Misinformation about vaccines on social media is a growing concern among healthcare professionals, medical experts, and researchers. Although such concerns often relate to the total sum of information flows generated online by many groups of stakeholders, vaccination controversies tend to vary across time, place, and the vaccine at issue. We studied content generated by administrators on three Facebook pages in Denmark established to promote critical debate about Human Papillomavirus (HPV) vaccination. We developed a qualitative coding frame allowing us to analyze administrators’ posts in terms of prevalent topics and intertextual material incorporated by linking and sharing. We coded more than a third of the posts (n = 699) occurring in the period from November 2012, when the first page was founded, to May 2019. We found that the pages mainly addressed the reports of adverse events following HPV vaccination and the (perceived) inadequate response of healthcare systems. To construct their central message, the pages assembled different sources, mostly reporting from Danish news media, but also personal narratives, scientific information, political assertions, and more. We conclude that HPV vaccination assemblages such as these pages are heterogeneous and contextual. They are not uniform sites of vaccine criticism, but rather seem to respond to and exchange information and misinformation within the communication environment in which they are embedded.

IntroductionTraditional news media play an important, yet notoriously complex role in vaccination communication. News media remain a common source of information about vaccines and potentially influence individual decisions to choose vaccination or not. In Denmark, Human papillomavirus (HPV) vaccination rates remained relatively high until suspected adverse reactions began to receive extensive coverage in the news. Existing research studies associate the decline in HPV vaccination rates with misleading or negative news stories.MethodsWe probed Danish media coverage beyond dichotomies such as misleading vs. informative, or negative vs. positive. We combined quantitative and qualitative approaches to media coverage of the Danish HPV vaccination crisis and recovery. Our research design focused on six national newspapers and allowed us to identify 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). We used qualitative content analysis to discern the main topics covered, and we analyzed contextual factors that affected the meanings of our main topics.ResultsOur results confirm the rise of suspected adverse reactions as the dominant main topic in 2015. However, we find that news stories about adverse reactions were diverse and closely related to other main topics such as conflicts of interests and debate among experts and other stakeholders. In 2017, the media began downplaying suspected adverse reactions when concerns about declining vaccination rates and misinformation by the media were voiced.DiscussionOur findings suggest that controversial media messages about vaccination are hard to classify as either negative or positive but must be interpreted carefully in context of what is known about the controversy. Learning from past media controversies remains important to understanding the media's role in the social construction of risks and benefits associated with vaccination.