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Just The Shot 'An attempt to swindle nature': Press anti-immunisation reportage 1993-1997 Trade Rush Highlights Tragedy Of Iraqi Children

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Parents urged to go along. 149 words 21 September 1998 Nottingham Evening Post NOTTEP English (c) 1998 Nottingham Evening Post PARENTS who are worried about getting their children vaccinated are being invited to a public meeting on Sunday. Organiser The Vaccination Awareness Network (Van) gives information about possible side effects of vaccines and is a support group for parents who do not want their children vaccinated. The meeting is at 2pm in the cafe at the Rainbow Centre, Mansfield Road, and will include a talk by Paul Randall, a cranial osteopath from Retford who has been researching potential side effects of vaccines. Van member Kath Maeso, a mother-of-three from Clinton Street, Beeston, said: "We are not trying to dissuade anyone from giving vaccinations to their children, but intend to give them as much information about the subject as we can," she said. Admission is free and children are welcome. For details about Van, call (0115) 948 0829. (c) Nottingham Evening Post, 1998. Document nottep0020010925du9l0078b

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NEWS AND FEATURES; AGENDA Just The Shot Megan James Megan James Reported And Co-Produced The ABC-TV Science Unit Documentaries On Vaccination Aired On September 23 and October 3. 2,513 words 18 December 1996 Sydney Morning Herald SMHH 9 English Copyright of John Fairfax Group Pty Ltd Immunisation is a topic which gets many people hot under the collar, as MEGAN JAMES discovered when she presented a Quantum program on the subject. Here, she writes about the need for a wide-ranging debate on the benefits and risks of childhood vaccination. ON Monday the ABC was due to make a regular rebroadcast of a two-part Quantum documentary originally screened 11 weeks ago. It didn't. For the first time in Quantum's 12 years, ABC TV management withdrew a program from the schedule because of the controversy it caused. The program was about a medical issue that involves every Australian, but which many health authorities would prefer was not debated: the benefits and risks of childhood vaccination. The Quantum team behind the program knew it was a divisive issue. We were careful to exclude the views of those who advise against vaccination. We balanced both sides of the debate in air time, and the emotional weight of the case studies discussed. And yet dozens of furious letters followed from doctors and heavyweight institutions such as the Australian College of Pediatricians. One letter, from Dr David Vaux of the Walter and Eliza Hall Institute for Medical Research, ended with: "Vaccination is not an issue that needs to be debated." From the medical establishment's perspective, Vaux makes good sense. Why have a debate about vaccination when, says Vaux, "next to clean water, vaccination is the most effective health measure available"? When it's rid the world of smallpox and Australia of polio? And when 118 Australians died last decade from diseases that vaccines may have prevented? The simplest response is that vaccines have side effects. And Australia's health authorities do not deny this. The debate is about how serious these side effects are and how often they occur. The problem in Australia is that anyone who raises concerns and questions about side effects is lumped in with those who assert that vaccines kill and injure more children than they protect. But a long way short of saying "don't vaccinate", there are some well-founded and moderate criticisms of Australia's current vaccination Page 3 of 29 2012 Factiva, Inc. All rights reserved.

schedule that consumers deserve to hear. The first debate is about exactly what information people should be given on side effects at the time of vaccination. In 1992, after a woman was blinded by an operation intended to improve her sight, the High Court ruled that doctors have a duty of care to warn of all side effects of all medical procedures even if the occurrence is rare. Many doctors argue that this is an unreasonable expectation. Dr Roy Robins-Brown, from Melbourne's Royal Children's Hospital, says he does not think that doctors need to warn their patients of very rare risks. "Few people can conceive what this means or how to balance this against the risk of not taking the vaccine," he says. Often the explanation goes no further than an assurance that the benefits in protecting their child from disease far outweigh any risks. But vaccine critics such as Maureen Hickman, the president of the Australian Council for Immunisation Information, say that's an insult to parents' intelligence. "It's clear from the hundreds of parents who write to us that a large percentage of the population is told nothing at all about the risks of the vaccine most often associated with serious side effects, DPT," says Hickman. DPT is the "triple antigen" diphtheria, pertussis and tetanus vaccination, the whooping cough or pertussis component of which is linked to most side effects. But it's not just a question of no information, it's a question of which information. And how different medical professionals interpret the information. A Commonwealth Department of Health booklet for parents, Understanding Childhood Immunisation, states that the "most careful long-term studies show there is probably not a link between DPT and brain damage". But overseas, one of the world's most respected medical bodies has found that there probably is a link between DPT and brain damage, albeit limited. The study was by the US National Academy of Sciences' Institute of Medicine (IOM), a group that advises the US Government on health issues. The IOM's 1994 review of the huge British National Childhood Encephalopathy Study states that "the balance of evidence is consistent with a causal relation between DPT and the forms of chronic nervous system dysfunction described in the ... study in those children who experience a serious acute neurological illness within seven days of receiving DPT vaccine". The IOM says the risk of "chronic nervous dysfunction" (problems ranging from learning disabilities to severe brain damage to death) is rare but measurable. This is not to underplay the seriousness of whooping cough. In 1994, Australia had about 4,000 cases. Many children suffer terribly: long coughing fits ending with the characteristic "whoop" as they struggle for breath. All medical authorities say whooping cough causes brain damage at a far higher frequency than the vaccine. Pneumonia can be a complication and, in very young infants, the disease has a death rate of between one in 300 and one in 2,000.

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With many suspected side effects, the fairest thing to say is that the jury is still out. Yet Australian medical authorities tend to interpret this as "not guilty". Dr Gavin Frost, a senior adviser to the Federal Government on vaccines, says: "I don't believe it (DPT) does cause permanent damage ... because that's been the experience in Australia and many countries before, during and after that analysis by the IOM. "Certainly, children have chronic brain damage; some of those have received vaccines and some have not, and I find no evidence which leads me to believe that more have it after the vaccine and therefore possibly due to it." A Newcastle clinical immunologist, Dr David Sutherland, says: "I don't recognise rheumatoid arthritis as a result of hepatitis B vaccination." Such medical professionals don't want to raise what they see as unwarranted fears. That may lower immunisation rates further, leading to more disease and deaths than vaccines could ever cause, they argue. But the danger of this line of thinking is that doctors may fail to investigate possible side effects. Next week, a group of concerned parents and health professionals will present the Federal Health Minister, Dr Wooldridge, with 150 reports of what they say are injuries to their children, mostly from DPT. While more than a million children are vaccinated each year in Australia, this is the biggest set of suspected adverse reactions ever given to the Australian Government -all previously unreported. The cases are mostly of children with serious disabilities, ranging from epilepsy to severe brain damage. They have been compiled since 1991 by the Vaccination Awareness Network. Stacey Chapman, of Milperra, says her son Rhys, now 5, became epileptic after his 18-month DPT, HIB and polio vaccinations on May 7, 1993. "He had no signs of any ill health before the shots, but by midnight on the same day he was hot, frothing at the mouth and he turned blue. My husband called an ambulance and we took him to Bankstown Hospital." Rhys has been on medication to control his seizures ever since and Chapman now sees a GP who administers vaccines one at a time. The parents, from lawyers to farmers, say they were not warned of any serious side effects of vaccines. All say the medical professionals they approached ruled out any connection between the change in their child and the vaccine. The doctors neither filed a medical report nor sought an investigation. Many of the parents had tried to get health authorities to look into the cases, but were told investigations could not proceed because parents didn't have a record of the batch or lot number of the vaccination given. This time, says VAN spokesperson Meryl Dorey, "we've recorded the cases as closely as possible to the official NSW forms for adverse events. Many are still missing the vaccine lot and batch numbers, but this time the ball is in the Government's court to record and investigate the cases." Page 5 of 29 2012 Factiva, Inc. All rights reserved.

This is not to claim that these 150 "anecdotes" constitute scientific evidence of vaccine damage. The doctors involved may well be correct in saying they are all sad coincidence. But without investigating all cases, how can parents be sure that medical authorities are not underestimating the rate and severity of vaccine side effects in our community? Pro-vaccination experts such as Frost are pushing for better medical reporting of suspected vaccine side effects. A Serious Adverse Events Following Vaccination Surveillance Scheme was set up in early 1995. There were 160 notifications in its first year, mainly of prolonged crying, fits, severe local reaction and of children in hypertonic (floppy) states. BUT there are still fears of under-reporting, as it's only in NSW that doctors are required to report adverse events to the scheme. It's voluntary in other States and territories. In Australia, it's only recently (see story below) that a case of vaccine-associated damage has been compensated. Australia does not have a compensation system for vaccine injuries, although a number of other nations do, including New Zealand, Britain, Japan and the United States. In the US, where vaccination is compulsory, the National Vaccine Injury Compensation Program has compensated about 1,000 families in the past four years for serious vaccine-associated injuries, 75 per cent of them related to DPT. Even given our vastly different populations, it is hard to accept that not one Australian child has experienced a serious side effect of vaccines. Frost argues that as long as vaccination is not compulsory here, there is no legal obligation to have a compensation system. On the question of whether pro-vaccination governments have a moral obligation to compensate vaccine-related injuries, Frost says: "I think a child who is damaged in Australia, whether by trauma, by vaccine, or by injury, is compensated in many ways. Australia has a social security system which provides the needs of a child who is brain damaged - from whatever cause. Special treatment, special care, special education." But the public remains in the dark about how frequent and severe side effects are. And Australia's support services for the disabled do not pick up the pieces to the same extent that a compensation system would. Without suggesting that parents should stop vaccinating, perhaps, as vaccination critics argue, it's time our medical authorities stopped attempting to stifle debate by attacking those who present moderate criticisms. The National Health and Medical Research Council has recently added five more shots to the list of vaccinations recommended for all Australians, not just infants. If ever public confidence is to be improved, it had best be soon. VACCINE FIGHTS HEAD FOR THE COURTROOM Page 6 of 29 2012 Factiva, Inc. All rights reserved.

LATE last month, for what is believed to be the first time in Australia, a court recommended a payment for an injury attributed to a vaccine. The Medical Panel of the NSW Workers Compensation Court recommended that a Newcastle nurse be compensated with a six-figure sum for permanent impairment from crippling rheumatoid arthritis. Four expert witnesses gave evidence that her condition was related to the hepatitis B vaccine, and the court's medical panel concluded that her routine hepatitis B shot was the most likely cause of the arthritis. Judith Mascord worked for Newcastle's Mater Hospital Community Aged and Mental Health Services. Her work involved dressing wounds, which put her in a high-risk category for coming in contact with hepatitis B. "I'd had hep B vaccinations before, and felt fluey, but not too bad," she says. On August 18, 1994, she was told by hospital staff that it was time for her next hep B vaccination. Three days later, her symptoms began: pains in ankles and feet, jaw spasms, and her finger joints and later her shoulders locked at work. By February 1995, she had to have her knees drained of fluid. Mascord says she was not warned of any side effects of the hepatitis B vaccine. In fact, while the National Health and Medical Research Council's current handbook on vaccination lists "transient and minor" joint pain as a possible side effect, it makes no mention of arthritis occurring after hepatitis B vaccination. But, as an example of how the official acceptance of possible side effects may be changing, the draft for the 1997 version of the handbook does list "arthritis" as one adverse event that has been reported. But it goes on to state "there is inadequate evidence to either accept or reject the possibility that they are caused by hepatitis B vaccination". Mascord's solicitor, Trevor Carter, expects more cases to follow. "We're investigating the case of a 13-year-old boy who began suffering severe arthritis two weeks after a standard rubella vaccination," he says. In the Supreme Court of Queensland, a 25-year-old woman is seeking damages for the alleged negligence of a general practitioner who administered a DPT (diphtheria, pertussis and tetanus) vaccination and against the hospital that treated the alleged reaction. The woman's solicitors, Ebsworth and Ebsworth, say that after her second DPT immunisation at six months of age, she suffered a severe and immediate reaction, including fever and convulsions. This allegedly led to severe brain damage and blindness. Two other cases involving the DPT vaccine have been lodged - one in NSW, the other in the Victorian Supreme Court. Both involve teenage boys who developed cerebral palsy after they were given their second DPT vaccinations at four months of age. Dr David Sutherland, a Newcastle clinical immunologist and medico-legal consultant, is critical of the increase in medical litigation. "I think it's getting silly. I don't believe arthritis is a consequence of hep B vaccine. I can't tell you it never occurs, but it doesn't fit with our current understanding of the course of the Page 7 of 29 2012 Factiva, Inc. All rights reserved.

disease. "We have to define the level of proof that we require, because otherwise we'll effectively create a new tax which will push up insurance premiums, and people will stop having vaccinations. I just wonder where it is going to stop." Dr Paul Spira, a Sydney adult neurologist also involved in medico-legal work, admits "the litigious side is selfgenerating. Once a case has been tried there is a 'find effect'". But he believes there is a genuine change in medical and scientific circles about possible side effects. "I'm a great believer in vaccination in general, but I think with DPT there is increasing evidence showing the first dose can cause febrile convulsions and sensitises the child, then the second one can, in rare cases, cause brain damage. "The fact that they are looking to introduce acellular vaccine is an admission that there is a problem with the whole-cell vaccine." Document smhh000020011015dsci00u9c

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'An attempt to swindle nature': Press anti-immunisation reportage 1993-1997 Julie-Anne Leask; Simon Chapman 7,772 words 1 February 1998 Australian & New Zealand Journal of Public Health AUP 17 Vol. 22, No. 1 English Copyright (c) 1998 Bell & Howell Information and Learning Company. All rights reserved. Abstract: There is some evidence that low childhood immunisation rates in Australia may be attributed partly to parental antipathy toward immunisation. The anti-immunisation movement is becoming more organised in its efforts to lobby against childhood immunisation, while the lessening of the public's exposure to the effects of vaccine-preventable disease has provided a climate ripe for such a lobby to have a disproportionate influence on parents. Forty months of Australian print media coverage of immunisation were reviewed for anti-immunisation arguments and their underlying ideological subtexts. Of 2440 articles about childhood immunisation, 115 (4.7 per cent) contained statements opposing immunisation. Eight subtexts that referenced wider discourses about medicine, the state and the body dominated anti-immunisation discourse (cover-up; excavation of the facts; unholy alliance for profit; towards totalitarianism; us and them; vaccines as poisonous chemical cocktails; vaccines as cause of idiopathic ills; and back to nature). Attempts to redress claims made against immunisation must not only address specific claims about vaccine efficacy and safety but be grounded in a reframing of the ideological appeals that currently frame the contents of antiimmunisation discourse. (Aust N Z J Public Health 1998; 22: 17-26) TWO hundred years after Jenner's observations on the protective effect of cowpox on smallpox, Australian childhood immunisation rates remain disturbingly low, with only 52 per cent of Australian children aged three months to six years being fully immunised for their age in 1995.1 Between October 1996 and September 1997 seven infants died from pertussis in Australia.2 In the first 10 months of 1997, 6468 pertussis and 535 measles cases were notified throughout Australia.3 Low immunisation rates have been explained primarily in terms of practical access problems, parental apathy and provider misconceptions about contraindications.4-10 Parental antipathy to immunisation has not been identified as a major factor in studies examining reasons for low immunisation rates. More recently, however, the 1995 Australian national survey on childhood immunisation found that 18.4 per cent of parents whose children were not immunised against diphtheria, tetanus and pertussis were opposed to immunisation, with a further 6.6 per cent citing concern about side- effects as their reason for not vaccinating their children.1 Another Sydney study found 'concern about side effects' to be one of four leading reasons parents gave for not having their children fully immunised.11 Against a background of low immunisation rates, many Australian public health workers are expressing concern that the antiimmunisation movement has become more organised and strategic in its efforts and might be influencing immunisation rates. The Public Health Association has held a workshop12 and the Commonwealth Department of Health and Family Services has published a booklet13 on responding to arguments against immunisation. Following the broadcast of two national television documentaries on a respected Page 9 of 29 2012 Factiva, Inc. All rights reserved.

science program purporting to examine `both sides' of the immunisation debate,14 this journal published a supplement highly critical of the programs.15 While the important role played by media campaigns in promoting immunisation has been studied,16-18 the effect of negative publicity has received little comment in the literature.19-22 The potential for the media to damage public confidence in immunisation was demonstrated in the United Kingdom in 1974, when a television documentary showing two children with severe neurological damage allegedly from the pertussis vaccine was followed by a dramatic reduction in immunisation rates.23 Similarly, there has been little research examining the extent to which anti-immunisation arguments are publicised in communities.20,24,25 In Australia, writings by opponents of immunisation are readily located in the literature of the natural health movement. These are widely available through newsagents, health food shops and at regular public meetings called by community groups like the Immunisation Investigation Group and the Vaccination Awareness Network. Such groups, while claiming not to be anti-immunisation but pro-choice, promote themselves as champions of transparency in public information. They circulate selected research and self-published literature that supports their main argument that vaccination is unsafe and ineffective. While the aggregated circulations of the many publications in these 'alternative' fields is substantial, they do not compare with the reach attained by mainstream broadcast and print media. Together these reach nearly 100 per cent of the population on most days of the year, and accordingly, are likely to be the vehicles that expose the greatest number of the community to anti-immunisation views. In this paper we examine the coverage of anti-- immunisation issues in the Australian print news media. We first quantify this coverage, comparing it to that given to pro-immunisation news items, and note the most common specific claims made by opponents of immunisation as revealed through their letters to newspapers and in news reports highlighting their claims. In the main part of the paper, we examine the ideological substrate in which these claims are embedded, providing them with their rhetorical force and their newsworthiness. Part of any comprehensive strategy to redress the appeal of anti-immunisation rhetoric must involve a careful analysis not only of what its proponents argue but of how they frame their claims in terms of wider social discourses, which render these claims newsworthy instead of being dismissed as merely eccentric and incredible. Methods All press reports on any aspect of childhood immunisation were obtained from a media monitoring agency for the 40-month period from November 1993 to February 1997. This collection included reports published in all Australian metropolitan and regional newspapers from November 1993 until December 1995, then in metropolitan newspapers only until February 1997. To assess the monitoring agency's claim to have supplied all articles on immunisation, we compared those supplied by the agency taken from the Sydney Morning Herald with the actual coverage of the subject area, as determined by a search of CDROM versions of that newspaper for the entire sample period. Eighty per cent of articles were provided in 1994, 94 per cent in 1995 and only 36 per cent in 1996. In view of the poor collection rate for 1996, all articles after January 1996 were excluded from the content analysis but retained for the analysis of subtextual themes. The news clips (n = 2440) were divided into two categories: those wholly or partly devoted to argument critical of immunisation, including articles in which proponents of immunisation addressed claims being made by anti-immunisationists, and those not containing any reference to arguments opposing immunisation. A content analysis was then undertaken on articles in the first category. These were coded for: Page 10 of 29 2012 Factiva, Inc. All rights reserved.

newspaper in which published date headline, subheading and any highlighted lead sentences type of article (for example, news item, letter, editorial) perspective of protagonist anti-immunisation claims used spokespersons or experts mentioned. 'Perspective of protagonist' refers to the apparent stance of the person introducing the arguments opposing immunisation. They were coded thus: pro-immunisation: the protagonist came from an apparently proimmunisation perspective anti-immunisation: the protagonist came from an apparently anti-immunisation perspective. 'Anti-immunisation claims' refer to the explicit claims about immunisation that appeared in each article. Next, all articles containing quotations from an anti-immunisation protagonist were reviewed for the principal subtexts found in any part of the article. 'Subtexts' refer to wider systems of ideological reference in which these claims were embedded. These go beyond claims specifically anchored to the subject of immunisation and locate anti- immunisation arguments within discourses that give wider meaning to the specific claims being made. Lists of both anti-immunisation claims and subtexts expanded as the coding proceeded. Instances of these were debated between the two authors during coding and the lists refined and adjusted until a coherent scheme was determined that appeared to admit all instances (Table 1). Reliability The coding of articles for the perspective of the protagonist was tested for reliability by supplying three independent reviewers with a random subsample of 50 articles. The raters, who were blinded to the initial categorisation, were issued with the above definitions of pro-immunisation and anti-immunisation perspectives and were asked to code articles into either category. All raters had perfect agreement with the authors' classification for all 50 articles. The coding of the eight principal subtextual categories was tested similarly. Three raters coded a random subsample of 40 passages. Each rater was issued with a set of definitions (Table 1) and was asked to assign a category to each passage. Table 1: The level of inter-rater reliability was measured using a kappa statistic for agreement over and above that expected by chance. The Page 11 of 29 2012 Factiva, Inc. All rights reserved.

equation for kappa specified by Fleiss for multiple-rater agreement was calculated using the ST:TA program.26 The kappa statistic for agreement between authors and each of the three raters was 0.83, 0.83 and 0.86, respectively. The combined score for general agreement on subtextual categories for the three raters was 0.76. These scores reflect an acceptable level of agreement? Results From the sample period November 1993 to December 1995, 2440 articles and letters were counted. Ninety per cent (n = 2196) contained no references to any anti-immunisation claim. Of the 10 per cent (244) that referred to anti-immunisation, about half (115) were written by or about people who were opposed to immunisation, with the remainder (129) being written by or about supporters of immunisation who identified anti-immunisation arguments. In the 115 articles containing statements from those opposed to immunisation, 48 different individuals were quoted. Just under half of those articles (55) contained quotes from the same six people, five of whom were representatives of various immunisation lobby groups. Seventy-five of the anti-immunisation articles (65 per cent) were published in Queensland and 33 (29 per cent) appeared in two newspapers; the Sunshine Coast Daily and the Northern Star. Sixty-five different claims about immunisation were counted in the 244 articles with reference to anti-immunisation. Table 2 shows the eight most common claims classified by the perspective of the protagonist advancing them. Anti-immunisation claims did not occur in isolation. During the period, public calls for parents to immunise their children in the face of disease outbreaks and proposed policy changes aimed at improving immunisation rates provided a context in which the claims of anti-immunisationists were asserted. The school entry requirement of a certificate indicating immunisation status and the introduction of the Australian Childhood Immunisation Register prompted many letters, which, although responding to the perceived invasion of civil liberties, would also proselytise on the dangers of vaccines. Some articles and letters were prompted by a Queensland couple's decision to take their local council to court in the Equal Opportunity Commission for disallowing their unvaccinated children to attend the council day care centre. Throughout much of 1994 two prominent anti-immunisationist conducted lecture tours through eastern Australia exhorting against immunisation and promoting their self-published books. Rural newspapers would print their claims in articles announcing their visit with headlines: 'Health expert visits' or 'Lectures on using natural health to replace vaccines soon'. In addition, the anti-immunisation lobby group, the Australian Vaccination Network, through their regular newsletter, urge members to write to local newspapers. Subtextual analysis During the sample period, November 1993 to February 1997, 108 letters and 40 news articles that contained statements from persons opposed to childhood immunisation were published. Each letter or article written by or about anti-immunisationists was reviewed for its use of subtexts (Tables 1 and 3). Up to eight subtexts were coded for each article. We provide illustrative examples of passages from articles and letters for each of the eight principal subtexts we found being used. We have prefaced each of these with examples from literature from the turn of the century opposing smallpox vaccination, to illustrate the resilience and continuity of these themes. COVER-UP: Page 12 of 29 2012 Factiva, Inc. All rights reserved.

{I}t is a case of downright deliberate falsehood, propagated at the public expense and to the public misleading {1893, p. 77} 28 One of the anti-immunisationists' most persistent claims was that a widespread conspiracy of information suppression prevents the public from knowing the true facts about the safety and efficacy of vaccines. Table 2: Table In the 200 years of vaccination the public has been deceived, misled and lied to. It represents the greatest medical cover-up in history. She said the side effects of immunisation were potentially fatal and often swept under the carpet by the medical establishment. EXCAVATION OF THE 'FACTS': {T}here exists a vast mass of medical evidence that such diseases as syphilis, erysipelas, eczema, and scrofula can be communicated or stirred up by vaccination {1895, pp. 82-3}.29 As confirmation of this conspiracy, allegations of cover-up were frequently accompanied by a deluge of statistics and supportive information, often couched in language claiming that intrepid truth-seekers had needed to search for or excavate the real information that had been hidden from the public. The information so uncovered would often be communicated in dramatic language, frequently involving allusions to vastness to convey both the dedication of those searching for the truth and the sheer enormity of the cover-up. While some alluded to hidden facts that needed to be unearthed, others implied that one had only to scratch the surface to reveal the alarming statistics on immunisation and that any interested member of the public could readily obtain such information. As if to counter the medical community's frequent references to those opposing immunisation as being antiscientific, research data were often invoked to support the case. I spent the next six years researching vaccination and uncovered massive amounts of scientific and medical evidence clearly proving that vaccines played no part whatsoever in the decline of infectious diseases. {S} he had studied more than 40 000 pages of medical research to form the opinion that immunisation was dangerous and unnecessary. All this information-and more-can be found in simple to read English in medical journals. References to international research were common, implying that Australian health authorities' knowledge of immunisation was parochial and outdated compared with the more informed views of its opponents. Somebody in the Australian health system is not telling Australians just what is happening in the rest of the world in the Page 13 of 29 2012 Factiva, Inc. All rights reserved.

vaccination debate. A frequently 'excavated' claim was that a number of experts had rejected immunisation and that the medical establishment was secretly divided. Many anti-immunisationists insinuated that there were rumblings in the medical establishment as an impending shift in expert opinion approached and that we were at the brink of the abandonment of an outdated practice. Quotations or headlines conveying 'dissent in the medical ranks' were found in 27 per cent of articles. For example: There is growing concern among people around the world and in the scientific and medical community about the safety and efficacy of vaccines. I found the biggest critics of vaccinations are the medical scientists, ... many of them won't vaccinate their own children. The Lancet and other journals constantly print findings from doctors and researchers disputing and acknowledging that vaccines are not working and can cause damage. One opposing 'expert' cited in 16 articles and letters was Viera Scheibner, a retired micropalaeontologist. Although her qualifications are in a nonmedical field, this was never acknowledged or footnoted, presumably allowing her 'Dr' title to connote medical training for many readers. 'I was a professional scientist and you can't study cot death without stumbling over vaccinations,' Dr Scheibner said. Notions that anti-immunisationists were in the forefront of contemporary science, while 'orthodox' doctors were woefully and dangerously ill-informed positioned people like Scheibner as heroic whistleblowers: It is really embarrassing to have the orthodox profession of doctors not telling people about the terrible things that can happen to their children if they are vaccinated. UNHOLY ALLIANCE FOR PROFIT: Vaccination is paid for out of the public pocket and whatever the evidence adverse to its usefulness, it will be upheld as beneficial by those who profit by it {1885, p.584.}30 The narrative of cover-up was frequently paired with the motive of corruption. Vested interests were said to be manipulating parents to ensure that the evidence against vaccines was suppressed so that sales could proceed unabated. Although doctors and government officials were implicated as complicit in an unholy alliance, the ultimate dark force behind the conspiracy was the pharmaceutical companies who were committed to maintaining demand for their products. Who will profit from the pressure to vaccinate? Not the children but the vaccine manufacturers-the medical mafia. I was horrified ... to learn of the blatant cover-ups and pure profit motivation of pharmaceutical companies and medical Page 14 of 29 2012 Factiva, Inc. All rights reserved.

associations in regard to vaccination. The medical establishment and drug companies lie because they want to sell vaccines. Governments were explicitly aligned with drug companies, with the implication that they had something to gain from the relationship: This thinly disguised propaganda, presumably initiated by the Queensland Government Health Department whose policy is aligned more with the remunerative motive of the drug companies making the vaccines. Such claims were never accompanied with explanations of what governments would gain from such collusion, particularly when immunisation costs millions of dollars to provide free to Australian children. TOWARDS TOTALITARIANISM: {T}he laws ... have been passed to support an exploded nostrum, forced upon the community in contravention of parental rights, experience and commonsense {1909, p. vi}.31 In 1996 the National Childhood Immunisation Register, incorporating a mailed parental reminder system, was established. Many letters linked the existence of the register with the spectre of government invasion of privacy, exertion of excessive control on parents and of children being forcibly held down and injected with whatever drug the government of the day dictated: Once the computer state-linked `vaccination-tracking system' has been implemented, it would be able to tag, track down and force children against their will to be injected with every existing and new vaccine that policymakers deem `necessary,'. The implementation of the register would greatly widen the power of health bureaucrats and the medical establishment in achieving their agenda of universal vaccination coverage of our children. Although government proposals to make childhood immunisation compulsory were not evident during the period, many drew attention to this issue, voicing strong opposition through depicting various 'slippery slope' scenarios redolent of totalitarian states with impersonal and brutalising government 'machinery' overruling parental authority: Once the machinery of compulsion is in place it will be extremely difficult to dismantle. To suggest that a government take over decisions of what parents may or may not give their children is to remove the rights of parents and make the state mother and father. No public health risk exists to justify what would amount to be an enforced program of mass brain damage. Compulsory vaccination would set a dangerous precedent -Page 15 of 29 2012 Factiva, Inc. All rights reserved.

compulsory use of antibiotic to treat disease? Compulsory abortions for high risk pregnancies? US AND THEM: Hence it is that vaccination is dreaded and detested by the poor on whom it is inflicted without parley or mitigation; in itself a bearer of illness, it is likewise a cruel aggregation of weakness and illness {1885, p. x1}.30 The warning that vaccination programs would erode civil liberties was frequently set in the context of a depersonalisation of those in authority coupled with the positioning of anti-immunisationists as concerned citizens providing worried parents with revelations that the corrupted authorities would not provide: The only vested interests parents have in their children is a love for them, unlike the drug companies to whom vaccinations are a multimillion dollar concern. People have the right to choose what path they want to ... I let them know all the information so they can make an informed choice. This theme was expressed well in a Michael Leunig cartoon. It showed a mother holding her baby facing a male doctor holding an oversized needle: Mother: 'Wait a moment; I have some doubts' Doctor: `You doubt medical science?' Mother: `I'm sorry, my HEART has some doubts-I must listen to my heart on this matter, PLE.nsE' Doctor: YOUR HEART! What does your heart know? It is outnumbered. It has no AUTHORITY This dialogue framed an adversarial situation where the cold hard face of scientific reason was pitted against the caring intuition of a mother's love for her child. In addition, parents who did not immunise their children were framed as wisely cautious: The rate of childhood immunisations is dropping because parents are becoming more caring and are looking closer at what is being done to their children. Get your head out of the clouds Dr X, parents are not simply complacent about immunisation. There are a lot of maimed, unreported statistics out there. Stop treating people like idiots. People are not going to take risks with their cherished loved ones. This framing strategy referenced other news reports in which prominent medical professionals stated that parents who did not vaccinate were complacent: `It really is just complacency' (AMA official, The Australian 21 January 1997) and one letter in which a Monash University academic wrote:

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Obligatory vaccination is the only way the rest of us will be protected from the non-immunised ignorant, apathetic, complacent and pig-headed, who are a drain on the rest of society when they themselves are unnecessarily sick or a source of infection for the innocent. Framing non-immunising parents as caring and discerning invoked the image of doctors as relics from an age where medical authority went unquestioned and where parental concerns were trivialised: For those doctors with an ivory tower mentality, left over from the days when they were inviolable authority figures, the debate has led some to a more face-to-face appreciation of their clients' needs. It really angers me how doctors trivialise this serious medical procedure. Vaccination is a serious medical procedure that has damaged and killed many children. Many press reports quoted vaccine advocates responding to antiimmunisation rhetoric by arguing that the benefits of vaccination outweighed the risks. Against this the testimony of parents alleging serious effects of a vaccination lent an authenticity to antiimmunisation arguments that contrasted with what may have been seen as bland and irresponsible assurances from ill-informed doctors: {O}ur son is one of the AMA's sacrifices. And for those who claim it is for the good of society, like we were told by one helpful doctor, perhaps they could come round to our place and explain to my little girl why she can never be like the other children. One article referred to one mother's decision not to vaccinate. It showed a photograph of a smiling woman holding her healthy child with the caption `healthy enough to fight off disease'. Two other similar articles carried photos of parents who had chosen not to immunise with a smiling and healthy looking child. One father was referred to in a similar vein: He offers no more convincing proof of the benefits of such a lifestyle than his own rude health and that of his son. VACCINES AS POISONOUS CHEMICAL COCKTAILS: This infusion of poison injected into the blood stream of the masses only served to intensify the disease {about 1956}s2 The three major alternatives to vaccination being presented were: acquiring natural immunity through contracting the diseases themselves, natural health practices and homoeopathic vaccination. In two letters, writers advocated the alternative of `prayer and Christian living'. To legitimise such `natural alternatives' it was necessary to discredit or demonise the vaccines themselves. This was done by reference to the allegedly toxic ingredients of vaccines, their contamination by exotic and frightening sounding concoctions and images of the purity of children's pristine bodies being violated by injections: Vaccines are highly noxious. They contain formaldehyde, aluminium phosphate, thiomersal, foreign proteins and contaminating animal proteins

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Vaccines, by introducing viruses directly into the blood stream, actually pushed diseases deeper into the body and eroded the immune system. {T}oxins, animal tissue, unknown viruses and other harmful material are given direct access to babies' vital organs. I refuse to endanger my children's health and well being by pumping their young bodies full of highly toxic, immune destroying material. Oliver Brennan's perfect baby skin has never been bared to a needle VACCINES AS CAUSE OF IDIOPATHIC ILLS: Many of these strange `mystery diseases' that baffle the entire medical world are the sordid product of vaccine poisons {about 1956, p.5}.32 Being so 'toxic', vaccines were, perhaps, ideal candidates to be blamed as causal agents in a range of conditions with unknown or uncertain origin. This ascription is not new. Late last century the smallpox vaccine was being linked to the contemporary scourges of syphilis and leprosy. In the 1990s vaccines are invoked as explanations of mysterious diseases and conditions such as cot death, childhood cancer, autism and even crime. VACCINATION LEFT SON AUTISTIC, SAYS MOTHER Dr Viera Scheibner attributes asthma, attention deficit disorder, hyperactivity, childhood cancer and leukemia to vaccinations. In his book, Mr Miller discusses the possibility that mandatory vaccines can trigger developmental disorders and autoimmune diseases and that they cause childhood behaviour problems which later lead to criminal activity and violent crime. BACK TO NATURE: Finally, vaccination is an attempt to swindle nature {1885, p. 595}.30 Dangerous concoctions of deadly chemicals were contrasted with the option of the 'natural' methods that maintained the pristine environment of the healthy child's body. Occasionally, this was contextualised in a romanticisation of the past, a `return to the garden' and the idea that vaccinations were violations of some natural order: In the past, children began life protected by their natural immune systems. I think most people agree that God made nature perfect, he also gave man a perfect built-in defence system that works well if not interfered with by poisons such as drugs, antibiotics etc.

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Society's increasing preference for alternative therapies was captured in journalistic comment from some articles: The couple use natural methods to boost what they say is a baby's naturally strong immune system. Oliver is still being breast fed and eats only organic vegetables. The family also uses some homoeopathic remedies. RELIGIOUS CRUSADE: The world resounded with praises of the immortal Jenner, saviour of mankind from smallpox. Enveloped in the smoke of such incense, it is scarcely surprising that the idol came to believe that his worshippers knew him better than he did {1885, p. xvi}.30 Finally, many articles repeated imagery that evoked a religious battle with soldiers from two sides locked in a duel. The antiimmunisationists were said to be crusaders, struggling, often in vain, to have their voices heard: VACCINES NOT SAFE: CRUSADER I wish Mr and Mrs Beattie all the best success with the struggle. Interestingly, despite their own self-conscious faith in natural immunity anti-immunisationists sometimes descri bed 'believers' of immunisation in religious terms: If they've been traditionally vaccinated, that's where their belief and their faith is. Until this happens immunisation is little more that a religion with no scientific fact to back it up-pushed by high priests who have the audacity to call themselves doctors of medicine. In summary, the eight themes we identified that coursed through the news reports formed a coherent narrative that can be summarised as follows: Vaccines are the modern equivalents of witches' brews, brutally injected into babies' pristine bodies. These concoctions are commodities promoted by the faceless, venal pharmaceutical industry, which enjoys the support of governments and the medical profession. Doctors' professional arrogance and concern to close ranks in the face of damning evidence has not allowed them to acknowledge what is plain to see for anyone who takes the trouble to search: that vaccines maim and kill infants, as the testimony of grieving parents shows us undeniably. Further, a whole host of allegedly mysterious illnesses and social problems is also caused by vaccines. The public has not been told this because it would cause the conspiracy between the drug industry and governments to unravel, with the general totalitarian agenda of government being the main casualty. There are many doctors who privately agree with this assessment, but are either being ignored or gagged. Those attempting to blow the whistle on this conspiracy are not quacks but scientifically literate and intrepid truth-tellers, motivated by their rapport with parents and their outrage at having discovered the extent of the conspiracy. Vaccines are poisons, which are in every sense unnatural-in contrast to pathways toward natural immunity such as homoeopathy and healthy living. Those advocating vaccines are urging us to expose our children to these witches' brews rather than choose healthy, natural lifestyles. Page 19 of 29 2012 Factiva, Inc. All rights reserved.

Discussion Although the anti-immunisation case receives scant news coverage compared with normative or overtly promotional items on the value of immunisation, it is possible that even the small coverage it receives may be influential with nonimmunising parents. In attempting to understand the appeal of anti-immunisation coverage, it is instructive to first consider its appeal to those who publish it. News is selected in a manner quite unlike the peer reviewing process that determines whether original research is published in research journals. Journalists and editors selecting news are rarely qualified in any area of science or medicine and are therefore poorly positioned to judge whether the often elaborate quasi-scientific claims made by anti-immunisationists have any substance. More fundamentally, it is also naive to assume that a primary criterion used to select news is that it should be capable of being interrogated by the highest standards of scientific evidence. Indeed, as we have shown, a core characteristic of much antiimmunisation news is that it is self-consciously paradigm-challenging, thereby positioning itself as deservedly newsworthy precisely because of the forthright challenges it claims to lay, Galileo-like, at the door of the scientific church. The Vaccination Awareness Network heads its home page with a quote from the German philosopher Arthur Schopenhauer: 'All truth goes through three stages. First it is ridiculed. Then it is violently opposed. Finally, it is accepted as self-evident'.33 Similarly, an anti-immunisation tract published in the 1950s directly invoked the Galileo parallel: Back in the middle ages, Galileo was tormented, tortured, and threatened with death because he taught that the world was round. We like to relegate to the past such acts of ignorance and barbarism, and believe that such outrages against progress could not happen in our day and age. But we are having parallels of this same kind of intolerance in the healing field.32 At the heart of anti-immunisation discourse is an appeal to an individualistic ideology that valourises vigilance against the erosion of civil liberties, suspicion of authority figures and the prevention of disease through 'natural' host resistance. By framing their arguments in this way, anti-immunisationists locate their cause under a canopy of similar newsworthy discourses that centre on the moral authority of the individual. For many, this evokes a virtuous outlook that would contrast favourably with what they may see as an unquestioning compliance with the dictums of the medico-industrial axis. Armed with tragic case studies of children post hoc ergo propter hoc harmed by immunisation, conspiracy theories of profitmotivated cover-ups, and in a context where medical authority is increasingly under challenge for its iatrogenic failures, the individualistic rejection of immunisation orthodoxy can appear a rational and principled choice. Furthermore, immunisation requires that parents take a small but active risk with their children for the benefit of disease prevention in the community and for future generations who face a world free of such diseases, as has been the case with smallpox.34 Some may see the risk they are being asked to take as a risk that will bring little benefit to their child, with the arguments for vaccination embracing communitarian rather than individualistic values. The response dilemma So what might our analysis imply for public health officials concerned to maximise public confidence in immunisation? Within the limitations of a study confined to print media, our analysis reveals a reactive response, by which anti-immunisation claims are more frequently introduced by health professionals attempting to refute Page 20 of 29 2012 Factiva, Inc. All rights reserved.

them than by anti-immunisationists themselves. Such reiteration risks amplifying public awareness of anti-immunisation arguments. It has been postulated that increasing the frequency of contact with a concept increases familiarity, which is more likely to generate a positive response.35 This would suggest that to lessen the public's exposure to anti-immunisation claims, health professionals should not respond defensively by repeating the anti-arguments. However, McGuire's psychological inoculation theory supports the type of public health response demonstrated in our sample.36 McGuire posited that certain beliefs-termed cultural truisms-are widely held by a society to be almost self-evidently true. Cultural truisms go largely unchallenged, as people are seldom required to support their adherence to them. Psychological inoculation theory would see childhood immunisation as a cultural truism that has previously enjoyed widespread and unquestioned acceptance. In the terms of the metaphor, most adherents to immunisation have not developed 'antibodies' to challenge their beliefs. With the decline of vaccine- preventable diseases, new generations of parents miss the reinforcing effect of familiarity with the consequences of such diseases. This creates a climate in which anti-immunisation arguments can easily gain credence. With many parents being unrehearsed in refuting arguments, their support for immunisation is susceptible to erosion and abandonment. The theory asserts that in order for there to be sufficient resistance to such attack, the community should be given homoeopathic-like `weak doses of the opposing view' while also being exposed to arguments that support the truism.37 The inoculation metaphor applied to such a scenario would support public health professionals initiating awareness of anti-immunisation arguments while at the same time reinforcing the importance of immunisation. The usual responses of the public health community to antiimmunisationists have vacillated between dismissiveness, ('I feel that even to give it the credibility of being an issue worth debating suggests it has some credence'38) and efforts to provide detailed rebuttals of their various claims.14 An assumption underlying this cognitively oriented response would appear to be that if the public were assisted in understanding that anti-immunisationists are simply ill-informed or wrong in their arguments, many would set aside their reservations about immunisation and vaccination rates would improve. Here, the criteria seen to define the debate are those concerning the quality of evidence being advanced by the parties to the debate. However, only a minority of those opposed to immunisation would be able to give detailed accounts of the relevant immunological, toxicological and epidemiological issues that might justify their positions. Immunisation defaulters have been shown to have limited knowledge about vaccination and vaccine-preventable diseases.39 In fact, Meszaros et al. showed that when parents who had decided to forego pertussis vaccination were presented with evidence about risks and benefits they became more committed to their antipathetic position. This response was moderated by underlying values about death and chronic disability. Indeed, much of the research on those adhering to the 'rational noncompliance' position on immunisation41 reveals that the decision not to immunise a child is based on a complex web of factors, including personal experience with attributed adverse reactions, advice from family and friends, general scepticism about health professionals and a preference for alternative methods of preventing disease.42,43 Such factors indicate that parents choosing not to immunise their children would feel comfortable with their position by virtue of its consistency with wider reference systems: with values, predilections and what has been described as `philosophical or intuitive resistance to the idea of immunization'.44 It has been argued that dedicated 'rational noncompliers' are unlikely to alter their stance on immunisation. The group most likely to be swayed by the negative publicity about immunisation are Page 21 of 29 2012 Factiva, Inc. All rights reserved.

those parents who are generally supportive of immunisation but who are concerned about adverse reactions:41 'swinging voters'. In this context, any attempt to dissuade this group from accepting antiimmunisation argument entirely based on evidence is likely to fail to address the core dispositions that potentially attract them to the values underscoring anti-immunisation advocacy in the first place. Once these are identified and deconstructed, as we have done, the more basic elements at the core of antiimmunisation belief systems may suggest quite different communication strategies. For example: The cover-up discourse championed by antiimmunisationists along with the associated tactics of forming 'independent' groups investigating adverse reactions appropriates powerful values that act to position medicine as the defensive, guilty-until-proven-innocent party. These accusations could be neutralised by establishing and publicising processes whereby investigations into alleged adverse reactions were made more publicly transparent. The obvious question as to why governments would wish to stage a decades-long cover-up when immunisation annually costs them millions of dollars should be proposed. In Australia until recently, the largest supplier of vaccines was a government laboratory. Medicine must avoid all remnants of communication policy that simply denies or denigrates the possibility of adverse reactions. The perhaps inescapable tendency to engage in post hoc ergo propter hoc attribution over adverse reactions requires that far greater attention should be given to the development of risk-communication strategies. As with much in public health, scant attention has been given to ways of communicating the risks of vaccine-preventable diseases compared with the infinitesimal risks of serious adverse reactions to vaccines.45 Recent discussion about anchoring such communication to analogue, visual and verbal scales could be fruitful here.46 Efforts should be made to broaden the coalition of voices speaking out in support of immunisation beyond voices largely confined to those from medicine and government who are vulnerable to dismissal by those harbouring anti-authority sentiments. A coalition of parents supportive of immunisation could be established in order to highlight the overall support for immunisation that exists among parents and to counter antiimmunisation claims in the media and other public forums. When doctors do take lead roles, they should address parental concerns about side-- effects and serious reactions with clear information in lay terms. Older health care workers, such as infant nurses who experienced the polio epidemic of the 1950s or those who have worked in developing nations where vaccine-preventable diseases are endemic, should also be encouraged to play active roles. The 'excavation' strategy might equally be used to good effect against anti-immunisationists. Public health should trawl cinematic and pictorial archives for footage of victims of infectious disease epidemics and the often-moving testimonies of those involved in their care and treatment. Public historical travelling exhibitions and television documentaries may also be good vehicles for reminding the community of the impact of these epidemics. Equally, as illustrated by our historical citation of anti-immunisationists from early this century, there may be advantage in illustrating the historical continuity of vaccine-phobics, particularly in light of the ravages and subsequent radical abatement of most of these diseases in nations with robust immunisation programs. When health professionals refute the favourite assertions of antiimmunisationists, they should be prepared with responses that answer the arguments directly rather than dismissive disqualifications. Once an argument is dealt with, advocates of immunisation should immediately reframe the debate in proactive terms, emphasising the benefits of immunising. Page 22 of 29 2012 Factiva, Inc. All rights reserved.

More effort should be given to exposing the questionable research history and postgraduate training of maverick doctors and others claiming Chomsky-like status as truth excavators. Similarly, while the value many parents see in the alternative therapies needs to be acknowledged, the potential dangers of going too far with natural health practices requires attention. Accounts of parents holding `measles parties' where unimmunised children are exposed to the disease in the hope of conferring on them natural immunity,47 instances of placing children in warm manure to draw out 'toxins', fasting sick children for days at a time and other such procedures are examples that are likely to convey to many a picture of fanaticism run amok. Such accounts can be found in natural health literature adjacent to quasi-scientific antiimmunisation tracts. Acknowledgments The NSW Health Department and CSL Ltd provided grants to undertake and publish this research. CSL Ltd supplied all press clippings. The authors are grateful to Lyndall Thurley for assistance in coding and to Petra Macaskill for statistical advice. References 1. Australian Bureau of Statistics. Children's immunisation, Australia, April 1995. (,at. no. 4352.0. (Canberra: ABS, 1996. 2. (Communicable Diseases Network Australia and New Zealand, (Canberra, 1998. Guidelines for the control of pertussis in Australia. In press. 3. Communicable Disease Surveillance. Commun Dis Intell 1997; 21: 324. 4. Bell JC, Whitehead P, Chev T, Smith W, Capon AG, Jalaludin B. The epidemiology of incomplete childhood immunization: an analysis of reported immunization status in outer western Sydney J Paediatr Child Health 1993; 29: 384-8. 5. Essex C, Counsell AM, Geddis DC. Immunization status and demographic characteristics of New Zealand infants in the first 6 months of life. J Paediatr Child Health 1993; 29: 379-83. 6. Jones K, Fasher B, Hanson R, Burgess M, et al. Immunization status of casualty attenders: risk factors for non-compliance and attitudes to `on the spot.' immunization. J Paediatr Child Health 1992; 28: 451-4. 7. Cutts FT, Orenstein WA, Bernier RH. Causes of low preschool immunization coverage in the United States. Annu Rev Public Health 1992; 13: 385-98. 8. Peckham C. The Peckham report. National Immunisation Study. Factors influencing immunisation uptake in childhood. Horsham, West Sussex: Action Research for the Crippled Child, 1989. 9. Li J, Taylor B. Factors affecting uptake of measles, mumps, and rubella immunisation. BMJ 1993; 307: 168-71. Page 23 of 29 2012 Factiva, Inc. All rights reserved.

10. Pearson M, Makowiecka K, Gregg J, Wollard J, et al. Primary immunisations in Liverpool: I: Nl,ho withholds consent? Arch Dis Child 1993; 69:110-14. 11. Skinner J, March 1., Simpson JM. A retrospective cohort study of childhood immunisation status in northern Sydney. Aust l Public Health 1995; 19: 58-63. 12. Hall R. Immunisation myths-workshop on responding to arguments against immunisation. Canberra: Public Health Association of Australia, March 1995. 13. Hall R. Immunisation myths and realities: responding to arguments against immunisation. Canberra: Australian Government Publishing Service, 1996. 14. http://wis.abc.net.all/quantum/info/q9622-l.hun. 15. Thompson S. Vaccination: protection at what price? Aust NZ /Public Health 1997; 21(Suppl): 1-8. 16. Macdonald H, Roder D. The planning, implementation and evaluation for an immunization promotion campaign in South Australia. Hygie 1985; 4: 13-16. 17. Zimicki S, Hornick RC, Vel/osa CC, Hernandez JR, et al. Improving vaccination coverage in urban areas through a health communication campaign: the 1990 Philippine experience. Bull I0 1994; 72: 409-22. 18. Paunio M, Virtanen M, Peltola H, Cantell k, et al. Increase of vaccination coverage by mass media and individual approach: Intensified measles, mumps, and rubella prevention program in Finland. Amn,J Epidemiol 1991; 133: 1152-9. 19. Harding C. Immunisation as depicted bY the British national press. Community Ll(ed 1985; 7: 87-98. 20. Freed G, Katz SL, Clark Sl. Safety of vaccinations: Miss America, the media and public health. JA:YLA 1996; 276: 1869-72. 21. Gonzalez E. TV report on DTP galvanizes US pediatricians. JA.7{LA 1982; 248: 12-14, 20-2. 22. Sutton S, Gill E. Immunisation uptake: the role of parental attitudes. London: Health Education Authority, 1993. 23. Griffith AH. Medicine and the media: vaccination against whooping cough. J Biol Standard 1981: 9: 475-82. 24. Harding CM. Whooping cough vaccination: the case presented by the British national press. Child Care Health Der 1985; ll: 21-30.

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25. Hinman AR. The pertussis vaccine controversy. Public Health Rep 1984: 99: 255-9. 26. Fleiss JL. Statistical methods for rates and proportions. 2nd edn. New York: Wiley, 1981. 27. Streiner DL, Norman GR. Health measurement scales: a practical guide to their development and use. 2nd edn. Oxford: Oxford University Press, 1995 28. Milnes A. What about vaccination? The vaccination question plainly put and plainly answered. London: Allen, 1893. 29. Hutton AW. 7he vaccination question. London: Methuen, 1895. 30. hite W. The story of a great delusion in a series of matterof-fact chapters. London: Allen, 1885. 31. Booth A. A beautiful arm: a history of the vaccination delusion. London: Sampson Low, Marston & (Company, 1909. 32. McBean E, The poisoned needle: supr-essed facts about vaccination. Mokelumne Hill, California: Health Research, undated, circa 1956. 33. http://www.oz-email.rom.al/-shotinfo. 34. Medley GF. Conflicts between the individual and communities in treatment and control. In: Isham VS, Medley GF, editors. Models for infectious human diseases: their structure and relation to data. Cambridge: Cambridge University Press, 1996: 336. 35. Zajonic RB. Attitudinal effects of mere exposure. J Pers Soc Psychol 1968; 9 (suppl): 1-27. 36. McGuire WJ. The effectiveness of supportive and refutational defenses in immunizing and restoring beliefs against persuasion. Sociometry 1961; 24: 184-97. 37. O'Keefe DJ. Persuasion: theory and research. London: Sage, 1990: 180. 38. Bird J. Author claims jab is a danger. Gladstone Observer {Queensland}, 19 September, 1995. 39. Dalphinis J. Do immunisation defaulters know enough about immunisation? Health Visitor 1986; 59: 342-4. 40. Meszaros JR, Asch DA, Braon J, Hershey JC, et al. Cognitive processes and the decisions of some parents to forego pertussis vaccination for their children. J Clin Epidemiol 1996; 49: 697-703. 41. Rogers A, Pilgrim D. The risk of resistance: perspectives on the mass childhood immunisation program. In: Gabe J, editor. Medicine, health and risk: sociological approaches. Oxford: Blackwell, 1995: 73-90. 42. Rogers A, Pilgrim D. The pros and cons of immunisation. Health Care Anal 1995; 3: 99-107. Page 25 of 29 2012 Factiva, Inc. All rights reserved.

43. New S, Senior M. 'I don't believe in needles': qualitative aspects of a study into the uptake of infant immunisation in two English health authorities. Soc Sci Med 1991; 33: 509-18. 44. Stone DH. The difference between ideological and intellectual dissent. Health Care Anal 1995; 3: 111-13. 45. Freudenburg WR. Perceived risk, real risk: social science and the art of probabilistic risk assessment. Science 1988; 242: 44-9. 46. Calman KC, Royston GHD. Risk language and dialects. BMJ 1997; 315: 939-42. 47. Rogers R, Pilgrim A. Rational non-compliance with childhood immunisation: personal accounts of parents and primary health care professionals. London: Health Education Authority London 1993. Department of Public Health and Community Medicine, University of Sydney Correspondence to Associate Professor Simon Chapman, Department of Public Health and Community Medicine, University of Sydney, NSW 2006. Email: [email protected] Document aup0000020010915du210000y

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Trade Rush Highlights Tragedy Of Iraqi Children 974 words 26 May 1997 Canberra Times CANBTZ English Copyright The Federal Capital Press of Australia Pty Limited. All rights reserved. YOUR report "Austrade joins scramble for slice of Iraqi action" (CT, May 13, p.3) serves as a reminder of one of the ongoing human tragedies of this decade, which has been quietly forgotten until Western trade opportunities make it newsworthy again. Since 1991 the people of Iraq, and particularly the children, who are the most vulnerable, have been denied very basic supplies such as food and medicines, because of UN sanctions, with disastrous consequences. (Sadly, Austrade's success, US2 billion sanction-free trading to commence in June, has been in "re-establishing Australia's export profile'' rather than in saving any lives.) In 1995 a UN Food and Agricultural Organisation mission to Iraq found that severe malnutrition was widespread among children in Baghdad, and stated that the sanctions had been responsible for the deaths of more than 560,000 children. Your reporter Ian McPhedran, who visited Iraq in late 1996, reported on a desperate society with a desperate health-care system. He quoted a doctor at the Saddam Children's Hospital, who said, "We have no food or medicine so the children usually go home to die.'' The sanctions have been imposed and maintained primarily by the United States, who seem to imagine that starving babies and children will somehow help bring peace and security to the Middle East. When the present Secretary of State in the US, Madelaine Albright, was asked whether the lives of half a million children were too high a price to pay for the sanctions against Iraq, she said, "I think this is a very hard choice, but the price, we think, is worth it.'' How easy it is for Mrs Albright to be noble in sacrifice when someone else makes the sacrifice. The Gulf War was meant to have been fought to protect the powerless from the ruthless pursuit of power. The people of Iraq are now in desperate need of such protection, not only from their own regime, but from those in the West who regard the sacrifice of a generation of (someone else's) children as a worthy price to pay in their bid to topple one man. (Dr) SUSAN WAREHAM President Medical Association for Prevention of War (Australia) Pap-smear testing being handled well YOUR article headed "ACT doctors criticised for handling of smear tests" by Kirsten Lawson should not go unanswered (CT, May 10). While a qualitative study of 29 women is a valid form of research, often designed to indicate areas for further research, such a small study Page 27 of 29 2012 Factiva, Inc. All rights reserved.

should not be used as the basis for generalisations of the sort found in this article. It is appreciated that for many women an abnormal smear test carries with it significant anxieties and distress and that information is useful in reducing this apprehension. Information is readily available especially in the surgeries of family practitioners who are the referral source for gynaecologists. Booklets such as the one published by the Commonwealth Department of Human Services and Health entitled Pap Smear results: A Guide for Women with an Abnormal Pap Smear Test address the problem of an abnormal smear test in detail. Several state cancer councils also have published useful booklets on the topic. In an initiative to address standards in this area of practice the Royal Australian College of Obstetricians and Gynaecologists has recently conducted a large national quality assurance study in colposcopy and treatment of abnormal smear conditions. An anonymous patient questionnaire asked patients to rate their satisfaction with explanations about the smear test and its cause, the examination (colposcopy), and any proposed treatment; and to rate their satisfaction with the opportunity to discuss their future health or any sexual or general concerns they had in relation to their condition. Over 80 per cent of respondents were satisfied or very satisfied with all aspects of their care, with areas such as explanations about the results of the cervical smear achieving a 95 per cent satisfaction rate. This study showed that the gynaecologists in the ACT were practising at a standard comparable with their colleagues in the the states. Australian women can be reassured by the results of this project that specialist gynaecologists in this country are practising colposcopy and treating abnormal smear problems, both clinically and psychologically, at a high standard and that the majority of their patients appear to be satisfied with their overall care. ROBERT ROME Chairman Royal Australian College of Obstetricians and Gynaecologists' Colposcopy Committee Information about vaccination crucial I WAS SOMEWHAT saddened when I read the editorial "Immunisation a must" (CT, May 21). As coordinator of Vaccination Awareness Network Canberra (V.A.N. CAN) I see it as my responsibility to support group members in their decisions, provide information to the community, to facilitate understanding within the wider community, but most of all to fight ignorance.

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It is not my intention to argue the pros and cons of vaccination in this limited space but to open up clear communication lines in the community to avoid discrimination and witch hunts. A distressing fact is that the cricketer Clive Lloyd's son recently became paralysed from the waist down due to a reaction to the MMR vaccine he was vaccinated during a vaccination campaign in the UK. Anyone is welcome to contact me at V.A.N. CAN for information packs and support if they choose not to vaccinate, or if they are just curious about vaccination. Call me for meeting dates. Others concerned with this matter can access a plethora of information via the Internet and by asking at your local book stores to order in books. (It is currently very hard to buy material on the dangers of vaccination even though there are scores of books on the subject.) CARRIE WRIGHT Coordinator Vaccination Awareness Network Canberra Watson Document canbtz0020011005dt5q005u5

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