Laeth Nasir, MBBS

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.

Other articles offer more unusual theories. One warns of the imminent development of a “Supervaccine” containing “raw DNA from 40 different kinds of bacteria and viruses that will be given to all newborn infants and timed [sic] released into the body throughout life.”⁷

Concerns about civil liberties were mentioned on 5 of the sites reviewed. One site¹¹ claims that “the system will monitor, intimidate, harass and punish conscientious parents, their children and health care providers if they do not conform with every government recommended vaccination health care policy.” This site offers instructions on how to remove children from a state vaccine registry.

Nearly all of the Web sites reviewed make an effort to appear unbiased about vaccination. This is often reflected in the names chosen for the organizations and Web sites and also in many of their mission statements. For example: “Our mission: to help the public make informed and intelligent decisions about childhood and adult vaccines.”¹² Several Web sites are very skillful in maintaining ambiguity on their home page: for example, “Vaccination. Does it work? Is it safe? Investigate so that you can make an informed choice.”¹³ Typically, moving to the next page exposes the reader to an alarming list of adverse effects.

Many of these Web sites list contraindications to vaccination. In addition to those that are generally accepted, several sites list conditions that are not normally recognized as contraindications. Some of the advice offered to parents is directly at odds with accepted medical practice (Table).

Several pages provide advice and resources for parents wishing to avoid childhood vaccination. “How to Legally Avoid School Immunizations”¹⁴ reviews religious and philosophical exemptions to immunization and strategies for obtaining them. Instructions are provided to help parents write letters to exempt their children from vaccination.

Discussion

Antivaccination Web sites are not difficult to find. Parents surfing the Web for information on vaccination are very likely to encounter one or more of these sites.

Most of the sites reviewed in this study use several arguments to make a case against vaccination. Fifteen of the 26 sites reviewed appear to be associated with groups or individuals advocating the use of alternative medicine to treat or prevent infectious disease. The association between anti-immunization attitudes and promoters of unconventional therapies has been noted previously.¹⁵ One study from the United Kingdom reported that the use of homeopathy by the family was the most common reason for parental refusal of childhood immunizations.¹⁶ A study carried out in the United States reported that one third of a national sample of chiropractors opposed immunization.¹⁷

With the rise in popularity of alternative and complementary medicine among the general public, more individuals may be advised to avoid immunizations by providers of alternative care. Although there is no direct evidence that increased use of complementary medicine results in a decline in immunization rates, Australia, which has the lowest childhood immunization rate in the developed world,¹⁸ also has the highest reported use of complementary medicine in the general population.¹⁹

Other organizations appear to be contributing to the antivaccination debate as well, each focusing on its own agenda, such as civil liberties or conspiracy theories. In this respect, the modern antivaccination movement appears to share many characteristics with these types of movements in the past. What is new is the availability of this information to many individuals who may not be able to assess its reliability. Another difference is the ease with which the new medium allows small geographically isolated groups to network.

Although the actual number of proponents of the antivaccination movement is unknown, the efforts of a dedicated minority coupled with declining public awareness of the seriousness of vaccine preventable diseases may set the stage for the erosion of an important cornerstone of public health. Physicians should be aware of this growing movement and consider offering anticipatory guidance to parents about questionable material on the Internet. Research clarifying the relationship between alternative health care beliefs and immunization practices is urgently needed.

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.

Other articles offer more unusual theories. One warns of the imminent development of a “Supervaccine” containing “raw DNA from 40 different kinds of bacteria and viruses that will be given to all newborn infants and timed [sic] released into the body throughout life.”⁷

Concerns about civil liberties were mentioned on 5 of the sites reviewed. One site¹¹ claims that “the system will monitor, intimidate, harass and punish conscientious parents, their children and health care providers if they do not conform with every government recommended vaccination health care policy.” This site offers instructions on how to remove children from a state vaccine registry.

Nearly all of the Web sites reviewed make an effort to appear unbiased about vaccination. This is often reflected in the names chosen for the organizations and Web sites and also in many of their mission statements. For example: “Our mission: to help the public make informed and intelligent decisions about childhood and adult vaccines.”¹² Several Web sites are very skillful in maintaining ambiguity on their home page: for example, “Vaccination. Does it work? Is it safe? Investigate so that you can make an informed choice.”¹³ Typically, moving to the next page exposes the reader to an alarming list of adverse effects.

Many of these Web sites list contraindications to vaccination. In addition to those that are generally accepted, several sites list conditions that are not normally recognized as contraindications. Some of the advice offered to parents is directly at odds with accepted medical practice (Table).

Several pages provide advice and resources for parents wishing to avoid childhood vaccination. “How to Legally Avoid School Immunizations”¹⁴ reviews religious and philosophical exemptions to immunization and strategies for obtaining them. Instructions are provided to help parents write letters to exempt their children from vaccination.

Discussion

Antivaccination Web sites are not difficult to find. Parents surfing the Web for information on vaccination are very likely to encounter one or more of these sites.

Most of the sites reviewed in this study use several arguments to make a case against vaccination. Fifteen of the 26 sites reviewed appear to be associated with groups or individuals advocating the use of alternative medicine to treat or prevent infectious disease. The association between anti-immunization attitudes and promoters of unconventional therapies has been noted previously.¹⁵ One study from the United Kingdom reported that the use of homeopathy by the family was the most common reason for parental refusal of childhood immunizations.¹⁶ A study carried out in the United States reported that one third of a national sample of chiropractors opposed immunization.¹⁷

With the rise in popularity of alternative and complementary medicine among the general public, more individuals may be advised to avoid immunizations by providers of alternative care. Although there is no direct evidence that increased use of complementary medicine results in a decline in immunization rates, Australia, which has the lowest childhood immunization rate in the developed world,¹⁸ also has the highest reported use of complementary medicine in the general population.¹⁹

Other organizations appear to be contributing to the antivaccination debate as well, each focusing on its own agenda, such as civil liberties or conspiracy theories. In this respect, the modern antivaccination movement appears to share many characteristics with these types of movements in the past. What is new is the availability of this information to many individuals who may not be able to assess its reliability. Another difference is the ease with which the new medium allows small geographically isolated groups to network.

Although the actual number of proponents of the antivaccination movement is unknown, the efforts of a dedicated minority coupled with declining public awareness of the seriousness of vaccine preventable diseases may set the stage for the erosion of an important cornerstone of public health. Physicians should be aware of this growing movement and consider offering anticipatory guidance to parents about questionable material on the Internet. Research clarifying the relationship between alternative health care beliefs and immunization practices is urgently needed.

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.

Other articles offer more unusual theories. One warns of the imminent development of a “Supervaccine” containing “raw DNA from 40 different kinds of bacteria and viruses that will be given to all newborn infants and timed [sic] released into the body throughout life.”⁷

Concerns about civil liberties were mentioned on 5 of the sites reviewed. One site¹¹ claims that “the system will monitor, intimidate, harass and punish conscientious parents, their children and health care providers if they do not conform with every government recommended vaccination health care policy.” This site offers instructions on how to remove children from a state vaccine registry.

Nearly all of the Web sites reviewed make an effort to appear unbiased about vaccination. This is often reflected in the names chosen for the organizations and Web sites and also in many of their mission statements. For example: “Our mission: to help the public make informed and intelligent decisions about childhood and adult vaccines.”¹² Several Web sites are very skillful in maintaining ambiguity on their home page: for example, “Vaccination. Does it work? Is it safe? Investigate so that you can make an informed choice.”¹³ Typically, moving to the next page exposes the reader to an alarming list of adverse effects.

Many of these Web sites list contraindications to vaccination. In addition to those that are generally accepted, several sites list conditions that are not normally recognized as contraindications. Some of the advice offered to parents is directly at odds with accepted medical practice (Table).

Several pages provide advice and resources for parents wishing to avoid childhood vaccination. “How to Legally Avoid School Immunizations”¹⁴ reviews religious and philosophical exemptions to immunization and strategies for obtaining them. Instructions are provided to help parents write letters to exempt their children from vaccination.

Discussion

Antivaccination Web sites are not difficult to find. Parents surfing the Web for information on vaccination are very likely to encounter one or more of these sites.

Most of the sites reviewed in this study use several arguments to make a case against vaccination. Fifteen of the 26 sites reviewed appear to be associated with groups or individuals advocating the use of alternative medicine to treat or prevent infectious disease. The association between anti-immunization attitudes and promoters of unconventional therapies has been noted previously.¹⁵ One study from the United Kingdom reported that the use of homeopathy by the family was the most common reason for parental refusal of childhood immunizations.¹⁶ A study carried out in the United States reported that one third of a national sample of chiropractors opposed immunization.¹⁷

With the rise in popularity of alternative and complementary medicine among the general public, more individuals may be advised to avoid immunizations by providers of alternative care. Although there is no direct evidence that increased use of complementary medicine results in a decline in immunization rates, Australia, which has the lowest childhood immunization rate in the developed world,¹⁸ also has the highest reported use of complementary medicine in the general population.¹⁹

Other organizations appear to be contributing to the antivaccination debate as well, each focusing on its own agenda, such as civil liberties or conspiracy theories. In this respect, the modern antivaccination movement appears to share many characteristics with these types of movements in the past. What is new is the availability of this information to many individuals who may not be able to assess its reliability. Another difference is the ease with which the new medium allows small geographically isolated groups to network.

Although the actual number of proponents of the antivaccination movement is unknown, the efforts of a dedicated minority coupled with declining public awareness of the seriousness of vaccine preventable diseases may set the stage for the erosion of an important cornerstone of public health. Physicians should be aware of this growing movement and consider offering anticipatory guidance to parents about questionable material on the Internet. Research clarifying the relationship between alternative health care beliefs and immunization practices is urgently needed.