Development of a Codebook of Online Anti-Vaccination Rhetoric to Manage COVID-19 Vaccine Misinformation

"...contributes to the nascent literature on COVID-19 vaccine hesitancy beliefs and the ways in which anti-vaccine messages are persuasive."

Vaccine hesitancy (delay in acceptance of a vaccine or outright refusal to take a vaccine despite its availability) represents a significant hurdle to managing the COVID-19 pandemic. Multiple mechanisms can contribute to the spread of vaccine hesitancy, among which misinformation and disinformation spread through social media and user-generated content platforms play an important role. Work in the field of public health messaging has demonstrated that messaging that focuses on narrative and rhetoric (form) tends to yield better persuasive outcomes than messaging that focuses on facts alone (content). In that vein, this study uses qualitative coding methodology to identify salient narratives and rhetorical styles in the emerging vaccine hesitancy discourse. The researchers hope to provide public health communicators, social media moderation teams, and civil society groups engaged in managing disinformation with a codebook of anti-vaccination themes, both general and specific to COVID-19, in response to which counter-messages might be tailored.

Definitions of key terms used in this study:

• "Narrative": "a particular structure that describes the cause-and-effect relationships that take place over a particular time period that impact particular characters" (Dahlstrom, 2014).
• "Trope": "a subsidiary element of narrative, indicative of the larger narrative or narratives in which it is contained... - narratives which might be vague, only partially articulated, or even based on mysterious/absent plot, characters, and/or meaning..."
• "Narrative trope": "some semiotic element - visual, aural, or written - which connotes a larger story or worldview."
• "Rhetorical strategy": "those modes of persuasion that can be separated from narrative appeals, which do not in-and-of-themselves indicate a larger story or narrativized worldview....This study takes an expansive view of rhetoric, to include audio-visual as well as written and verbal rhetoric."

Data collection aimed to develop corpora (i.e., large collections of codable content) for two separate rounds of coding. Using hashtag and keyword searchers, a team of subject matter experts identified 20 channels (i.e., bounded sources of content, such as a social media account) that appeared to contain a high degree of anti-vaccine content and/or COVID denialism. For each round, five distinct channels were selected for preliminary coding. Only publicly available, English-language media were selected; geography was not considered. Two rounds of coding led to the researchers' classification of online, English-language, anti-vaccine and COVID-19-denial content according to 22 narrative tropes and 16 rhetorical strategies.

The codebook organises these narratives and rhetorics according to theme, imagined antagonist, and frequency. Of the narrative tropes, five patterns represented more than half of the coded items: "Corrupt Elites", "Vaccine Injury", "Sinister Origins", "Freedom Under Siege", and "Health Freedom". These narrative tropes addressed five major types of antagonists: (i) the government, (ii) the medical establishment and political/economic elites; (iii) mainstream (and implicitly, pro-vaccine) society at large; (iv) an unspecified "shadowy villain"; and (v) the vaccine itself. Some additional unclassified antagonists form a miscellaneous category. Of rhetorical styles, four patterns represented just over 40% of all coded rhetorical items: "Think of the Children!", "Do Your Own Research", "Heroes and Freedom Fighters", and "Panic Button" (see Table 1 in the paper).

All nine of these codes appeared across all four major platforms from which data were sampled: YouTube, Twitter, Facebook, and Instagram. In keeping with this study's action research methodology, factors other than the frequency with which a code appeared either within or across channels, such as interaction with other narratives and rhetorics and subjective judgments of emotional intensity, were taken into account when determining salience.

To look at one example, a common rhetorical strategy that cut across narratives targeting all categories of antagonists was to present COVID-19 vaccine resistance as a part of a global movement of "honest, everyday citizens who are on the cusp of rising up against an oppressive 'global elite'....This rhetoric frames its accompanying narrative to suggest that the voices of ordinary people all around the world are articulating that narrative as a unified mass....This rhetoric taps into...populist persuasive strategies and schemata...[that] frame the pure, ordinary people against the nefarious, evil elite. In some cases, populist rhetoric intersects with nationalist rhetoric, arguing that only a stronger state can save ordinary people from bad elites. In other cases, these populist frames intersect with anti-government resistance, framing elites as not only out of touch with the needs of the pure, ordinary people but actively working against them in tyrannical ways..."

Based on this research, some suggestions for local, national, and international governments, as well as civil society organisations, who are trying to manage the COVID-19 "infodemic" include:

• Facilitate the timely dissemination of accurate information based on science and evidence, in particular to high-risk groups.
• Devise messaging campaigns that are both positive - communicating the latest in scientific understanding of COVID-19 and its spread and prevention - and defensive - featuring counter-messages against misinformation that the catalogue of anti-vaccine message styles offered in this study might help guide.
• Be aware that audiences do not need to be warned against every type of misinformation or disinformation they might encounter (i.e., an effective counter-message addressing exaggerated claims of vaccine injury can in theory be expected to confer some resistance to any other narrative trope or rhetorical strategy listed in this codebook).
• Consider using counter-messaging that addresses tropes and/or strategies that appear most frequently in the codebook and that are thematically linked to other denialist narratives and rhetoric (e.g., "Brave Truthtellers").
• Conduct rigorous pre-testing of public health messaging that addresses anti-vaccination audiences, already hardened in their beliefs, in light of the potential for backlash in counter-messaging campaigns, as well as the risk that carelessly repeating false information can help spread it.

The researchers suggest future empirical research to illuminate questions such as: Which of these rhetorical strategies and messages are most encountered online and for which demographic groups? Which of the messages carries the most persuasive appeal? How can persuasive rhetorical strategies be effectively countered in online spaces? How might different narratives and rhetorics appeal to audiences in different countries, different demographics and subcultures, and in different languages? One could also carry out a study of people holding anti-vaccine and COVID-denialist attitudes that tests the salience of the narratives and rhetorics presented here and that addresses overlapping attitudes and worldviews to better ascertain why certain narratives and rhetorics are appealing.

In conclusion: "The identification of these narratives and rhetorics may assist in developing effective public health messaging campaigns, since narrative and emotion have demonstrated persuasive effectiveness in other public health communication settings."