Complexity and Controversy in Media Coverage of Human Papillomavirus (HPV) Vaccination: A Qualitative Content Analysis of News Coverage in Denmark 2008-2018

"Learning from past media controversies remains important to understanding the media's role in the social construction of risks and benefits associated with vaccination."



Since the emergence of vaccination as a public health measure, issues such as safety, effectiveness, ethics, and politics of vaccination campaigns have been surrounded by persistent public debate. Some of that debate has played out in the news media, a common source of information about vaccines and potentially influence individual decisions to vaccinate or not. In Denmark, human papillomavirus (HPV) vaccination rates remained relatively high until suspected adverse reactions began to receive extensive coverage in the news. This paper presents the results of a qualitative content analysis of newspaper coverage, exploring how the Danish HPV controversy emerged in different contexts over time.



In Denmark, press freedom co-exists with strong state support for and regulation of the media market. Due to government subsidies, Denmark has a high number of national newspapers, which all publish in the Danish language and all focus on information provision along with democratic inclusion of all social groups in a mediated, political process of gaining consensus about important issues. Reporting on vaccination, the Danish media will be expected to hold those with power accountable and give voice to underrepresented voices, while also seeking to report on scientific information and scientific controversy.



The Danish HPV vaccination programme for girls aged 12-16 years began in January 2009, following a start-up programme that began in October 2008. From 2013 to 2015, across national news and social media platforms, many stories about vaccinated girls with symptoms normally associated with Postural Orthostatic Tachycardia Syndrome (POTS) and Complex Regional Pain Syndrome (CRPS) began to appear. In March 2015, the national broadcasting channel TV 2 produced and aired a documentary entitled "The Vaccinated Girls - Sick and Abandoned" (in Danish, "De vaccinerede piger - Syge og svigtede"). The reporting of adverse reactions increased rapidly, leading Denmark to request the European Medicines Agency (EMA) to reinvestigate the safety of HPV vaccines. EMA (2015) concluded that the evidence does not support a causal link between HPV vaccination and suspected adverse reactions.



This research focused on 6 national newspapers: Politiken (center-left, readership 498,000), Jyllands-Posten (right-wing liberal, readership 351,000), Berlingske Tidende (right-wing conservative, readership 299,000), Information (left-leaning, readership 171,000), B.T. (traditionally populist right-wing tabloid, readership 367,000), and Ekstra Bladet (traditionally left-leaning tabloid, readership 245,000). The research identified 865 articles published in periods of peak media coverage from 2008 to 2018 (extracted from a total sample of 1,437 articles published between 1991 and 2019). Driven by a desire to probe Danish media coverage beyond dichotomies such as misleading vs. informative or negative vs. positive, the researchers used qualitative content analysis to discern the main topics covered and to analyse contextual factors that affected the meanings of the main topics.



Results show that media coverage dealt mainly with "Budget discussions" (Peak #1), "Expanded HPV programme" (Peak #2), "Adverse reactions and risks" (Peaks #3 and #4), "HPV vaccination debate" (Peak #5), and "HPV vaccination for males" (Peak #6). Using a contextual approach to the interpretation of main topics, the researchers observe that media coverage of adverse reactions and risks associated with HPV vaccination was in fact diverse. It included reporting of suspected adverse reactions by the "HPV girls" but also experts disagreeing about scientific evidence in support of suspected adverse reactions and criticism of how the healthcare system deals with patients suffering from POTS and CRPS. In Peak #4 (Q2, 2016), media coverage of the debate around HPV vaccination became nearly as prominent as media coverage of adverse reactions and risks, and the topic "HPV vaccination uptake", which included concerns about the decline of HPV vaccination rates, rose in relative importance. In 2017, the media began downplaying suspected adverse reactions when concerns about declining vaccination rates and misinformation by the media were voiced.



This research supports the findings of previous studies of HPV media coverage in Denmark, which showed that suspected adverse reactions was the most important topic in 2015. However, the heterogeneity of main topics suggests the complexity of different roles or tasks performed by the media. Furthermore, the Danish HPV vaccination media coverage was neither positive nor negative. Even in 2015, the year in which TV 2 broadcast their controversial documentary, newspapers covered adverse reactions in different ways. Some news articles did report uncritically on individual stories about suspected adverse reactions, but others included critical and extensive discussions among experts about the causality implied by the documentary.



Thus, this study suggests that the media responded to HPV vaccination issues in many ways. Newspapers reported on girls and their families who felt they were unable to get proper response from the healthcare system regarding their symptoms and syndromes. They also covered hesitant parents, experts discussing scientific uncertainty about suspected adverse reactions and vaccine effectiveness, experts worried about misinformation and misleading anti-vaccination campaigns, health authorities concerned about vaccination uptake, journalists reflecting on their own role, and more. In short: "The media coverage was neither negative nor misleading. It was as complex and controversial as the issue of HPV vaccination itself."



The researchers conclude: "Covering vaccination debates and campaigns, the media certainly can be misleading. They may provide misinformation, and their tendency to sensationalize news may lead to false perceptions about scientific controversy over vaccination and conflicts between patients and the healthcare system. Consequently, researchers and others need to pay close attention to media coverage of vaccination to understand the complexities and contexts involved."