 2017 Corriere issues’ retrieved articles and modified accordingly.

We considered two study periods:

• ·1^st January 2007–31^st December 2017 (11 years, Sp1)
• ·1^st January 2015–31^st December 2017 (3 years, Sp2)

For Sp1 we reported temporal trends of citations of the quote «vaccin*» and their association with three key events that occurred during the study period:

• 1.The pandemic influenza A H1N1 (April 2009-August 2010)^29,30
• 2.The « Fluad case» (November-December 2014)^4,11
• 3.The adoption of the new Italian law on mandatory vaccination (5thAugust 2017)^16,17

For Sp2 we reported on:

• ·Average number of published articles per month;
• ·Specific topic of the article differentiating between articles focusing on immunization polices, services and specific programmes (influenza and other vaccines), using six different categories (Table 1);
• ·Location and visibility of the article (i.e. front page, specific sections of the newspaper);
• ·Overall approach of the article, using two different categories – i) Neutral/ Favorable approach towards vaccines; ii) Hesitant /contrary approach towards vaccines.

Descriptive and analytic analysis was performed using Microsoft Excel software for Windows.

Disclosure of potential conflicts of interest

No potential conflicts of interest were disclosed.